频率应答功能完整课件.ppt

Acceleration detection circuit The acceleration detection circuit converts physical motion into an electrical signal proportional to the level of movement. A count is generated each time the activity sensor signal exceeds a user-programmable (positive) activity threshold level and subsequently returns to below the negative threshold level (see for a more detailed description of the threshold: Programming the sensor – Activity Threshold). Vibration vs. acceleration Vibration sensor (Piezoelectric Crystal) The piezoelectric sensor is bonded to the inside surface of the pacemaker case. Mechanical forces are transmitted by the surrounding connective tissue, fatty tissue, and muscles. The extent of contact and the coupling mass of the mechanical forces can vary considerably. Accelerometer sensor The accelerometer is mounted on the pacemaker’s hybrid circuitry. Therefore, measured accelerations are independent of surrounding tissue and patients physical properties. Studies Studies have shown that measurement of acceleration provides a better correlation with the level of exertion than does measurement of the frequency of activity signals (Connelly 1993, Sharp et al, 1997). 压电晶体Kappa400，感知器焊在机壳上，有正反面，对压力、撞击有反应。 加速度感知器焊在集成电路上，方便生产，对身体以外振动无反应。 Mode Rate response becomes active by programming the sensor to a rate responsive mode (XXXR) Increased tidal volume and rate increase transthoracic impedance, which increases the pacing rate. １、原理 每分钟通气量传感器通过测量电极导线顶端电极与脉冲发生器之间的经胸阻抗，测得潮气量和呼吸频率，然后计算出每分钟通气量，并与安静状态的基础值相比较，经脉冲发生器的内设算法自动调节起搏输出频率。每分钟通气量传感器需要特殊的双极电极导线。 ２、临床应用 此类传感器的最大优点为起搏频率的改变与活动量变化的相关性比较好，因此在临床上应用比较广泛。如Ela Talent、Medtronic Kapp400、Guidant Insignia Plus;Guidant Pulsar Max II等。但与体动传感器比较，这类传感器对运动反应的起始频率上升比较慢，比窦房结慢30秒钟。此外，还受其它因素，如讲话及非运动或代谢性增加引起呼吸频率加快的影响。 通过环状电极发放阈下刺激来测试经胸阻抗，Kappa 400测电极阻抗不需要额外起搏，由测试经胸阻抗时同时测试。 16HZ/秒， 3%的时间在测试。很费电，需要耗费5%的电量。 改变观念：理想的频率应答应该反映迅速同时也是为患者提供长期而且生理的频率支持。所以，57人试验为长期的生理频率提供了模板。Sigma在不能进行分层管理的前提下，只能在日常活动范围提供生理的频率支持。所以DR 100，2秒钟根据计数点变换一次频率，30秒的关系指的是 注释：