JP2010104750A - Method and device for regulation of heart rate and blood pressure - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a method and a device for determination and regulation of the heart rate and the blood pressure by determining whether or not the heart rate or the blood pressure need be raised, and adding prescribed stimulation to the living body for raising the heart rate or the blood pressure, or generating an alarm when necessary. <P>SOLUTION: The heart rate and the blood pressure are detected of a prescribed part of the living body, and the heat rate and the blood pressure are detected prior to hemodialysis, prior to an anesthetized operation, or immediately after starting these to be stored. The heart rate and the blood pressure are detected after starting the hemodialysis, or after starting the anesthetized operation. Threshold values are set for a desired level of the heart rate and the blood pressure after starting the hemodialysis or the anesthetized operation based on the stored heart rate and the blood pressure. The heart rate and the blood pressure which vary with time are compared with the threshold values. Whether or not it is necessary to add electric stimulation, magnetic stimulation or other stimulation to the living body at a prescribed time interval is determined, and the electric stimulation or magnetic stimulation is added to the living body based on the result of determination, while at the same time, alarm is generated. <P>COPYRIGHT: (C)2010,JPO&INPIT

Description

The present invention determines whether or not there is a need for an increase in heart rate or an increase in blood pressure and applies a predetermined stimulus to the living body to increase the heart rate or increase the blood pressure. The present invention relates to an adjustment method and apparatus.

Blood pressure decreases during hemodialysis when water is removed. This decrease in blood pressure is called dialysis hypotension and is said to occur in tens of percent of dialysis patients. The problem is that it may be forced to stop during dialysis. In this case, there is a risk of life, so a good treatment is desired.
There is a drug method as a treatment method for dialysis hypotension. However, this method of increasing blood pressure with a drug is not suitable for the treatment of hypotension accompanying heart rate reduction such as bradycardic atrial fibrillation. A treatment method that increases blood pressure by increasing the heart rate is considered appropriate for the treatment of blood pressure reduction associated with heart rate reduction. Currently, pacemakers that have the function of increasing the heart rate of patients with bradycardic atrial fibrillation are commercially available. This principle is to measure the myocardial contraction force by the impedance (myocardial impedance) between the pacemaker main body and the pacemaker lead, and adjust (increase) the heart rate based on this impedance change. In fact, the blood pressure during hemodialysis after pacemaker wearing in patients with bradycardic atrial fibrillation who had to be stopped due to dialysis hypotension before wearing the pacemaker showed a tendency to decrease in blood pressure, but immediately An increase in numbers was observed. As a result, it has been reported that the dialysis was successfully completed without stopping from the decrease in blood pressure with the increase in heart rate.
On the other hand, blood pressure reduction is caused not only by hemodialysis but also by anesthesia during surgery. Such a decrease in blood pressure caused by anesthesia or the like may lead to the discontinuation of the operation, which in turn leads to life threatening and is a serious problem.
For healthy individuals without heart disease, autonomic nerves work and sympathetic nerves predominate even if blood pressure decreases during dialysis, and heart rate adjustment is performed, increasing heart rate and increasing blood pressure. it can. However, in the case of bones of patients with heart diseases such as bradycardic atrial fibrillation, such heart rate adjustment cannot be performed.
In such a background, it is judged whether there is a need for an increase in heart rate or blood pressure, and feedback is given to increase the heart rate or blood pressure by applying a predetermined stimulus to the living body, and in some cases an alarm is given at that time It is desired to develop a method and an apparatus for determining and adjusting a heart rate and a blood pressure that generate blood pressure.

When dialysis hypotension occurs and dialysis is forced to stop, it is important to investigate the cause of dialysis hypotension. If the cause of dialysis hypotension is heart disease such as bradycardic atrial fibrillation, this measure is necessary. One is implantation of a pacemaker having the above functions.
However, pacemaker implantation may not be performed for some reason. In the case of blood pressure reduction caused by anesthesia during surgery, pacemaker implantation is not indicated because heart disease is not the cause. Therefore, the present invention determines whether or not there is a need for an increase in heart rate or an increase in blood pressure and applies a predetermined stimulus to the living body to increase the heart rate or increase the blood pressure, and in some cases, an alarm is generated at that time. It is an object of the present invention to provide a determination adjustment method and apparatus.

The heart rate and blood pressure determination adjustment method according to claim 1 of the present invention detects a heart rate and blood pressure from a predetermined part of a living body (detection means), and before blood pressure dialysis or before surgery under anesthesia or immediately after the start thereof. The heart rate and blood pressure are detected and stored (memory means), and the heart rate and blood pressure after the start of hemodialysis or after surgery under anesthesia are detected (detection means), stored (memory means), and stored. Threshold is set to any level of heart rate and blood pressure after starting hemodialysis or starting under anesthesia, based on heart rate and blood pressure immediately before starting hemodialysis, before surgery under anesthesia or immediately after starting hemodialysis, and immediately after starting surgery under anesthesia (Threshold setting means), and compares the heart rate and blood pressure, which fluctuates with time, with these threshold values (comparison means) to apply electrical stimulation, magnetic stimulation or other stimulation to the living body at predetermined time intervals. Judgment is made (determination means) whether or not there is a necessity, and an electrical or magnetic stimulus is applied to the living body based on the determination result (stimulation means), and alarm generation means for simultaneously generating an alarm is provided. It is characterized by.
Moreover, the heart rate blood pressure determination adjustment apparatus according to claim 2 of the present invention detects the heart rate and blood pressure using an electrode and a blood pressure sensor mounted on a predetermined part of a living body, for example, as shown in FIG. Detection means), before blood pressure dialysis or before surgery under anesthesia, or immediately after starting these, the heart rate and blood pressure are detected and stored (memory means), and the heart rate after hemodialysis starts or after surgery under anesthesia The number and blood pressure are detected and stored (memory means), and the stored heart rate and blood pressure before hemodialysis, before anesthesia surgery or immediately after hemodialysis, and immediately after the start of surgery under anesthesia, and after surgery or under anesthesia Set a threshold at any level of heart rate and blood pressure after the start (threshold setting means), compare heart rate and blood pressure that change over time with these thresholds, electrical stimulation or magnetic stimulation, etc. An alarm that determines whether or not it is necessary to apply a stimulus to a living body at a predetermined time interval (determination means), and based on this determination result, an electrical stimulus or a magnetic stimulus is applied to the living body (stimulation means) and simultaneously generates an alarm A heart rate blood pressure determination adjustment device characterized by comprising:

In the case of the electrical stimulation type, it is output from the electrical stimulation device in the heart rate blood pressure determination adjustment device. In the case of the magnetic stimulation type, it is output from the magnetic stimulation device in the heart rate blood pressure determination adjustment device.
In particular, the magnetic stimulation method is a non-invasive and painless method because it applies eddy current to the myocardium or sympathetic nerve through a magnetic stimulation coil that generates magnetic flux when supplied with a pulse current. Less burden on patients.

The purpose of the electrical stimulation device disclosed in JP-A-2007-075304 is to treat pelvic visceral dysfunction / painful disease and pelvic visceral dysfunction / pain, and there is no disclosure regarding heart rate blood pressure regulation.
Further, in Japanese Patent Application Laid-Open No. 57-22770, current supply to a magnetic stimulation coil causes the charging voltage of a capacitor charged by a DC power source to be discharged to the magnetic stimulation coil through a switching element that is switching-controlled at a predetermined repetition rate. A magnetic therapy device is disclosed. However, the purpose of this magnetic therapy device is to attach a magnetic stimulation coil to the body with a sucker or the like and improve the blood flow to treat stiff shoulders, muscle fatigue, rheumatoid arthritis, etc. No response to number or blood pressure regulation is disclosed.
On the other hand, Japanese Patent Laid-Open No. 09-276418 discloses a (magnetic stimulation type) urinary incontinence treatment device. However, this publication does not disclose heart rate blood pressure regulation.

In order to achieve this object, the electrical stimulation type heart rate adjustment treatment device of the present invention generates a myocardial stimulation current by setting two or more biostimulation electrodes at a position sandwiching the heart on the surface of the living body. And a means for generating a myocardial stimulation current.
In the case of electrical stimulation, if such a device is placed in a dialysis treatment room or operating room of a hospital and the myocardial stimulation electrode is set so as to sandwich the heart to generate a pulsed current, the heart myocardium is pulsed. Easily stimulated by electric current. In particular, the peak value of the pulse current is 30 mA at the maximum, and a good heart rate blood pressure regulation effect can be obtained by generating a pulsed current having a pulsed current repetition frequency of 60 to 150 ppm. The maximum pulse width is about 1 ms.
In addition, by automatically observing the electrocardiogram with the determination device, the timing of the patient's myocardial contraction is determined, and the electrical stimulation in the heart rate blood pressure adjusting device is appropriately performed between the patient's own myocardial contraction and myocardial contraction. The device automatically adds to the living body (myocardium or sympathetic nerve) to increase the heart rate and thus increase blood pressure.

In order to achieve this object, the magnetic stimulation heart rate blood pressure control apparatus of the present invention includes a magnetic stimulation coil that is set near the heart outside the living body to generate magnetic flux, and is repeatedly applied to the coil stationary tool and the magnetic stimulation coil. Coil feeding means for feeding power so as to generate a pulsed magnetic flux is provided.
In the case of the magnetic stimulation type, if such a coil stationary device is placed in a dialysis treatment room or operating room of a hospital and the magnetic stimulation coil is set near, above, below, or next to the heart, magnetic flux is generated. , Magnetic flux penetrates into the body and the heart muscle is easily stimulated by eddy currents. In particular, by generating a pulsed magnetic flux having a maximum magnetic flux density of 3 Tesla, a good heart rate blood pressure regulation effect can be obtained. The pulsed magnetic flux may have a repetition frequency of 60 to 150 ppm, or a pulsed magnetic flux may be automatically added appropriately between the self pulse and the self pulse while observing the patient's self pulse. The maximum pulse width is about 1 ms. The peak value of the pulse current flowing through the coil is 100A to 3000A.

When the biostimulation method is an electrical stimulation method, two positive and negative stimulation electrodes are arranged so as to sandwich the myocardium of the right atrium or the right ventricle, and when the biostimulation method is a magnetic stimulation method, the N pole, Two coils of the S pole may be arranged so as to sandwich the myocardium of the right atrium or the myocardium of the right ventricle.

When the biostimulation method is an electrical stimulation method, two positive and negative stimulation electrodes are arranged on the chest side and the back side of the living body, and when the biostimulation method is a magnetic stimulation method, two electrodes, N pole and S pole, are arranged. Coils may be placed on the chest and back sides.

When the biostimulation method is an electrical stimulation method, two positive and negative electrodes are placed so that the stimulation current flows through the right atrial myocardium or the apex of the right ventricular myocardium. In the case of the method, two coils of N pole and S pole may be arranged so that an eddy current caused by a varying magnetic field flows through the atrial appendage of the myocardium of the right atrium or the apex of the myocardium of the right ventricle.

There may be provided stimulation time adjusting means for measuring a change in heart rate and adjusting the number of biological stimulations within a predetermined time or the time interval between stimulations based on the measured change in heart rate.
You may have the minimum blood pressure setting means for setting the minimum blood pressure for starting irritation | stimulation. In addition, a heart rate adjusting means for measuring myocardial contraction force for adjusting the heart rate based on a change in myocardial contraction force may be provided. The myocardial contractile force may be measured by myocardial electrical impedance. Furthermore, you may have a stimulation upper limit lower limit setting means which sets the upper limit and the minimum of the frequency | count of stimulation and the time interval of a stimulus and a stimulus.
There may be provided a stimulation frequency adjusting means for increasing the number of stimulations when the blood pressure decreases and decreasing the number of stimulations when the blood pressure increases. Alternatively, it may have a stimulation time adjusting means for measuring a change in heart rate and adjusting the number of biological stimulations within a predetermined time or the time interval between stimulations based on the measured change in heart rate.
Further, it may have a blood pressure time reduction rate measuring means and a stimulation time interval adjusting means for increasing the number of stimuli per unit time based on the blood pressure time reduction rate or adjusting the time interval between stimulations. . The display may be a blood pressure measured every unit time or a moving average of measured values, and the heart rate may have a heart rate adjusting means for adjusting the heart rate based on the value of the moving average.
All of the above means are means for maintaining appropriate blood pressure, that is, means for providing an appropriate timing, stimulation time interval, and number of stimulations, and selecting an optimal stimulation method.

The dialysis time may be 3 to 4 hours, and the operation time may exceed 8 hours.
When the heart rate is adjusted continuously for a long time as described above, the magnetic stimulation coil generates heat, and therefore it is necessary to cool the magnetic stimulation coil by the cooling means.

In the invention according to claim 1 and 2, heart rate and blood pressure are detected (detection means) using an electrode and a blood pressure sensor mounted on a predetermined part of a living body, before blood pressure dialysis or before anesthesia operation, or these The heart rate and blood pressure immediately after the start of blood pressure were detected and stored (memory means), and the heart rate and blood pressure after the start of hemodialysis or after surgery under anesthesia were detected and stored (memory means) and stored. Threshold values are set to any level of heart rate and blood pressure before hemodialysis, before surgery under anesthesia or immediately after hemodialysis, and immediately after the start of surgery under anesthesia. (Threshold setting means), it is necessary to compare the heart rate and blood pressure, which fluctuates over time, with these thresholds and to apply electrical stimulation, magnetic stimulation or other stimulation to the living body at predetermined time intervals. Whether or not (determination means) is used, and the determination result is fed back to adjust and set the stimulation frequency, stimulation timing, stimulation time interval, stimulation size, etc. (heart rate adjustment means) Magnetic stimulation is applied to a living body (stimulation means) and alarm means for generating an alarm at the same time is provided. Therefore, it is possible to easily determine and adjust the heart rate or blood pressure of a patient during blood pressure dialysis or surgery under anesthesia.

Embodiments of the heart rate blood pressure determination adjustment method and apparatus according to the present invention will be described below with reference to the drawings. FIG. 1 is a block diagram showing a configuration of an embodiment of a heart rate blood pressure adjusting apparatus according to the present invention. 1A and 1B are diagrams showing a situation in which an electrode and a blood pressure sensor are attached to a patient and an electric stimulus is applied to adjust a heart rate or blood pressure. 1C and 1D are diagrams showing a situation in which an electrode and a blood pressure sensor are attached to a patient and a heart rate or blood pressure is adjusted by applying magnetic stimulation. FIG. 3 is a block diagram of a heart rate blood pressure determination adjustment unit that operates after inputting the heart rate output of the electrocardiograph and the output of the sphygmomanometer. 2A and 2B are each equipped with an electrical stimulation device and a magnetic stimulation device. In any device, an alarm device, a display device, and a recording device are mounted. FIG. 3 is a flowchart showing the flow of heart rate blood pressure determination adjustment according to the present invention. FIG. 4 shows a heart rate and blood pressure trend graph measured at a predetermined part of a living body, and heart rate threshold values (lower limit value, upper limit value). Value) and blood pressure threshold values (upper limit value, lower limit value).
Although not shown, the heart rate blood pressure determination adjustment unit includes a heart rate storage unit 11, a heart rate threshold setting unit 12, a threshold value heart rate comparison unit 13, a heart rate increase necessity determination unit 14, a heart rate adjustment unit 15, and a blood pressure. The storage unit 16, blood pressure threshold setting unit 17, threshold blood pressure comparison unit 18, blood pressure increase necessity determination unit 19, and the like.

In FIG. 1, 1 is an electrocardiograph having a built-in bioamplifier or the like, for example, electrodes E1 to E3 attached to a predetermined part of a living body, right hand, left hand, foot, or right clavicle, left clavicle, or foot The electrocardiogram derived from the electrodes E1 to E3 thus detected is detected, and the heart rate is measured.

In FIG. 1, the heart rate is measured by attaching an electrode and measuring the electrocardiogram. However, the pulse rate may be measured by a pulse oximeter or pulse wave meter using light to substitute for the heart rate measurement. . An electrocardiogram is susceptible to noise due to the influence of electromagnetic waves, but pulse waves measured by applying light are considered to be less affected by electromagnetic waves and are useful in this apparatus.

The sphygmomanometer 2 shown in FIG. 1 may use either a cuff type or a fina press type, but it is necessary to measure blood pressure fluctuations at predetermined time intervals. Alternatively, blood pressure fluctuation may be continuously measured by directly measuring the blood pressure of the thigh or ankle artery.

4 is a heart rate blood pressure determination adjustment unit, which is constituted by, for example, a CPU having RAM, ROM, etc., and detects the heart rate or blood pressure level before hemodialysis or immediately after the start from the heart rate or blood pressure measured in 2; A comparison is made with a heart rate or blood pressure threshold set in consideration of these, and it is determined whether or not to adjust the heart rate and blood pressure based on the result. Based on this determination, control is performed as to whether or not a stimulus is applied to the living body. In some cases, control is performed as to whether an alarm signal is output from 9. When automatically determining whether or not to adjust the heart rate and blood pressure, the determination can be made by storing a heart rate and blood pressure adjustment determination program in the ROM in advance. Alternatively, manual determination by a setting operation of the operation unit 3 described below is also possible. The RAM also includes the detected heart rate data before blood dialysis or anesthesia surgery, blood pressure data, heart rate after the start of hemodialysis or anesthesia surgery, blood pressure data, threshold levels for manual determination, and other requirements. Temporarily store data. The alarm signal is output from the determination adjustment unit 4 when the heart rate or blood pressure level is lower than the lower threshold level or higher than the upper threshold level.

In FIG. 2, reference numeral 3 denotes an operation unit constituted by, for example, a keyboard or an operation panel having push buttons. Selection of automatic determination or manual determination, heart rate or blood pressure measured by the electrocardiograph 1 and the sphygmomanometer 2 Setting of threshold values, setting of these alarm levels, release of alarms, setting of various required data, and the like are performed. Reference numeral 8 denotes a display device, which is composed of, for example, a CRT or a liquid crystal display device, and displays heart rate and blood pressure trends, alarm levels, required data, and the like.

Reference numeral 9 denotes an alarm unit, which includes a light emitting element such as a light emitting diode (LED) and a driving unit thereof, and generates an alarm by lighting or blinking by an alarm signal output from the determination unit adjustment 4. Or you may comprise the alarm device 9 by acoustic elements, such as a buzzer or a small speaker, and its drive part, for example. Further, the alarm device 9 can be configured to emit an alarm with light and sound simultaneously by combining an LED and either a buzzer or a speaker.

Reference numeral 7 denotes a recording apparatus, which records changes over time such as a signal based on a heart rate or blood pressure output from the determination unit adjustment 4 and an alarm level for later analysis and analysis.
Reference numerals 5 and 6 respectively denote an electrical stimulation device and a magnetic stimulation device, which have a function of applying electrical stimulation or magnetic stimulation to a living body's myocardium or sympathetic nerve at predetermined time intervals according to instructions from the determination adjustment unit 4.

Next, with reference to the flowchart of FIG. 3 and the heart rate and blood pressure trend graph of FIG. 4, the processing for determining whether or not the heart rate needs to be increased or whether the blood pressure needs to be increased will be described. Note that the processing in FIG. 3 is processing when automatic determination is selected by the blood pressure heart rate determination adjustment unit 4. Furthermore, the trend graph of the measured heart rate or blood pressure shown in FIG. 4 is a graph after starting hemodialysis, for example, and the horizontal axis is the time axis, and in the case of hemodialysis, the scale is 3 to 4 hours. The left vertical axis represents systolic pressure, and the right vertical axis represents heart rate. In this graph, the systolic pressure drops markedly after about 1 hour, the heart rate increases immediately after that, and the decrease in systolic pressure is suppressed, resulting in difficulty in dialysis without the systolic pressure dropping too much. Dialysis could be continued. That is, it was possible to prevent the blood pressure from falling below the threshold value. The determination as to whether or not these increases are necessary may be made based on the blood pressure rate within a certain time.

An electrogram is taken in via the electrodes E1 and E2 of FIG. 1 and the electrocardiograph 1 (step S1-1). The electrocardiogram or heart rate data captured by the determination adjustment unit 4 is sent to the display device 8 and the heart rate trend waveform is displayed on the screen (step S2-1). Similarly, blood pressure data is taken in via a blood pressure sensor and a sphygmomanometer (step S1-2). The blood pressure data taken into the determination adjustment unit 4 is sent to the display device 8, and a blood pressure trend waveform is displayed on the screen (step S2-2).
FIG. 4 shows that, for example, after the start of hemodialysis, the detected blood pressure value is initially about 130 mmHg. It decreased with time, and decreased to about 70 mmHg about 1 hour after the start of dialysis.
The heart rate during this period is approximately 60 to 65 bpm.

The determination adjustment unit 4 detects and stores the minimum heart rate value and the maximum blood pressure value before hemodialysis or immediately after the start of hemodialysis from the captured heart rate and blood pressure (step S3).
Note that the heart rate upper limit threshold value, systolic blood pressure upper limit threshold value, heart rate minimum threshold value and systolic blood pressure minimum threshold value are manually input in advance in the operation unit, and stored in the determination adjustment unit 4 in advance. Further, the heart rate and blood pressure after the start of hemodialysis are detected and automatically stored in the determination adjustment unit 4 at predetermined time intervals (step S4).

Next, the determination adjustment unit 3 automatically sets the stored heart rate maximum value, systolic blood pressure maximum value, heart rate minimum value (threshold value), and systolic blood pressure minimum value (threshold value) as alarm levels (step S5). ), Measurement of heart rate and blood pressure is continued (step S5). This alarm level can be arbitrarily set in consideration of hemodialysis time, water removal amount, other hemodialysis conditions, blood pressure value of the patient before dialysis, patient condition, and the like. In the case of surgery under anesthesia, it can be arbitrarily set in consideration of the type of anesthetic, the scheduled operation time, the blood pressure value of the patient (before surgery), the patient's condition, and the like.

The determination adjustment unit 4 monitors the systolic blood pressure that is automatically input sequentially, detects whether it is lower than the systolic blood pressure threshold (alarm level) (step S10), and the systolic blood pressure threshold (for example, 80 mmHg). If lower, an alarm signal is sent to the alarm unit 6 and an alarm is generated from the alarm unit 9 by, for example, flashing of light (step S11). At the same time, the determination adjustment unit 4 sends an instruction signal to the electrical stimulation device 5 or the magnetic stimulation device 6 so as to apply biological stimulation to the myocardium or sympathetic nerve at a predetermined stimulation frequency or at a predetermined timing. By this instruction, as apparent from FIG. 5, the heart rate immediately increased, and then the systolic blood pressure was maintained from 90 mmHg to about 100 mmHg, and the hemodialysis stop was avoided.

If it is determined in step S15 that the systolic blood pressure value is equal to or greater than the threshold value (alarm level), the stimulation is stopped (step S16), the alarm is also stopped (step S17), and the process proceeds to step S18 to determine the systolic blood pressure. Measurement is performed, and the display of the blood pressure trend waveform in step S19 is continued.

In step S20, the determination adjustment unit 4 determines again whether the systolic blood pressure has decreased below the alarm level. If the systolic blood pressure is higher than the alarm level, the blood pressure detection (step S21) and the blood pressure trend display (step S22) are continued. .

If it is determined in step S20 that the blood pressure is still lower than the alarm level, the process returns to step S11 to generate an alarm and further increase the stimulation frequency or determine the timing for applying the stimulus while automatically observing the self pulse. The stimulation frequency or stimulation intensity (stimulation voltage or magnetic flux density) is increased.

The blood pressure measurement is continued while terminating the alarm in step S17 (step S18), the blood pressure trend is displayed on the screen of the display device 8, or the recording device 7 records it (step S19).

It is determined whether or not to continue the measurement (step S23). If not, the electrical stimulation device 5 or the magnetic stimulation device 6 is stopped to complete the measurement of the heart rate and the blood pressure. If the measurement is continued, the process returns to step S8. The above processing after step S8 is repeated. After the stimulation in step S13, it is also determined whether the heart rate has increased (step S14). If not, the determination adjustment unit 4 further adjusts the stimulation (step S12), and the stimulation is continued. (Step S13). If the heart rate has increased, detection of the heart rate is continued (step S18), and a heart rate trend is displayed (step S19).

As described above, the processing in the flowchart shown in FIG. 3 is automatic determination, but the blood pressure threshold value or alarm level setting in steps S3, S4 and S5 in FIG. 3 is displayed on the screen of the display device 8. It can be done manually while observing several trends or blood pressure trends. In this case, from the trend display on the screen, the doctor or nurse reads the value of systolic diastolic blood pressure immediately after the start of hemodialysis or dialysis and after the start of hemodialysis, and inputs the numerical data using the keys of the operation unit 3 At the same time, a systolic blood pressure threshold value or an alarm level is input and set.

As described above, in the present invention, since the heart rate or systolic blood pressure can be adjusted, the dialysis stop due to low blood pressure during hemodialysis can be avoided, and hemodialysis can be performed to the end. In addition, when blood pressure drops due to anesthesia or other effects during anesthesia surgery, and it becomes difficult to continue surgery, heart rate and blood pressure are increased by applying electrical or magnetic stimulation to the myocardium or sympathetic nerve. It can be done to the end without stopping the operation. For further safety considerations, it is possible to calculate heart rate and time blood pressure in addition to the heart rate time integral value calculation means and display the heart rate time integral value on the vertical axis at the same time. Good. The time-integrated value of heart rate is related to cardiac output and is considered to change with the amount of water removed during dialysis. In other words, if the heart rate integrated value increases at a predetermined angle with time, the condition including the patient's blood pressure is considered to be good. It is possible to monitor that attention needs to be paid to the situation. The trend of the heart rate measured with an electrocardiograph or a pulse meter and the trend of only the heart rate time integral value may be displayed simultaneously, or a blood pressure trend may be added. It also has means for setting the rate of time increase, time decrease, and target value for each time of the heart rate time integrated value, and compared with the target value for each time, and it was below the target value at each time. In this case, an alarm may be generated by alarm means.
In this way, even without a cardiac output meter, it can be an auxiliary means for ensuring safety during dialysis of the patient. Moreover, the patient state can be monitored only by the trend display of the heart rate and the heart rate time integral value without measuring blood pressure.

Although the stimulation current by the electrical stimulation method is difficult to enter a deep part of the body, the magnetic flux by the magnetic stimulation method has an advantage that it can penetrate deep into the body and an eddy current can be generated even in the deep part. However, since the pulsed magnetic flux is also generated around the living body other than the target site, it affects other devices in the dialysis room or the operating room as noise. Therefore, it is necessary to surround the stimulation coil with permalloy, silicon steel plate or other magnetic material having a high magnetic permeability so that the magnetic flux does not leak. For this purpose, the stimulation coil is preferably built in the bed (bottom or side). On the other hand, there is no problem with the magnetic stimulation method, but there is a risk of burns at the stimulation electrode mounting portion with the electrical stimulation method. However, in consideration of the fact that if the area is too large, the current density becomes small and effective stimulation cannot flow to the myocardium, the area of the stimulation electrode is desirably about 3 cm to 5 cm in diameter.

The present invention determines whether or not there is a need for an increase in heart rate or an increase in blood pressure and applies a predetermined stimulus to the living body to increase the heart rate or increase the blood pressure. Since it can be used as an adjustment method and apparatus, it may be used to prevent dialysis difficulties during hospital hemodialysis.

1 is a block diagram showing a configuration of an entire apparatus according to a first embodiment. 1A and 1B are electrical stimulation types, and FIGS. 1C and 1D are magnetic stimulation types. It is a block diagram for demonstrating the heart rate blood pressure adjustment apparatus which is a component of FIG. It is a flowchart which shows the flow of the heart rate blood pressure adjustment of the Example of FIG. FIG. 2 is a trend graph of blood pressure, heart rate, and heart rate time integrated value displayed by the embodiment of FIG. 1.

Explanation of symbols

1 electrocardiograph (pulse meter, pulse meter)
2 Blood pressure monitor 3 Operation unit 4 Blood pressure heart rate determination adjustment unit 5 Electrical stimulation device 6 Magnetic stimulation device 7 Recording device 8 Display device 9 Alarm device 10 Bed A1 Cuff type blood pressure sensor A2 Fina press type blood pressure sensor A3 Arterial blood pressure measurement catheter E1 Stimulation electrode (positive or negative)
E2 stimulation electrode (negative or positive)
E3 earth electrode M

Claims (2)

Heart rate and blood pressure are detected using electrodes and blood pressure sensors attached to a predetermined part of a living body, and heart rate and blood pressure are detected and stored before blood pressure dialysis or before surgery under anesthesia or immediately after the start. At the same time, heart rate and blood pressure after the start of hemodialysis or after surgery under anesthesia are detected and stored, and the heart rate before hemodialysis, before surgery under anesthesia, immediately after hemodialysis, or immediately after surgery under anesthesia is stored. Based on the number and blood pressure, thresholds are set to any level of heart rate and blood pressure after the start of hemodialysis or surgery under anesthesia, and the heart rate and blood pressure that change over time are compared with these threshold values. It is determined whether or not it is necessary to apply a stimulus or a magnetic stimulus to a living body at a predetermined time interval, and an electric stimulus or a magnetic stimulus is applied to the living body based on the determination result Heart rate blood pressure determining and adjusting how. Heart rate and blood pressure are detected using electrodes and blood pressure sensors attached to a predetermined part of a living body, and heart rate and blood pressure are detected and stored before blood pressure dialysis or before surgery under anesthesia or immediately after the start. At the same time, heart rate and blood pressure after the start of hemodialysis or after surgery under anesthesia are detected and stored, and the heart rate before hemodialysis, before surgery under anesthesia, immediately after hemodialysis, or immediately after surgery under anesthesia is stored. Based on the number and blood pressure, thresholds are set to any level of heart rate and blood pressure after the start of hemodialysis or surgery under anesthesia, and the heart rate and blood pressure that change over time are compared with these threshold values. It is determined whether or not it is necessary to apply a stimulus or a magnetic stimulus to a living body at a predetermined time interval, and an electric stimulus or a magnetic stimulus is applied to the living body based on the determination result That heart rate blood pressure decision adjusting device.

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