Marchionni P, Scalise L, Ercoli I, Tomasini E P
Dipartimento di Ingegneria Industriale e Scienze Matematiche, Università Politecnica delle Marche, Via Brecce Bianche, Ancona, Italy.
Rev Sci Instrum. 2013 Dec;84(12):121705. doi: 10.1063/1.4845635.
Many conventional medical monitoring devices, while not technically invasive, are nevertheless obtrusive insofar as they require contact with the patient. This obtrusiveness sometimes poses problems in daily clinical practice. The need for contact with electrodes or transducers is particularly relevant in the case of patients recovering in intensive care units where continuous monitoring is required, in turn requiring continuous direct transducer contact for prolonged periods. Among the many physiological parameters commonly acquired, the respiratory and the cardiac rates of the patients are of primary importance. Typically these two parameters are measured respectively using spirometry and electrocardiography (ECG), both involving obtrusive measurement systems requiring contact with the patient with an air conduit and electrodes. This paper presents an optical measurement method for the simultaneous assessment of respiration and heart rates based on the measurement of the chest wall movements, associated with inspiratory/expiratory activities of the lungs and by the mechanical pumping action of the heart. The measurement method has been adapted for use with preterm infants and it has been applied to 55 patients recovering in a Neonatal Intensive Care Unit. The method is based on the use of a laser Doppler vibrometer (LDVi) pointed at the left, ventral thoracic surface of the patient. LDVi-based measures of respiration and heart rate have been simultaneously acquired for each patient, in parallel with the same quantities acquired using conventional reference instrumentation (flow-meter and ECG) for comparison purposes. Results show that for respiration rate, differences with respect to the spirometer data are <3%, while for the cardiac rate they are <6% with respect to ECG data. The method proposed in this paper has the advantage of requiring no contact with the patient. Moreover, it supports, by means of a single instrument, the simultaneous measurement of respiration and heart rates, thus reducing the burden of the number of electrodes, transducers, and other instrumentation that must be applied to the patient--a consideration that is particularly important in the Neonatal Intensive Care Unit. In addition to the measurement of respiration rate, we also describe the sensitivity of the LDVi method in detecting key respiration events (irregular inspiration/expiration cycles, apneas, and hiccups) which are relevant to clinical monitoring.
许多传统的医学监测设备虽然在技术上并非侵入性的,但由于需要与患者接触,所以仍具有侵扰性。这种侵扰性在日常临床实践中有时会带来问题。对于在重症监护病房中康复且需要持续监测的患者而言,与电极或传感器接触的必要性尤为突出,这反过来又要求长时间持续直接接触传感器。在通常获取的众多生理参数中,患者的呼吸频率和心率最为重要。通常分别使用肺活量测定法和心电图(ECG)来测量这两个参数,这两种方法都涉及侵扰性测量系统,需要通过空气导管和电极与患者接触。本文提出了一种基于胸壁运动测量的光学测量方法,用于同时评估呼吸频率和心率,胸壁运动与肺部的吸气/呼气活动以及心脏的机械泵血作用相关。该测量方法已适用于早产儿,并已应用于在新生儿重症监护病房康复的55名患者。该方法基于使用激光多普勒振动计(LDVi)指向患者的左胸前表面。已为每位患者同时获取基于LDVi的呼吸频率和心率测量值,并与使用传统参考仪器(流量计和ECG)获取的相同数据并行,以便进行比较。结果表明,对于呼吸频率,与肺活量测定仪数据的差异<3%,而对于心率,与心电图数据的差异<6%。本文提出的方法具有无需与患者接触的优点。此外,它通过单一仪器支持同时测量呼吸频率和心率,从而减少了必须应用于患者的电极、传感器和其他仪器的数量负担——这一考量在新生儿重症监护病房尤为重要。除了测量呼吸频率外,我们还描述了LDVi方法在检测与临床监测相关的关键呼吸事件(不规则吸气/呼气周期、呼吸暂停和打嗝)方面的灵敏度。