JP5084923B2 - 生理学的徴候を着装携行式にモニタするモニタ装置、システムおよび記録媒体 - Google Patents
生理学的徴候を着装携行式にモニタするモニタ装置、システムおよび記録媒体 Download PDFInfo
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Description
その改善点は、誘導プレチスモグラフの一次側巻線のインダクタンスが反射インダクタンスの約10倍を超える大きさになるように、誘導プレチスモグラフを発振器に結合するインピーダンス整合変圧器、および、誘導プレチスモグラフを変圧器に結合するケーブル、または誘導プレチスモグラフの導体を中に具備して身体部分周囲に複数回巻き付けるケーブルを選択すること、または、中心導体の直径に対するスクリーン直径の比率が、ユニット長さ当たりのインダクタンスを低下させるために最小限になるよう、変圧器に誘導プレチスモグラフを接続するケーブルを選択することを含む。
医療をこのように移動させると、医療費用が削減でき、治療計画に対する患者の関わり方および参加の仕方が深くなる可能性があるため、社会的に望ましいことがわかっている。非侵襲的かつ着装携行式モニタ装置は、血管カテーテルなどの身体内に配置される侵襲性センサに付随し、病院外でかなり高まる危険性がなくなるため、こうした移行を補助できるものである。
マイクロプロセッサ・ユニットはさらに、モニタ対象の個体がマイクロプロセッサ・ユニットへの情報やコマンドを入力できる入力装置を含む。
本明細書でいう「誘導プレチスモグラフ」は、測定対象である領域の周囲に密着させた可撓性導体の自己インダクタンスを決定することにより、身体の断面積を測定する方法をいう。実質的に平面状である導電性ループのインダクタンスは、とりわけループの断面積と共に変化することでよく知られているため、インダクタンス測定値を、プレチスモグラフ領域の定量値に変換することができる。ループをインダクタンスとして可変周波数LC発振器に接続した後、発振器の周波数をループ・インダクタンスの断面積と共に変化させることなどの従来技術で周知の技法により、変化するループ・インダクタンスを測定することができる。発振器の周波数をデジタル値に変換し、これをさらに処理して、対象の生理学的パラメータを得る。
以下に、本発明の具体的な態様を様々に組み合わせて説明する。説明する組み合わせは代表例として挙げるものであり、何ら限定するものではない。当業者であれば、例示の有無にかかわらず、これらの具体的な態様を、異なるモニタ作業に対応させられるように異なる組み合わせで利用可能であることが明白であろう。簡単な例を挙げると、心臓(肺)パラメータの場合には、肺(または心臓)用センサをモニタ装置から除去することができる。一方、例示する実施形態に、必要であれば追加センサを付加することもできる。
図9は、モニタ対象の個体への負担を最小限にしながら、経済的な方法で、日常活動に対して着装携行式に基本的な肺および心臓のパラメータをモニタするための、本発明によるモニタ装置の一実施形態を示す。この装置は、モニタ用衣服1と、センサ撚り合わせケーブル2と、マイクロプロセッサ・ユニット3とを含む。
ベルト5を、好ましくは剣状突起と同じ高さに配置し、ベルト7を、好ましくは頸部基部上1〜2cmのところに配置する。この衣服に、ECG電極と、ECGリード10(右腕信号付近)および11(左腕信号付近)および12(左脚シート信号付近)とを具備する切抜き部分12を設けることが好ましい。別の実施形態において、センサ・ベルト4および6またはセンサ・ベルト5をなくすことができる。または任意のセンサ・ベルト7の省略、または追加センサ・ベルトの装着なども可能である。
センサ導体を、複数の別個の接続部分によりこれに取付けることができる。これを、糸で縫いつけたループにすることができる。より好ましくは、ベルトは、織り込みまたは編み込み処理時に、正弦曲線状に配置された銅製ワイヤを中に一体化させた、織り弾性材料または編み込み弾性材料を含む。2001年1月31日に提出され、本願の譲受人に譲渡された米国特許出願第09/774,333号を参照されたい(その内容全体を本明細書内に引用したものとする)。センサ導体を、膠を利用するなど、従来技術で周知の他の方法で、下に位置する材料に装着させることもできる。
睡眠時のいびきの検出は、睡眠時無呼吸症の研究に有用な、初期または真性上気道閉塞を示す価値あることである。このような実施形態では、マイクロプロセッサ・モジュールが、標準化された方法および標準化されたフォーマットで、経皮的に測定可能な大量の生理学的パラメータを反映する情報を蓄積できる。
上述したように、本発明のモニタ装置に、主要信号ケーブルと二次的信号ケーブルとを具備することができる。図1は、主なセンサ・ベルト4、5および6からの信号を伝送する主要信号ケーブル2と、二次的センサ・ベルト7とを示す。
このケーブルはまた、リード10および11などの端部に設けられたECG信号を伝送する装備と、コネクタ15で受信するその他のセンサからの信号用装備とを有する。さらに、二次的信号ケーブル16により、任意に、身体上に配置された複数の他のセンサから信号を伝送することができる。
別法として、ニューラル・ネットワークやルール・ベース・システムなどの人工技術を用いて、より強力なマイクロプロセッサ・ユニットに、より複雑な警報状態を認識させることができる。
さらに、バッテリ電力を物理的にユニット3の一部とすることができる。別法として、例えば衣服1のポケット内に、別個のバッテリ・ユニットを配置することもできる。
次に、図2および図3を参照すると、非侵襲的生理学的モニタ用衣服30の別の実施形態は、誘導プレチスモグラフ・センサ20〜25を含む。これらのセンサは、モニタ対象である個体にその胴部上で着用される衣服31に、刺繍、縫付け、埋込み、織込み、印刷により施されている、または他の方法で固定または保持されている。図2および図3に示すように、この衣服は、骨盤領域および上大腿をカバーする部分を備えた、タートルネック型長袖衣服31を含むことができる。別の実施形態では、長袖衣服31ではなく、この衣服は、センサ25を具備していない、図4に示す袖なしシャツ31aを含むことができる。さらに、この衣服を、図2に示した脚部分を設けずに製作することができる。モニタ用衣服30はさらに、衣服31の後身ごろ内側に縫付ける、埋め込む、または接着剤などで固定できる心電図記録用電極センサ26を含むことができる。別法として、心電図記録用電極センサ26を、モニタ対象の個体に直接固定してもよい。衣服31を、ベルクロ(商標登録)ストリップまたは紐16(図2および図3参照)などの固定具32を用いて、身体周囲にぴたりと固定することができる。別法として、衣服は、図4に示すように固定具のないシャツを含むことができる。この実施形態では、センサ20〜25は、それ自体を個体胴部上に固定するための弾性材料部分を含むことができる。
この別法は、例えば、モニタ対象の個体が蝋または難聴である場合、または、メッセージに大量の情報が含まれており、単に可聴メッセージを聞いただけでは把握または理解できない可能性がある場合に利用できる。こうした変形案ではまた、新たなメッセージが提示される場合、個体がマイクロプロセッサ・ユニット33のモニタ・スクリーンに対する視野方向内にいない可能性があるため、モニタ対象の個体に向けられる追加信号が必要である。このため、マイクロプロセッサ・ユニット33は、新たなメッセージがあることをモニタ対象の個体に知らせるための照明可能ランプなどの信号方式デバイスを有する、または作動させることができる。マイクロプロセッサ・ユニット33がモニタ用衣服30に取付けられているため、この信号方式デバイスはまた、作動されると、モニタ対象の個体が感じるようにマイクロプロセッサ・ユニット33を振動させるものであってもよい。
一好適実施形態において、電極20〜26は、マイクロプロセッサ・ユニット33に接続することのできる電子モジュールに配線されている。このモジュールは、マイクロプロセッサ・ユニットの処理装置を用いて、モニタ、警報およびデータのロギング機能を実行する。さらに、デフォルト値とモニタ信号とを比較して、それらが共に許容範囲内であることを確認することができる。モニタ信号が許容範囲値を超えている、または下回っている場合、警報機能が個体にそれを警報する。
製造元に連絡を取ってください。」(製造元の名前および住所を提示してもよい)など、誤動作時に取るべき行動に関するメッセージ。
例えば、160ミリ秒の減速時間の基底線が140ミリ秒に落ちると、マイクロプロセッサ・ユニット33は「利尿促進用錠剤を午後5時に1つ飲んでください。」と出力することができる。減速時間が120ミリ秒に落ちると、マイクロプロセッサ・ユニットは「直ちに医者を呼んでください。」と出力することができる。中心静脈圧は、身体内の流体平衡を反映するものである。この値が低いと、利尿剤の過剰投与による循環血液量減少が起きており、この値が高いと、心不全が重症になっている可能性がある。このように、その日のCVPが8cmH2Oであり、次の日が4cmH2Oとなったら、マイクロプロセッサ・ユニットは「投薬について、直ちに医者に相談してください。」と出力することができる。
本発明は、衣服1に具備する複数のセンサに関わる電子モジュールとユニット3との間に、いくつか可能な電子回路を配線して含む。図5に、この回路、主に誘導プレチスモグラフ信号を処理するための回路の物理的配線として選択可能な例を示す。ここでは、前の場合と同様に、衣服1は、主要信号ケーブル2によりマイクロプロセッサ・ユニット3に接続された誘導プレチスモグラフ・センサ・ベルト4、5および6を含む。ECGにはリード10および11が具備され、第3のリード47も衣服1の下に配置されている。これらのリードが一緒に、標準3リード式ECGの代表的な信号を収集する。
これは、平均すれば縮小可能な、10ppm誤差を下回る数値である。例えば、2.5ミリ秒について平均すると、およそ2ppm未満の誤差となる。したがって、図7の復調器ブロックでは、誘導プレチスモグラフに必要な正確さを実現している。一方、復調器ブロックが単に0.5ミリ秒サンプリング間隔内で発振器サイクル数をカウントすると、そのランダム誤差は、約3300ppmに対して、0.5ミリ秒毎におよそ300kHz周期または1.67ピコ秒の半分となる。このように不正確になると、最大でも1000ppmの振幅である呼吸および心臓誘導プレチスモグラフの信号は完全に隠れてしまう。
図10は、本発明によるモニタ装置を組み入れた、本発明によるシステムの操作方法全体を示すものである。ここでは、モニタ対象である個体80を、モニタ用衣服を着用し、本発明の好適実施形態による(データ入力のために)マイクロプロセッサ・ユニット(総称してモニタ装置とする)を保持しているものとして図示している。
当業者であれば、本明細書内の記載から様々な実施形態を追加できることが明らかであろう。
他のプレチスモグラフ・センサを、本発明のモニタ装置に組み入れることができる。まず、既存のセンサが収集したデータを他のセンサで増補することができる。例えば、1つまたは複数の胸部センサ・ベルトを、剣状突起の高さに配置された上述の心臓用ベルト上に追加することにより、心臓機能についてさらなる情報が得られる。
誘導プレチスモグラフ・センサ・ベルトの数を、例えば10本、20本または30本以上に増やし、胴部の鉛直軸方向に実質的に均等に配置して、シャツのような衣服を作製することができる。これらのベルトからの信号は、データ速度の上昇にも十分に対応可能なマイクロプロセッサ・ユニット(またはコンピュータ・システム)と通信状態にある、ベルトより少ない数のローカル電子モジュールに多重送信される。
無線周波数(RF)回路およびプロトコルが進出しているため、少なくとも主信号ケーブルを、誘導プレチスモグラフ・センサとマイクロプロセッサ・ユニットとの間の無線伝送に置き換えると有利になる可能性がある。任意に、すべてのデータ・ケーブルをなくすことができる。これは、モニタ対象の個体にとって、モニタ装置のモニタ用衣服との併用方法が簡略化される点で有利である。
3 ユニット
2,16 信号ケーブル
4 プレチスモグラフ・センサ・ベルト
5 胸部誘導プレチスモグラフ・センサ・ベルト
6 腹部誘導プレチスモグラフ・センサ・ベルト
7 頸部誘導プレチスモグラフ・センサ・ベルト
8 個体締め具
10,11 ECGリード 14 二次的ケーブル
15 コネクタ
20〜25 センサ(電極)
26 心電図記録用電極センサ
28 パルス・オキシメータ・センサ
30,30a モニタ用衣服
31 タートルネック型長袖衣服
31a 袖なしシャツ
33 マイクロプロセッサ・ユニット
Claims (10)
- 個体の生理学的パラメータを非侵襲的にモニタするモニタ装置であって、
モニタ対象である個体の胴部用シャツを含むモニタ用衣服と、
1つまたは複数の誘導プレチスモグラフ(IP)センサであって、
(i)胴部周囲に密着させるために前記衣服に装着される弾性材料による細長いベルトと、
(ii)細長いベルトに装着され、巻き付けられる胴部の断面積に応答するインダクタンスを有する少なくとも1本の可撓性の導電性ループを含むインダクタンス・センサと、
(iii)胴部に沿ってIPセンサが長手方向に移動することを実質的に防止するようにIPセンサの周方向の締め具合を調節する締め具と、
をそれぞれ含むIPセンサと、
前記IPセンサから信号を受信し、受信した信号すべてから導き出されるデジタル・データを取外し可能なコンピュータ可読記憶媒体内に記録するマイクロプロセッサを含むマイクロプロセッサ・ユニットと
を含むモニタ装置。 - センサが具備する導電性ループのインダクタンスが示す生理学的パラメータに測定範囲内の変化がないとき、各IPセンサの長手方向の移動が実質的に防止される、請求項1に記載のモニタ装置。
- モニタ用衣服が、IPセンサを実質的に長手方向に移動させるほど大きな力をIPセンサにかけずに胴部を長手方向に伸張できるように設けた余分な布帛を含む、請求項1に記載のモニタ装置。
- モニタ用衣服が、実質的に長手方向に移動させるほど大きな力をIPセンサにかけずに胴部を長手方向に伸張できるように長手方向の弾性が十分である布帛を含む、請求項1に記載のモニタ装置。
- 締め具が、シンチ・ベルトと、余分なシンチ・ベルトを張力下で剥離自在に把持する把持具とを含む、請求項1に記載のモニタ装置。
- 締め具が絞り紐を含む、請求項1に記載のモニタ装置。
- 心室の収縮に応答して信号を生成する心臓タイミング・センサをさらに含み、前記マイクロプロセッサ・ユニットがさらに、前記心臓タイミング・センサから受信した信号から導き出されるデジタル・データを記録する、請求項1に記載のモニタ装置。
- 前記IPセンサから前記マイクロプロセッサ・ユニットへと信号を伝送する信号ケーブルをさらに含む、請求項1に記載のモニタ装置。
- 個体の生理学的パラメータを非侵襲的にモニタするモニタ装置であって、
モニタ対象の個体の胴部用シャツおよびそのシャツを開閉する長手方向ファスナを含むモニタ用衣服と、
胴部周囲に密着して配置され、その胴部の断面積に応答するインダクタンスを有する少なくとも1本の可撓性の導電性ループを具備するインダクタンス・センサをそれぞれ含む、1つまたは複数の誘導プレチスモグラフ(IP)センサと、
心室収縮の発生に応答して信号を生成する心臓タイミング・センサと、
前記IPセンサ及び心臓タイミング・センサから信号を伝送する信号ケーブルと、
前記信号ケーブルから信号を受信し、受信した信号すべてから導き出されるデジタル・データを取外し可能なコンピュータ可読記憶媒体内に記録するマイクロプロセッサを含むマイクロプロセッサ・ユニットと
を含み、
ここで、前記信号ケーブルは少なくとも一つのモジュールを含み、前記モジュールが前記IPセンサの導電性ループに接続されることにより前記導電性ループは電気的に完成し、前記導電性ループの両端部は前記モジュールから取外し可能であり、そして、前記モジュールはIPセンサに応答して信号を生成する回路を含む、
モニタ装置。 - 少なくとも1つのIPセンサが、胴部に沿ってIPセンサが長手方向に移動することを実質的に防止するようにIPセンサの周方向の締め具合を調節し、シャツをゆるめることを妨げないように配置され得る締め具をさらに含む、請求項9に記載のモニタ装置。
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JP2011136182A (ja) | 2011-07-14 |
US20030135127A1 (en) | 2003-07-17 |
EP2324761A3 (en) | 2014-06-18 |
US9750429B1 (en) | 2017-09-05 |
EP2324761A2 (en) | 2011-05-25 |
EP2324760B1 (en) | 2019-07-24 |
IL152300A (en) | 2007-08-19 |
JP2003530184A (ja) | 2003-10-14 |
US20110087115A1 (en) | 2011-04-14 |
CA2405848C (en) | 2010-11-09 |
EP2324760A2 (en) | 2011-05-25 |
JP2010279715A (ja) | 2010-12-16 |
KR20030066322A (ko) | 2003-08-09 |
IL152300A0 (en) | 2003-05-29 |
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