Computer assisted instruction system for therapy of heart failure based on simulation of cardiovascular system.

心力衰竭的合理治疗既要反映临床规律，又要对血流动力学进行定量评价。本课题的目的是将计算机模拟技术应用于以临床经验规则和统计数据为基础的心力衰竭计算机辅助治疗系统中，心血管系统模型由体肺网络和左右心动力学组成。对于后者，我们采用EMAX模型，参数代表收缩力和舒张刚度。该模型能较好地模拟各种类型的心力衰竭和运动试验对循环的影响。通过该模型，可以从测量的血流动力学参数中估计心力衰竭患者的心血管参数，并利用非线性规划技术制定和求解最佳治疗方案。（1）输入患者的背景、疾病名称、根据NYHA标准的严重程度、在各个点处测量的压力和心输出量。(2)计算机响应输入数据并输出估计的参数值和建议的最佳治疗方案。根据用户的要求提供药物信息。CAI系统、心血管学教科书、相关图表和模拟程序分别存储在各自的文件中，并由Takeuchi的QRS快速检索系统处理。该系统有助于医生在临床实践中做出决策，也有助于学生了解基本的心血管生理学。

Adequate treatment of cardiac failure should reflect both clinical rules and quantitative evaluation of hemodynamics. The purpose of the project was to incorporate the simulatin technique into the computer assisted instructin system for the therapy of heart failure primarily based on the clinical empirical rules and statistical data.The model of the cardiovascular system was composed of sytemic and pulmonary networks and left and right cardiac dynamics. For the latter we adopted EMAX model with the parameters representing contractilities and diastolic stiffness. Heart failure of various types and effect of exercise testing on the circulation were well simulated by the model. The cardiovascular parameters of patients with heart failure could be estimated from the measured hemodynamic variables through the model and the optimal therapeutic regimen was formulated and solved with the technique of nonlinear programming.The CAI to help doctors at the bedside of cardiovasculasr clinic proceeds as follows: (1)Input of the patient's background, name of the disease, the severity according to NYHA criteria, the measured pressures at the various spots and cardiac output. (2) The computer responds to the input data and outputs the estimated parameter values and the suggested optimum therapeutic regimen. The drug informatin is also provided upon user's request.The CAI system, textbook of cardiology, pertinent graphs and tables, and the simulation programs were stored in their respective files and handled by a quick retrieval system (QRS by Takeuchi).The system was found useful for the physicians' decision-making in the clinical practice as well as for the students' understanding of basic cardiovascular physiology.