JP2011200607A - Electronic sphygmomanometer - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an electronic sphygmomanometer which permits blood pressure to be correctly measured even when a person to be measured inserts the upper arm into a cuff from a correct direction (one end (insertion hole)) or inserts oppositely (the other end (insertion hole)) to the correct direction.SOLUTION: The cuff 2 of the electronic sphygmomanometer 1 includes a large airbag 14, which can pressurize the upper arm by supplying air, and a plurality of small airbags 500 arranged inside the large airbag 14 and in one extremity insertion hole and the other extremity insertion hole of the large airbag 14, detects the pulse waves of the large airbag 14 and the small airbags 500 which are detected in the midcourse of the pressurization or depressurization of the large airbag 14, and discriminates small airbags located downstream by the correlation with a trend change of the pulse wave of the large airbag 14 or the difference in the appearance time of a K sound and measures the blood pressure by using the signals of the discriminated small airbags.

Description

  The present invention relates to an electronic sphygmomanometer, and in particular, the cuff can be separated from the sphygmomanometer body, and even if the place where the sphygmomanometer body is installed is away from the measurer, the measurer is stretched in the sitting position and is not subjected to abdominal pressure. It is related with the type of electronic blood pressure monitor which can be measured by.

In recent years, pseudohypertension due to white coat hypertension has been a problem in blood pressure measurement for hypertension treatment performed in medical institutions. As a cause of this pseudohypertension, mental instability such as tension and anxiety in front of a doctor in a hospital is considered. On the other hand, attention has been focused on blood pressure values measured alone in a mentally stable home. For this reason, an electronic sphygmomanometer of the type that is used for home blood pressure measurement and is measured by one person is attracting attention.
The problem with this type of sphygmomanometer is how to put it on the arm of the cuff. When the position of the air bag in the cuff is not appropriate for the upper arm, or when the wrapping strength is not appropriate for the upper arm, the cuff air bag is not compressed correctly on the upper arm and the blood pressure is measured high There is. In recent years, in order to solve this, simply by inserting the arm into the cylindrical cuff, the cuff air bag can be automatically placed at the correct position of the arm and blood pressure can be measured with the correct wrapping strength. An electronic sphygmomanometer in which the sphygmomanometer body and the cuff are integrated has been developed (see Patent Document 1).

However, when the user uses the sphygmomanometer, the cuff for inserting the arm is integrated with the sphygmomanometer body, so if the position of the sphygmomanometer body is away from the measurer, the measurer is bent forward It is easy to measure with. For this reason, the abdomen of the measurer is compressed and the abdominal pressure increases, and as a result, a phenomenon in which the blood pressure increases may be seen. This increase in blood pressure has been pointed out as the occurrence of new pseudohypertension.
Therefore, in order to cope with the inconvenience of the occurrence of pseudohypertension, even if the cuff can be separated from the sphygmomanometer main body and the place where the sphygmomanometer main body is installed is away from the measurer, the measurer is in the sitting position. A type of electronic sphygmomanometer has been developed that can perform measurement without applying abdominal pressure in a stretched state.
In addition, as aging progresses recently, the deterioration of arteriosclerosis due to aging has caused problems due to infarction of limb arteries. As a method of easily examining this without using CT or MRI, the blood pressure in the infarcted region is measured by lowering blood flow injury, and the cuff is wrapped around the extremities and the blood pressure is measured simultaneously. In the past, measurement was performed by wrapping and fixing a cuff around the hand and foot, and in the case of an unconscious patient, it took time and effort to wear the cuff.

JP 2005-237427 A

In the above-described electronic sphygmomanometer, when using a method for capturing and measuring changes caused by the generation of blood flow that flows downstream (peripheral side) of the cuff, for example, when using the Ribaroch Korotkoff method, the ultrasonic method, Must be placed downstream of the cuff (peripheral side, such as the hands and ankles), and the cuff must be carefully worn.
As an example, when the Rivaroch Korotkoff method is used, the state of blood flow downstream of the cuff is detected by detecting Korotkoff sounds (K sounds).
K sound is generated when the internal pressure of the cuff ischemic air bag is raised above the maximum blood pressure value and the blood vessel is temporarily closed, then the internal pressure is gradually lowered, the internal pressure becomes below the maximum blood pressure, and the blood vessel under the cuff begins to open. This is a sound signal that can be detected in the downstream part of the cuff until the internal pressure becomes lower than the minimum blood pressure and the occlusion of the blood vessel under the cuff disappears.
If the measurer inserts the cuff so that the sensor is positioned downstream of the cuff and, for example, inserts it into the upper arm, normal blood pressure can be measured.
However, if the measurer mistakenly inserts the cuff in the reverse direction and the K sound sensor is placed on the upstream side (shoulder end) of the cuff, it will be impossible to accurately capture the K sound, and the blood pressure will be correct. Measurement cannot be performed.
In order to solve the above problems, an object of the present invention is to provide an electronic sphygmomanometer that can accurately measure blood pressure regardless of the orientation of the cuff inserted into the upper arm by the measurer.
Moreover, it is possible to save the trouble of wrapping the cuff when wearing the limbs at the same time. The purpose is to provide an electronic sphygmomanometer with a cuff that can be measured just by inserting it.

An electronic sphygmomanometer of the present invention has a cylindrical cuff that can be inserted into an extremity and can be pressurized, and a sphygmomanometer body formed separately from the cuff, and the cuff supplies air. A large air bag capable of pressurizing the limbs, and the large air bag disposed at both ends in the width direction of the cuff between the air bag of the cuff and the living body on the side in contact with the living body when the cuff is attached. A small air bag having an air volume smaller than that of the air cuff, a sensor for detecting pneumatic vibration of the small air bag disposed inside or outside the cuff, and the small air disposed at both ends of the cuff. Phase difference of generation of air vibration signal of bag, or change or appearance of amplitude of pulse wave detected from low frequency component lower than K sound signal component of signal and high frequency component as K sound signal component Comparing the time difference, when the cuff is worn, either end of the cuff The blood pressure is measured using a sensor signal that has a function of determining whether it is the distal part of the heart (left ventricle side) or the peripheral part (hand side or ankle side) and the peripheral part of the cuff is judged by the judgment function. It is characterized by doing.
According to the said structure, even if a measurement person inserts this cuff into limbs from which direction, a correct blood pressure measurement can be performed.
By mounting a small air bag on both ends of the surface on the living body contact side in the width direction of the air bag for ischemia, even if it is inserted into the arm from either side of the cuff insertion port, Since it is arranged on the downstream side (that is, the side closer to the shoulder and the side closer to the finger) and which is arranged on the distal side of the upper arm, correct blood pressure measurement can be performed.

In the case of a cuff in which two small air bags are disposed at both insertion portions, preferably, the portion disposed at the insertion port at one end is disposed at the 3 o'clock and 9 o'clock positions when viewed from the insertion port side. The small air bag of the insertion port at the other end is arranged at the position of 6 o'clock and 12 o'clock with respect to the insertion port in the previous period.
For example, the radial artery used for blood pressure measurement of the upper arm bends diagonally downward from the central part of the cubical fosa on the opposite side of the elbow and runs into the inner side of the upper arm (the body side), and then in the longitudinal direction of the upper arm Running along the top. Therefore, when the cuff is attached to the upper arm and the small air bag of the downstream insertion port is positioned on the radial artery, the position on the upstream radial artery is counterclockwise as viewed from the insertion port side where the arm is inserted. The position is shifted from 60 to 90 degrees in the direction. Therefore, according to the above configuration, when the arm is inserted from the insertion port at one end and the small air bag on the downstream side is positioned on the artery, the small air disposed in the insertion port on the upstream side Since the position of the bag is close to the radial artery, the vibration of the artery can be detected with high sensitivity, and it is possible to reliably determine which insertion port is located on the distal side of the upper arm.
Preferably, a plurality of the small air bags are arranged along the circumferential direction of the air bag for ischemia.
According to the above configuration, when the measurer inserts the cuff into the right or left upper arm or the right or left foot, the small air bag is also positioned around the arm or foot from the position on the artery of the measurement site. Even in a state shifted in the direction, any one of the small air bags can be disposed at a position close to the artery of the upper arm, so that the K sound signal can be accurately obtained.
In addition, when cuffs are attached to the limbs, blood pressure is measured simultaneously, and when used as a cuff for a sphygmomanometer used in a test method for identifying arterial infarction from the difference in blood pressure values, measurement can be performed simply by inserting the cuff into the limbs. Therefore, it is not necessary to perform wrapping work and alignment with an artery, and a convenient examination can be realized.

Preferably, the air bag for ischemia has a plurality of bent portions for folding, and the small air bag is arranged between the plurality of bent portions.
According to the above configuration, the cuff including the air bag can be folded without affecting the small air bag such as deformation.
Preferably, a bone member is provided inside the outer member.
According to the above configuration, when air is supplied to the air bag, the phenomenon that the outer member of the cuff swells outside can be prevented, and accurate blood pressure measurement can be performed.

According to the present invention, even if the cuff is inserted into the arm or the leg from either of the two arms or the leg insertion opening of the cuff, the small air bag for detecting the K sound arranged in the two insertion openings is provided. One of them is located on the distal side of the arm or foot, and by comparing the signal of the small air bag at the insertion slot, for example, by comparing the difference in the K sound detection start time, the small air bag located on the distal side is reliably Since the blood pressure can be measured using the signal of the small air bag on the side that is determined to be downstream, there is redundancy that allows correct measurement regardless of the direction of insertion of the cuff into the arm or foot An electronic blood pressure monitor that is easy to use can be provided.
In addition, since a plurality of small air bags are arranged along the circumferential direction of the air bag for ischemia, when the measurer inserts a cuff into the right or left arm or right foot or left foot, the small air bag is also disposed. Even if the air bag is shifted from the position on the artery of the measurement site in the peripheral direction of the arm or foot, any of the small air bags can be arranged at a position close to the artery of the upper arm. A signal can be obtained. Further, by mounting the small air bag while avoiding the bent portion of the air bag for ischemia, the small air bag can be folded without being affected by deformation or the like.
Further, by disposing a bone member between the large air bag for ischemia and the outer member, when the air is supplied to the air bag, the phenomenon that the outer member of the cuff swells outside can be prevented, and the arm Alternatively, even when the leg is thin, blood pressure can be blocked by a large air bag, and a sphygmomanometer that can take a wide range of applicable arm circumferences can be provided.

It is a perspective view which shows preferable embodiment of the electronic blood pressure monitor of this invention from the front side. It is a disassembled perspective view of the cuff of an electronic blood pressure monitor. It is sectional drawing which shows the internal structure of the cuff of an electronic blood pressure monitor. It is a figure which shows the example of a shape of the bone member arrange | positioned inside an outer cloth. It is a side view which shows the cuff which has a bone member. 6A is a perspective view showing the unit UT of the outer cloth and the air bag, FIG. 6B is a perspective view of the unit UT as seen from another direction, and FIG. It is a perspective view which shows the state which folded unit UT. FIG. 7A is a perspective view showing an air bag and a small air bag, and FIG. 7B is a diagram showing an air bag, an outer cloth, an inner cloth cover, and a small air bag. It is a figure which shows the example of a sheet | seat which forms an air bag. It is a figure which shows a small air bag. It is a block diagram which shows the connection relation of an air bag, a small air bag, a pump, a condenser microphone, etc. It is a block block diagram of an electronic sphygmomanometer. In embodiment of this invention, it is a figure explaining the relationship between the width | variety of an air bag and the width | variety of a small air bag. FIG. 13A shows a low frequency component signal ZT from a small air bag obtained through a condenser microphone from a small air bag upstream (shoulder side) of the cuff and a high frequency component signal ZR from the small air bag. . FIG. 13B shows a low frequency component signal ZS from a small air bag obtained through a condenser microphone from a small air bag on the downstream side (finger side) of the cuff and a high frequency component signal ZH from the small air bag. . It is a flowchart which shows the process of determining which small air bag is arrange | positioned in the cuff peripheral side or the center side from the low frequency signal of the small air bag of the cuff in pressurization. It is a flowchart which shows the process of determining which small air bag is arrange | positioned in the cuff peripheral side or the center side from the low frequency signal of the cuff small air bag under pressure reduction. It is a figure which shows another embodiment of this invention. It is a figure which shows another embodiment of this invention. It is a figure which shows another embodiment of this invention. It is a blood-pressure measurement flowchart of this invention.

Hereinafter, preferred embodiments of the present invention will be described in detail with reference to the drawings.
FIG. 1 is a perspective view showing a preferred embodiment of an electronic blood pressure monitor according to the present invention from the front side, and FIG. 2 is an exploded perspective view of a cuff of the electronic blood pressure monitor. FIG. 3 is a cross-sectional view showing the internal structure of the cuff of the electronic blood pressure monitor.
The electronic sphygmomanometer 1 shown in FIG. 1 is also called an automatic electronic sphygmomanometer, can separate the cuff 2 from the sphygmomanometer main body 10, and the measurer is in the sitting position even if the place where the sphygmomanometer main body 10 is installed is away from the measurer. This is an electronic sphygmomanometer of the type that can be measured without stretching the back and applying abdominal pressure.
The electronic sphygmomanometer 1 is a device that uses the Rivaloch Korotkoff method as an example of a blood pressure measurement method, and measures blood pressure by detecting a Korotkoff sound (K sound).
As shown in FIG. 1, the electronic sphygmomanometer 1 includes a soft cylindrical cuff 2 made of a deformable and soft material, and a sphygmomanometer body 10. The cuff 2 and the blood pressure monitor main body 10 are separate bodies.

As shown in FIG. 1, this electronic sphygmomanometer 1 is a sphygmomanometer that measures blood pressure by inserting along the direction D1 from the insertion opening 11R of the cuff 2 to the insertion opening 11P in the upper arm T of the measurer. The cuff 2 and the sphygmomanometer body 10 are connected to each other by a flexible tube 4 that is an air supply / exhaust path and separate tubes 4P1 and 4P2.
The air bag 14 of the cuff 2 is connected to the pumps 44 and 45 side of the sphygmomanometer body 10 through the tube 4.
The four small air bags 500A1, 500A2, 500B1, and 500B2 of the cuff 2 connect the tubes from 500A1 and 500A2 to the tube 4P1, and connect the tubes from 500B1 and 500B2 to the tube. 4P2 is connected to condenser microphones 600A and 600B of blood pressure monitor main body 10.

First, the structure of the sphygmomanometer body 10 will be described with reference to FIG.
As shown in FIG. 1, the sphygmomanometer body 10 includes a casing 30 and a display unit 31. The casing 30 is a member having a thin internal space made of plastic, for example, and has an inclined upper surface portion 32, a front end surface portion 33, a rear end surface portion 34, side surface portions 35 and 36, and a bottom surface portion 42. .
As shown in FIG. 1, an inclined display portion 31 is disposed on the upper surface portion 32 of the casing 30 so that the measurer can easily confirm the display content of the display portion 31. The casing 30 is provided with a start / stop button 37 as an example of a measurement start operation unit, a memory call / time / alarm setting button 38, and a button 39 that is not stored. This button is used to start or stop the blood pressure measurement operation when the measurer presses the start / stop button 37.

  In FIG. 1, when setting the time, for example, by simultaneously pressing and holding the memory call / time / alarm setting button 38 and the button 39 not to be stored, the display unit can be operated as an operation / setting / input function. A time setting screen is displayed at 31, and the time displayed on the time setting screen can be set while being selected by the memory call / time / alarm setting button 38.

  In FIG. 1, for example, by pressing the memory call / time / alarm setting button 38, for example, 100 blood pressure measurement records in the past can be displayed on the display unit 31. The maximum blood pressure value, the minimum blood pressure value, the pulse rate, and the date and time displayed on the display unit 31 can be displayed in order each time the memory call / time / alarm setting button 38 is pressed. The button 39 that is not stored is a button that is pressed only when, for example, the measurer does not store the maximum blood pressure value, the minimum blood pressure value, the pulse value, and the pulse pressure in the memory unit 69.

  The display unit 31 is arranged along the X direction. For example, a liquid crystal display device can be used as the display unit 31. As shown in FIG. 1, for example, the display unit 31 includes a maximum blood pressure value, a minimum blood pressure value, a pulse rate, a pulse pressure, and a display mark during measurement operation. Various measurement values such as battery replacement display marks can be displayed.

  As shown in FIG. 1, the side portions 35 and 36 are formed in a curved surface so that the measurer can easily hold the blood pressure monitor main body 10. The memory call / time / alarm setting button 38 and the non-stored button 39 are arranged in the vicinity of the display unit 31 on the upper surface 32. As shown in FIG. 1, inside the casing 30 is a circuit board including two condenser microphones 600A and 600B, a speaker 43, two pumps 44 and 45, an exhaust valve 46, a control valve 47, and a control system. 48 and a memory unit 69 are arranged. The speaker 43 is provided to output a voice guide or a music guide.

Next, the structure of the cuff 2 will be described with reference to FIGS.
As shown in FIG. 1, the cuff 2 is compressed in a state where the blood pressure is measured by inserting the elbow or knee from the opening 11P by inserting the cuff 2 into the upper arm or thigh T from the opening 11R in the direction D1. for,
It has a substantially cylindrical structure (tubular body) with both ends cut so that it can be inserted into an arm or a leg.

  As shown in FIGS. 2 and 3, the cuff 2 is a deformable and soft cylinder, and is made lightweight.

The inner surface of the outer cloth 16 can cover the outer surface of the air bag 14 for ischemia, and the inner cloth 17 covers the inner surface of the air bag 14.
Here, as the inner cloth 17, it is preferable to use a slippery and stretchable material, and the outer cloth 16 is deformed, but preferably a material that hardly stretches.
In the air bag 14 for ischemia, the outer cloth 16 and the inner cloth 17 are each joined in a ring shape by short ends being sewn, bonded, or fused, and the outer cloth 16 is on the outside and the inner cloth 17 is on the inside. It is accommodated in a donut-shaped bag formed by overlapping in a ring shape and joining both ends by sewing, bonding, or fusion.
For example, (201BE), which is a cloth material that can be deformed but has low stretchability, is used for the outer cloth 16.
As for the characteristics of this cloth material, the tensile strength is a value measured by the JIS L1096-A method, the vertical is 1445 N / in, the horizontal is 827 N / in, and for example, a fabric of 100% polyester is used.

  The inner cloth 17 is deformable and slippery, and is preferably a stretchable cloth material. For example, the tensile strength measured by the JIS L1096-A method is 94.9 N / in. 150.7 N / in, and the tensile elongation measured by the JIS L1096-A method is 517% vertical and 400% horizontal. For example, 80% nylon, 20% polyurethane cloth Is used.

1 is compressed by air supplied from the pumps 44 and 45 of the sphygmomanometer main body 10 through the tube 4 to compress the arm or the foot T. The material of the air bag 14 for hemostasis is made of a material such as vinyl chloride, polyurethane, synthetic rubber, natural rubber or the like.
The air bag 14 for ischemia compresses the arm or the foot T when air is supplied through the tube 4 and inflated by pumps 44 and 45 indicated by broken lines in the blood pressure monitor main body 10 shown in FIG.
In order to reduce the internal pressure of the ischemic bladder 14 at a constant speed, the control valve 47 gradually exhausts air from the ischemic bladder 14.
When the measurement is finished, the air is rapidly exhausted from the inside of the air bag 14 by the exhaust valve 46 to the outside.
The detailed structure of the air bag 14 for ischemia will be described later.

Next, with reference to FIG. 4 and FIG. 5, the bone member 150 arrange | positioned inside the outer fabric 16 is demonstrated.
FIG. 4 shows an example of the shape of the bone member 150 arranged inside the outer fabric 16, and FIG. 5 is a side view showing the cuff 2 having the bone member 150.
As shown in FIG. 4, the bone member 150 is fixed to the inner surface 16N of the outer cloth 16 by an adhesive, for example.
The bone member 150 is a metal product or a plastic molded product, and is arranged along the longitudinal direction 16S of the outer cloth 16, and is composed of a plurality of bones 150H.
The bones 150H are arranged at the same interval so as to be parallel to the short direction 16T of the outer cloth 16. Each bone 150H has a circular cross-section or a rectangular cross-section, but the cross-sectional shape and number are not particularly limited.

Since the bone member 150 is arranged on the inner surface 16N of the outer cloth 16 as described above, even if the cuff using the soft outer cloth is used as shown in FIG. When the air is filled in the air bag 14, the air bag 14 for ischemia and the outer cloth 16 are not greatly inflated along the longitudinal direction 16T.
For this reason, the measurer can stably and reliably perform blood pressure measurement with the upper arm in the same manner as the cuff in which the air bag 14 for ischemia is arranged in a hard cylinder.

Here, structural examples of the air bag 14 for ischemia and the small air bag 500 will be described.
FIG. 8 shows an example of a sheet for forming the ischemic air bag 14.
First, the structure of the air bag 14 for ischemia will be described.
The sheet SW shown in FIG. 8 is a substantially rectangular thermoplastic resin sheet, for example, and a polyurethane sheet is used as an example.
The sheet SW includes a dust filter connecting pipe 220, four broken line portions (an example of a bent portion) 222, and joint portions 223 and 224.
The connection pipe 220 connects the ends of the tube 4 shown in FIG.
The joining portions 223 and 224 form the air bag 14 by heat fusion or high frequency fusion.
The sheet SW is embossed with heat or a high-frequency welder to form four broken line portions (an example of a bent portion) 222.
Further, a connecting tube 220 with a dust filter for supplying and exhausting air is fused to the outer surface opposite to the biological contact surface side of the air bag 14 for ischemia.
As shown in FIG. 8, the air capacity in the sheet SW constituting the ischemic air bag 14 should be supplied from the pumps 44 and 45 to the inside of the sheet SW, that is, the inside of the ischemic air bag 14 as much as possible. In order to reduce the amount of air, an extensible cushion material 240 is disposed inside the seat SW so as to escape the crease 222 so as not to deform the cushion material 200 when the cuff is folded.

As shown in FIG. 7 and FIG. 8, a total of four small air bags 500 (500A1, 500A2, 500B1, 500B2) are fixed to the inner side surfaces 14G, 14F of the ischemic air bag 14 by, for example, an adhesive or an adhesive. Has been.
The air capacity of the small air bag 500 is smaller than the air capacity of the air bag 14, and the two small air bags 500 are arranged so as to face each other.
The inner surface portions 14F and 14G are portions sandwiched between adjacent broken line portions 222 and 222, respectively.
As shown in FIGS. 7A and 8, two small air bags 500 (500B1, 500B2) are arranged on the upstream side 14M and the downstream side 14N of the inner side surfaces 14G and 14F of the air bag 14, respectively. .
The upstream side 14M of the inner side surfaces 14G and 14F of the air bag 14 for ischemia is the upstream side of the artery of the upper arm T and the shoulder side when the cuff is attached to the measurement site, for example, the upper arm by inserting the arm from the 14M side. is there. Further, the downstream side 14N of the inner side surfaces 14G and 14F of the air bag 14 for ischemia is the downstream side of the artery of the upper arm T and the finger side.
As described above, the small air bags 500 are disposed on the upstream side 14M and the downstream side 14N of the inner side surfaces 14G and 14F of the air bag 14 for the following reason.
Whether the measurer is inserted into the upper arm T from the direction D1 shown in FIG. 1 or from the opposite direction, one of the small air bags 500 is arranged at a position on the artery of the upper arm T. This is because the K sound signal can be accurately obtained.
Further, on the upstream side 14M and the downstream side 14N, a plurality of small air bags 500 are arranged in the circumferential direction of the cuff 2 at positions 180 degrees apart from each other, so that the measurer can move either the left or right upper arm. Even if the cuff 2 is inserted into T, the small air bag 500 is placed on the measurement site artery. This is because the K sound signal can be obtained accurately.
Accordingly, when the measurer inserts the cuff into the upper arm T from the direction D1 shown in FIG. 1 (normal insertion), one of the two small air bags 500B1 and 500B2 on the downstream side 14N is connected to the upper arm T. Can be placed corresponding to the artery.
When the measurer inserts into the upper arm T from the direction opposite to the direction D1 shown in FIG. 1 (reverse insertion), one of the two small air bags 500B1 and 500B2 on the upstream side 14M is connected to the upper arm T. Can be placed corresponding to the artery.

FIG. 9 shows an enlarged structure example of the small air bag 500. The small air bags 500A1, 500A2, 500B1, and 500B2 are in close contact with the measurement surface HM of the arm or foot T of the measurer and It corresponds to the artery.
The material of the small air bags 500 (500A1, 500A2), 500B1, 500B2), which shows a small bag of one insertion port (500A1) of the cuff in FIG. 9, can be the same material as the air bag 14, for example. The air bag 500 has a rectangular shape.
The four side portions of the small air bag 500 are sealed by fusion, for example, and form an air accommodating portion.
A tube for extracting a signal is fused to the side portion 501. This tube is connected to a tube of a small air bag at the same end, and further connected to the other end of the tube 4P1. 507A are connected to the condenser microphone 600A.
Further, the tube 4P1 is connected to the mechanical filter 700A by the tube 4RA, and the mechanical filter 700A is connected to the pumps 44 and 45 via the piping paths 63D1 and 63D2.
A small amount of air is supplied from the pumps 44 and 45 to the small air bag 500A via the mechanical filter 700A1.
The air in the small air bags 500A1 and 500A2 can be transferred to the condenser microphone 600A, which is an example of the vibration detection sensor, through the tube 4P1 by changing the motion of the artery to air vibration.
The condenser microphone 600A can convert the air vibration into an electric signal to obtain a K sound signal.
The condenser microphone 600A is connected to a mechanical filter 700A. The mechanical filter 700A is connected to pumps 44 and 45, an exhaust valve 46, an exhaust control valve 47, and a pressure sensor 64.
The connection tube between the main body 10 and the cuff 2 is a tube 4, a tube 4 P 1, 4 P 2, and a three lumen tube.
Similarly, for the small bags 500B1 and 500B2 on the other insertion port side of the cuff, each signal extraction tube is connected, further connected to the tube 4P2, connected to the condenser microphone 600B in the main body, and The tube 4P2 is connected to a mechanical filter 700B in the main body. The mechanical filter 700B is connected to pumps 44 and 45, an exhaust valve 46, an exhaust control valve 47, and a pressure sensor 64.

Next, referring to FIG. 10, the connection relationship between the air bag 14, the small air bag 500 (500A1, 500A2, 500B1, 500B2), the pumps 44, 45, the condenser microphone 600 (600A, 600B), etc. explain.
As shown in FIG. 10, the Korotkoff sound (K sound) detection system 50 includes four small air bags 500A1, 500A2, 500B1, and 500B2 of the cuff 2, two condenser microphones 600A1 and 600B2, and two mechanical filters 700A and 700B. have.
The two small air bags 500A1 and 500A2 are connected to one condenser microphone 600A via the tube 4P1,
Further, the remaining two small air bags 500B1 and 500B2 are similarly connected to the other condenser microphone 600B2 via the tube 4P2.
When air is supplied to the air bag 14 for ischemia, a small amount of air is also supplied to the four small air bags 500A1, 500A2, 500B1, and 500B2 via the mechanical filters 700A and 700B. Thereby, the pressure fluctuation of the air in the small air bag can be obtained by each condenser microphone.
The mechanical filters 700A and 700B are connected to a pressure sensor 64, pumps 44 and 45, an exhaust valve 46, and a control valve 47.
The pressure sensor 64, the pumps 44 and 45, the exhaust valve 46, and the control valve 47 operate according to commands to the control system 56.
The two mechanical filters shown in FIG. 10 are composed of a thin tube and a tank, and have LPF characteristics that block high-frequency components, eliminating the control sound of the control valve 47 and the drive sound of the pumps 44 and 45. In order not to affect the detection signal of the condenser microphone, it is arranged.
An example in which two small air bags are arranged at 9 o'clock and 3 o'clock as viewed from one insertion port of the cuff, and two small air bags are arranged at 12 o'clock and 6 o'clock at the other insertion port. This will be described with reference to FIG.
FIG. (A) is a diagram in which, for example, a cuff is inserted into the left arm from the insertion opening of D1 and is attached to the left upper arm.
FIG. B is a view for explaining the arrangement of a large air bag for ischemia incorporated in the cuff and a small air bag for detecting a K sound.
In FIG. (A), the 14M side where the arm is inserted is located in the central part of the arm, and the opposite side 14N is located on the distal side of the arm.
As shown in the figure, the radial artery where the K sound is generated enters the arm from the cubical fosa on the opposite side of the elbow and runs under the arm in parallel with the upper arm.
As an ideal positioning position for the cuff, when the small air bag 500B1 is positioned on the radial artery, the artery on the central side of the cuff is 60 degrees clockwise from the position of the small air bag 500B1 as viewed from the mouth inserted into the arm. If the small air bag is arranged on the central side with a displacement of 0 o'clock from the small air bag 500B2, the position on the radial artery and the displacement increase.
In order to cope with this, as shown in the figure (A), the small air bag disposed on the insertion port side of 14M located on the central side is shifted by 90 degrees with respect to the small air bags 500B1 and 500B2 on the 14F side. It arrange | positions in the position of 500A1,500A2.
The positional relationship with the large air bag built in the cuff is as shown in FIG. The small air bag escapes and arranges the unevenness 222 installed as a position for generating wrinkles when inflated in a cylindrical shape.
Next, an example in which a plurality of small air bags are arranged in the circumferential direction of the cylindrical cuff will be described with reference to FIGS. FIG. 16 shows an example in which three are arranged at the insertion opening of the cylindrical cuff and an example in which four are arranged at each, and FIG. 17 shows an example in which four are arranged at the insertion opening.
In the case of the arrangement of three each, as shown in FIG. 16A, it is arranged at the position of 3 o'clock, 6 o'clock, and 9 o'clock as seen from the insertion port. Further, in the case of the arrangement of 4 pieces each, as shown in FIG.
As shown in FIG. 17 (B), the unevenness 222 installed to generate wrinkles when the air bag is inflated into a cylindrical shape is arranged to escape.
Signals from a plurality of small air bags arranged on the respective insertion port sides are connected to a condenser microphone for two insertion ports and a mechanical filter by collecting the tubes from the respective small air bags.
In the case of two-piece arrangement and three-piece arrangement, it is necessary to adjust the position of the cuff so that one of the small air bags located on the distal side is located on the artery. In the case of individual arrangement, the small air bag 500A2 of FIG. 16- (A) is located at the position of the biceps brachial muscle in the case of the upper arm and at the position of the biceps femoris in the case of the thigh. It is necessary to adjust the position of the cuff.
However, in the case of the arrangement of four each, there is an advantage that adjustment of the mounting position of the cuff is unnecessary.

Next, FIG. 11 is a block diagram of the electronic blood pressure monitor 1 of FIG.
A circuit block of the electronic sphygmomanometer 1 shown in FIG. 11 will be described. The circuit block of the electronic blood pressure monitor 1 is shown. As shown by the broken line in the circuit block of the electronic sphygmomanometer 1, the sphygmomanometer body 10 includes a Korotkoff sound (K sound) detection system 50, a pressurization system 51, an exhaust system 52, and a pressure detection system 53 shown in FIG. A power system 54, a sound system 55, and a control system 56.

  The control system 56 includes a drive unit 58 of the display unit 31, a timer 59, a memory unit 69, and the like. The drive unit 58 of the display unit 31 controls the display unit 31 to display items to be displayed. The memory unit 69 is a ROM that stores a program to be processed by a CPU (central processing unit) of the control system 56 and a RAM that stores data. The timer 59 counts various operation times. The operation unit 57 is electrically connected to the control system 56, and includes the start / stop button 37, the volume button 38, and the mode selection button 39 described above.

The Korotkoff sound (K sound) detection system 50 of FIG. 11 has already been described with reference to FIG. 10, but the four small air bags 500A1, 500A2 and 500B1, 500B2 of the cuff 2 and the two condenser microphones 600A, 600B. And two mechanical filters 700A and 700B.
The two small air bags 500A1 and 500A2 are connected to one condenser microphone 600A via the tube 4P1, and the remaining two small air bags 500B1 and 500B2 are connected to the other condenser microphone 600B via the tube 4P2. It is connected.
Condenser microphones 600A and 600B are connected to mechanical filters 700A and 700B via tubes 4RA and 4RB.
The mechanical filters 700 </ b> A and 700 </ b> B are connected to the pressure sensor 64, the pumps 44 and 45, and the control valve 47 through the piping unit 63, and are subjected to air vibration caused by the pulsation of the pumps 44 and 45 and It is shut off.

  The condenser microphones 600A and 600B are electrically connected to the control system 56 so that the air vibration from the small air bag is converted into an electric signal, amplified, A / D converted, and supplied to the control system 56. It has become.

A pressure detection system 53 shown in FIG. 11 includes a piping part 63, a pressure sensor 64, and a tube 4. The pressure sensor 64 is electrically connected to the control system 56 via a drive unit (constant current unit), an amplifier, a filter, and an integration A / D unit 65.
The control detection system 56 in FIG. 11 detects the K sound signal, the generation point and the disappearance point of the K sound signal from the air vibration signals input to the condenser microphones 600A and 600B.
The K-sound detection system 50 uses the pressure sensor 64 to pressurize the cuff 2 with the pump 44 and 45 to a pressure 30 to 40 mmHg higher than the maximum blood pressure, At the same time as detecting the pressure in the air bladder 14, the K sound signal is detected using the condenser microphones 600A and 600B.
The control system 56 in FIG. 11 determines which one of the two K sound signals is the K sound signal from the small air bag disposed on the downstream side of the cuff, and uses the K sound signal of the small air bag determined to be the downstream side. By detecting the output value of the pressure sensor 64 at the generation point of the K sound signal and the output value of the pressure sensor 64 at the disappearance point, the maximum blood pressure value and the minimum blood pressure value are calculated, and the calculated maximum blood pressure value and minimum blood pressure value are calculated. Is displayed on the display unit 31.
Further, the control system 56 calculates the pulse rate from the appearance interval of the vascular pulsation or the K sound signal obtained from the maximum blood pressure value and the minimum blood pressure value.

The pressurization system 51 includes pumps 44 and 45 and a pump drive unit 62.
The drive unit 62 drives and controls the pumps 44 and 45 according to a command from the control system 56.
The pumps 44 and 45 inject air into the blood bag 14 of the cuff 2 through the piping part 63 of the pressure detection system 53.

  Next, the exhaust system 52 will be described. The exhaust system 52 includes two drive units 66 and 67, an exhaust valve (forced exhaust unit) 46, and a control valve (decompression control unit) 47. The exhaust valve 46 and the control valve 47 are arranged in the middle of the piping part 63. The control system 56 instructs the drive unit 66 to open and close the exhaust valve 46, and the control system 56 instructs the drive unit 67 to control opening and closing of the control valve 47. Based on the pressure signal from the pressure detection system unit 53, the orifice of the control valve 57 is controlled so that the pressure can be reduced by 3 to 5 mmHg / sec.

  The power supply system 54 includes a battery 68, a power supply control unit 69C, and a power supply monitoring unit 70. The battery 68 is, for example, a lithium ion battery that can be repeatedly charged, but the type is not particularly limited, and may be a dry battery or the like. The voltage of the battery 68 is controlled by the power control unit 69C and supplied to the control system 56, and also serves as a driving power source for the pumps 44 and 45 and a power source supplied to the sound control unit 71. The power monitoring unit 70 monitors the remaining amount of the battery 68 and the like. Moreover, a 100V commercial power supply can be used by using an AC adapter.

  The audio system 55 includes an audio control unit 71 and an amplification unit 72. The voice control unit 71 and the amplification unit 72 are controlled by a command from the control system 56. The voice control unit 71 sends voice guidance data or music data to the amplifying unit 72 and amplifies it according to a command from the control system 56, so that the speaker 43 generates a voice announcement and a music guidance announcement. can do.

  A blood pressure measurement procedure according to the present embodiment will be described with reference to the flowchart of FIG.

  In step S1, the control unit 56 fully opens the exhaust valve 46 and the control valve 47, eliminates residual air in the air bag, and initializes the zero set of the pressure sensor 64. ).

  In step S2, the control unit 56 fully closes the exhaust valve 46 and the control valve 47 via the drive units 66 and 67, drives the pumps 44 and 45, and sets the ischemic bladder 14 to a predetermined maximum blood pressure. Pressurization is performed to a pressurization set pressure value 30 to 40 mmHg higher.

When the pressure setting pressure value is reached, it is determined during pressurization whether one of the condenser microphones 600A and 600B, which are two K sound sensors, is located on the distal side (downstream side) of the arm or foot. If so, downstream determination processing A is performed in step S3. Details of the downstream determination process A will be described later with reference to FIG.
In the case of a specification that does not make a determination during pressurization, step S3 is not performed.

As described above, based on the data of the pressurization process, it is determined whether the condenser microphone to which the small air bag located on the distal side of the upper arm is connected is 600A or 600B, and the signal of the condenser microphone determined to be the distal side is obtained. Use to measure blood pressure.
In step S4, decompression is started in the decompression system at a decompression speed of 3 to 5 mmHg / sec.

When it is determined during decompression whether one of the two K sound sensors, the condenser microphones 600A and 600B, is located on the distal side (downstream side), both condenser microphones 600A and 600B are used. After the K sound is detected, the downstream determination B in step S5 is performed.
Details of downstream determination will be described later with reference to FIG.
The blood pressure is measured using the signal of the condenser microphone determined to be the peripheral side.
Step S5 is not performed in the case of a specification that does not make a determination during decompression.

In step S6, the pressure value of the large air bag at the timing when the K sound is first recognized is set to the highest blood pressure value by the signal of the condenser microphone determined to be downstream, and further, the pressure decreases and the K sound is synchronized with the beat. Confirm that it has occurred, and if the K sound cannot be detected for two consecutive beats, it is determined that the K sound has disappeared, and the pressure value of the large air bag at the last recognized K sound detection timing is determined as the minimum blood pressure value. To do.
Further, the pulse rate is calculated from the number of K sounds generated from the highest blood pressure to the lowest blood pressure and the time required for decompression.
In step S 7, the detected maximum blood pressure value, minimum blood pressure value, and pulse rate are displayed on the display unit 31.
In step S8, the detected maximum blood pressure value, minimum blood pressure value, and pulse rate are recorded in the RAM together with the date and time.

A function for determining which of the two insertion openings of the cuff 2 inserted into the arm or the foot T is located in the peripheral part of the arm or the foot will be described.
First, a method of comparing the signals of the condenser microphones 600A and 600B during decompression and detecting using the phase difference between the two signals will be described.
Normally, when the air bag 14 for ischemia is pressurized to a pressure equal to or higher than the maximum blood pressure value, and the pressure is gradually reduced, blood flow is stopped by the cuff, and the upstream side of the cuff 2 attached to the measurement site (circulatory system center) The blood flow enters the cuff from the region side), and a signal due to this blood flow is generated. However, there is no change on the downstream side.
Further, when the pressure reduction progresses and the internal pressure of the ischemic bladder 14 becomes lower than the maximum blood pressure, a signal due to the generation of blood flow including the K sound signal is generated on the downstream side.
Therefore, a temporal phase difference is generated in the signal generation timing of the condenser microphone connected to the small air bags placed on the upstream side and the downstream side of the cuff 2.
Therefore, comparing the time Tda and Tdb from when pressure reduction is started with the condenser microphones 600A and 600B to when the K sound is first detected, the small air bag connected to the larger condenser microphone is connected to the arm or leg. Judged to be located in the distal part.
The actual determination operation of the sphygmomanometer will be described with reference to FIG.
After the sphygmomanometer supplies and pressurizes to the internal pressure value of the large air bag 30 to 40 mmHg higher than the preset maximum blood pressure value, the operation after starting the decompression at the decompression speed of 3 to 5 mmHg / sec. explain.
In S11, the signals from the small air bags 500A1, 500A2, and 500B1, 500B2 installed on the two insertion ports of the cuff connected by the condenser microphones 600A and 600B are A / D converted at a sampling time of 4 ms. To start recording in the RAM 1.
A high frequency component (40 to 100 Hz) is collected from each data recorded in S12 by a BPF digital filter and recorded in the RAM 2.
In S13, a K sound waveform is detected from the data recorded in the RAM 2, and the PP value is calculated as an amplitude. When this amplitude exceeds a threshold value, it is recognized as a K sound. Also, the time from the start of decompression is measured by a timer.
In S14, it is checked whether the K sound is recognized for the first time in both of the condenser microphones 500A and 500B.
When the K sound is recognized in both the condenser microphones 500A and 500B, in S15, the time Tda and Tdb from when the pressure reduction is started until the K sound is recognized for the first time by the condenser microphones 500A and 500B are calculated.
In S16, it is checked whether Tda and Tdb are the same. If they are the same, an error is assumed in S17 because there is an influence of noise.
If Tda and Tdb are not the same, Tda and Tdb are compared in S18.
If Tda is large, it is determined in S19 that the small air bag 500A (500A1, 500A2) is the distal side, and blood pressure measurement is performed using the signal of the small air bag 500A.
If Tdb is large, the small air bag 500B (500B1, 500B2) is determined as the distal side in S20, and the blood pressure measurement is performed using the signal of the small air bag 500B.
Further, when the signals of the condenser microphones 600A and 600B at the time of pressurization are compared and the internal pressure of the air bag 14 for ischemia is lower than the maximum blood pressure value, a signal due to the generation of blood flow is generated in both the upstream and downstream portions. When the internal pressure of the air bag 14 for ischemia becomes higher than the maximum blood pressure value, the signal caused by the upstream blood flow remains generated, but the signal caused by the downstream blood flow is attenuated. And disappear.
Therefore, the time Tua and Tub from when the K sound is generated once to the disappearance of the signal of the condenser microphones 600A and 600B after the pressurization is started is observed and connected to the condenser microphone that disappears first. It is determined that a small air bag is located in the distal part of the arm or leg.
The determination operation of an actual blood pressure monitor will be described with reference to FIG.
At S1, the signals from the small air bags 500A1, 500A2 and 500B1, 500B2 installed on the two insertion port sides of the cuff connected by the condenser microphones 600A and 600B are superimposed on the signal from the pressure sensor. The detected pulse wave of the large air bag is A / D converted at a sampling time of 4 ms, and recording into the RAM 11 is started.
At S2, low frequency components (0.5 to 10 Hz) are collected from each recorded data by the BPF digital filter and recorded in the RAM 22.
In S 3, a pulse wave waveform is detected from the data recorded in the RAM 22, and the PP value is calculated as an amplitude and recorded in the RAM 33.
In S4, it is checked whether the internal pressure P of the large air bag has reached a pressure setting value that is 30 to 40 mmHg higher than the preset maximum blood pressure value.
When the internal pressure of the large air bag reaches the set pressure value, in S5, the amplitude values of the RAM 33 are arranged in time series, and the pulse wave amplitude of the large air bag and the amplitude detected from the signals of the condenser microphones A and D are respectively A quadratic regression curve equation is calculated by plotting the X axis on the XY plane with the time Y axis as the amplitude value.
At S6, a correlation coefficient is obtained and compared with the secondary regression curve of the amplitude change of the large air bag and the secondary regression curve of the amplitude change of the condenser microphone 600A or the secondary regression curve of the amplitude change of 600B.
The correlation between the secondary regression curve of the amplitude change of the large bladder and the secondary curve of the condenser microphone 600A and the correlation coefficient of the secondary regression curve of the amplitude change of the large bladder and the secondary curve of the condenser microphone 600B When larger than the number, it is determined in S7 that the small air bag 500A (500A1, 500A2) connected to the condenser microphone 600A is on the downstream side.
Blood pressure measurement is performed using the signal of the condenser microphone 600A.
The correlation between the secondary regression curve of the amplitude change of the large bladder and the secondary curve of the condenser microphone 600A and the correlation coefficient of the secondary regression curve of the amplitude change of the large bladder and the secondary curve of the condenser microphone 600B If smaller than the number, it is determined in S6 that the small air bag 500B (500B1, 500B2) connected to the condenser microphone 600B is on the downstream side.
Blood pressure is measured using the signal from the condenser microphone 600B.

Since the air bag has a plurality of folded portions for folding, and the small air bag is arranged between the plurality of folded portions, the cuff including the air bag is not affected by the arrangement of the small air bags. It can be securely folded at the folded portion and can be stored compactly.
Since the bone member is provided inside the outer member, the phenomenon that the outer member of the cuff swells outside when air is supplied to the air bag can be prevented, and accurate blood pressure measurement can be performed.

By the way, this invention is not limited to the said embodiment, A various modified example is employable. The display unit 31 is not particularly limited in type, for example, an organic EL device, a fluorescent display device, or the like other than a liquid crystal display device.
In the example of the electronic blood pressure monitor shown in the figure, the cuff has a structure that can be deformed and can be folded when blood pressure measurement is not performed. However, the electronic blood pressure monitor of the present invention can be made of, for example, plastic instead of a foldable outer cloth. It is also possible to adopt a structure in which an air bag is arranged in the housing using a hard housing made of the product.
In the embodiment of the present invention described above, the folded cuff 2 may be detachably fixed to the upper surface of the sphygmomanometer main body 10 using a fixing means when not measured when not measured. . As a fixing method of the cuff 2, for example, the cuff and the sphygmomanometer body are detachably fixed by a magnetic attraction force using a magnet and a metal plate, or a tape member having a male member and the male member are used. By attaching a tape member having a female mold member that can be mechanically attached to the mold member in a detachable manner, the tape can be detachably fixed.
Moreover, although the condenser microphone is mentioned as an example of the K sound sensor (sensor), a piezoelectric microphone, a dynamic microphone, or the like can be used as a sensor capable of measuring the K sound. Moreover, as long as only the insertion direction is notified, the sensor is not limited to a sensor that can measure the K sound, and examples include an ultrasonic sensor, a strain gauge, and an optical sensor.

  DESCRIPTION OF SYMBOLS 1 ... Electronic sphygmomanometer, 2 ... Cuff, 4 ... Tube, 4P1 ... Tube of condenser microphone 600A, 4P2 ... Tube of condenser microphone 600B, 10 ... Main body of blood pressure monitor, 14 .. Large air bag, 16... Outer cloth (an example of an outer member), 17. 500B1, 500B2 ... Cuff Small air bag (also called a small cuff or small bag), 600A, 600B ... Condenser microphone (an example of sensor)

Claims (6)

A cylindrical cuff that can be inserted into the arm or foot and pressurized,
A sphygmomanometer body formed separately from the cuff,
The cuff is
A large air bag capable of pressurizing the arms or legs by supplying air;
A pressure detection unit connected to the large air bag, and a pump and a valve for increasing and reducing the pressure of the large air bag.
Arranged in the circumferential direction in the vicinity of each of the two insertion openings in the cylindrical cuff on the arm or leg contact side of the large air bag and for inserting the cylindrical cuff into the arm or leg A small air bag having an air capacity smaller than the large air bag air capacity, and the two air connected to the small air bag and two insertion ports by tube piping A vibration detection sensor,
The time series of the pulse wave superimposed on the pressure signal detected by the large air bag during the process of pressurizing and pressing the arm or foot with the large air bag or the process of depressurizing at a constant pressure reduction rate. Correlation between amplitude change and time-series amplitude change of air vibration from small air bags near the two insertion ports, or air vibration (K sound) of the small air bags arranged at the two insertion ports The function of comparing the difference in the occurrence time of the two or more of the two insertion openings is determined based on the correlation or the difference in the occurrence time in the previous period, and the determination is made. An electronic sphygmomanometer that measures blood pressure using a signal from the air vibration detection sensor connected to the small air bag.   When two small air bags are disposed at the insertion port in the previous period, the small air bags are disposed facing each other at approximately 6 o'clock and approximately 12 o'clock at one insertion port, and at the other insertion port. The electronic sphygmomanometer according to claim 1, wherein the first small air bag is shifted by approximately 90 degrees and disposed at approximately 3 o'clock and approximately 9 o'clock. An abutting cloth portion that is a cylindrical body that covers the inner surface of the air bag, and that abuts against the surface to be measured of the upper arm;
An outer member joined to the outside of the abutting cloth portion so as to accommodate the air bag,
The contact cloth part is deformable and stretchable, and the outer member is formed of a cloth member that is deformable but less stretchable than the contact cloth part. The electronic blood pressure monitor according to claim 1 or claim 2. A tube connected to the air bag and the small air bag;
A pump for sending air to the air bag and the small air bag through the tube,
The electronic sphygmomanometer according to claim 1, wherein the sensor and the pump are disposed in the sphygmomanometer main body.   5. The air bag according to claim 1, wherein the air bag has a plurality of folded portions for folding, and the small air bag is disposed between the plurality of the folded portions. Electronic blood pressure monitor.   The electronic blood pressure monitor according to any one of claims 1 to 5, wherein a bone member is provided inside the outer member.

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