多部位心电标测Electrocardialpotentialmapping教学课件

多部位心电标测Electrocardialpotentialmapping教学课件主要内容心电信息学WhatisECG（心电图）?Multi-channelECGrecordingsystem，ECGpotentialmapping，ECGsimulation(forward&inverseECG)ItsapplicationsFuturedevelopmentNankaiUniversity,CYLi8/15/20198/15/20191/12/20232Electrocardialpotentialmapping心电信息学Inageneralterm,itreferstotheinformaticsofelectricalactivityofheart.心电信息学是把通过各种手段所获得的有关心脏电活动的信息，加以处理和分析，总结出能表示心脏电生理状态的特征量或参数；从而达到对心脏的认识。原始信号的获得，对原始信号的处理，NankaiUniversity,CYLi8/15/20198/15/20191/12/20233Electrocardialpotentialmapping一、WhatisECG(electrocardiograph)?在整个心脏电激动的综合过程,心肌细胞兴奋的产生、传导和恢复过程中产生生物电变化，用仪器在人体表面记录的这种电位变化波形叫心电图,1905年Einthoven发明了心电图机记录心电图，临床上有单道心电图机、三道心电图机、同步12导心电图机等；心电图学主要研究心电图的产生原理；分析心电图的图形以了解心脏活动的情况，协助诊断心脏疾病（如心律失常等）并研究其发生机理。近年来心电图学在理论和实践方面都有很大进展，心电图诊断已成为临床医学特别是心脏内外学科的一个重要课题。

NankaiUniversity,CYLi8/15/20198/15/20191/12/20234Electrocardialpotentialmapping心室肌细胞动作电位mV-90-600+200心室肌细胞动作电位示意图1234300msNankaiUniversity,CYLi8/15/20198/15/20191/12/20235Electrocardialpotentialmapping心脏传导系统NankaiUniversity,CYLi8/15/20198/15/20191/12/20236ElectrocardialpotentialmappingMeasurementofECGNankaiUniversity,CYLi8/15/20198/15/20191/12/20237Electrocardialpotentialmapping标准肢体导联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)体表电位标测Epicardialpotentialmapping心外膜电位标测Endocardialpotentialmapping心内膜电位标测Three-dimensionalpotentialmapping三维电位标测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(心导管)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（病态问题）NankaiUniversity,CYLi8/15/20198/15/20191/12/202328ElectrocardialpotentialmappingECGinverseproblemToobtainquantitativeinformationaboutcardiacactivity，theinverseproblemofelectrocardiographymustbesolved.TheECGinverseapproachesareusedtonon-invasivelyreconstructtheelectricalstateoftheheartfromremoterecordingsoftheelectricalactivityatthebodysurface.Therearemanyalgorithmsavailabletosolvetheinverseproblems.Thesealgorithmsmustbeexperimentallyvalidated.NankaiUniversity,CYLi8/15/20198/15/20191/12/202329Electrocardialpotentialmapping五、TheapplicationsMethodologyofmodernBSPMincludes:computerisedsignalcollection(计算机化的信号采集)(simultaneousmultichannelrecordingfromseveraldecadesofleadpointsonthechestsurface,digitalisationofECGsignal,multiplexingandstorage),computeriseddatapresentation(计算机化的数据表示)(ECGcurves,differenttemplatesofmapsasaresultofapplicationofmathematicalinterpolationstechniqueslikelinearorpolynomic,datacompressione.g.timeintegrationofthevoltage,rapidcalculationofquantitiesnotdirectlymeasuredlikedifferentdurations,anglesetc.)computeriseddataevaluation(计算机化的数据分析)(signalprocessingbasedonmedicalknowledge).

NankaiUniversity,CYLi8/15/20198/15/20191/12/202330ElectrocardialpotentialmappingECGDataevaluationTimeseriesanalysis（时间序列分析）,HRV(heartratevariability)Spatialanalysis（空间分析）QTdispersion,InverseECG,sourcepredictionSpatialpatternofECGparametersSpatial-temporalanalysis（时空分析）CardiacactivationtimeNankaiUniversity,CYLi8/15/20198/15/20191/12/202331Electrocardialpotentialmapping心率变异（HRV）HRV是指心率的波动，或者心动周期之间的差异性。正常人的心率有相当于平均值10%的波动，这种波动程度的降低是心脏异常的表现。HRV的分析方法：时域分析，RR间期的标准差，<50ms异常频域分析，LF(0.04-0.15Hz)和HF(0.15-0.4Hz)的功率谱的比较，非线性分析：散点图，相关维数，复杂度等。NankaiUniversity,CYLi8/15/20198/15/20191/12/202332ElectrocardialpotentialmappingDispersioninventricularrepolarisation(心室复极不一致)研究表明：室性心律失常是由心室复极不一致导致的，进而研究QT离散度等，通过分析ST段位移的空间分布确定心肌缺血部位等；分析体表、心脏表面的兴奋时间图，判断异常心肌的部位等；NankaiUniversity,CYLi8/15/20198/15/20191/12/202333Electrocardialpotentialmapping国内的研究状况浙江大学生命科学与医学工程学系；天津大学精仪学院生物医学工程与科学仪器系；重庆大学电气工程学院；第四军医大学生理教研室；首都医科大学NankaiUniversity,CYLi8/15/20198/15/20191/12/202334Electrocardialpotentialmapping国外研究状况北美一些大学，DukeUniversity,UniversityofUtah，CaseWesternReserveUniversity，DalhousieUniversit