JP2016163659A - Respiratory function testing device and respiratory function testing system - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a respiratory function testing device capable of appropriately estimating a condition of a respiratory function based on a pulse wave signal.SOLUTION: Lung compliance according to a value of intrathoracic pressure can be grasped by estimating the intrathoracic pressure based on a volume signal and a pulse wave signal, and displaying on a display unit an intrathoracic pressure/volume curve from which a fluctuation amount of the volume to a fluctuation amount of the intrathoracic pressure can be grasped. When the volume being monitored is determined to be of an abnormal value in relation to the intrathoracic pressure estimated based on the pulse wave being monitored in a first monitoring process of the volume signal and the pulse wave signal, abnormality notification is conducted by the display unit and a loudspeaker.SELECTED DRAWING: Figure 6

Description

  The present invention relates to a respiratory function test apparatus and a respiratory function test system that can test a respiratory function.

  Conventionally, as shown in Patent Document 1, a respiratory function test apparatus that estimates lung compliance based on different inspiratory amounts of subjects and intrathoracic pressure estimated from pulse wave signals has been proposed.

JP 2014-226422 A

  However, in the conventional technique as shown in Patent Document 1, there is a problem that lung compliance is not properly estimated in consideration of the exhalation of the subject. The present invention has been made based on such a background, and an object of the present invention is to provide a respiratory function testing apparatus and the like that can appropriately estimate the state of respiratory function based on a pulse wave signal.

  In order to solve the above problems, the following measures were taken. The reference numerals used in the description of the best mode for carrying out the invention and the drawings to be described later are appended in parentheses for reference, but the constituent elements of the present invention are not limited to the appended description.

  The means 1 includes respiratory measurement means (such as the flow sensor 50 and the pressure sensor 11) that measures the respiratory volume during a period including the expiration period and the inspiration period, and pulse wave measurement means that measures the pulse wave (the pulse wave probe 60 and the pulse wave) Module 61), estimation means for estimating the intrathoracic pressure based on the pulse wave measured by the pulse wave measurement means (CPU 14 executing the processing of S110 to S120), the intrathoracic pressure estimated by the estimation means, and the Respiration comprising: display means (display 18) for displaying a relationship with the respiratory capacity measured by the respiration measurement means (intrathoracic pressure / volume curve or estimated intrathoracic pressure / volume curve created in S121). This is a functional inspection device (spirometer 100).

  The means 2 is the respiratory function test apparatus (spirometer 100) of the means 1, and the display means (display 18) is a relationship curve (in accordance with the intrathoracic pressure) indicating the relationship between the intrathoracic pressure and the respiratory capacity. Intrathoracic pressure / volume curve that can grasp the volume) is displayed.

  The means 3 is the respiratory function test apparatus (spirometer 100) of the means 2, and the display means (display 18) is a relational curve (fluctuation of intrathoracic pressure) capable of grasping lung compliance according to the intrathoracic pressure. A thoracic pressure / volume curve capable of grasping the amount of change in volume according to the amount) is displayed.

  The means 4 is a respiratory function test apparatus (spirometer 100) selected from the means 1 to 3, wherein the respiratory volume is monitored by the respiratory measuring means and the pulse wave is monitored by the pulse wave measuring means. When performing the operation, the notification means for performing notification when the relationship between the intrathoracic pressure and the respiratory volume is determined to be abnormal (in the first monitoring process, the volume being monitored is the intrathoracic pressure / volume curve) It is further characterized by further comprising a display 18 and a speaker 20) for performing notification when the value is an abnormal value in relation to the intrathoracic pressure specified in S211.

  The means 5 is any respiratory function test apparatus selected from the means 1 to 3 (a spirometer 100 configured not to perform flow and volume monitoring), and the pulse wave is monitored by the pulse wave measuring means. When the intrathoracic pressure is determined to be abnormal, the notification means for performing the notification (whether or not the intrathoracic pressure estimated based on the pulse wave signal is out of the range of the resting intrathoracic pressure) It is characterized by further comprising a display 18 and a speaker 20) for making a determination and notifying abnormality when it is off.

  The means 6 is any respiratory function test apparatus (spirometer 100 capable of executing flow and volume monitoring) selected from the means 1 to 3, wherein the respiratory flow rate (flow signal) by the respiratory measurement means. When the respiratory flow monitoring by the respiratory measurement means and the pulse wave monitoring by the pulse wave measurement means are being executed, the relationship between the intrathoracic pressure and the respiratory flow is determined to be abnormal. Breathing, further comprising: a notification means for giving notification to the display 18 and the speaker 20 for giving notification when the estimated intrathoracic pressure / the flow being monitored in the second monitoring process is an abnormal value. Functional inspection device.

  The means 7 includes a first device (a spirometer 100 ′ including the flow sensor 50 and the pressure sensor 11) that measures a respiratory volume during a period including an expiration period and an inspiration period, and a pulse wave measurement means that measures a pulse wave. (Pulse wave probe 60 and pulse wave module), estimation means (CPU, RAM, etc.) for estimating the intrathoracic pressure based on the pulse wave measured by the pulse wave measurement means, and intrathoracic pressure estimated by the estimation means And a second device (pulse wave measuring device 110) comprising display means (display capable of displaying an intrathoracic pressure / volume curve) for displaying a relationship between the respiratory volume acquired by the first device. A respiratory function test system (200) characterized by the following.

  Further, means 8 is the respiratory function test system of means 7, wherein the second device (pulse wave measuring device 110 that does not execute flow and volume monitoring) executes pulse wave monitoring by the pulse wave measuring means. A means for informing when the intrathoracic pressure is determined to be abnormal (determining whether or not the intrathoracic pressure estimated based on the pulse wave signal is out of the range of the resting intrathoracic pressure) The respiratory function test system further includes a display and a speaker for notifying the abnormality when it is disconnected.

  Means 9 is the respiratory function test system of means 7, wherein the second device can communicate with the first device (the volume can be monitored by being communicable with the spirometer 100 ′). And when the relationship between the intrathoracic pressure and the respiratory volume is determined to be abnormal when the respiratory volume is monitored by the first device and the pulse wave is monitored by the pulse wave measuring means. Respiratory function test, further comprising notification means for performing notification (a display and a speaker for performing notification when the volume being monitored is an abnormal value in relation to the estimated intrathoracic pressure in the intrathoracic pressure / volume curve) System.

  The means 10 is the respiratory function test system of the means 7, wherein the first device can perform monitoring of a respiratory flow rate (flow signal), and the second device can communicate with the first device. Yes (flow can be monitored by being able to communicate with the spirometer 100 '), and when monitoring the respiratory flow by the first device and monitoring the pulse wave by the pulse wave measuring means Informing means for informing when the relationship between the intrathoracic pressure and the respiratory flow is determined to be abnormal (a display and a speaker for informing when the respiratory resistance obtained by dividing the intrathoracic pressure by the flow being monitored is an abnormal value) And a respiratory function test system.

  According to the present invention, it is possible to appropriately estimate the state of the respiratory function based on the pulse wave signal.

FIG. 1 is a functional block diagram showing an example of a spirometer. FIG. 2 is a diagram illustrating an example of a flow sensor included in the spirometer. FIG. 3 is a diagram showing an example of reference data creation processing executed by the CPU of the spirometer. FIG. 4 is a diagram illustrating an example of a volume signal and a pulse wave signal. FIG. 5 is an explanatory diagram showing a method for estimating intrathoracic pressure. FIG. 6 is a diagram showing an example of an intrathoracic pressure / volume curve. FIG. 7 is a diagram illustrating an example of the first monitoring process executed by the CPU of the spirometer. FIG. 8 is a diagram illustrating an example of the second monitoring process executed by the CPU of the spirometer. FIG. 9 is an explanatory diagram showing an example of the appearance of the spirometer. FIG. 10 is a diagram showing the configuration of the respiratory function test system.

  Hereinafter, a spirometer 100 which is an example of a respiratory function testing device according to the present invention will be described with reference to the drawings. In the following description, the respiratory flow rate may be referred to as “flow” and the respiratory volume may be referred to as “volume”.

[1. Configuration of Spirometer 100]
As shown in FIG. 1, the spirometer 100 includes a main body 10, a flow sensor 50, a pulse wave probe 60, and the like. The main body 10 includes an operation key 17, a display 18, a speaker 20, a printer 21, a pressure sensor 11, a pulse wave module 61, an A / D converter 12, a CPU 14, a ROM 13, a RAM 15, and an RS232C connector 16. The main body 10 and the flow sensor 50 are connected by a differential pressure tube 30.

  The flow sensor 50 is detachably mounted on the main body unit 10 and generates a differential pressure proportional to the respiratory flow rate. As shown in FIG. 2, the flow sensor 50 includes a connection port 52 for connecting a filter and a mouthpiece (not shown). When the subject breathes through the mouthpiece connected to the connection port 52, a differential pressure is generated in the flow sensor 50, and this differential pressure is transmitted through the differential pressure tube 30 composed of two tubes. Is transmitted to the pressure sensor 11 in the main body 10.

  The operation keys 17 are used when selecting measurement items or inputting subject information (age, height, etc.). For example, it consists of ten numeric keys from 0 to 9, direction keys for selecting measurement items, and the like. Also included is a print key operated when printing out the data output to the display 18. As shown in FIGS. 1 and 2, the flow sensor 50 is provided outside the main body, and one end of a differential pressure tube 30 composed of two tubes is connected, and the other end is a differential pressure tube connection port of the main body 10. (Not shown). In the state where the subject holds the flow sensor 50, the mouthpiece connected to the connection port 52 is included in the mouth, and the respiratory flow is measured by breathing, and the measured respiratory flow is integrated. Thus, the respiratory capacity such as vital capacity is measured.

  The pressure sensor 11 outputs an analog signal proportional to the detected differential pressure. In this example, it is a semiconductor differential pressure sensor, for detecting a differential pressure between tube connection ports, and for outputting a voltage proportional to the differential pressure detected by the differential pressure detection unit. An output terminal is provided. The A / D converter 12 is for converting an analog electronic signal into a digital signal. In this example, it is a semiconductor A / D converter, which converts an analog signal output from the output terminal of the pressure sensor 11 into a digital signal that can be processed by the CPU 14 to be described later, and outputs the digital signal from the digital output terminal.

  The pulse wave probe 60 is a transducer attached to the fingertip of the person to be measured, and includes a light emitting element and a light receiving element (sensor). As an example, light having a specific wavelength is emitted from the light emitting element, and the light receiving element measures the amount of light reflected by the fingertip and outputs it as an electrical signal. For example, a light emitting diode having a center wavelength of 520 to 550 nm can be used as the light emitting element. The pulse wave probe 60 is connected to a pulse wave connector (not shown) of the main body 10. The pulse wave module 61 includes an A / D converter that converts an analog signal output from the pulse wave probe 60 into a digital signal, and is based on the amount of reflected light with respect to the amount of light generated from the light emitting element. A pulse wave signal is generated and output as an electrical signal. The pulse wave signal measured noninvasively in this way is stored in the RAM 15 by the CPU 14 and can be displayed on the display 18. Note that the CPU 14 can count the pulse rate and the like based on a pulse wave signal with a pulse output from the pulse wave module 61.

  The CPU 14 executes the measurement program stored in the ROM 13 by using the RAM 15 as a work area, thereby controlling the operation of each connected component or receiving a signal from each component to perform various processes. Is what you do. In this example, processing for calculating a respiratory flow rate such as an expiratory flow rate or an inspiratory flow rate is performed based on a digital signal that is an output from the A / D converter 12 and indicates a value proportional to the differential pressure. This calculation is performed based on a relational expression between a differential pressure and a respiratory flow rate that are stored in advance. That is, the differential pressure is specified from the digital signal, and the specified differential pressure is input to the relational expression to calculate the respiratory flow rate. In this example, the respiratory volume (volume) is calculated by integrating the respiratory flow rate (flow). The flow signal, volume signal, and pulse wave signal thus measured are accumulated in the RAM 15, and when the measurement is completed, the measurement data accumulated in the RAM 15 is stored in the ROM 13. The measurement data stored in the ROM 13 can be displayed on the display 18 as shown in FIG.

  The ROM 13, which is a non-volatile memory, stores measurement data for the respiratory function in addition to storing measurement data as described above. The ROM 13 also stores guide audio data, and this audio data is reproduced by the speaker 20. The display 18 is an LCD display, and is provided on the upper surface of the main body unit 10 and outputs predetermined data to the screen by performing output control from the CPU 14 via an LCD driver circuit (not shown). The printer 21 is, for example, a thermal printer, and outputs predetermined data on paper so that the CPU 14 can perform printing control via a thermal head driver, and is displayed on the display 18, for example. Print data. The speaker 20 is an audio output means for prompting the subject to exhale or inhale by an audio guide, and an audio based on audio data stored in the ROM 13 in advance is output.

  The RS232C connector 16 is a terminal for transmitting / receiving data to / from a device outside the spirometer such as a PC via a RS232C cable. In this example, the interface with the external PC is an RS232C connector, but the present invention is not limited to this and may be another interface.

  The flow sensor 50 will be described in detail with reference to FIG. A connection port 52 for connecting a filter and a mouthpiece is provided on a side surface of the flow sensor case 51 serving as a housing of the flow sensor 50. A handle 56 for holding the flow sensor case 51 is provided below the flow sensor case 51.

  In the flow tube 53 in the flow sensor case 51, a screen 55 is disposed as a resistor that generates respiratory resistance. The screen 55 is a mesh-like material and is arranged so as to block the gas flow. When a gas flow occurs in the flow pipe 53, a differential pressure is generated before and after the screen 55. The pressure before and after the screen 55 is supplied to a differential pressure tube connection port (not shown) of the main body via a pressure port disposed before and after the screen 55 and a differential pressure tube 30 connected to each of the pressure ports. ). That is, one of the two tubes constituting the differential pressure tube 30 transmits the pressure at the front of the screen (on the connection port 52 side) to one tube connection port connected to the tube, and the other transmits the pressure at the rear of the screen. It transmits to the other tube connection port connected with a tube. On the main body 50 side, the flow rate of the gas flowing in the flow tube 53, that is, the respiratory flow rate can be measured by detecting the differential pressure between the two tube connection ports. This respiratory flow rate is also called a respiratory flow rate. Note that this type of flow sensor is a so-called differential pressure type and is widely used.

  Instead of the flow sensor 50, a face mask that covers the nostril and mouth may be used in order to supplement the fluctuation of the respiratory capacity due to breathing from the nostril. In addition, the use of a face mask facilitates long-term breath monitoring of the subject.

[2. Standard data creation process]
Next, reference data creation processing executed by the spirometer 100 (CPU 14 or the like) will be described with reference to FIG. First, on the initial screen, icons corresponding to various measurements such as “create reference data” are displayed on the display 18. When “reference data creation” is selected by the operation key 17, the reference data creation program is activated, and it becomes possible to measure the respiratory flow rate and the respiratory volume and the pulse wave.

  In this state, the subject grasps the flow sensor 5, includes the mouthpiece provided in the flow sensor 5 in the mouth, and places the pulse wave probe 60 on a finger (or a place where a pulse wave such as an arm can be measured). When breathing (expiration and inhalation) is performed in accordance with instructions from a doctor or laboratory technician in the mounted state, the respiratory measurement means (flow sensor 50, differential pressure tube 30, pressure sensor 11, A / D converter 12, CPU 14, etc.) The respiratory flow (flow) is measured, and the respiratory volume (volume) is measured as an integrated value of the respiratory flow (S101 in FIG. 3). The time-series data of the respiratory flow rate and the respiratory volume measured here is accumulated in the RAM 15, and for example, as shown in FIG. 4A, the horizontal axis (X axis) is time, and the vertical axis (Y axis) is A volume curve with the respiratory volume and a flow volume curve with the horizontal axis (X axis) as the respiratory flow rate and the vertical axis (Y axis) as the respiratory volume are displayed on the display 18. The flow volume curve is a curve showing the relationship between the respiratory volume and the respiratory flow rate at the same time point. The tidal volume and vital capacity (VC) can be calculated based on the volume curve measured in the period including the inspiration period in which the volume increases and the expiration period in which the volume decreases.

  Further, together with the respiration capacity, a pulse wave is measured by a pulse wave measuring means (pulse wave probe 60, pulse wave module 61, CPU 14, etc.) (S101 in FIG. 3). The time-series data of the pulse wave measured here is accumulated in the RAM 15, and for example, as shown in FIG. 4B, the horizontal axis (X axis) is time, and the vertical axis (Y axis) is the pulse wave. A pulse wave signal having an amplitude is displayed on the display 18. FIG. 4B shows a temporal change in the pulse wave signal output (voltage), and the vertical axis indicates the magnitude [V] of the pulse wave output from the reference value (0). Yes. In addition, since each time series data of respiratory volume and pulse wave signal is stored in association with the measurement time, the correspondence between respiratory volume and pulse wave signal at a specific time can be grasped It has become.

  Next, the CPU 14 performs a filtering process on the acquired pulse wave signal (S110). In this filtering process, in order to extract the intrathoracic pressure signal reflected in the pulse wave from the pulse wave signal, noise caused by disturbance light noise or the like and noise caused by body movement (lower frequency than the chest cavity signal). A) A signal of 0.1 Hz or less is cut. Next, the CPU 14 specifies the peak of the pulse wave signal for each cycle of the pulse wave (S111). For example, the time at which the time differential value of the pulse wave signal changes from positive to negative (the time at which the pulse wave signal changes from increasing to decreasing) is specified, and the measurement data at that time is specified as the peak of the pulse wave in that cycle To do.

  Next, the CPU 14 connects the peaks specified in S111 and creates a first envelope indicated by a solid line in FIG. 5A (S112). Next, the CPU 14 specifies the peak of the first envelope, connects each peak of the first envelope, and creates a second envelope indicated by a dotted line in FIG. 5A (S113). Next, as shown in FIG. 5B, the difference between the first envelope and the second envelope is taken, and this difference is used as a relative intrathoracic pressure signal (S114). The method of estimating the relative intrathoracic pressure by such a method is a known technique, and is disclosed in Patent Document 1 described above.

  Next, as shown in FIG. 5C, the CPU 14 executes calibration for converting the relative intrathoracic pressure signal as a relative value into an absolute value (S120). Calibration is to calculate the absolute value of the intrathoracic pressure by calculating a conversion coefficient for matching the amplitudes of the relative intrathoracic pressure signal, which is a relative value, with the amplitude of the intraoral pressure signal, which is an actually measured value. Since the relative intrathoracic pressure and the intraoral pressure correspond to each other, the relative intrathoracic pressure can be converted into an absolute value based on the magnitude of the relative intrathoracic pressure signal and the magnitude of the intraoral pressure signal. In this calibration, normalization is performed by dividing the amplitude of the relative intrathoracic pressure signal by the average pulse wave amplitude so as to exclude the influence of changes in the pressing pressure of the pulse wave probe 60 and the like. This calibration is also a known technique, and is disclosed in Patent Document 1 described above.

  The intraoral pressure signal required for calibration is obtained by actually measuring the intraoral pressure using, for example, a CPAP (Continuous Positive Airway Pressure) mask (so-called nasal mask). The intraoral pressure signal measured for the subject to be measured for the pulse wave is stored in the ROM 13 or is acquired from the intraoral pressure measuring device connected to be communicable via a communication connector (for example, RS232C connector 16), and calibrated. When performing calibration, calibration is performed using the intraoral pressure signal.

  Note that the intraoral pressure signal may be measured in the same respiratory state as the state of the subject who estimates the intrathoracic pressure. For example, when estimating the intrathoracic pressure in the state of resting breathing, the intraoral pressure signal in the state of resting breathing is used for calibration, and when measuring vital capacity (that is, when breathing to the maximum expiratory position and the maximum inspiratory position is required) It is preferable to use the intraoral pressure signal in the same breathing state as that of the vital capacity measurement for calibration.

  Since the relative value and the absolute value of the intrathoracic pressure are associated by this calibration, the absolute value of the intrathoracic pressure can be estimated by measuring (estimating) the relative intrathoracic pressure in the subsequent processing. . Next, the CPU 14 creates an intrathoracic pressure / volume curve indicating the relationship between the intrathoracic pressure as an absolute value and the respiratory capacity (S121). The created intrathoracic pressure / volume curve can be displayed on the display 18. FIG. 6 shows a case where the subject is caused to breathe so as to reach the maximum expiratory position by calling from the maximum inspiratory position (for example, measurement of the vital capacity, which is a difference in capacity between the maximum inspiratory position and the maximum expiratory position) ) Shows the intrathoracic pressure / volume curve.

Intrathoracic pressure / P where the horizontal axis is intrathoracic pressure ΔP (cmH ₂ O) and the vertical axis is vital capacity VC (%) (in this example, 0% is the maximum expiratory position and 100% is the maximum inspiratory position) As shown in FIG. 6, the slope of the volume curve changes in accordance with the change in ΔP.

Here, pulmonary compliance is the amount of change in volume relative to the amount of change in intrathoracic pressure. The greater the amount of change in volume relative to the amount of change in intrathoracic pressure, the greater the flexibility of the lungs, and the amount of change in intrathoracic pressure. If the change in volume is small, it can be determined that the flexibility of the lung is low. Since lung compliance varies depending on the value (range) of intrathoracic pressure, as shown in FIG. 6, the intrathoracic pressure range including both ΔP of less than 0 cmH ₂ O and ΔP of 0 cmH ₂ O or more. It is preferable to actually measure the respiratory volume in and to estimate lung compliance based on the actually measured value. Further, as shown in FIG. 6, it is preferable that different lung compliances (gradients VC / ΔP) can be grasped according to the value of the intrathoracic pressure by the intrathoracic pressure / volume curve.

By displaying the intrathoracic pressure / volume curve as shown in FIG. 6, it becomes possible to grasp the lung compliance according to the value of the intrathoracic pressure, and the respiratory function can be estimated appropriately. In the example of FIG. 6, the transition of the volume when 0% of the vertical axis is the maximum expiratory position and 100% is the maximum inspiratory position is displayed, but the vertical axis is replaced with the actual value of the vital capacity, You may make it display the change of the measured volume. Further, the reserve expiration volume (ERV) may be calculated and displayed based on the volume actually measured when ΔP is 0 cmH ₂ O.

  FIG. 6 is a curve when the subject makes a call from the maximum inspiratory position to the maximum expiratory position (when the vital capacity is measured). Instead of the curve at the time of measuring the vital capacity, or at the time of measuring the vital capacity In addition to the above curve, an intrathoracic pressure / volume curve may be created when the subject is subjected to rest breathing.

[3. First monitoring process]
By using the intrathoracic pressure / volume curve acquired in the reference data creation process, it is possible to monitor the subject's pulse wave and grasp the degree of dyspnea as shown in FIG. Here, as the first monitoring process, the volume monitoring using the spirometer 100 is executed in parallel with the monitoring of the pulse wave. When monitoring the volume, a face mask can be used instead of the flow sensor 50.

  In the first monitoring process, the CPU 14 acquires a volume signal and a pulse wave signal (S200). Next, the above-described relative intrathoracic pressure signal acquisition process of S110 to S114 is executed for the acquired pulse wave signal (S210). Next, based on the fact that the relative value and the absolute value of the intrathoracic pressure signal are associated by the calibration described above, the intrathoracic pressure is specified from the relative intrathoracic pressure (S211).

  Next, the CPU 14 determines whether or not the volume being monitored is an abnormal value in relation to the intrathoracic pressure specified in S211 in the intrathoracic pressure / volume curve (S212). Specifically, it is determined whether or not the volume being monitored deviates from the volume corresponding to the intrathoracic pressure specified in S211 in the intrathoracic pressure / volume curve. The volume measured in S200, If the difference from the volume corresponding to the estimated intrathoracic pressure in the internal pressure / volume curve is equal to or greater than a predetermined threshold (Yes in S212), that fact is displayed on the display 18 or a warning sound is emitted from the speaker 20. Thus, abnormality notification is performed (S213). And acquisition of a volume signal and a pulse wave signal is continued (S200). The abnormality notification in S213 is continued for a predetermined time.

  On the other hand, when the volume being monitored is a normal value in relation to the intrathoracic pressure specified in S211 in the intrathoracic pressure / volume curve (No in S212), that is, the volume measured in S200 and the intrathoracic pressure / volume curve. If the difference from the volume corresponding to the estimated intrathoracic pressure is less than a predetermined threshold, the acquisition of the volume signal and the pulse wave signal is continued (S200).

  Here, if the measured volume deviates from the volume corresponding to the estimated intrathoracic pressure, there is a possibility that lung compliance may have decreased, so it is considered abnormal that the subject is in a dangerous state. By performing the notification, it is possible to take appropriate measures against acute exacerbations and the like. For example, when the subject's breathing is normal (there is no problem in breathing difficulty), the volume range (referred to as “normal range”) corresponding to the intrathoracic pressure in the intrathoracic pressure / volume curve is stored in advance. In this case, the notification may be executed when the volume being monitored is out of the normal range for the estimated intrathoracic pressure.

  Based on the pulse wave signal, the heart rate range in the subject's resting breathing state is stored in advance as the resting heart rate, and the volume range corresponding to the intrathoracic pressure in the resting breathing state is determined in the intrathoracic pressure / volume curve. It is better to store it as a resting volume.

  When the monitored volume is outside the resting volume range for the intrathoracic pressure estimated based on the monitored pulse wave, the heart rate is later than the timing when the resting volume is outside the resting volume range. If the number falls outside the range of the resting heart rate, it can be assumed that the subject is unable to maintain a resting state due to respiratory factors, so that the patient is informed that an abnormality has occurred in the respiratory function. good. On the other hand, if the heart rate is outside the resting heart rate range before the resting volume range, the subject is unable to maintain the resting state due to cardiovascular factors. Therefore, it is preferable to notify that an abnormality has occurred in the circulation function.

  In addition, when the monitored heart rate is outside the range of the resting heart rate, the volume is outside the range of the resting volume at a timing later than the timing when the heart rate is outside the range of the resting heart rate. In this case, since it can be estimated that the subject is unable to maintain a resting state due to a circulatory system factor, it is preferable to notify that an abnormality has occurred in the circulatory function. On the other hand, if the volume is out of the resting volume range before the heart rate is out of the resting heart rate range, the subject cannot maintain the resting state due to respiratory factors. Since it can be estimated that the respiratory function is abnormal, it is better to notify that an abnormality has occurred in the respiratory function.

(3-1. Configuration that does not execute flow and volume monitoring)
Note that, after the reference data creation process is executed, only the pulse wave signal may be monitored without monitoring the flow signal and the volume signal. In this case, in the process corresponding to S200, only the monitoring of the pulse wave signal is performed without monitoring the flow signal and the volume signal, and in the process corresponding to S212, whether the estimated intrathoracic pressure is an abnormal value or not. It is good to judge whether.

  Specifically, in the intrathoracic pressure / volume curve, the intrathoracic pressure range corresponding to the volume fluctuation in the resting breathing state is stored in advance as the resting intrathoracic pressure, and in the processing corresponding to S212, the pulse wave signal It is preferable to determine whether or not the intrathoracic pressure estimated on the basis of the above is out of the range of resting intrathoracic pressure, and when it is out, an abnormality notification is performed.

(3-2. Configuration not performing calibration)
Further, in the reference data creation process, based on the relative intrathoracic pressure estimated based on the pulse wave signal without performing calibration, that is, without requiring measurement of intraoral pressure (estimation of intrathoracic pressure as an absolute value). The respiratory function may be determined. Specifically, without executing the process of S120, in the process corresponding to S121, a relative intrathoracic pressure / volume curve indicating the relationship between the relative intrathoracic pressure and the volume obtained in S114 is created. For example, the relative intrathoracic pressure / volume curve is obtained by replacing the horizontal intrathoracic pressure in FIG. 6 with the relative intrathoracic pressure.

  Then, without executing the process corresponding to S211 in the first monitoring process, in the process corresponding to S212, it is determined whether or not the volume being monitored is an abnormal value in relation to the estimated relative intrathoracic pressure. (For example, determine whether the difference between the volume measured in S200 and the volume corresponding to the estimated relative intrathoracic pressure in the relative intrathoracic pressure / volume curve is equal to or greater than a predetermined threshold) In some cases, it is preferable to perform abnormality notification (in the case of a predetermined threshold value or more).

  In some cases, such as when the subject is an infant, it is difficult to actually measure using an intraoral pressure sensor. In such a case, as described above, the respiratory function may be determined based on the estimated relative intrathoracic pressure and the actually measured volume.

[4. Second monitoring process]
The second monitoring process shown in FIG. 8 can be executed in parallel with the first monitoring process described above or without executing the first monitoring process. In the second monitoring process, based on the correspondence between the relative intrathoracic pressure acquired in the reference data creation process and the intrathoracic pressure, which is an absolute value, it is possible to monitor the subject's pulse wave and grasp the degree of dyspnea It becomes. Here, as the second monitoring process, the flow monitoring using the spirometer 100 is executed in parallel with the monitoring of the pulse wave. Also when performing flow monitoring, a face mask can be used instead of the flow sensor 50.

  In the second monitoring process, the CPU 14 acquires a flow signal and a pulse wave signal (S201). Next, the above-described relative intrathoracic pressure signal acquisition process of S110 to S114 is executed for the acquired pulse wave signal (S210). Next, based on the fact that the relative value and the absolute value of the intrathoracic pressure signal are associated by the calibration described above, the intrathoracic pressure is specified from the relative intrathoracic pressure (S211).

  Next, the CPU 14 calculates a respiratory resistance obtained by dividing the intrathoracic pressure specified in S211 by the monitored flow, and determines whether or not the calculated respiratory resistance is an abnormal value (S220). For example, it is determined whether or not the respiratory resistance is within a range of values at the time of acute exacerbation. If the respiratory resistance is an abnormal value (Yes in S220), the fact is displayed on the display 18 or a warning sound is emitted from the speaker 20 to notify the abnormality (S213). And acquisition of a flow signal and a pulse wave signal is continued (S201). The abnormality notification in S213 is continued for a predetermined time. On the other hand, when the calculated respiratory resistance is a normal value (No in S220), the acquisition of the flow signal and the pulse wave signal is continued (S201).

  Here, in the case where the subject to be monitored is an asthmatic patient, there is a possibility of acute exacerbation when the calculated respiratory resistance is an abnormal value. By notifying the abnormality that the subject is in a dangerous state, it is possible to take appropriate measures against acute exacerbation and the like.

  Further, based on the pulse wave signal, the heart rate range in the subject's rest breathing state may be stored in advance as a resting heart rate, and the breathing resistance range may be stored as the resting breathing resistance.

(4-1. Configuration not performing calibration)
In addition, in the reference data creation process, without performing calibration, that is, without requiring actual measurement of intraoral pressure (estimation of intrathoracic pressure), respiratory function based on the relative intrathoracic pressure estimated based on the pulse wave signal. The determination may be performed. Specifically, without executing the process of S120, in the process corresponding to S121, a relative intrathoracic pressure / volume curve indicating the relationship between the relative intrathoracic pressure and the volume obtained in S114 is created. For example, the relative intrathoracic pressure / volume curve is obtained by replacing the horizontal intrathoracic pressure in FIG. 6 with the relative intrathoracic pressure.

  Then, without executing the process corresponding to S211 in the second monitoring process, in the process corresponding to S220, it is determined whether or not the index value obtained by dividing the estimated relative intrathoracic pressure by the flow being monitored is an abnormal value. Then, when the value is an abnormal value (when it is equal to or greater than a predetermined threshold value), it is preferable to notify the abnormality.

  In some cases, such as when the subject is an infant, it is difficult to actually measure using an intraoral pressure sensor. In such a case, as described above, it is preferable to determine the respiratory function by calculating an index value related to respiratory resistance based on the estimated relative intrathoracic pressure and the actually measured flow.

  As described above, it is possible to easily monitor the degree of asthma symptom by using a spirometer including a flow measuring means for measuring a flow and an intrathoracic pressure estimating means for estimating an intrathoracic pressure (appearance of FIG. 9). (See diagram). For example, if the respiratory resistance calculated based on the monitored flow and the estimated intrathoracic pressure (or relative intrathoracic pressure) is within the low range, “normal” is displayed on the display 18 and the respiratory resistance is within the intermediate range. If there is any, “caution” is displayed, and if the respiratory resistance is within the high range, “danger” is displayed.

  Thus, appropriate measures can be taken by executing notification according to the value of the respiratory resistance. For example, when “CAUTION” is displayed, the subject can be in a resting state, and when “DANGER” is displayed, a measure can be taken such as taking the patient to the hospital.

  In the example of FIG. 9, the flow sensor 50 for detecting the differential pressure and the main body 10 are connected by the differential pressure tube 30, but the differential pressure detection unit (flow sensor) is provided inside the main body. It is good also as a structure which connects from a main-body part to a mouthpiece with a breathing tube. According to this, it is possible to improve the portability of the apparatus by reducing the number of components connected to the main body. In addition, regarding the main body, a smaller LED device than the display 18 is provided instead of the display 18, and the breathing state is notified by the emission color of the LED device, so that the main body is also reduced in size and more portable. be able to. For example, if the respiratory resistance is in the low range, the LED device emits blue light, if the respiratory resistance is in the middle range, emits yellow light, and if the respiratory resistance is in the high range, emits red light. good.

[5. Respiratory function test system]
FIG. 10 is an explanatory diagram showing the configuration of the respiratory function test system 200. The respiratory function inspection system 200 includes a spirometer 100 ′ and a pulse wave measuring device 110. Unlike the spirometer 100 described above, the spirometer 100 ′ does not have a pulse wave measurement function. The pulse wave measuring device 110 includes the pulse wave probe 60 and the pulse wave processing device 70 described above. Like the spirometer 100 described above, the pulse wave processing device 70 includes a pulse wave module and a control unit such as a CPU, a RAM, and a ROM for processing a pulse wave signal. The pulse wave processing device 70 includes an RS232C connector as an input / output port for communicating with the spirometer 100 ′, and further includes a display as a display unit and a notification unit and a speaker as a notification unit.

  Here, the pulse wave processing device 70 acquires (receives) the volume signal measured by the spirometer 100 ′ by being connected to the RS232C connector 16 provided in the main body 10 ′ of the spirometer 100 ′ via a communication cable. ) Is possible. Then, the pulse wave signal processing device 70 executes processing similar to the reference data creation processing based on the received volume signal and the pulse wave signal measured by itself, creates an intrathoracic pressure / volume curve, and displays it on the display. .

  Further, the pulse wave processing device 70 can execute monitoring of the pulse wave signal, but cannot monitor the flow signal and the volume signal by itself. For this reason, as described above, in the process corresponding to S212, the intrathoracic pressure estimated based on the pulse wave signal is equal to the resting intrathoracic pressure, as in the example shown in the “configuration in which flow and volume monitoring is not performed”. It is preferable to determine whether or not out of the range, and to notify abnormality when it is out of range.

  The pulse wave processing device 70 continuously acquires (receives) the volume signal from the spirometer 100 ′, and the volume signal monitored by the spirometer 100 ′ and the pulse wave monitored by itself. Based on the signal, similarly to the process of S212 in the first monitoring process, it is determined whether or not the volume being monitored is an abnormal value in relation to the estimated intrathoracic pressure in the intrathoracic pressure / volume curve. If it is a value, abnormality notification may be performed.

  Further, the pulse wave processing device 70 continuously acquires (receives) a flow signal from the spirometer 100 ′, and the flow signal monitored by the spirometer 100 ′ and the pulse wave monitored by itself. Based on the signal, similar to the process of S220 in the second monitoring process, the respiratory resistance is calculated by the estimated intrathoracic pressure ÷ the flow during monitoring, and it is determined whether or not the calculated respiratory resistance value is an abnormal value. If the value is an abnormal value, abnormality notification may be performed.

11 ... Pressure sensor 13 ... ROM
14 ... CPU
DESCRIPTION OF SYMBOLS 18 ... Display 50 ... Flow sensor 60 ... Pulse wave probe 61 ... Pulse wave module 100 ... Spirometer 100 '... Spirometer 110 ... Pulse wave measuring device 200 ... Respiratory function test system

Claims (10)

A respiration measuring means for measuring a respiration volume in a period including an expiration period and an inspiration period;
A pulse wave measuring means for measuring a pulse wave;
Estimating means for estimating an intrathoracic pressure based on the pulse wave measured by the pulse wave measuring means;
A respiratory function testing device comprising: display means for displaying a relationship between an intrathoracic pressure estimated by the estimating means and a respiratory capacity measured by the respiratory measuring means. The respiratory function testing device according to claim 1,
The respiratory function testing device, wherein the display means displays a relationship curve indicating a relationship between the intrathoracic pressure and the respiratory capacity. The respiratory function testing device according to claim 2,
The respiratory function testing device according to claim 1, wherein the display means displays a relational curve capable of grasping lung compliance according to the intrathoracic pressure. The respiratory function testing device according to any one of claims 1 to 3, wherein
When performing monitoring of respiratory volume by the respiratory measurement means and monitoring of pulse waves by the pulse wave measurement means,
A respiratory function testing apparatus, further comprising a notification unit that performs notification when the relationship between the intrathoracic pressure and the respiratory capacity is determined to be abnormal. The respiratory function testing device according to any one of claims 1 to 3, wherein
When monitoring the pulse wave by the pulse wave measuring means,
A respiratory function testing device further comprising notification means for performing notification when the intrathoracic pressure is determined to be abnormal. The respiratory function testing device according to any one of claims 1 to 3, wherein
Monitoring of respiratory flow by the respiratory measurement means can be performed,
When performing the monitoring of the respiratory flow by the respiratory measurement means and the monitoring of the pulse wave by the pulse wave measurement means,
A respiratory function testing device further comprising notification means for performing notification when the relationship between the intrathoracic pressure and the respiratory flow rate is determined to be abnormal. A first device for measuring a respiratory volume during a period including an expiration period and an inspiration period;
A pulse wave measuring means for measuring a pulse wave;
Estimating means for estimating an intrathoracic pressure based on the pulse wave measured by the pulse wave measuring means;
A second device comprising: display means for displaying a relationship between the intrathoracic pressure estimated by the estimating means and the respiratory capacity acquired by the first device;
A respiratory function test system characterized by comprising: The respiratory function test system according to claim 7,
The second device includes:
A respiratory function test system, further comprising a notification unit that performs notification when the intrathoracic pressure is determined to be abnormal while monitoring the pulse wave by the pulse wave measurement unit. The respiratory function test system according to claim 7,
The second device includes:
Can communicate with the first device;
Notification that performs notification when the relationship between the intrathoracic pressure and the respiratory volume is determined to be abnormal while monitoring the respiratory volume by the first device and the monitoring of the pulse wave by the pulse wave measuring means A respiratory function testing system further comprising means. The respiratory function test system according to claim 7,
The first device is capable of monitoring respiratory flow,
The second device includes:
Can communicate with the first device;
Notification that performs notification when the relationship between the intrathoracic pressure and the respiratory flow is determined to be abnormal when monitoring the respiratory flow by the first device and monitoring the pulse wave by the pulse wave measuring means A respiratory function testing system further comprising means.

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