多部位心電標測Electrocardialpotentialmapping教學課件

多部位心電標測Electrocardialpotentialmapping教學課件主要內(nèi)容心電信息學WhatisECG（心電圖）?Multi-channelECGrecordingsystem，ECGpotentialmapping，ECGsimulation(forward&inverseECG)ItsapplicationsFuturedevelopmentNankaiUniversity,CYLi8/15/20198/15/20191/12/20232Electrocardialpotentialmapping心電信息學Inageneralterm,itreferstotheinformaticsofelectricalactivityofheart.心電信息學是把通過各種手段所獲得的有關(guān)心臟電活動的信息，加以處理和分析，總結(jié)出能表示心臟電生理狀態(tài)的特征量或參數(shù)；從而達到對心臟的認識。原始信號的獲得，對原始信號的處理，NankaiUniversity,CYLi8/15/20198/15/20191/12/20233Electrocardialpotentialmapping一、WhatisECG(electrocardiograph)?在整個心臟電激動的綜合過程,心肌細胞興奮的產(chǎn)生、傳導和恢復過程中產(chǎn)生生物電變化，用儀器在人體表面記錄的這種電位變化波形叫心電圖,1905年Einthoven發(fā)明了心電圖機記錄心電圖，臨床上有單道心電圖機、三道心電圖機、同步12導心電圖機等；心電圖學主要研究心電圖的產(chǎn)生原理；分析心電圖的圖形以了解心臟活動的情況，協(xié)助診斷心臟疾?。ㄈ缧穆墒С５龋┎⒀芯科浒l(fā)生機理。近年來心電圖學在理論和實踐方面都有很大進展，心電圖診斷已成為臨床醫(yī)學特別是心臟內(nèi)外學科的一個重要課題。

NankaiUniversity,CYLi8/15/20198/15/20191/12/20234Electrocardialpotentialmapping心室肌細胞動作電位mV-90-600+200心室肌細胞動作電位示意圖1234300msNankaiUniversity,CYLi8/15/20198/15/20191/12/20235Electrocardialpotentialmapping心臟傳導系統(tǒng)NankaiUniversity,CYLi8/15/20198/15/20191/12/20236ElectrocardialpotentialmappingMeasurementofECGNankaiUniversity,CYLi8/15/20198/15/20191/12/20237Electrocardialpotentialmapping標準肢體導聯(lián)NankaiUniversity,CYLi8/15/20198/15/20191/12/20238ElectrocardialpotentialmappingECGrecordingmachineNankaiUniversity,CYLi8/15/20198/15/20191/12/20239Electrocardialpotentialmapping2-1、Anexample256channelsystemAmpS/HMulDemulControllingUnitComputerTransducerA/DNankaiUniversity,CYLi8/15/20198/15/20191/12/202313ElectrocardialpotentialmappingItsfeatures256channelsBatterypoweredThreefunctions:ECG,EGG,latepotentialProgrammablemicrocontroller12-bit,800nsADCProgrammablechannelamplification50,100,200,500,1k,2k,5k,10kProgrammablesamplingrate2,10,20,100,200,500,1k,2k(Hz)NankaiUniversity,CYLi8/15/20198/15/20191/12/202314Electrocardialpotentialmapping2-2、192-channelsystemNankaiUniversity,CYLi8/15/20198/15/20191/12/202315Electrocardialpotentialmapping2-3、256channelsystemActiveTwosystembyBioSemi.256channelAD-boxwithbatteryNankaiUniversity,CYLi8/15/20198/15/20191/12/202316Electrocardialpotentialmapping三、ElectrocardialpotentialmappingBodysurfacepotentialmapping(BSPM)體表電位標測Epicardialpotentialmapping心外膜電位標測Endocardialpotentialmapping心內(nèi)膜電位標測Three-dimensionalpotentialmapping三維電位標測NankaiUniversity,CYLi8/15/20198/15/20191/12/202317Electrocardialpotentialmapping3-1.BodysurfacemappingNankaiUniversity,CYLi8/15/20198/15/20191/12/202318ElectrocardialpotentialmappingElectrodesPanel4x12:Totalof48electrodeson1connectorNankaiUniversity,CYLi8/15/20198/15/20191/12/202319ElectrocardialpotentialmappingMappingincolorNankaiUniversity,CYLi8/15/20198/15/20191/12/202320ElectrocardialpotentialmappingMappingindifferenttimesNankaiUniversity,CYLi8/15/20198/15/20191/12/202321Electrocardialpotentialmapping3-2.EpicardialpotentialmappingElectrodes:electrodesockNankaiUniversity,CYLi8/15/20198/15/20191/12/202322ElectrocardialpotentialmappingEpicardialmapping60safterLADOcclusion

Coronaryartery120safterLADOcclusionNankaiUniversity,CYLi8/15/20198/15/20191/12/202323Electrocardialpotentialmapping3-3.EndocardialpotentialmappingCardiaccatheter(心導管)forpatient,Umbrellaelectrodeforanimalexperiment;NankaiUniversity,CYLi8/15/20198/15/20191/12/202324Electrocardialpotentialmapping3-4ThreedimensionalmappingEndocardial,epicardialandbodysurfacerecordingatthesametime.Withneedleelectrodes,transmuralinformationcanbeobtained.NankaiUniversity,CYLi8/15/20198/15/20191/12/202325Electrocardialpotentialmapping四、ECGsimulationCurrentsourceVolumeconductorGoverningequationNumericalsolutionExperimentalvalidationNankaiUniversity,CYLi8/15/20198/15/20191/12/202326ElectrocardialpotentialmappingECGproblemssourceofelectricalcurrentatthesurfaceoftheheart:ΓEpropagationthroughthechest,bioelectricvolumeconductor:Ωmeasureofpotentialatthesurfaceofthetorso:ΓTΦistheelectrostaticpotential,σ

istheelectricalconductivitytensor,NankaiUniversity,CYLi8/15/20198/15/20191/12/202327ElectrocardialpotentialmappingTwomodelsForwardmodelWell-posedproblemInversemodelIll-posedproblem（病態(tài)問題）NankaiUniversity,CYLi8/15/20198/15/20191/12/202328ElectrocardialpotentialmappingECGinverseproblemToobtainquantitativeinformationaboutcardiacactivity，theinverseproblemofelectrocardiographymustbesolved.TheECGinverseapproachesareusedtonon-invasivelyreconstructtheelectricalstateoftheheartfromremoterecordingsoftheelectricalactivityatthebodysurface.Therearemanyalgorithmsavailabletosolvetheinverseproblems.Thesealgorithmsmustbeexperimentallyvalidated.NankaiUniversity,CYLi8/15/20198/15/20191/12/202329Electrocardialpotentialmapping五、TheapplicationsMethodologyofmodernBSPMincludes:computerisedsignalcollection(計算機化的信號采集)(simultaneousmultichannelrecordingfromseveraldecadesofleadpointsonthechestsurface,digitalisationofECGsignal,multiplexingandstorage),computeriseddatapresentation(計算機化的數(shù)據(jù)表示)(ECGcurves,differenttemplatesofmapsasaresultofapplicationofmathematicalinterpolationstechniqueslikelinearorpolynomic,datacompressione.g.timeintegrationofthevoltage,rapidcalculationofquantitiesnotdirectlymeasuredlikedifferentdurations,anglesetc.)computeriseddataevaluation(計算機化的數(shù)據(jù)分析)(signalprocessingbasedonmedicalknowledge).

NankaiUniversity,CYLi8/15/20198/15/20191/12/202330ElectrocardialpotentialmappingECGDataevaluationTimeseriesanalysis（時間序列分析）,HRV(heartratevariability)Spatialanalysis（空間分析）QTdispersion,InverseECG,sourcepredictionSpatialpatternofECGparametersSpatial-temporalanalysis（時空分析）CardiacactivationtimeNankaiUniversity,CYLi8/15/20198/15/20191/12/202331Electrocardialpotentialmapping心率變異（HRV）HRV是指心率的波動，或者心動周期之間的差異性。正常人的心率有相當于平均值10%的波動，這種波動程度的降低是心臟異常的表現(xiàn)。HRV的分析方法：時域分析，RR間期的標準差，<50ms異常頻域分析，LF(0.04-0.15Hz)和HF(0.15-0.4Hz)的功率譜的比較，非線性分析：散點圖，相關(guān)維數(shù)，復雜度等。NankaiUniversity,CYLi8/15/20198/15/20191/12/202332ElectrocardialpotentialmappingDispersioninventricularrepolarisation(心室復極不一致)研究表明：室性心律失常是由心室復極不一致導致的，進而研究QT離散度等，通過分析ST段位移的空間分布確定心肌缺血部位等；分析體表、心臟表面的興奮時間圖，判斷異常心肌的部位等；NankaiUniversity,CYLi8/15/20198/15/20191/12/202333Electrocardialpotentialmapping國內(nèi)的研究狀況浙江大學生命科學與醫(yī)學工程學系；天津大學精儀學院生物醫(yī)學工程與科學儀器系；重慶大學電氣工程學院；第四軍醫(yī)大學生理教研室；首都醫(yī)科大學NankaiUniversity,CYLi8/15/20198/15/20191/12/202334Electrocardialpotentialmapping國外研究狀況北美一些大學，DukeUniversity,UniversityofUtah，CaseWesternReserveUniversity，DalhousieUniversit