多部位心电标测专家讲座

多部位心电标测

（Electrocardialpotentialmapping）南开大学物理学院生物物理系李川勇NankaiUniversity,CYLi4/25/20231Electrocardialpotentialmapping多部位心电标测第1页主要内容心电信息学WhatisECG（心电图）?Multi-channelECGrecordingsystem，ECGpotentialmapping，ECGsimulation(forward&inverseECG)ItsapplicationsFuturedevelopmentNankaiUniversity,CYLi4/25/20232Electrocardialpotentialmapping多部位心电标测第2页心电信息学Inageneralterm,itreferstotheinformaticsofelectricalactivityofheart.心电信息学是把经过各种伎俩所取得相关心脏电活动信息，加以处理和分析，总结出能表示心脏电生理状态特征量或参数；从而到达对心脏认识。原始信号取得，对原始信号处理，NankaiUniversity,CYLi4/25/20233Electrocardialpotentialmapping多部位心电标测第3页一、WhatisECG(electrocardiograph)?在整个心脏电激动综合过程,心肌细胞兴奋产生、传导和恢复过程中产生生物电改变，用仪器在人体表面统计这种电位改变波形叫心电图,1905年Einthoven创造了心电图机统计心电图，临床上有单道心电图机、三道心电图机、同时12导心电图机等；心电图学主要研究心电图产生原理；分析心电图图形以了解心脏活动情况，帮助诊疗心脏疾病（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，心电图诊疗已成为临床医学尤其是心脏内外学科一个主要课题。

NankaiUniversity,CYLi4/25/20234Electrocardialpotentialmapping多部位心电标测第4页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,CYLi4/25/20235Electrocardialpotentialmapping多部位心电标测第5页心脏传导系统NankaiUniversity,CYLi4/25/20236Electrocardialpotentialmapping多部位心电标测第6页MeasurementofECGNankaiUniversity,CYLi4/25/20237Electrocardialpotentialmapping多部位心电标测第7页标准肢体导联NankaiUniversity,CYLi4/25/20238Electrocardialpotentialmapping多部位心电标测第8页ECGrecordingmachineNankaiUniversity,CYLi4/25/20239Electrocardialpotentialmapping多部位心电标测第9页BasicfeaturesofECGNankaiUniversity,CYLi4/25/202310Electrocardialpotentialmapping多部位心电标测第10页二、Whymapping?传统12导联电极位置不足；80年代提出，指采取多个电极（24-250）均匀排列覆盖整个躯干，统计多部位体表心电信息，以取得心电信号更多空间信息。统计系统：由计算机控制多通道数据采集系统，完成心电信号采集、显示、处理。NankaiUniversity,CYLi4/25/202311Electrocardialpotentialmapping多部位心电标测第11页mappingsystem无创检测,体表心电图:标准12导联，动态心电图，体表多部位检测(bodysurfacepotentialmapping，BSPM)，体表心磁图（Magnetocardiography，MCG），有创检测,动作电位、单向动作电位测量，心内膜、心外膜心电图（Endocardialandepicardialelectrogram），希氏束电图（His-Bundleelectrogram）NankaiUniversity,CYLi4/25/202312Electrocardialpotentialmapping多部位心电标测第12页2-1、Anexample256channelsystemAmpS/HMulDemulControllingUnitComputerTransducerA/DNankaiUniversity,CYLi4/25/202313Electrocardialpotentialmapping多部位心电标测第13页Itsfeatures256channelsBatterypoweredThreefunctions:ECG,EGG,latepotentialProgrammablemicrocontroller12-bit,800nsADCProgrammablechannelamplification50,100,200,500,1k,2k,5k,10kProgrammablesamplingrate2,10,20,100,200,500,1k,2k(Hz)NankaiUniversity,CYLi4/25/202314Electrocardialpotentialmapping多部位心电标测第14页2-2、192-channelsystemNankaiUniversity,CYLi4/25/202315Electrocardialpotentialmapping多部位心电标测第15页2-3、256channelsystemActiveTwosystembyBioSemi.256channelAD-boxwithbatteryNankaiUniversity,CYLi4/25/202316Electrocardialpotentialmapping多部位心电标测第16页三、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,CYLi4/25/202317Electrocardialpotentialmapping多部位心电标测第17页3-1.BodysurfacemappingNankaiUniversity,CYLi4/25/202318Electrocardialpotentialmapping多部位心电标测第18页ElectrodesPanel4x12:Totalof48electrodeson1connectorNankaiUniversity,CYLi4/25/202319Electrocardialpotentialmapping多部位心电标测第19页MappingincolorNankaiUniversity,CYLi4/25/202320Electrocardialpotentialmapping多部位心电标测第20页MappingindifferenttimesNankaiUniversity,CYLi4/25/202321Electrocardialpotentialmapping多部位心电标测第21页3-2.EpicardialpotentialmappingElectrodes:electrodesockNankaiUniversity,CYLi4/25/202322Electrocardialpotentialmapping多部位心电标测第22页Epicardialmapping60safterLADOcclusion

Coronaryartery120safterLADOcclusionNankaiUniversity,CYLi4/25/202323Electrocardialpotentialmapping多部位心电标测第23页3-3.EndocardialpotentialmappingCardiaccatheter(心导管)forpatient,Umbrellaelectrodeforanimalexperiment;NankaiUniversity,CYLi4/25/202324Electrocardialpotentialmapping多部位心电标测第24页3-4ThreedimensionalmappingEndocardial,epicardialandbodysurfacerecordingatthesametime.Withneedleelectrodes,transmuralinformationcanbeobtained.NankaiUniversity,CYLi4/25/202325Electrocardialpotentialmapping多部位心电标测第25页四、ECGsimulationCurrentsourceVolumeconductorGoverningequationNumericalsolutionExperimentalvalidationNankaiUniversity,CYLi4/25/202326Electrocardialpotentialmapping多部位心电标测第26页ECGproblemssourceofelectricalcurrentatthesurfaceoftheheart:ΓEpropagationthroughthechest,bioelectricvolumeconductor:Ωmeasureofpotentialatthesurfaceofthetorso:ΓTΦistheelectrostaticpotential,σ

istheelectricalconductivitytensor,NankaiUniversity,CYLi4/25/202327Electrocardialpotentialmapping多部位心电标测第27页TwomodelsForwardmodelWell-posedproblemInversemodelIll-posedproblem（病态问题）NankaiUniversity,CYLi4/25/202328Electrocardialpotentialmapping多部位心电标测第28页ECGinverseproblemToobtainquantitativeinformationaboutcardiacactivity，theinverseproblemofelectrocardiographymustbesolved.TheECGinverseapproachesareusedtonon-invasivelyreconstructtheelectricalstateoftheheartfromremoterecordingsoftheelectricalactivityatthebodysurface.Therearemanyalgorithmsavailabletosolvetheinverseproblems.Thesealgorithmsmustbeexperimentallyvalidated.NankaiUniversity,CYLi4/25/202329Electrocardialpotentialmapping多部位心电标测第29页五、TheapplicationsMethodologyofmodernBSPMincludes:computerisedsignalcollection(计算机化信号采集)(simultaneousmultichannelrecordingfromseveraldecadesofleadpointsonthechestsurface,digitalisationofECGsignal,multiplexingandstorage),computeriseddatapresentation(计算机化数据表示)(ECGcurves,differenttemplatesofmapsasaresultofapplicationofmathematicalinterpolationstechniqueslikelinearorpolynomic,datacompressione.g.timeintegrationofthevoltage,rapidcalculationofquantitiesnotdirectlymeasuredlikedifferentdurations,anglesetc.)computeriseddataevaluation(计算机化数据分析)(signalprocessingbasedonmedicalknowledge).

NankaiUniversity,CYLi4/25/202330Electrocardialpotentialmapping多部位心电标测第30页ECGDataevaluationTimeseriesanalysis（时间序列分析）,HRV(heartratevariability)Spatialanalysis（空间分析）QTdispersion,InverseECG,sourcepredictionSpatialpatternofECGparametersSpatial-temporalanalysis（时空分析）CardiacactivationtimeNankaiUniversity,CYLi4/25/202331Electrocardialpotentialmapping多部位心电标测第31页心率变异（HRV）HRV是指心率波动，或者心动周期之间差异性。正常人心率有相当于平均值10%波动，这种波动程度降低是心脏异常表现。HRV分析方法：时域分析，RR间期标准差，<50ms异常频域分析，LF(0.04-0.15Hz)和HF(0.15-0.4Hz)功率谱比较，非线性分析：散点图，相关维数，复杂度等。NankaiUniversity,CYLi4/25/202332Electrocardialpotentialmapping多部位心电标测第32页Dispersioninventricularrepolarisation(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造成，进而研究QT离散度等，经过分析ST段位移空间分布确定心肌缺血部位等；分析体表、心脏表面兴奋时间图，判断异常心肌部位等；NankaiUniversity,CYLi4/25/202333Electrocardialpotentialmapping多部位心电标测第33页国内研究情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,CYLi4/25/202334Electrocardialpotentialmapping多部位心电标测第34页国外研究情况北美一些大学，DukeUnive