System for determining characteristics of blood flow

• US 4,562,843 A
• Filed: 07/06/1981
• Issued: 01/07/1986
• Est. Priority Date: 09/29/1980
• Status: Expired due to Fees

• Current Assignee: Djordjevich Ljubomir, Max S. Sadove
• Original Assignee: Djordjevich Ljubomir, Max S. Sadove
• Inventors: Djordjevich, Ljubomir, Sadove, Max S.
• Primary Examiner(s): Howell, Kyle L.
• Assistant Examiner(s): Jaworski, Francis J.
• Application Number:
  US06/280,321
• Time in Patent Office: 1,646 Days
• Field of Search: 128/713, 128/670-675, 128/734, 128/693, 128/713, 128/677
• US Class Current: 600/485
• CPC Class Codes: A61B 5/0205 Simultaneously evaluating both cardiovascular conditions and different types of body conditions, e.g. heart and respiratory condition
• CPC Class Codes: A61B 5/0295 using plethysmography, i.e. measuring the variations in the volume of a body part as modified by the circulation of blood therethrough, e.g. impedance plethysmography
• CPC Class Codes: A61B 5/0535 Impedance plethysmography for measuring blood flow A61B5/0295
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 40/63 for local operation
• CPC Class Codes: G16Z 99/00 Subject matter not provided for in other main groups of this subclass

Abstract

Method and apparatus are disclosed for determination and display of hemodynamic characteristic values of a patient in a variety of statistical forms and in relative or absolute terms, the measurement determination being made by non-invasive impedance plethysmography under control of a central processor. A characteristic value representative of variation of blood vessel cross-sectional area is measured across a patient'"'"'s body section, blood pressure is measured in the body in simultaneity with the characteristic value, and signals representative of the characteristic value and blood pressure are then processed to obtain the hemodynamic characteristic values.

Claims

1. A method for measuring a hemodynamic characteristic of a living body having elastic blood vessels comprising the steps of:

measuring a characteristic value across a section of said body, said characteristic value being at least representative of the variation in cross-sectional area of the blood vessels within that section;

measuring blood pressure in said body simultaneously with the measurement of said characteristic value; and

processing signals representative of the characteristic value and the blood pressure measurements with a processing means to obtain an electrical signal representing the hemodynamic characteristic;

said processing step including the step of utilizing at least one hemodynamic equation which relates said characteristic value, said blood pressure and the modulus of elasticity of the blood vessels within said section as a function, and including the step of calculating said modulus of elasticity.

2. The method as set forth in claim 1 further characterized in that said step of measuring said characteristic value includes measuring the electrical impedance across said section.

3. The method as set forth in claim 2 characterized in that said step of processing includes the step of selecting said hemodynamic formula for the determination of cardiac output over a time period.

4. The method as set forth in claim 2 further comprising the step of selecting said hemodynamic formula for the determination of modulus of elasticity of the arterial walls in said body section.

5. The method as set forth in claim 2 wherein said step of utilizing a hemodynamic equation includes utilizing the equation ##STR1## where ρ

=resistivity of the blood

L=distance of the section over which the impedance is measured

Z=impedance variation due to blood flow variance

Zc=impedance due to the tissue comprising the section

Ao=unstretched cross sectional area of the blood vessels of the section.

P=pressure variation causing the blood flow variance

E'"'"'=(K² -1/K² +1)E

E=modulus of elasticity for the blood vessels of the section.

K=Ro/Ri the ratio of the outer to the inner diameters of the blood vessels of the section.

6. An apparatus for determining the value of a characteristic of blood flow in a section of a living body having elastic blood vessels comprising:

an inpedance plethysmograph for connection to said body having electrodes for attachment at spaced positions along said section of said body for selectively outputting a signal representative of the value of the electrical impedance of said body section,

means for simultaneously measuring blood pressure of said living body and for outputting a signal representative thereof; and

a processor having means for receiving said signals representing said electrical impedance and said blood pressure, means for storing corresponding values of the blood pressure and electrical impedance signals as a plurality of sets; and

means for processing said simultaneously measured sets of said signals with corresponding sets of hemodynamic equations which relate said impedance, said blood pressure, and the modulus of elasticity of the blood vessels within said section as a function so as to calculate said modulus of elasticity, and so as to generate said blood flow characteristic.

7. The apparatus as in claim 6, further comprising:

means for outputting stored values, wherein said processor is additionally responsive to said stored values.

8. The apparatus as set forth in claim 6 including means for displaying the value of said blood flow characteristic.

9. The apparatus as set forth in claim 6 in which said blood flow characteristic is cardiac output.

10. The apparatus as set forth in claim 6 in which said blood flow characteristic is rate of blood flow.

11. The apparatus as set forth in claim 6 in which said blood flow characteristic is a function of the modulus of elasticity of the blood vessels within the body section.

12. The apparatus as set forth in claim 6 in which said blood flow characteristic is contractility of the left ventricle of the heart in said body.

13. The apparatus as in claim 6 further characterized in that said blood flow characteristic is cardiac index.

14. The apparatus as in claim 6 further characterized in that said blood flow characteristic is useful power output of the heart.

15. The apparatus as in claim 6 further characterized in that said blood flow characteristic is systemic vascular resistance.

16. The apparatus as in claim 6 further characterized in that said blood flow characteristic is stroke volume.

17. The apparatus as in claim 6 further characterized in that said blood flow characteristic is cross-sectional area of the blood vessels within the body section.

18. The apparatus as set forth in claim 6 wherein said processor processes simultaneous sets of the equations:

##STR2## where ρ

=resistivity of the blood

L=distance of the section over which the impedance is measured

Z=impedance variation due to blood flow variance

Zc=impedance due to the tissue comprising the section

Ac=unstretched cross sectional area of the blood vessels of the section.

P=pressure variation causing the blood flow variance

E'"'"'=(K² -1/K² +1)E

E=modulus of elasticity for the blood vessels of the section.

19. A method of measuring a hemodynamic characteristic across a section of a living body having elastic blood vessels comprising the steps of:

determining the viscosity and resistivity of the blood of the body;

attaching a plethysmograph for measuring an electrical impedance across said section of the body said impedance being at least representative of the variance in the cross sectional area of the blood vessels within said section;

attaching means for measuring blood pressure;

measuring personal characteristics of said body;

processing signals representative of the characteristic value and the blood pressure measurements with a processing means to obtain an electrical signal representing the hemodynamic characteristic;

said processing step including the step of utilizing at least one hemodynamic equation which relates said characteristic value, said blood pressure and the modulus of elasticity of the blood vessels within said section as a function, and including the step of calculating said modulus of elasticity; and

further processing said personal characteristics with a hemodynamic equation which relates said hemodynamic characteristic as a function of the calculated modulus of elasticity of said blood vessels, said viscosity, said resistivity, and said personal characteristics to determine the hemodynamic characteristic.

20. The method as in claim 19 wherein said personal characteristics are from the class of age, sex, height, and weight.

21. The method as in claim 19 further comprising the step of:

calculating the average cross-sectional area of vessels in the portion of the body as a function of the measured electrical impedance and blood pressure values.

22. The method as in claim 19 wherein said personal characteristic measuring step include the step of taking a blood sample from said body and performing a hematocrit on said sample to determine the viscosity and electrical resistivity of the blood sample.

23. A method of determining the kinetic energy of blood flow through a blood vessel comprising the steps of:

measuring an electrical property across a section of a body overlying the section of the blood vessel,

measuring blood pressure in said body simultaneously with the measurement of the electrical property;

processing values representative of multiple sets of the simultaneous measurements of the blood pressure and the electrical property to obtain a first value representing the mean area of the section of the blood vessel, a second value representing the rate of blood flow, and a third value representing the mean blood velocity; and

processing values representative of the rate of blood flow and mean blood velocity to obtain a value representing the kinetic energy of blood flow.

24. A method for measuring the total heart power comprising the steps of:

measuring an electrical property across a section of a body overlying the section of the blood vessel,

measuring blood pressure in said body simultaneously with the measurement of the electrical property;

processing values representative of multiple sets of the simultaneous measurements of the blood pressure and the electrical property to obtain a first value representing potential energy of blood flow, and a second value representing kinetic energy of blood flow; and

processing the values representing the potential and the kinetic energies of the blood flow to determine the value of the total heart power.

25. The method of claim 24 further comprising the steps of:

determining a value representing body surface area,

processing the values representing the total heart power and the body surface area to obtain a cardiac power index value representing the total heart power per body surface area.

27. The system as set forth in claim 24 further comprising:

means for displaying the value representative of the hemodynamic characteristic.

28. The system as set forth in claim 27 wherein said measurements are taken over a time period and said display is in the face of a curve.

26. A system for measuring a hemodynamic characteristic comprising:

means for non-invasively measuring a characteristic value across a section of a living body,

means for non-invasively measuring blood pressure in said body simultaneously with the measurement of said characteristic value; and

means for processing signals representative of the characteristic value and the blood pressure measurements through an electronic device to obtain an electrical signal representing the hemodynamic characteristic.

29. The system as in claim 26 further characterized in that said characteristic value is impedance.

30. The system as set forth in claim 29 wherein said processing is performed by passing signals representing said impedance and blood pressure signals through an electronic device for outputting said electrical signal representing a hemodynamic characteristic in accordance with selected formulae.

31. The system as set forth in claim 30 in which said formulae are selected for the determination of cardiac output over a time period.

32. The system as set forth in claim 30 in which said formulae are selected for the determination of modulus of elasticity of the arterial walls in said body section.

80. The system as in claim 26 or 33 or 34 or 44 or 40 or 50 or 51 or 56 or 58 or 61 or 62 further comprising:

means for displaying the hemodynamic characteristic in a format from the class of formats of absolute values, relative values, deviation from mean, range of values, time averaged values, minimum values, average minimum values, mean values, maximum values, average maximum values, instantaneous rate of change of values, maximum rate of change of values, minimum rate of change of values, mean rate of change of values, and average rate of change of values.

33. An apparatus for measuring hemodynamic characteristics comprising:

means for measuring across a section of a living body and determining a characteristic value;

means for measuring blood pressure in said body simultaneously with the measurement of the characteristic value;

means for determining a hemodynamic characteristics from the simultaneous measurements; and

means for displaying the determined hemodynamic characteristics.

34. The apparatus as in claim 33 further comprising:

means for repeating the simultaneous measurements a plurality of times; and

means for determining hemodynamic characteristics responsive to the plurality of simultaneous measurements.

35. The apparatus as in claim 33 or 34 further comprising:

means for measuring an electrical characteristic value across the section of living body, and

means for determining the characteristic value from the measured electrical characteristic value.

36. The apparatus of claim 35 further characterized in that said electrical characteristic value is a function of electrical impedance Z.

37. The apparatus as in claim 36 further comprising:

means for determining the electrical impedance measurements corresponding to systolic P_S and diastolic P_D blood pressure measurements;

means for determining an elasticity value E from the simultaneous blood pressure and impedance measurements corresponding to systolic and diastolic pressure, and a third pair of simultaneous measurements of pressure and impedance;

means for determining the respective cross sectional area of the vessel for each set of measurements from the respective pressure and impedance measurements and E.

38. The apparatus as in claim 37 further comprising:

means for determining the rate of blood flow Q as a function of the determined elasticity value E and the measured impedances and pressures.

39. The apparatus as in claim 38 further comprising:

means for determining the stroke volume V as a function of the rate of blood flow Q integrated over the time of a cardiac cycle.

40. The apparatus as in claim 38 further comprising:

means for taking a plurality of time-sequential impedance and pressure measurements and averaging said plurality to determine a surface impedance, Z base, a mean pressure, P mean, and a mean elasticity, E mean,

means for deriving a mean area, A mean, responsive to Z base, P mean and E mean; and

means for determining an average velocity of blood responsive to the rate of blood flow Q and the mean area, A mean.

41. The apparatus of claim 35 further characterized in that said electrical characteristic value is the first time derivative dz/dt of the electrical impedance Z.

42. The apparatus as in claim 34 wherein the means for measuring blood pressure is further comprised of:

means for attaching a blood pressure measuring device to the patient'"'"'s body; and

means for generating signals from the device which vary with time during the cycle of blood flow.

43. The apparatus as in claim 34 or 42 wherein said means for measuring said characteristic value is further comprised of:

means for attaching first and second electrode sets in spaced relationship to one another across the section of the body;

means for injecting an electrical signal into said first electrode set;

means for detecting an electrical signal as received by said second electrode set; and

means for outputting said signal representative of said characteristic value.

44. A system for measuring and determining a hemodynamic characteristic comprising:

means for determining viscosity and resistivity of blood of a patient;

means for attaching a plethysmograph to measure an electrical property across a portion of the patient'"'"'s body, means for simultaneously measuring blood pressure and the electrical property across the section of the patient;

means for inputting personal characteristics of the patient; and

means for processing the personal characteristics and the simultaneously measured values of the blood pressure and the electrical property, to determining the hemodynamic characteristic.

45. The system as in claim 44 wherein said personal characteristics are from the class of the patient'"'"'s age, sex, height, and weight.

46. The system as in claim 44 further comprising:

means for calculating the average cross-sectional area of vessels in the portion of the body as a function of the measured electrical property and blood pressure values.

47. The system as in claim 44 wherein said electrical property is impedance.

48. The system as in claim 44 further comprising means for taking a blood sample and determining a hemotocrit therefrom.

49. A system for measuring the cross-sectional area of a section of a blood vessel comprising:

means for measuring an electrical property across a section of a body overlying the section of the blood vessel,

means for measuring blood pressure in said body simultaneously with the measurement of the electrical property,

means for processing values representative of the simultaneous measurements of the blood pressure and the electrical property to obtain a value representing the cross-sectional area of the section of the blood vessel.

50. A system for measuring the elasticity of a section of a blood vessel comprising:

means for measuring an electrical property across a section of a body overlying the section of the blood vessel,

means for measuring blood pressure in said body simultaneously with the measurement of the electrical property, and

means for processing values representative of multiple sets of the simultaneous measurements of the blood pressure and the electrical property to obtain a value representing the elasticity of the section of the blood vessel.

51. A system for measuring the rate of blood flow in a section of a blood vessel comprising:

means for measuring an electrical property across a section of a body overlying the section of the blood vessel,

means for measuring blood pressure in said body simultaneously with with the measurement of the electrical property, and

means for processing values representative of multiple sets of simultaneous measurements of the blood pressure and the electrical property to obtain a value representing the rate of blood flow in the section of the blood vessel.

52. The system as in claim 51 further comprising:

means for integrating the rate of blood flow over the time of one cardiac cycle to determine pulse stroke volume.

53. The system as in claim 51 further comprising:

means for integrating the rate of blood flow over one minute to determine cardiac output.

54. The system as in claim 53 further comprising:

means for determining a value for the body surface area, and

means for determining a cardiac index as a function of the cardiac output and the body surface area.

55. The system as in claim 53 further comprising:

means to determining heart rate;

means for determining stroke volume as a function of the cardiac output divided by the heart rate.

56. A system for measuring the mean velocity of blood across a section of a blood vessel comprising:

means for noninvasively measuring an electrical property across a section of a body overlying the section of the blood vessel,

means for noninvasively measuring blood pressure in said body simultaneously with the measurement of the electrical property;

means for processing values representative of multiple sets of the simultaneous measurements of the blood pressure and the electrical property to obtain a value representing the mean area of the section of the blood vessel;

means for processing values representative of multiple sets of the simultaneous measurements to obtain a value representating the rate of blood flow in the section of the blood vessel, and

means for deriving the mean velocity of blood responsive to the rate of blood and the mean area.

57. The system as in claim 56 further comprising means for displaying the mean velocity of blood, rate of blood flow, and mean area.

58. A system for measuring vascular resistance comprising:

means for measuring blood pressure in said body at two points on said body, overlying said section;

means for processing values representative of the two-point measurements of the blood pressure to obtain a value representing differential blood pressure of the section of the blood vessel,

means for determining cardiac output; and

means for determining vascular resistance as a function of the cardiac output and the differential blood pressure.

59. The method as in claim 58 wherein the vascular resistance is systemic;

and

the two points measured are mean right artial pressure and mean arterial pressure.

60. The system as in claim 58 further comprising:

means for detemining the rate of blood flow, and

means for determining a value for the potential energy of blood flow as a function of the differential blood pressure and the rate of blood flow.

61. A system for determining the kinetic energy of blood flow through a blood vessel comprising:

means for measuring an electrical property across a section of a body overlying the section of the blood vessel,

means for measuring blood pressure in said body simultaneously with the measurement of the electrical property;

means for processing values representative of multiple sets of the simultaneous measurements of the blood pressure and the electrical property to obtain a first value representing the rate of blood flow, and a second value representing the mean blood velocity; and

means for processing values representative of the rate of blood flow and mean blood velocity to obtain a value representing the kinetic energy of blood flow.

62. A system for measuring the total heart power comprising:

means for measuring an electrical property across a section of a body overlying the section of the blood vessel,

means for measuring blood pressure in said body simultaneously with the measurement of the electrical property;

means for processing values representative of multiple sets of the simultaneous measurements of the blood pressure and the electrical property to obtain a first value representing potential energy of blood flow, and a second value representing kinetic energy of blood flow; and

means for processing the values representing the potential and the kinetic energies of blood flow to determine the value of the total heart power.

63. The system of claim 62 further comprising:

means for determining a value representing body surface area, and

means for processing the values representing the total heart power and the body surface area to obtain a value representing the total heart power per body surface area.

64. A method for measuring a hemodynamic characteristic in a section of a living body having elastic blood vessels comprising:

measuring an electrical parameter across said body section to determine an impedance value for said section;

measuring a blood pressure value in said body simultaneously with the measurement of the impedance value;

determining impedance values corresponding to the systolic and the diastolic blood pressure of the body;

calculating an elasticity value E from the simultaneous blood pressure and impedance measurements corresponding to said systolic and diastolic pressures, and a third pair of measurements of mean pressure and impedance, and determining the respective cross sectional area of the blood vessels within said section for each set of measurements from the respective pressure and impedance measurements and E.

65. The method as set forth in claim 64 further comprising the step of:

determining the rate of blood flow Q as a function of the determined elasticity value E and the measured impedances and pressures.

66. The method as in claim 65 further comprising the step of:

determining the stroke volume V as a function of the rate of blood flow Q integrated over a fixed time t of a cardiac cycle.

67. The method as in claim 65 further comprising the step of:

determining cardiac output as a function of the rate of blood flow Q integrated over a set of predetermined limits.

68. The method as in claim 65 wherein the step of measuring blood pressure further comprises:

attaching a blood pressure measuring device to said body; and

generating signals from the device which vary with time during the cycle of blood flow.

69. The method as set forth in claim 68 wherein the step of measuring said characteristic value is further comprised of the steps of:

attaching a first electrode set and second electrode set to said body in spaced relationship to one another;

injecting an electrical signal into said first electrode set;

detecting an electrical signal as received by said second electrode set; and

outputting said signal representative of said representative value.

70. The method as set forth in claim 64 further comprising the steps of:

taking a plurality of time-sequential impedance and pressure measurements and averaging said plurality to determine a base impedance, Z base, a mean pressure, P mean, and a mean elasticity, E mean,

deriving a mean area, A mean, corresponding to Z base, P mean and E mean; and

,

determining an average velocity of blood corresponding to Z base, P mean and E mean; and

,

determining an average velocity of blood corresponding to Q and A mean.

71. A method for measuring the instantaneous rate of blood flow in a section of a living body having elastic blood vessels comprising the steps of:

measuring an electrical parameter across a section of said body having the blood vessels within, said electrical property being at least representative of the variance in cross sectional area of the blood vessels within that section;

measuring blood pressure in said body simultaneously with the measurement of said electrical parameter;

processing values of multiple sets of simultaneous measurements of the blood pressure and the electrical parameter;

solving a set of hemodynamic equations which relates the axial velocity of the blood in said vessels as a function of various unknowns, said equations having of the same number of unknown variables as the number of measurement sets, wherein one of the unknowns is the modulus of elasticity of the blood vessels within said section;

multiplying the axial velocity of the blood flow by the cross sectional area of the blood vessels of said section to yield an instantaneous rate of blood flow therethrough.

72. The method as set forth in claim 71 further comprising the step of:

integrating the rate of blood flow over a predetermined period to determine cardiac output.

73. The method as in claim 72 further comprising the step of:

determining the heart rate; and

determining stroke volume as a function of the cardiac output divided by the heart rate.

74. A method as set forth in claim 73 comprising:

measuring blood pressure in said body at two points, on said body;

processing values representative of the two-point measurement of the blood pressure to obtain a value representing differential blood pressure of the blood vessels of said section,

determining cardiac output; and

determining vascular resistance as a function of the cardiac output and the differential blood pressure.

75. The method as in claim 73 wherein the vascular resistance is sytemic;

and the two points measured are mean right atrial pressure and mean arterial pressure.

76. The method as in claim 74 further comprising the steps of:

determining the instantaneous rate of blood flow, and

determining a value for the potential energy of blood flow due to the power output of the heart as a function of the differential blood pressure and the rate of blood flow.

77. The method as in claim 74 further comprising the step of:

measuring blood pressure in said body at said mean right atrial pressure and pressure at a point at any other artery.

78. The method as set forth in claim 74 further comprising the step of integrating the rate of blood flow over one cardiac cycle to determine stroke volume.

79. The method as in claim 71 further comprising the steps of:

determining a value for the body surface area, and

determining a cardiac index as a function of the cardiac output and the body surface area.