【作者】 陈迪虎；

【导师】 杨圣； 褚家如；

【作者基本信息】 中国科学技术大学 ， 测试计量技术及仪器， 2009， 博士

【摘要】 心脏猝死是指因心脏原因引起的突然、快速、意料不到的死亡。心脏猝死是一种严重危害人类健康的疾病,它具有发病率高、发病突然和死亡率高的特点,患者一旦出现症状,通常1会在一小时内死亡。就现有的急救技术水平而言,心脏多停搏1分钟,抢救的成功率就会下降7%到10%,如果心脏停搏时间超过10分钟,患者活下来的希望就微乎其微了。更为不幸的是,有60%到70%的心脏猝死事件发生在医院之外,根本不可能在10分钟之内得到专业化的抢救。因此避免心脏猝死主要是依靠预测和预防。心脏猝死预测研究已有几十年的历史,有广泛影响的预测方法也已发展到十几种之多,但这些方法都有各自的局限性,至今尚无一种方法能够很好地满足临床实践的需求。本文基于课题组新发现的心室复极的S-T-U段的一系列微伏级的高频小波,我们将它命名为心室复极高频波。由于心室复极阶段与心脏猝死的密切联系以及高频心电信号对于心脏疾病的诊断价值,心室复极高频波在心脏猝死预测和心脏疾病诊断方面有着巨大潜力。心室复极高频波研究的意义在于:(1)在心脏猝死的预测方面,能得到比QT变量、T波交替更好的结果。(2)可以用于对心脏病患者治疗前、治疗中和治疗后心脏猝死危险性预测。(3)将成为临床心脏疾病诊断的新方法、新工具。本研究课题基于国家自然科学基金资助项目(项目编号:60571034),将为心室复极高频波的研究提供先进的硬件和软件平台,对心室复极高频波产生的机理及其与心脏猝死和心脏疾病的联系作进一步的研究。本论文的主要工作在于:(1)发现并提出了心室复极高频波这一全新的心电现象,对心室复极高频波的深入研究将开辟出一个全新的研究领域,为心脏疾病的诊断和心脏猝死风险的预测提供新的方法。(2)从心脏模型结构和电生理的角度对心室复极高频波的电生理基础进行了研究。对心室复极高频波的产生机制做出了初步的论证,为以后的活体解剖实验和心腔内标测提供了理论依据和实际参考。(3)利用临床试验和数据库数据分析,研究了室性心动过速和心肌梗塞两类疾病患者的心室复极高频波波形的特征和参数,并取得了有价值的发现。心室复极高频波的病理特性从实验的角度论证了心室复极高频波的研究潜力和意义,并为心室复极高频波诊断阳性标准的建立奠定了基础。(4)解决了心室复极高频波体表检测的关键性问题。采用零相移滤波、自适应滤波和小波域维纳滤波等多种信号处理方式相结合的方法成功实现了心室复极高频波的体表无创检测。该方法曾被用于体表希氏束的无创检测,与国外的同期研究对比显示,该方法具有一定的先进性。同时,该方法不仅仅局限于希氏束和心室复极高频波等心电信号的检测,通过一定形式的调整也可以适用于一般情况下的微弱信号检测。(5)建立了心室复极高频波规范,搭建了心室复极高频波的硬件检测平台和软件综合系统,并在常规心电信号处理的某些方面,如QRS波识别和心电信号压缩提出了改进的方法。硬件平台和软件系统为心室复极高频波的研究提供了工具。本文研究的内容和结论实现了预期的目的并达到了国家自然科学基金项目的要求。更多还原

【Abstract】 Sudden cardiac death is a sudden,rapid and unexpected death due to cardiac causes.It is seriously harm to the human health.Sudden cardiac death has the characteristics of high incidence,incidence of sudden and high mortality.People will die within one hour once they have this symptom.Considering the existing technology level of first aid,a victim’s chance of survival will be reduced by 7 to 10 percent with the heart arrest for one more minute.If this time exceeds 10 minutes,the chance of survival will be very little.More unfortunately,there are 60%to 70%of sudden cardiac death occured outside the hospital and in these cases it is impossible for the victims to get a professional salvage within 10 minutes.So the effective way to deal with sudden careiac death is not salvage after the incident but prediction and prevention before.The research for the prediction of sudden cardiac death has gone for decades and the prediction methods which have abroad influence have developed to as many as a dozen.But all these methods have their own limitations and so far there is no methods can perfectly meet the practical clininical needs.This paper is based on the newly discovered high frequency ventricular repolarization waves(HFVRW),a series of high frequency waves existing in the ventricular repolarization section(S-T-U section).Because of the close relationship between sudden cardiac death and ventricular repolarization and the value of high frequency ECG signal for the diagnosis of heart diseases,it can be predicted that the high frequency ventricular repolarization waves will have great potential in the prediction of sudden cardiac death and the diagnosis of heart diseases.The significance of the high frequency ventricular repolarization waves research reflects in several aspects:(1) High frequency ventricular repolarization waves has the potential to get a better result than QT variable and T-wave alternans(TWA) in prediction of sudden cardiac death.(2) The risk of sudden cardiac death can be monitored through HFVRW before,during and after treatment for patients who have heart failure.(3) High frequency ventricular repolarization waves will be a new means for clinical heart disease diagnosis.This project is supported by the National Natural Science Foundation of China (Project No.:60571034).It will provide advanced hardware and software platform for the research of the high frequency ventricular repolarization waves and perform further research on the procreant mechanism of the HFVRW and the relationship between the HFVRW and sudden cardiac death.The main work of this thesis is as follow:(1) Discovered and put forward this brand new electrocardial phenomenon:the high frequency ventricular repolarization waves.A more depth study to the HFVRW will open a new field of research and will provide new methods for the diagnosis of heart diseases and prediction of the risk of SCD.(2) Carried out research on the electrophysiological base of HFVRW from the point of heart electrophysiologyl and heart model structure.Make a preliminary demonstrate tomechanism of HFVRW.All above can provede a theoretical basis and practical reference for the future experiments and vivisection intracardiac mapping.(3) Carried out research on the characteristics and patameters of HFVRW of patients suffered from ventricular tachycardia and myocardial infarction by using clinical trials and ECG database.Valueble finding has been got.The pathological characteristics of HFVRW can demonstrate the potential and research significance of the HFVRW from the aspect of experiment,and can provide a foundation for the establishment of the HFVRW positive diagnositic criteria.(4) Resolved the key problem for the body surface detection of HFVRW.The non-invasive body surface HFVRW detection has been achieved by the combining using of zero phase shift filtering,adaptive filtering and wavelet domain wiener filtering.This method has been used for the non-invasive detection of His bundle waves.Comparison with abroad research in the same period reveals that this method has a certain advance.In addition,this method is not limited to the detection of His bundle waves and HFVRW.It can be applied to the general case of weak signal detection after a certain adjustment.(5) Established the norms of the HFVRW,set up the hardware platform and integrated software system fot the detection and carried out improvement in some aspect of normal ECG processing,such as the QRS peaks detection and ECG compression.This integrated system can provide tools for the research of HFVRW.The work and conclusion of this paper has achieved the expected purpose and reach the requirements of the National Natural Science Foundation of China.更多还原