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БЕЛОРУССКИЙ ГОСУДАРСТВЕННЫЙ УНИВЕРСИТЕТ ИНФОРМАТИКИ И РАДИОЭЛЕКТРОНИКИ
кафедра ЭТТ
РЕФЕРАТ на тему:
“Моделирование процесса электростимуляции методом передаточной функции”
МИНСК, 2008
Некоторые авторы рассматривают нервно-мышечный аппарат как биологическую
структуру, состоящую из аналоговой и дискретной частей, соединенных
последовательно. Дискретная часть представлена пороговым элементом 2 и
управляющим мультивибратором – 3. Эта часть описывает поведение
структуры при подпороговых входных воздействиях. Аналоговую часть 1
можно считать линейной при подпороговых электрических раздражениях.
Методика съема АВК состоит в получения динамической (переходной)
характеристики звена при помощи входных воздействий в виде импульсов с
конечной амплитудой и длительностью. Индикатором является пороговый
элемент 2. Оказалось, что АВК представляет собой величину, обратную
переходной характеристике звена 1, и имеет форму, показанную на рисунке.
В качестве входных сигналов могут быть использованы линейно-нарастающие
(треугольные) импульсы, максимальная длительность которых должна
достилать 3с.
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9020000000205000000140246027c0115000000fb02ebff0000000000009001000000a10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d010100030000001e000700000016040b023c01f1011e010400000002010100040000002
d010600050000000902000000020d000000320af2012601010004001e01f1013b010b024
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fff1000000026060f001600ffffffff0000e4000000bb010000e70000006602000004000
0002d010400040000002d01050004000000060102001000000024030600e600bc01e500b
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701e500cf01e500cf01e600cf011000000024030600e600d201e500d101e500d201e500d
a01e500da01e600da011000000024030600e600dd01e500dc01e500dd01e500e501e500e
501e600e5011000000024030600e600e801e500e701e500e801e500f001e500f001e600f
0011000000024030600e600f301e500f201e500f301e500fb01e500fb01e600fb0110000
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0000000
Рисунок 1. Амплитудно-временная кривая (АВК) возбудимости
нервно-мышечного аппарата.
а – АВК без обработки; б – структурная схема аналого-дискретного
преобразователя; в – АВК после обработки, I0 – реобаза, I – удвоенная
реобаза.
Функциональное состояние нервно-мышечного аппарата может быть детально
изучено при помощи стимуляционной электромиографии. В ее основе лежит
исследование прямого мышечного ответа, или М-ответа, возникающего при
электрическом раздражении периферического нерва вследствие ортодромного
распространения возбуждения (в дистальном направлении). М-ответ является
суммарным моторным потенциалом, он возникает в результате суммирования
потенциалов действия ДЕ, возбудившихся почти одновременно. Методика
исследования и характеристики М-ответа описаны в соответствующих
руководствах. Получаемые данные характеризуют продолжительность
латентного периода, М-ответа и его амплитуду в норме и при
патологических изменениях Известно, что вслед за латентным периодом
наступает абсолютная рефракторная фаза. Для нерва и нервно-мышечного
синапса мышц она разная. Это обусловливает их различную лабильность,
т.е. неодинаковую способность проводить максимальное числа импульсов в
секунду.
Наибольшей лабильностью обладает нервное волокно, а самой малой –
нервно-мышечный синапс. Так, пессимальное торможение возникает в
нервно-мышечной бляшке на частотах 100-200, а в нерве 350-600 имп. /с.
Если раздражение наносится в фазе относительной рефрактерности, то
латентный период увеличивается, а амплитуда ответа уменьшается.
Способность нерва, нервно-мышечного синапса и мышцы проводить
максимальное число импульсов в секунду зависит от продолжительностей
латентного периода и фазы абсолютной рефрактерности. По сумме этих
временных интервалов и длительности одиночного стимулирующего сигнала
определяются максимальные частоты, а по длительности латентного периода
и всей рефрактерной фазы – минимальные частоты следования стимулирующих
импульсов, вызывающих гладкий тетанус. При появлении утомления амплитуда
и другие параметры вызванного суммарного моторного потенциала
изменяются. Ценные данные дает исследование скорости распространения
возбуждения по периферическим нервам, нервно-мышечной передачи и
рефлекторного ответа мышцы (Н-рефлекса) В целом электрофизиологические
параметры нервно-мышечного аппарата четко характеризуют его
функциональное состояние и позволяют определять режимы
электростимуляции.
Применяя импульсный и особенно переменный ток для воздействия на ткани
организма, следует учитывать, что электропроводность тканей имеет также
емкостную составляющую, обусловленную поляризационными явлениями в
тканях. В общем виде эквивалентная электрическая схема для цепи,
содержащей ткани организма, при воздействии постоянным и импульсным
токами может быть представлена в виде нескольких последовательно
включенных резисторов каждый из которых шунтирован конденсатором. В этой
схеме Rк и Ск соответствуют эквивалентным сопротивлению и емкости слоя
кожи и подкожной клетчатки, в которых емкость играет значительную роль,
а Rвн и Свн сопротивлению и емкости глубоко лежащих тканей, где емкость
имеет меньшее значение.
picscalex2240100090000039266000000006e6600000000040000000301080005000000
0b0200000000050000000c0283008601050000000701040000006e660000430f2000cc00
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Рисунок 2. Эквивалентная электрическая схема тканей организма при
воздействии постоянными и импульсными токами.
Для ориентировки укажем, что, например, при небольшой площади электродов
(несколько квадратных сантиметров) и незначительной силе тока
(постоянная составляющая-доли миллиампер) для эквивалентной схемы мощно
принять следующий порядок величин Rк: 1000-2000 Ом, Ск: 0.03-0.05мкФ,
Rвн: 500-1000 Ом и Свн: 0.01-0.02 мкФ.
Для электростимуляции нервно мышечного аппарата человека используют
различные импульсы, которые условно можно разделить две группы импульсы
низкой частоты (до 1000 Гц) и импульсы средней частоты (от 1 до 100
кГц).
Параметры импульсов выбираются иногда на основе общих соображений;
нередко их подбирают просто, исходя из субъективных ощущений пациента,
подвергающегося воздействию. Исследуются форма амплитуда (тока или
напряжения), длительность, частота следования, а также другие
характеристики электростимулирующих импульсов, вызывающих, например,
пороговое сокращение мышцы, т.е. по каким-либо объективным критериям
определяются оптимальные параметры. Какие электрические параметры
оказывают эффективное воздействие на ткань и как они изменяются внутри
живых тканей, в настоящее время еще окончательно не выяснено. Большую
роль при воздействии электрического тока на нервно-мышечный аппарат
играет полное сопротивление (активная и реактивная составляющие) кожи,
нервов, мышц и других тканей. Этим объясняется высокая эффективность
лишь определенной части амплитудно-частотного спектра стимула, а не
всего спектра.
Форма, длительность, мощность импульса.
Оптимальным электростимулирующим импульсом, вызывающим сокращение мышцы,
является, по-видимому, импульс, который имеет минимальную мощность и
оказывает наименьшее воздействие на кожу и ее рецепторы. Для
лабораторных исследований удобна прямоугольная форма импульса,
облегчающая количественный анализ, дозировку стимулов и допускающая
достаточно простую конструкцию аппаратуры. Раздражение импульсами одной
полярности приводит к “химическому” повреждающему эффекту, аналогичному
длительному действию на ткань постоянного тока, из-за смещения ионов в
одну сторону под воздействием монофазных сигналов. Во избежание явлений
электролиза в системе электроды – кожа надо использовать импульсы
чередующейся полярности.
Здесь возможны различные варианты:
· один высокоамплитудный импульс вызывает сокращение мышцы, а ему
предшествует (или следует за ним) низкоамплитудный противоположной
полярности, но равной энергии (рис.3, а, б);
· чередуется полярность одинаковых по своим параметрам прямоугольных
импульсов (рис.3, в). Частным случаем может быть чередование полярности
парных импульсов (рис.3, г), которые используются для того, чтобы
снизить амплитуду стимулов и тем самым уменьшить раздражающее
воздействие на рецепторы кожи.
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04000000f0010500040000002d0102000800000026060f000600ffffffff010010000000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Рисунок 3. Прямоугольные импульсы с чередующейся полярностью и равной
энергией.
Считается, что наиболее энергетически выгодной является экспоненциальная
форма импульса тока; при прямоугольной форме импульса возбуждение
возникает с затратами мощности, превышающими оптимальные на 22%. Для
скелетной мускулатуры оптимальная длительность импульса при минимальной
энергии раздражения составляет 0,064 – 1,23 мс, что соответствует
продолжительности потенциала действия двигательных нервных волокон. Это
относится к иннервируемым ими здоровым мышцам или к мышцам, находящимся
в спастическом состоянии в результате центральных парезов и параличей.
При периферических двигательных нарушениях длительность стимула должна
быть большей (до сотен миллисекунд).
В ряде исследований сравнивали энергию раздражения с энергией
надпорогового тетанического сокращения мышцы, варьируя поочередно
частоту, амплитуду и длительность стимулирующих импульсов. Если при этом
один из указанных параметров изменялся, а два других оставались
постоянными, то можно было получить оптимальные значения частоты, силы и
длительности. При этом ответная реакция определялась энергией
раздражения. Однако такой подход справедлив лишь до того момента, пока
не наступит мышечное утомление, при котором сила сокращения мышц падает
при тех же параметрах раздражения. Важным свойством нервно-мышечных
структур при раздражении электрическими сигналами является зависимость
возбудимости от скорости изменения амплитуды стимулирующего сигнала,
т.е. производной du/dt. Известна работа, в которой возбуждение W
выражается в виде функции ряда характеристик электрического стимула, в
число которых входят энергетическая и информационная компоненты,
скорость изменения амплитуды и др.:
picscalex100010009000003850200000200150000000000050000000902000000000400
000002010100050000000102ffffff00040000002e011800050000003102010000000500
00000b0200000000050000000c02c00220131200000026060f001a00ffffffff00001000
0000c0ffffffbfffffffe01200007f0200000b00000026060f000c004d61746854797065
0000800010000000fb0203fee300000000009001000000020002001053796d626f6c0002
040000002d01000008000000320abe01160501000000280010000000fb0203fee3000000
00009001000000020002001053796d626f6c0002040000002d01010004000000f0010000
08000000320abe011d0601000000290010000000fb0203fee30000000000900100000002
0002001053796d626f6c0002040000002d01000004000000f001010008000000320abe01
480801000000280010000000fb0203fee300000000009001000000020002001053796d62
6f6c0002040000002d01010004000000f001000008000000320abe014f09010000002900
10000000fb0203fee300000000009001000000020002001053796d626f6c000204000000
2d01000004000000f001010008000000320abe01ec0b01000000280010000000fb0203fe
e300000000009001000000020002001053796d626f6c0002040000002d01010004000000
f001000008000000320abe01f30c01000000290010000000fb0203fee300000000009001
000000020002001053796d626f6c0002040000002d01000004000000f001010008000000
320abe01ab0f01000000280010000000fb0203fee3000000000090010000000200020010
53796d626f6c0002040000002d01010004000000f001000008000000320abe01b2100100
0000290010000000fb0223fde300000000009001000000020002001053796d626f6c0002
040000002d01000004000000f001010008000000320abd01f203010000005b0010000000
fb0223fde300000000009001000000020002001053796d626f6c0002040000002d010100
04000000f001000008000000320abd015912010000005d0015000000fb0280fe00000000
00009001000000000402001054696d6573204e657720526f6d616e000081040000002d01
000004000000f001010008000000320ac0018b12010000002e0008000000320ac0011611
02000000647408000000320ac001291001000000740008000000320ac001da0e01000000
750008000000320ac0014b0d010000003b0008000000320ac0016a0c0100000074000800
0000320ac0017b0b01000000270008000000320ac001490a02000000752708000000320a
c001a709010000003b0008000000320ac001c60801000000740008000000320ac0011707
02000000752708000000320ac0017506010000003b0008000000320ac001940501000000
740008000000320ac001450401000000750008000000320ac0013b030100000066000800
0000320ac001400001000000570010000000fb02c0fd0000000000009001000000020002
001053796d626f6c0002040000002d01010004000000f001000008000000320a4a02f30d
01000000f20010000000fb0280fe0000000000009001000000020002001053796d626f6c
0002040000002d01000004000000f001010008000000320ac0011202010000003d000a00
000026060f000a00ffffffff01000000000010000000fb021000070000000000bc020000
00cc0102022253797374656d00cc040000002d01010004000000f0010000030000000000
(1)
Количественное значение каждой из компонент предлагается определять из
уравнения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, где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 – весовые коэффициенты.
Будем считать, что за период электростимуляционного воздействия Tо
характеристики биологических тканей изменяются незначительно. Известно,
что оптимальным электростимулирующим импульсом, вызывающим сокращение
мышцы, является импульс, которой имеет минимальную мощность и оказывает
наименьшее воздействие на кожу и рецепторы: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 (2)
где Pэл – мощность сигнала электростимуляции, Pм – мощность, развиваемая
соответствующей мышцей, u(t) – падение напряжения на электродах в
процессе электростимуляции, i(t) – ток, протекающий через электроды, Tс
– период сигнала, F(t) – сила, развиваемая мышцей, V(t) – скорость
сокращения мышцы, t – текущее время сеанса электростимуляции.
Этот критерий справедлив при выборе сигналов для мышц, основной функцией
которых является сократительная. Функционирование внутренних органов
связано не только с сокращением соответствующих гладких или
поперечно-полосатых мускулатуры. Оно носит более сложный характер,
поскольку связано с деятельностью различных физиологических систем и
может включать множество физиологических обратных связей. Так, например,
состояние желудочно-кишечного тракта определяется моторной,
моторно-эвакуаторной и секреторной функциями пищеварительной системы. В
связи с этим для выбора оптимальных сигналов стимуляции внутренних
органов предлагается следующий энергетический критерий: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 (3)
где Pсм – мощность, определяемая сократительной способностью
соответствующих мышц органа, Pф – мощность, характеризующая
функционирование данного органа (выполнение соответствующей функции).
Значение Pсм может быть измерено посредством определения
проинтегрированной электроактивности мышцы A за единицу времени, либо
через измерение силы F(t) и скорости V(t). Как правило, на интервале Tо
мощность Pсм является непрерывной функцией времени. Мощность Pф носит
периодический характер, что связано с периодичностью функционирования
самого органа. Поэтому для оценки мощности Pф предложено использовать
отношение времени функционирования органа Tф (проявляется выделением
мощности Pф и Pсм) к времени Tэ, в течение которого присутствуют только
сокращения мышц в околоэлектродной области (выделение мощности Pсм).
Тогда энергетический критерий выбора сигналов электростимуляции
приобретает вид: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 (4)
где K1, K2 – эмпирические коэффициенты пропорциональности, определяемые
индивидуально для каждого органа.
Порог болевого ощущения, вызываемого электрическими раздражителями,
изменяется в зависимости от формы импульсов, причем ее уровень зависит
от плотности и места приложения тока. Чтобы исследовать многообразие
местных и общих реакций организма на электростимуляцию, недостаточно
использовать только прямоугольные импульсы. С целью оптимизации формы
импульсов были испытаны стимулы разной форм (прямоугольные,
синусоидальные, треугольные, трапециевидные, экспоненциальные и
колоколообразные) и длительности (от микросекунд до десятков
миллисекунд), однофазные и двухфазные с разной длительностью фронта и
среза, частотой следования, с амплитудной, частотной и
амплитудно-частотной модуляцией, с выходом по напряжению и по току. Было
установлено, что в диапазоне частот следования от 1 до 150 Гц наименее
болезненны импульсы, которые моделируют форму тока действия нервного
волокна, генерируемого в области перехвата Ранвье, продолжительностью
0,7-0,8 мс (длительность фронта 25-100 мкс, среза 600-700 мкс). С
увеличением длительности импульса свыше 1 мс при воздействии через кожу
на нервно-мышечные структуры эти стимулы вызывают у человека дискомфорт
при частотах следования 1-20 Гц. Уменьшение длительности стимулирующих
импульсов до 0,1-0,2 мс не приводит к возникновению неприятных ощущений,
но требует увеличения амплитуды.
Применение низкочастотных импульсов для электростимуляции
нервно-мышечных структур даст определенный лечебный эффект. Они обладают
сравнительно небольшой мощностью, и путем изменения их параметров можно
добиться согласования с лабильностью стимулируемых структур (это не
относится к диадинамическим токам). Однако эти процедуры болезненны, так
как значительная часть энергии стимулов поглощается поверхностным слоем
кожи, что приводит к раздражению рецепторов (ощущается покалывание и
жжение).
Целесообразно использование для электростимуляции переменных токов
звукового диапазона (2-20 кГц). Уменьшение полного сопротивления
поверхностного слоя кожи с повышением частоты переменного тока позволяет
более равномерно распределить энергию стимулов между эпидермисом и
подкожными тканями. Отмечаются следующие особенности этих токов:
· специфический механизм возбуждения, связанный с появлением
деполяризации у обоих электродов;
· асинхронное возбуждение волокон, приближающее импульсацию к
существующей в естественных условиях;
· меньшее ветвление токов, позволяющее избирательно стимулировать мышцы;
· медленное развитие аккомодации мышц;
· преимущественное раздражение током мышц, а не рецепторов кожи, отсюда
меньшая болезненность.
При этом возможно как блокирование рецепторов, так и проведение
возбуждения в чувствительных нервных волокнах. Неприятные ощущения при
электростимуляции в основном могут быть связаны с возникающим мощным
тетаническим сокращением мышцы.
С 1969 г. используется форма импульса, возникающего в перехвате Ранвье
нервного волокна, в качестве огибающей для получения радиоимпульсного
стимула (несущее колебание – синусоидальный ток с частотой 10 кГц);
такой стимул вызывает практически безболезненные сокращения мышц. В
зависимости от возбудимости стимулируемых тканей (особенно при
периферических двигательных расстройствах) регулируют крутизну фронта и
среза импульса. Среди изученных электрических стимулов, вызывающих
безболезненное сокращение мышцы при минимальной энергии, этот импульс
оказался оптимальным. Проведено сравнение мощности различных импульсов,
вызывающих пороговое сокращение. Исследование проводилось путем
воздействия синусоидальными токами в диапазоне частот от 200 до 15000
Гц. Было установлено, что на частотах 10±2 кГц болевые ощущения уже
минимальны. При применении амплитудной модуляции стимула резко
уменьшалась мощность, необходимая для получения сокращения мышцы такой
же величины, по сравнению с немодулированными колебаниями. Длительность
импульсов составляла 1 мс на уровне 0,1 амплитудного значения, т.е.
находилась в пределах оптимальных длительностей, позволяющих получить
сокращение мышцы при минимальной энергий раздражения. При сравнении
мощности стимулов различной формы, вызывающих пороговое сокращение
двуглавой мышцы плеча (частота следования 75 Гц, площадь электродов 15
см2, расстояние между электродами 5 см), получены следующие пороговые
значения (приведены усредненные данные исследования 12 здоровых лиц):
(7,6+0,8) мВт для прямоугольного видеоимпульса, (4,0+1,1) мВт для
трапециевидного видеоимпульса с длительностью фронта 0,3 мс; (2,3±0,5)
мВт для видеоимпульса с крутым фронтом (25 мкс) и экспоненциальным
срезом; (1,1 ±0,3) мВт для радиоимпульса с аналогичной предыдущему
случаю формой и с несущей частотой 10 кГц. Мощность прямоугольного
радиоимпульса составляла (3,5±1,8) мВт при несущей частоте 1 кГц;
(4,6±0,7) мВт при несущей частоте 5 кГц и (8,3±1,2) мВт при несущей
частоте 10 кГц.
Из изученных стимулов энергетически наиболее выгоден радиоимпульс вида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с крутым фронтом (длительностью 25
мкс), экспоненциальным срезом (975 мкс) и несущей частотой 10 кГц. Этот
импульс вызывает минимальные болевые ощущения; по-видимому, это
объясняется тем, что каждый период колебания воздействует на рецепторы
тогда, когда они еще находятся в рефрактерной фазе, т.е. блокируется
возникновение сигналов в рецепторах и прохождение в чувствительных
нервных волокнах.
ЛИТЕРАТУРА
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Ж?е?, Г.А. К?а?а, Е.М. Про??. – М.: Л????ия Б?о?х ?а?й, 2000г. – 376с.
2. Э????ая ????? ?я ???я?и ???в и ??? /П? ?д Р.И. Утя??? и М. В?? – М.:
Э??о??из?т, 2000.384с.
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