【作者】 周玲；

【导师】 洪洋；

【作者基本信息】 中国医科大学 ， 生物医学工程， 2009， 硕士

【摘要】 目的现时临床心电学对心电环和心电波的观测均体现在整体表象性状上,如心电环横宽和周期等,心电波的幅度和间期等,还没有对其微分几何性状进行刻画。实际上,在心电环空间曲线上的瞬时心电向量随时间运行每一动点都存在快慢、弯曲和扭曲这三项微分几何基本性状,分别可用速率、曲率和挠率来量度。以Frank正交导联x(t)、y(t)、z(t)为基础,以微分几何数学模型为原理,计测与描述心电环的微分几何性状,描记心电环空间曲线的速率v(t)、曲率c(t)和挠率d(t)模量曲线,由v(t)、c(t)和d(t)三条图线所组成的标量图叫做微分几何心电图(differentiategeometry ECG,DG-ECG)。本文以微分几何数学模型作为基本原理,以小灶心肌梗死为应用例,并引用自然方程组作为依据,比较微分几何数学模型与临床诊断小灶心肌梗死的符合情况,指出微分几何心电图科学发展的必然前景,旨在为医学科学研究人员提供此数学模型作为一种诊断手段,发挥计算机功效,应用于临床实践,促进临床心电学科学的发展。方法采用VC++语言,建立心电环空间曲线的切速率、曲率和挠率数学模型,用ECG和VCG两个导联体系同步采集心电信号。Frank导联体系采集的心电信号输出三道正交心电图,±x输出体表左右电位差波形Vx(t),±y输出体表上下电位差波形vy(t),土z输出体表前后电位差波形Vz(t)。将毫伏级正交心电信号输入给心电放大器,放大到V级后输入给A/D转换器,A/D转换器将模拟信号转换为数字信号,再输入给计算机进行数据处理。通过计算机对临床已确诊的小灶心肌梗死组QRS环的曲率和挠率进行分析与描记,摸索正常组QRS环和小灶心肌梗死组QRS环的曲率和挠率模量心电图的的变化规律;分析小灶心肌梗死组QRS环反向曲率模量的最大值以及挠率模量的最大值情况。结果l、经过对正常组和小灶心肌梗死组76例QRS环的分析,得出23例小灶心肌梗死组QRS环均出现反向曲率,符合率达100%;53例正常组中只有1例QRS环出现反向曲率,符合率达2%.2、小灶心肌梗死组QRS环反向曲率模量的最大值在368-442(1/mv)之间变化,大多数集中在410(1/mv)左右,数值比较集中,心梗位置多数为前间壁。实验数据用SPSS13.0软件进行统计学处理,用均值±2标准误表示,其结果为(405.57±6.94)1/mv(P<0.05);QRS环挠率最大值在138-550(1/mv)之间变化,多数集中在400(1/mv)附近。实验数据用SPSS13.O软件进行统计学处理,其结果为(35 1.39±44.39)1/mv(P<0.05).3、在23例小灶心肌梗死组中,对QRS环反向曲率最大值对应时间和QRS环挠率最大值对应时间做相关性分析,其相关系数R=0.902(P<0.001).结论1、通过小灶心肌梗死临床应用例的分析证明微分几何心电图较传统的心电图、心电向量图具有不丢失信息的优越性;2、QRS环的正负曲率可以作为区分健康人和心肌梗死患者的依据,并具有显著阳性率;3、QRS环反向曲率模量最大值联合QRS环挠率模量最大值可以作为珍断和鉴别诊断小灶心梗的依据,并具有显著阳性率。更多还原

【Abstract】 ObjectiveUp until now,the observation of clinical cardiac electrocardiology on cardio electric vector loops and electrocardiogram are both on whole presentational characters, such as width and periods for cardio electro vector loop,amplitude and interphase for electrocardiogram,and there has been no depiction of its differential geometry properties.In fact,there are basic characteristic features with speed,curvature and deflection,during cardio electric vectors circulating along with time,which are measured by speed,curvature and deflection.With Frank system using x(t)、y(t)、z(t) as the basis,and the mathematical model of differential geometry as the principle, we can describe differential geometry character of the loop and depict three curves with speed v(t),curvature c(t)and deflection d(t),which combined together are called Differential Geometry ECG(differentiate geometry ECG,DG-ECG).This dissertation,using mathematical model of differential geometry as a basic principle,case with small areas myocardial infarction being applied,Natural Equation being introduced as the basis,compared the diagnoses between the mathematical model of differential geometry and the clinic diagnose,and pointed out the future of the development of Differential Geometry ECG.The theme is to provide the mathematical model for researchers of medicine as a diagnostic measure,utilizing the efficacy of computer,applying to clinical practice,and advancing development of clinical cardiac electrocardiology.MethodsVC++ language was used and the mathematic model of spacial curve was established which contained tangential velocity,curvature and deflection.ECG and VCG two leads system were used to collect cardiac electricity signals simultaneously. Cardiac electricity signals taken through Frank lead system were output in three orthogonal directions,±x outputs surface potential difference left and right Vx(t),±y outputs surface potential difference from top to bottom waveform Vy(t),±z outputs waveform surface before and after the potential difference Vz(t);cardiac electricity signal in three orthogonal directions with mV was inputting cardiac electricity amplifier, magnifying V and then inputting to A/D conversion;A/D conversion was used to convert analog signals into digital signals,and then putting into computer to process the experiment data;through the analysis of the computer on curvature and deflection with QRS loop,which were diagnosed SAMI by clinical diagnoses,we can try to find out variability law of the health with QRS loop and the SAMI,which contained speed, curvature and deflection;to analyze the SAMI with maximum modulus of negative curvature and maximum modulus of deflection with QRS loop.Results1.Through the analysis of the 76 health and SAMI,we found that there were negative curvature in all the 23 SAMI with QRS loop,and the accuracy ratio was 100%; the negative curvature occurred in only one of the 53 health,and the accuracy ratio was only 2%.2.Generally speaking,modulus of negative curvature with QRS loop for SAMI varied from 368 to 442(1/mv),mainly about 410(1/mv),and MI mostly happened on the fore-partitions.The experiment data were treated with software for SPSS 13.0, using means±2square,and the result was(405.57±6.94)1/mv(P＜0.05);the deflection with QRS loop varied from 138 to 550(1/mv),mainly about 400(1/mv).The experiment data were treated with software for SPSS13.0,and the result were (351.39±44.39)1/mv(P＜0.05).3.In the 23 SAMI,correlativity analysis was carried out on corresponding time between maximum modulus of negative curvature and maximum modulus of deflection with QRS loop,and the correlativity modulus was R=0.902(P＜0.001).Conclusion1.Through clinical application of SAMI,DG-ECG was proved to have the more superiority of collect information than conventional 12-leads ECG,Frank-VCG;2.Positive and negative curvature of QRS loop can be used as the foundation for differentiating the healthy from the MI,and the accuracy ratio were remarkable;3.Maximum modulus of negative curvature and maximum modulus of deflection with QRS loop can be used as the evidence for diagnosing SAMI,and the accuracy were remarkable.更多还原