A non-invasive method for monitoring central venous pressure and its application
The diameter parameters of the internal jugular vein are obtained by ultrasonic detector and calculated using linear regression equations, which solves the problem of time-consuming, difficult and accurate operation of CVP monitoring in the prior art, and achieves non-invasive, fast and accurate CVP prediction.
Patent Information
- Application Number
- CN202310634786.1
- Authority / Receiving Office
- CN · China
- Patent Type
- Patents(China)
- Current Assignee / Owner
- Filing Date
- 2023-05-31
- Publication Date
- 2025-03-25
- Estimated Expiration
- 2043-05-31
AI Technical Summary
The prior art has time-consuming and difficult operation when monitoring central venous pressure (CVP), and its accuracy is affected by a variety of factors, and there are complications such as infection, thrombosis and bleeding.
By studying the relationship between the diameter parameters of the surface veins and CVP, an ultrasonic detector was used to obtain the anterior and posterior diameter, left and right diameter, cross sectional area and perimeter of the internal jugular vein, and the predicted CVP value was calculated using linear regression equations.
The non-invasive, rapid and accurate prediction of CVP values is achieved, which reduces the manual operation of the doctor, reduces the risk of complications, and improves the accuracy and safety of monitoring.
Smart Images
Figure BDA0004259712640000031 
Figure BDA0004259712640000041 
Figure BDA0004259712640000051
Abstract
Description
Technical Field
[0001] The present invention relates to the technical field of sensors for medical instruments, and in particular to a method and application for monitoring central venous pressure. Background Art
[0002] Central venous pressure (CVP) is the pressure at the point where the superior and inferior vena cava enter the right atrium. It is a common indicator reflecting right heart function and blood volume. It is similar to the right atrial pressure (RAP) value and is the same as the right ventricular pressure during diastole. It can reflect the comprehensive situation of blood volume, cardiac function, and vascular tension. Moreover, central venous pressure reflects the whole body blood volume and cardiac function status earlier than arterial pressure. By continuously monitoring central venous pressure, the right heart preload can be accurately understood. When the central venous pressure is abnormal, it indicates possible diseases such as shock, heart failure, and heart failure. The normal value range is 4 to 8 mmHg. CVP monitoring is an effective indicator for guiding fluid therapy for critically ill patients and evaluating circulating blood volume. When the central venous pressure is high, it is often related to abnormal cardiovascular system. Common diseases include heart failure and heart failure. When the central venous pressure is low, it means that the pressure of the right atrium and the thoracic segment of the superior and inferior vena cava has decreased, which may be related to shock.
[0003] In clinical practice, the measurement is performed by inserting a central venous catheter through the internal jugular vein, subclavian vein, femoral vein or axillary vein to the junction of the superior and inferior vena cava and the right atrium. However, the operation is time-consuming and difficult, and complications such as infection, thrombosis and bleeding, pneumothorax and hemothorax may occur during puncture. Its accuracy is affected by factors such as the measurement pathway, patient position, and sensor position.
[0004] Therefore, developing a noninvasive, rapid and accurate method to predict CVP is an urgent clinical need. Summary of the invention
[0005] The present invention studies the relationship between the diameter parameters of the superficial veins and CVP, thereby obtaining a method for predicting the CVP value through the diameter parameters of the superficial veins, thereby completing the present invention.
[0006] In a first aspect, the present invention provides a method for non-invasively monitoring central venous pressure, the method comprising the following steps:
[0007] S1. Select the vein site to be tested;
[0008] S2. Place the probe of the ultrasonic detector at the corresponding area of the vein to be tested;
[0009] S3. Obtain the anterior-posterior diameter, left-right diameter, cross-sectional area and circumference data of the selected vein site by using an ultrasonic detector;
[0010] S4. The central venous pressure is calculated by using a linear regression equation based on the data of the anterior-posterior diameter of the vein, the left-right diameter of the vein, the cross-sectional area and the circumference of the detected vein.
[0011] The linear regression equation is: Y = w0a + w1b + w2c + w3d
[0012] Among them, Y is the dependent variable, i.e., the value of central venous pressure, where a, b, c, and d represent the anteroposterior diameter of the internal jugular vein, the left-right diameter of the internal jugular vein, the cross-sectional area of the internal jugular vein, and the circumference of the internal jugular vein, respectively;
[0013] When a, b, c, and d are the anteroposterior diameter, left-right diameter, cross-sectional area, and circumference of the internal jugular vein at the end of expiration, respectively; w0, w1, w2, and w3 are 0.10955944, 0.36938604, -0.03333283, and 0.11926442, respectively, and MSE is 20.287249684001473
[0014] When a, b, c, and d are the anterior-posterior diameter of the internal jugular vein, the left-right diameter of the internal jugular vein, the cross-sectional area of the internal jugular vein, and the circumference of the internal jugular vein at the end of inspiration, respectively; w0, w1, w2, and w3 are 0.34543744, 0.61360341, -0.08026889, and 0.11808912, respectively, MSE: 19.643026403900965;
[0015] Furthermore, the central venous pressure Y is calculated by the anterior-posterior diameter of the internal jugular vein at the end of expiration, the lateral diameter of the internal jugular vein, the cross-sectional area of the internal jugular vein, and the circumference of the internal jugular vein.
[0016] Further, the venous site is a venous site associated with a central vein.
[0017] Furthermore, the venous site is selected from one or more of the internal jugular vein, external jugular vein, subclavian vein, femoral vein and axillary vein.
[0018] Furthermore, the vein site is preferably the internal jugular vein.
[0019] Furthermore, the probe is a patch probe, through which the vein diameter parameters can be monitored in real time for a long time, reducing the manual operation of the doctor.
[0020] Furthermore, the patch probe may be a linear array probe, a phased array probe, a mechanical fan-scan probe, or a square array probe.
[0021] Furthermore, the patch probe is preferably a linear array probe.
[0022] Furthermore, the center frequency of the ultrasonic detector is 7.1 MHz, the array width is 38.4 mm, the array element base is 128, and the scanning mode is electronic linear array.
[0023] In a second aspect, the present invention provides an instrument for non-invasive central venous pressure monitoring, the instrument comprising an information acquisition unit, an information processing unit and an information display unit;
[0024] The information acquisition unit acquires data of the anterior-posterior diameter of the vein, the left-right diameter of the vein, the cross-sectional area and the circumference of the corresponding vein of the subject through an ultrasonic detector;
[0025] The information processing unit processes the data information obtained by the information acquisition unit through the following linear regression equation to obtain the value of the central venous pressure;
[0026] The linear regression equation is: Y = w0a + w1b + w2c + w3d
[0027] Among them, Y is the dependent variable, i.e., the value of central venous pressure, where a, b, c, and d represent the anteroposterior diameter of the internal jugular vein, the left-right diameter of the internal jugular vein, the cross-sectional area of the internal jugular vein, and the circumference of the internal jugular vein, respectively;
[0028] When a, b, c, and d are the anteroposterior diameter of the internal jugular vein, the left-right diameter of the internal jugular vein, the cross-sectional area of the internal jugular vein, and the circumference of the internal jugular vein at the end of expiration, respectively; w0, w1, w2, and w3 are 0.10955944, 0.36938604, -0.03333283, and 0.11926442, respectively, and MSE: 20.287249684001473;
[0029] When a, b, c, and d are the anterior-posterior diameter of the internal jugular vein, the left-right diameter of the internal jugular vein, the cross-sectional area of the internal jugular vein, and the circumference of the internal jugular vein at the end of inspiration, respectively; w0, w1, w2, and w3 are 0.34543744, 0.61360341, -0.08026889, and 0.11808912, respectively, MSE: 19.643026403900965;
[0030] The information display unit displays the value of the central venous pressure obtained after the information processing unit processes the corresponding information through a display device. BRIEF DESCRIPTION OF THE DRAWINGS
[0031] Figure 1 ROC curve of internal jugular vein parameters predicting elevated central venous pressure DETAILED DESCRIPTION
[0032] The following describes the embodiments of the present invention through specific examples, and those skilled in the art can easily understand other advantages and effects of the present invention from the contents disclosed in this specification. The present invention can also be implemented or applied through other different specific embodiments, and the details in this specification can also be modified or changed in various ways based on different viewpoints and applications without departing from the spirit of the present invention.
[0033] Example 1 Verification of the correlation between internal jugular vein diameter parameters and central venous pressure
[0034] The validation data set is selected from the following table 1
[0035] There were 39 critically ill patients in the EICU of Shanghai Sixth Hospital. All subjects signed informed consent forms and their clinical medical records were recorded in detail (see Table 1).
[0036] Table 1. Relevant test parameters of the subjects
[0037]
[0038]
[0039] Central venous pressure: refers to the patient's central venous pressure value obtained using central venous catheterization as the gold standard.
[0040] The values of the anterior-posterior diameter of the internal jugular vein, the left-right diameter of the internal jugular vein, the cross-sectional area of the internal jugular vein, and the circumference of the internal jugular vein at the end of expiration and inspiration were obtained by ultrasonic detection.
[0041] SPSS26.0 software was used for statistical analysis, and Pearson correlation analysis was used to verify the correlation between internal jugular vein parameters and central venous pressure.
[0042] The results showed that the anteroposterior diameter, left-right diameter and circumference of the internal jugular vein at end-expiration were moderately correlated with the central venous pressure (r1: 0.676, p1: 0.001; r2: 0.555, p2: 0.001; r3: 0.593, p3: 0.001), and the area of the internal jugular vein at end-expiration was highly correlated with the central venous pressure (r4: 0.702, p4: 0.001).
[0043] At the end of inspiration, the anterior-posterior diameter, left-right diameter, cross-sectional area and circumference of the internal jugular vein showed moderate correlation (r1: 0.608, p1: 0.001; r2: 0.492, p2: 0.001; r3: 0.609, p3: 0.001; r4: 0.538, p4: 0.001) (see Table 2).
[0044] Table 2 Correlation between internal jugular vein and central venous pressure
[0045]
[0046] R value: Pearson correlation coefficient, P value <0.05 indicates statistically significant difference
[0047] Judgment criteria: In statistics, the Pearson correlation coefficient (R value for short) is used to measure the correlation (linear correlation) between two variables X and Y.
[0048] The R value is: 0.01-0.19: very weak correlation; 0.20-0.39: weak correlation; 0.40-0.69: moderate correlation; 0.70-0.89: strong correlation; 0.90-1.00: extremely strong correlation.
[0049] Relationship between p value and significance level: According to the statistical significance test method, the p value obtained is generally significant when p<0.05 and very significant when p<0.01, which means that the probability that the difference between samples is caused by sampling error is less than 0.05 or 0.01. P<0.001 is considered to be highly statistically significant. This shows that the correlation between internal jugular vein parameters and central venous pressure is highly statistically significant.
[0050] Example 2: Assessing the sensitivity and specificity of internal jugular vein caliber parameters and elevated central venous pressure
[0051] Central venous pressure > 8 mmHg is considered elevated central venous pressure.
[0052] The sensitivity and specificity of evaluating central venous pressure by various internal jugular vein diameter parameters are shown in Table 3.
[0053] Table 3 Sensitivity and specificity of internal jugular vein parameters in predicting elevated central venous pressure
[0054]
[0055]
[0056] AUC: Area under the ROC curve.
[0057] Sensitivity: Also known as sensitivity, it refers to the proportion of people who are actually sick that can be correctly identified as patients by the screening method;
[0058] Specificity: refers to the proportion of people who are actually disease-free that can be correctly identified as non-patients by the screening method;
[0059] Youden index: Indicates the overall ability of a screening method to detect true patients and non-patients. The larger the index, the better the screening test is and the greater its authenticity.
[0060] The cut-off value is the judgment standard, which is the boundary value for determining the positive and negative results of the test. It determines the normal value of a certain indicator to distinguish between normal and abnormal.
[0061] AUC (Area Under Curve) is defined as the area under the ROC curve and enclosed by the coordinate axis. The closer the AUC is to 1.0, the higher the authenticity of the detection method.
[0062] The cross-sectional area of the internal jugular vein at end-expiration is >72.5 mm 2 The sensitivity of predicting elevated central venous pressure was 81% and the specificity was 38.9%. The sensitivity of predicting elevated central venous pressure when the internal jugular vein circumference at end-expiration was >41mm and the specificity was 44.4%. The sensitivity of predicting elevated central venous pressure when the internal jugular vein anteroposterior diameter at end-expiration was >10.4mm and the specificity was 38.1% and 0%.
[0063] The anteroposterior diameter of the internal jugular vein at the end of inspiration >10.4 mm had a sensitivity of 71.4% and a specificity of 27.8% for predicting elevated central venous pressure. 2 The sensitivity and specificity of the prediction of central venous pressure increase were 85.7% and 38.9%, respectively. The sensitivity and specificity of the prediction of central venous pressure increase when the internal jugular vein circumference at the end of inspiration was greater than 41 mm were 57.1% and 22.2%, respectively.
[0064] Example 3: Establishment of correlation equation between internal jugular vein parameters and central venous pressure
[0065] Based on the data in Table 1 above, the formula of the correlation equation between internal jugular vein parameters and central venous pressure was obtained using Matlab software.
[0066] The linear regression equation is: Y = w0a + w1b + w2c + w3d
[0067] Among them, Y is the dependent variable, i.e., the value of central venous pressure, where a, b, c, and d represent the anteroposterior diameter of the internal jugular vein, the left-right diameter of the internal jugular vein, the cross-sectional area of the internal jugular vein, and the circumference of the internal jugular vein, respectively;
[0068] When a, b, c, and d are the anteroposterior diameter, left-right diameter, cross-sectional area, and circumference of the internal jugular vein at the end of expiration, respectively; w0, w1, w2, and w3 are 0.10955944, 0.36938604, -0.03333283, and 0.11926442, respectively, and MSE is 20.287249684001473
[0069] When a, b, c, and d are the anterior-posterior diameter of the internal jugular vein, the left-right diameter of the internal jugular vein, the cross-sectional area of the internal jugular vein, and the circumference of the internal jugular vein at the end of inspiration, respectively; w0, w1, w2, and w3 are 0.34543744, 0.61360341, -0.08026889, and 0.11808912, respectively, MSE: 19.643026403900965;
[0070] The mean square error, i.e., MSE, of the central venous pressure Y value calculated based on the relevant parameters at the end of expiration and end of inspiration shows that the central venous pressure value calculated by the anterior-posterior diameter of the internal jugular vein, the left-right diameter of the internal jugular vein, the cross-sectional area of the internal jugular vein, and the circumference of the internal jugular vein at the end of inspiration has a smaller error than the central venous pressure value detected by the gold standard method. Therefore, it is preferred that the central venous pressure Y be calculated by the anterior-posterior diameter of the internal jugular vein, the left-right diameter of the internal jugular vein, the cross-sectional area of the internal jugular vein, and the circumference of the internal jugular vein at the end of inspiration.
Claims
1. A method for non-invasively monitoring central venous pressure, the method comprising the following steps: S1. Select the vein site to be tested; S2. Place the probe of the ultrasonic detector at the corresponding area of the vein to be tested; S3. Obtain the anterior-posterior diameter, left-right diameter, cross-sectional area and circumference data of the selected vein site by using an ultrasonic detector; S4. Calculate the central venous pressure value by using the linear regression equation based on the data of the anterior-posterior diameter of the vein, the left-right diameter of the vein, the cross-sectional area and the circumference of the detected vein site; The linear regression equation is: Y=w0a+w1b+w2c+w3d in, Y is the dependent variable, i.e., the value of central venous pressure, where a, b, c, and d represent the anteroposterior diameter of the internal jugular vein, the left-right diameter of the internal jugular vein, the cross-sectional area of the internal jugular vein, and the circumference of the internal jugular vein, respectively; When a, b, c, and d are the anteroposterior diameter, left-right diameter, cross-sectional area, and circumference of the internal jugular vein at the end of expiration, respectively; w0, w1, w2, and w3 are 0.10955944, 0.36938604, -0.03333283, 0.11926442, respectively, MSE: 20.287249684001473 When a, b, c, and d are the anterior-posterior diameter of the internal jugular vein, the left-right diameter of the internal jugular vein, the cross-sectional area of the internal jugular vein, and the circumference of the internal jugular vein at the end of inspiration, respectively; w0, w1, w2, and w3 are 0.34543744, 0.61360341, -0.08026889, 0.11808912, respectively, and MSE: 19.643026403900965.
2. The method for non-invasively monitoring central venous pressure according to claim 1, characterized in that: The venous site is a venous site associated with a central vein.
3. The method for non-invasively monitoring central venous pressure according to claim 1, characterized in that: The vein site is selected from the group consisting of the internal jugular vein, the external jugular vein, the subclavian vein, the femoral vein, and the axillary vein.
4. The method for non-invasively monitoring central venous pressure according to claim 3, characterized in that: The venous site is preferably the internal jugular vein.
5. The method for non-invasively monitoring central venous pressure according to claim 1, characterized in that: The probe of the ultrasonic detector in step S2 is a patch probe, which can monitor the anterior-posterior diameter, left-right diameter, cross-sectional area and circumference data of the vein selected in step S3 in real time for a long time, reducing the doctor's manual operation.
6. The method for non-invasively monitoring central venous pressure according to claim 5, characterized in that: The patch probe can be a linear array probe, a phased array probe, a mechanical fan-scan probe, or a square array probe.
7. The method for non-invasively monitoring central venous pressure according to claim 6, characterized in that: The patch probe is preferably a linear array probe.
8. The method for non-invasively monitoring central venous pressure according to claim 1, characterized in that: The center frequency of the ultrasonic detector is 7.1MHz, the array width is 38.4mm, the array element base is 128, and the scanning mode is electronic linear array.
9. An instrument for non-invasive central venous pressure monitoring, the instrument comprising an information acquisition unit, an information processing unit and an information display unit; the information acquisition unit acquires data on the anterior-posterior diameter of the vein, the left-right diameter of the vein, the cross-sectional area and the circumference of the corresponding venous part of the subject through an ultrasonic detector; The information processing unit processes the data information obtained by the information acquisition unit through the following linear regression equation to obtain the value of the central venous pressure; The linear regression equation is: Y=w0a+w1b+w2c+w3d in, Y is the dependent variable, i.e., the value of central venous pressure, where a, b, c, and d represent the anteroposterior diameter of the internal jugular vein, the left-right diameter of the internal jugular vein, the cross-sectional area of the internal jugular vein, and the circumference of the internal jugular vein, respectively; When a, b, c, and d are the anteroposterior diameter, left-right diameter, cross-sectional area, and circumference of the internal jugular vein at the end of expiration, respectively; w0, w1, w2, and w3 are 0.10955944, 0.36938604, -0.03333283, 0.11926442, respectively, MSE: 20.287249684001473 When a, b, c, and d are the anterior-posterior diameter of the internal jugular vein, the left-right diameter of the internal jugular vein, the cross-sectional area of the internal jugular vein, and the circumference of the internal jugular vein at the end of inspiration, respectively; w0, w1, w2, and w3 are 0.34543744, 0.61360341, -0.08026889, 0.11808912, MSE: 19.643026403900965; The information display unit displays the value of the central venous pressure obtained after the information processing unit processes the corresponding information through a display device.