Albinas Stankus KMU, Institute of Psychophysiology and Rehabilitation, Palanga, Lithuania albstan@ktl.mii.lt
Abstract: The goal of presented study is an elaboration of methodology for direct measurement of circulation by means of volume units. Particular hardware has been elaborated for this reason. A new principle in measurement of relative changes of the pulse wave amplitude allows registering by electroplethysmogram. It enabled directly to measure changes in the volume of tissues and to assess hemodynamics of various body parts by relative (ml/100ml) volume units and do this method more precise. This study enabled to improve this method for measurement of the blood circulation in legs. This method could be used for diagnostic purposes in vascular pathology. Introduction Popularity of the impedance plethysmography method is based on its simplicity. However, some biophysical and methodological problems occur in the impedance cardiography, performing measurements of the stroke volume. During the last 30 years, main attention of the investigators was focused on the comparison of the absolute stroke volume values, measured by this method and found by other methods. Among investigated persons correlation values in 23 studies were from 0.49 to 0.97. Because of physical reasons, results from earlier mentioned dependences might not be absolutely accurate. Usage of this method for investigations of the blood circulation in lower limbs is not doubtful. Values used in limbs volume computing, are the following: specific tissue impedance (ρ, Ω*cm), distance between electrodes (l, cm) and constant impedance (Z0 Ω). Specific impedance of tissues is considered constant and equal to 135-150Ω*cm. However experiment showed that it depends on blood hematocryte changes from 22 to 66%. Adapting the specific impedance in the concrete instances makes this method more difficult. In real conditions it is very difficult to keep parallelism of the placed band electrodes to precisely measure them and then to keep a distance. Constant impedance in many cases is measured incorrectly, also from indicator. Generally, there are too many approximate calculations and not enough precise measurements. Measurement of the specific impedance, dependent on tissues and blood properties (in the other words – homogeneity of the object to electrical conductance), is most difficult. Materials and Methods The new approaches measurement of hemodynamic is based on the premise, that we must measure tetrapolar means directly the ratio, as it is shown on equation: ∆V/V0=- ko (∆Z/Z0). It is easy to realize it by using a computer or/and electronic method [1]. Supposing, that the specific impedance of the measured area is constant, a direct ratio is found between the alternating volume changes and the total volume measured by the electrical method [1]. The blood filling of the measured segment, whose pulse curve indicates how it changes in time, averages the result, measured by this way. ∆V/V0= ml/ml *100 ⇒ %. This allows one to come to the measurement units, used in physiology – ml/100ml. The device is calibrated by 0.1 % change of the main impedance by a parallel connection of the resistor. The maximum amplitude values found, by using this method, indicate how many ml volume increases in each 100 ml segments between electrodes. The amplitude changes without additional calculations that are found relative changes of the volume in time. Circumferential electrodes are placed over a segment of the thigh, knee-joint, shin and foot. Results

I investigated 43 healthy subjects (HSs) 30 - 69 years old and 42 patients (Pts) with differently stage of
endarteritis obliterans, from 40 to 69 year age. Table 1 shows the results of measuring the magnitude of ratio resistances. Magnitude of maximal pulse wave’s amplitude ratio to constant impedance was at The maximume in knee-joint. In other region this ratio was lesser. The statistic analysis of the main parameters shows very distinct and reliable differences between the HSs and the Pts (p<0.01).All pulse wave amplitudes in the Pts were reliably decreased.

Table 1: Distribution of ratio resistance in leg Subjects
Healthy Right, % Patients Left, % Right, %

Left, %

0,115± 0,00 6 0,117± 0,00 7 0.099 0.007* 0.095 0.007*

0,165± 0,010 0,169± 0,011 0.121 0.008* 0.124 0.008*

0,115± 0,07 3 0,116± 0,08 3 0.079 0.006* 0.086 0.007*

0,103± 0,01 0 0,106± 0,08 0.073 0.006* 0.074 0.008*

Discussion Applying of this method, had solved several serious problems. 1. Registering amplitude changes without additional recalculations depict volumetric changes. The changes of the amplitude are valuated in percent values. For example, registered in the leg area 0.1 % the impedance changes mean, that for each 100 ml of the leg volume during the systole, comes 0.1 ml of blood. Its allow directly evaluate circulation of the various regions of the organism by measurement units, which are acceptable in medicine, e.g. ml/100ml of material. 2. The direct ΔZ/Z measurement is performed more precisely, than in other methods, where the Z value was found from the electropletysmographic sensor. 3. There is no need for calculations of the cross section area or the length of the conductor, because obtained results are not dependent on these values. Pulse wave volume changes are measured in each 100 ml. volume as much as in big or in small volumes. There is another dependence: physiological and anatomical. When changes in length or in the cross section area of the conductor occur because of changes in electrode position, and in the space between electrodes from another tissue type with different blood circulation can get in. The distance between the electrodes influences other physiological dependence, e.g. blood flow measurements is averaged more in higher volume because of the diversity of the tissues. 4. There is no need for the measurement of the specific impedance of the tissues, because during calculations the ratio of the impedances disappears. This method of measurement reveals some discussable problems, but does not avoid conflicts because non-homogeneity of the tissues to the electrical conductance. This problem may be solved only by searching for tissues homogeneity, e.g. finding the best places for generating and measuring electrodes. The problem of homogeneity is related to one problem – coefficients ko show, that absolute compliance does not always exists between impedance and volume. Current flow could occupy only a part of the volume seen or measured by physical methods. Adapting the practice values of the specific impedance [2] for different organs is difficult and inaccurate. It is better to define this value as specific impedance, corresponding to the body area and to measure it every time. That would allow closer a measurement of the blood circulation, not calculation. This theme has many unanswered questions and needs further investigating. Conclusions. The method of impedance plethysmogrephy with direct ΔZ/Z measurement of hemodynamic is more precisely. Relative amplitude of the leg artery pulse wave was decreased in patients with endarteritis obliterans of leg. References [1] STANKUS A., LAURINAVIČIUS A.(1995): ‚Elektopletizmografas‘. Patentas Nr. LT3906 BA61B 5/02:6 [2] FAES T. J., VAN DER MEIJ H. A., DE MUNCK J. C., HEETHAAR R. M. (1999): ‘The electric resistivity of human tissues (100 Hz-10 MHz): a meta-analysis of review studies’, Physiol. Meas., 20(4): pp. R1-10.

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