JP5436620B2 - 心肺蘇生中の胸部圧迫深度を測定する装置 - Google Patents
心肺蘇生中の胸部圧迫深度を測定する装置 Download PDFInfo
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Description
たとえば、フリーマン(Freeman)の米国特許出願公開第2001/0047140号(2001年11月29日)の「積分による蘇生法(Integrated Resuscitation)」によれば、
圧迫センサとして加速度計を用いた装置が開示され、加速度計を用いて胸部深度を測定することにいて記載されている。しかしながらフリーマンは、加速度計だけを用いた場合に本質的に生じる誤差を検出する方法を提供するものではない。すなわちフリーマンによる胸部圧迫深度の測定は正確ではない。
このようなドリフトの態様を正方向のドリフトと呼ぶ。一方、ドリフトにより圧迫モニタが実際の深度よりも徐々に浅くなる深度波形を検出する場合もある。言い換えれば、実際圧迫開始点は徐々に深くなるのに、圧迫モニタは開始点が初期の開始点とほとんど変わらないと検出することがある。このようなドリフトの態様を負方向ドリフトと呼ぶ。
・実際圧迫深度:任意の所定タイミングにおける実際の圧迫深度
・実際圧迫開始点:胸部圧迫が開始された実際の位置または点
・自動回帰移動平均:過去のデータサンプルを用いて現時点でのデータサンプルを修正する機能
・圧迫深度波形のベースライン部分:一連の実際圧迫開始点が最も頻繁に検出される圧迫深度の領域
・ベースラインリミッタ:圧迫深度波形のベースライン部分において作動するプロセッサまたは機能
・圧迫ピーク:圧迫深度が最大になる位置または点
・現時点での圧迫深度:任意の所定タイミングにおける圧迫深度
・現時点での開始点:現時点での圧迫の開始点
・圧迫深度:任意の所定タイミングで圧迫されたときの胸部深度で、リラックスした胸部位置から測定される深度
・実際圧迫開始点の推定値:胸部圧迫を開始した実際の位置または点の推定値
・初期圧迫開始点:一連の胸部圧迫を開始した位置または点
・圧迫開始点の測定値:胸部圧迫を開始した位置または点の測定値
・移動平均:過去のデータサンプルを用いて現時点でのデータサンプルの修正する機能
・過去の開始点:すでに計測された圧迫開始点
・圧迫深度波形のピーク位置:一連の実際のピーク位置が最も頻繁に検出される深度波形の位置
・圧迫開始点:胸部圧迫を開始した位置または点
[(0.5×100%)+(1.1×98.75%)+(0.9×96.25%)]÷3=0.853インチ
[(0.5×100%)+(1.1×98.75%)+(4.0×97.5%)+(0.9×96.25%)]÷4
=1.615インチ
すなわち、この値は実際の圧迫開始点の推定値である。
Dsは現時点での開始点の深度、nrはベースラインを超えた開始点すべてを削除した後に残っている開始点の数、iは開始点の数(または加算指数)、DBiはi番目の開始点の測定深度、ωは重み定数、そしてBはベースラインである。別の言い方をすれば、DBi×ωi−1をiが1からnrまで合計し、その加算値をnrで割る。DBiがBより大きい場合、そのDBiはゼロとする。
[(0.5×100%)+(1.082×98.75%)+(0.902×96.25%)]÷3=0.812インチ
換言すると、この値は実際の圧迫開始点の推定値である。
このとき、DSは現時点での開始点の深度、nrはベースラインを超えている開始点すべてを削除した後に残っている開始点の数、iは開始点数、DBiはi番目の開始点の測定深度、jはベースライン内にある最新の開始点の指数、DBi−jはベースライン内にある最新の開始点、PSは(DBi−DBi−j)の大きさのステップが生じる確率、ωは重み定数、そしてBはベースラインである。結果として得られたDsは、現時点での開始点の検出深度である。別の言い方をすれば、[(DBi−DBi−j)×PS×ωi−1)]をiが1からnまで加算し、その加算値をnrで割る。DBiがB(ベースライン)より大きい場合、そのDBiはゼロとする。
各変数は上記のように定義されるが、Dsの値は同様に現時点での圧迫の推定の実際開始点である。
すなわち、同一の深度波形に対し、ベースラインリミッタ演算およびピークリミッタ演算を行う。その効果は、深度波形を構成する信号がまずベースラインリミッタ演算部に供給され、次にピークリミッタ演算部に供給されることである(信号は分割されない。)。
すなわち電流スパイクはシステムのノイズ要因と関連している。システム識別部は、この情報用いて、システムのモデル化を支援することができる。同様に、システム識別部は、電圧、シャフト位置変位、あるいは光学式エンコーダまたは回転式エンコーダを基準ノイズとして用いて、システムをモデル化しやすくすることができる(ここでも基準ノイズは有用ではあるが必須のものではない。)。
Claims (4)
- 自動胸部圧迫装置を用いて患者の胸部の圧迫処置を実施しつつ、実際の心電図信号を推定する装置であって、
患者の心電図信号を測定できる心電計センサであって、実際の心電図成分およびノイズ成分を含む測定された心電図信号を生成できる心電計センサと、
患者の胸部の圧迫処置を実施するために配置され、患者の胸部の圧迫処置を反復して実施する自動胸部圧迫装置であって、胸部圧迫処置の有無を検出できるエンコーダを有し、胸部圧迫処置があったことを示す圧迫信号をエンコーダにより生成する自動胸部圧迫装置と、
測定された心電図信号および圧迫信号を受信できる信号処理システムであって、システム識別部が測定された心電図信号および圧迫信号を処理することにより測定された心電図信号のノイズ成分を推定し、測定された心電図信号およびそのノイズ成分を複合し、そして推定された実際心電図信号を計算するようにプログラムされた信号処理システムとを備えたことを特徴とする装置。 - 自動胸部圧迫装置を用いて患者の胸部の圧迫処置を実施しつつ、実際の心電図信号を推定する装置であって、
患者の心電図信号を測定できる心電計センサであって、実際の心電図成分およびノイズ成分を含む測定された心電図信号を生成できる心電計センサと、
患者の胸部の圧迫処置を実施するために配置され、患者の胸部の圧迫処置を反復して実施する自動胸部圧迫装置であって、胸部圧迫処置の有無を検出できる加速度計を有し、胸部圧迫処置があったことを示す圧迫信号を加速度計により生成する自動胸部圧迫装置と、
測定された心電図信号および圧迫信号を受信できる信号処理システムであって、システム識別部が測定された心電図信号および圧迫信号を処理することにより測定された心電図信号のノイズ成分を推定し、測定された心電図信号およびそのノイズ成分を複合し、そして推定された実際心電図信号を計算するようにプログラムされた信号処理システムとを備えたことを特徴とする装置。 - 自動胸部圧迫装置を用いて患者の胸部の圧迫処置を実施しつつ、実際の心電図信号を推定する装置であって、
患者の心電図信号を測定できる心電計センサであって、実際の心電図成分およびノイズ成分を含む測定された心電図信号を生成できる心電計センサと、
患者の胸部の圧迫処置を実施するために配置され、患者の胸部の圧迫処置を反復して実施する自動胸部圧迫装置であって、胸部圧迫処置の有無を検出できるエンコーダを有し、胸部圧迫処置があったことを示す圧迫信号をエンコーダにより生成する自動胸部圧迫装置と、
測定された心電図信号および圧迫信号を受信できる信号処理システムであって、システム識別部が、打切微分フィルタを含む自動回帰移動平均、カルマンフィルタ、帰納的最小二乗法フィルタ、帰納的操作変数法フィルタ、帰納的誤差予測法フィルタ、帰納的擬似回帰法フィルタ、時間変動システムの帰納的カルマンフィルタの群の中から選択された1つまたはそれ以上を用いて測定された心電図信号および圧迫信号を処理することにより、測定された心電図信号および圧迫信号を処理することにより測定された心電図信号のノイズ成分を推定し、測定された心電図信号およびそのノイズ成分を複合し、そして推定された実際心電図信号を計算するようにプログラムされた信号処理システムとを備えたことを特徴とする装置。 - 自動胸部圧迫装置を用いて患者の胸部の圧迫処置を実施しつつ、実際の心電図信号を推定する装置であって、
患者の心電図信号を測定できる心電計センサであって、実際の心電図成分およびノイズ成分を含む測定された心電図信号を生成できる心電計センサと、
患者の胸部の圧迫処置を実施するために配置され、患者の胸部の圧迫処置を反復して実施する自動胸部圧迫装置であって、胸部圧迫処置の有無を検出できる加速度計を有し、胸部圧迫処置があったことを示す圧迫信号を加速度計により生成する自動胸部圧迫装置と、
測定された心電図信号および圧迫信号を受信できる信号処理システムであって、システム識別部が、打切微分フィルタを含む自動回帰移動平均、カルマンフィルタ、帰納的最小二乗法フィルタ、帰納的操作変数法フィルタ、帰納的誤差予測法フィルタ、帰納的擬似回帰法フィルタ、時間変動システムの帰納的カルマンフィルタの群の中から選択された1つまたはそれ以上を用いて測定された心電図信号および圧迫信号を処理することにより、測定された心電図信号および圧迫信号を処理することにより測定された心電図信号のノイズ成分を推定し、測定された心電図信号およびそのノイズ成分を複合し、そして推定された実際心電図信号を計算するようにプログラムされた信号処理システムとを備えたことを特徴とする装置。
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