JP5568151B2 - Blood pressure pulse wave inspection device - Google Patents

Description

  The present invention relates to a blood pressure pulse wave inspection apparatus for deriving an index (hereinafter referred to as “arteriosclerosis degree”) to be used for inspection of arteriosclerosis by utilizing biological information such as blood pressure and pulse wave.

  The arteriosclerosis test includes, for example, a test for blood flow disorder in the lower limb blood vessels and a test for arterial extensibility. The blood pressure pulse wave inspection apparatus used for these examinations can measure biological information such as blood pressure and pulse wave to derive the degree of arteriosclerosis. Hereinafter, some examples of the degree of arteriosclerosis will be described. In addition, the measuring method of each index is not limited to the one described here, and can be measured by various methods.

  For example, ABI (Ankle Brachial Index) is used for the examination of blood flow disorders in the lower limb blood vessels.

  ABI is a value obtained by dividing the value of the systolic blood pressure of the ankle by the value of the systolic blood pressure of the upper arm, and is sometimes called API or ABPI. As an index similar to ABI, there is an index called TBI (Toe Pressure Index). The TBI is a value obtained by dividing the value of the systolic blood pressure of the toes (toes) by the value of the systolic blood pressure in the upper arm, and is sometimes called TPI or TBPI.

  For the examination of arterial extensibility, for example, aortic PWV (Pulse Wave Velocity) (see, for example, Non-Patent Document 1) and baPWV (brachial-ankle Pulse Wave Velocity: upper arm-ankle PWV) (for example, see Non-Patent Document 2) ), CAVI (Cardio-Ankle Vascular Index) (for example, see Non-Patent Document 3) and the like.

  PWV is a pulse wave velocity, and is a value having a velocity unit obtained by dividing the value of the distance between two different points on the blood vessel by the value of the time difference between the pulse waves at the two points. For example, various types of pulse wave sensors such as an air conduction type, a photoelectric type, an air bag type, an amorphous type, and a tonometry type may be used for measuring the pulse wave. Further, the aorta, which is an elastic artery, may be adopted as a target site for PWV measurement, and the PWV measured in the aorta is referred to as the aorta PWV. There are mainly two methods for measuring the aortic PWV.

In one aorta PWV measurement method, for example, the aorta PWV is obtained by the following equation (1).
PWV = (b + c−a) / ΔT (1)
Here, ΔT is the time difference between the pulse wave rising portion at the carotid artery portion and the pulse wave rising portion at the femoral artery portion, a is the distance from the suprasternal fossa to the carotid artery portion, and b is C is the distance from the umbilicus to the femoral artery.

In the other aorta PWV measurement method, for example, the aorta PWV is obtained by the following equation (2).
PWV = D × 1.3 / (ΔT + Tc) (2)
Here, ΔT is a time difference between the pulse wave rising portion in the carotid artery portion and the pulse wave rising portion in the femoral artery portion, and Tc is from the start of the heart II sound (heart sound generated when the aortic valve is closed). It is the time to the notch (dichroic notch) of the pulse wave in the carotid artery, and D is a straight line from the right edge of the second intercostal sternum where the heart sound microphone for measuring heart II sound is placed to the femoral artery It is a distance, and 1.3 is an anatomical correction value.

For example, baPWV is obtained by the following equation (3).
baPWV = (La−Lb) / Tba (3)
Here, Tba is the time difference between the pulse wave rising part at the upper arm and the pulse wave rising part at the ankle, each measured using a cuff, and La is the distance from the aortic valve opening to the ankle. , Lb is the distance from the aortic valve opening to the upper arm.

ここで、Ｐｓは、上腕の収縮期血圧であり、Ｐｄは、上腕の拡張期血圧であり、ρは血液密度であり、ΔＰは、Ｐｓ−Ｐｄである。また、ＰＷＶは、脈波伝播速度であり、例えば次の式（５）により求められる。

ここで、Ｔｂは、心II音の開始から上腕での脈波の切痕部までの時間であり、Ｔｂａは、上腕での脈波立ち上がり部と足首での脈波立ち上がり部との時間差であり、Ｄは、心II音を計測する心音マイクが置かれた胸骨右縁第II肋間から大腿動脈部までの直線距離であり、１．３は解剖学的補正値であり、Ｌ２は、大腿動脈部から膝関節中央部までの直線距離であり、Ｌ３は、膝関節中央部から足首カフ装着中央部までの直線距離である。 In CAVI measurement, blood pressure and pulse waves are measured by attaching cuffs to the upper arm and ankle (or popliteal area), and heart sounds are measured by attaching a heart sound microphone to the sternum. CAVI is obtained by the following equation (4), for example.

Here, Ps is the systolic blood pressure of the upper arm, Pd is the diastolic blood pressure of the upper arm, ρ is the blood density, and ΔP is Ps−Pd. Moreover, PWV is a pulse wave propagation velocity and is calculated | required by following Formula (5), for example.

Here, Tb is the time from the start of the heart II sound to the pulse wave notch in the upper arm, and Tba is the time difference between the pulse wave rising part in the upper arm and the pulse wave rising part in the ankle. , D is the straight line distance from the right intercostal intercostal space II where the heart sound microphone for measuring heart II sound is placed to the femoral artery, 1.3 is an anatomical correction value, and L2 is the femoral artery L3 is a linear distance from the knee joint central part to the ankle cuff wearing central part.

Yoshiaki Masuda, Hiroshi Kanai, “Fundamental and Clinical Arterial Pulse Waves”, Kyoritsu Shuppan, 15-19 pages, 2000 Toshio Ozawa, Yoshiaki Masuda, "Pulse wave velocity", Medical View, 28-29 pages Kohji Shirai, Junji Utino, Kuniaki Ohtsuka, Masanobu Takada, "A Novel Blood Pressure-independent Arterial Wall Stiffness Parameter; Cardio-Ankle Vascular Index (CAVI)", Journal of Atherosclerosis and Thrombosis, Vol.13, No.2

  As can be seen from the above description, detection of feature points such as a pulse wave rising portion and a notch portion is necessary for calculation of the degree of arteriosclerosis related to the arterial extensibility test. In addition, in other arteriosclerosis derivation methods not described here, it is necessary to detect some feature points. Therefore, the detection accuracy of feature points has a great influence on the reliability of the derived degree of arteriosclerosis.

  However, pulse waves tend to fluctuate and are not easily detected accurately. In particular, in the case of the air bag type, that is, the method of measuring the pulse wave by the pressure fluctuation of the air bag inside by wrapping the cuff around the measurement target part, it can be measured relatively easily, but it is easily affected by external factors. . Therefore, there is a certain limit to the reliability of the degree of arteriosclerosis.

  The present invention has been made in view of such a point, and an object thereof is to provide a blood pressure pulse wave examination apparatus capable of improving the reliability of the degree of arteriosclerosis obtained from the detection result of pulse waves.

A blood pressure pulse wave inspection device of the present invention includes a plurality of cuffs that can be wound around a plurality of parts of a subject , a measurement unit that measures the pulse waves of the subject using the plurality of cuffs , When measuring a pulse wave, a blood pressure pulse wave measurement unit including a pressure control unit that controls cuff pressure for each of the plurality of cuffs, and a feature part of the measured pulse wave are detected, and the detected feature part is A blood pressure pulse wave measurement unit that pressurizes the at least one cuff from a cuff pressure in a non-pressurized state during the pressurization. The blood pressure of the subject is measured using the at least one cuff, and the pressurization is stopped at a cuff pressure equal to or higher than the systolic blood pressure determined according to the measured systolic blood pressure of the subject. In this state, the pulse wave of the subject is measured using the at least one cuff while the cuff pressure is maintained .

  ADVANTAGE OF THE INVENTION According to this invention, the reliability of the arteriosclerosis degree calculated | required from the detection result of a pulse wave can be improved.

The figure which shows the structure of the blood pressure pulse wave test | inspection apparatus which concerns on one embodiment of this invention. The flowchart for demonstrating the arteriosclerosis degree calculation process which concerns on one embodiment of this invention The flowchart for demonstrating the pulse wave measurement process which concerns on one embodiment of this invention The figure for demonstrating the waveform analysis result which concerns on one embodiment of this invention The flowchart for demonstrating the 1st modification of the pulse wave measurement process which concerns on one embodiment of this invention The flowchart for demonstrating the 2nd modification of the pulse wave measurement process which concerns on one embodiment of this invention The flowchart for demonstrating the 3rd modification of the pulse wave measurement process which concerns on one embodiment of this invention

  Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings.

  FIG. 1 is a diagram showing a configuration of a blood pressure pulse wave inspection apparatus according to an embodiment of the present invention.

  In FIG. 1, the blood pressure pulse wave examination apparatus includes an arithmetic control unit 10, a display unit 70, a recording unit 75, a storage unit 80, a sound generation unit 85, an input / instruction unit 90, an upper arm measurement control unit 201, and a lower limb measurement control. The unit 202, the heart sound measuring unit 203, the electrocardiogram measuring unit 204, and the pulse wave measuring unit 205 are housed in the main body casing. The upper arm cuff 21R and the left upper arm cuff 21L are connected to the upper arm measurement control unit 201 via the hose 21h, respectively, and the lower ankle cuff 22R and the left ankle cuff 22L are connected to the lower limb measurement control unit 202, respectively. Are connected via a hose 22h, a heart sound microphone 23 is connected to the heart sound measuring unit 203, and an electrocardiogram electrode portion 24a for limbs and an electrocardiogram electrode portion 24b for chest are connected to the electrocardiogram measurement unit 204 to measure pulse waves. Amorphous pulse wave sensors 25 a and 25 b are connected to the unit 205. The upper arm measurement control unit 201 and the lower limb measurement control unit 202 constitute a blood pressure pulse wave measurement unit 200.

  The arithmetic control unit 10 is a computer having a CPU (Central Processing Unit), a ROM (Read Only Memory), a RAM (Random Access Memory), various interfaces, and the like. The arithmetic control unit 10 controls the operation of the entire apparatus described below by executing a control program stored in the ROM by the CPU.

  The arithmetic control unit 10 also includes an upper arm measurement control unit 201, a lower limb measurement control unit 202, a heart sound measurement unit 203, an electrocardiogram measurement unit 204, and a pulse wave measurement unit 205 (hereinafter referred to as “each biological body”. Control information measuring unit).

  Further, the arithmetic control unit 10 receives biological information supplied from each biological information measuring unit. The received biometric information is edited or converted into display data when it is necessary to display it on the screen, and then edited or converted into print data when it is necessary to print on report paper. The data is output to the recording unit 75 above. In addition, the arithmetic control unit 10 appropriately stores the received biological information in the storage unit 80 or reads the stored biological information.

  In addition, the arithmetic control unit 10 as a derivation unit performs waveform analysis of the biological information received from each biological information measuring unit. In the waveform analysis, detection of feature portions (segment points) in the waveform is performed. Examples of the characteristic part include a start part of heart II sound, a rising part of a pulse wave at the upper arm, a rising part of a pulse wave at the ankle, and a notch part of the pulse wave at the upper arm. The arithmetic control unit 10 calculates the degree of arteriosclerosis based on the analysis result and a numerical value (for example, blood pressure) indicated by the received biological information. Since the degree of arteriosclerosis that can be calculated and the calculation formula thereof have already been described, the description thereof is omitted here.

  The arithmetic control unit 10 also edits or converts the arteriosclerosis degree and the waveform analysis result into display data when necessary to be displayed on the screen, as in the case of the biological information, and displays the report data on the display unit 70. When it is necessary to print on paper, the data is edited or converted into print data and output to the recording unit 75. In addition, the arithmetic control unit 10 appropriately stores the degree of arteriosclerosis and the analysis result in the storage unit 80 and reads out the stored information.

  Further, the arithmetic control unit 10 outputs guidance data to the voice generation unit 85 when voice guidance for assisting the user's operation is necessary.

  Further, the arithmetic control unit 10 receives the contents of the input and instruction by the user's operation from the input / instruction part 90, and according to the received contents, each biological information measuring unit, display unit 70, recording unit 75, storage unit 80, voice Settings related to the function of the generation unit 85 are made, and the start and stop of each operation are controlled.

  The display unit 70 is a display device having a display screen such as an LCD (Liquid Crystal Display), for example, and displays biological information, waveform analysis results, and arteriosclerosis degree input as display data from the arithmetic control unit 10 on the screen. .

  The recording unit 75 has a paper feed mechanism, a print head, and the like as main components, and prints biometric information, waveform analysis results, and arteriosclerosis degree input as print data from the arithmetic control unit 10 on a sheet.

  The storage unit 80 includes a hard disk drive, a writable optical disk drive, a non-volatile memory, and the like, and can hold information from the arithmetic control unit 10.

  The sound generation unit 85 has a speaker or the like as a main component, and generates a guidance sound or a notification sound according to guidance data or a notification sound output instruction signal input from the arithmetic control unit 10.

  The input / instruction unit 90 includes a keyboard, a mouse, buttons, a touch panel, and the like, and enables input and instructions by user operations. The contents of user input and instructions are notified to the arithmetic control unit 10.

  The pulse wave measuring unit 205 is an amorphous pulse wave measuring means. The pulse wave measurement unit 205 supplies a pulse wave signal of the subject detected by the amorphous pulse wave sensors 25a and 25b appropriately attached to the subject to the arithmetic control unit 10, thereby measuring the pulse wave. I do. The pulse wave measurement may be started when the biological information acquisition apparatus is turned on, or may be started when a pulse wave measurement start instruction is received from the arithmetic control unit 10. The pulse wave measurement by the pulse wave measurement unit 205 is preferably used when the arithmetic control unit 10 obtains the aorta PWV. In this case, one of the amorphous pulse wave sensors 25a and 25b is the carotid part of the subject. The other is attached to the subject's femoral artery or knee.

  The electrocardiogram measurement unit 204 measures the electrocardiogram by supplying the operation control unit 10 with the electrocardiogram signals detected by the electrocardiogram electrode unit 24a for the limbs and the electrocardiogram electrode unit 24b for the chest attached to the subject. The limb electrocardiogram electrode portion 24a typically includes four electrocardiogram electrodes attached to the right wrist, the left wrist, the right ankle, and the left ankle, respectively. The electrocardiographic electrodes for both ankles are preferably formed so that attachment to both ankles is not hindered by the right ankle cuff 22R and the left ankle cuff 22L. Moreover, the electrocardiogram electrode portion 25b for the chest is typically composed of six electrocardiographic electrodes that are respectively attached to six locations on the chest.

  The heart sound measuring unit 203 measures the heart sound by supplying a heart sound signal detected by the heart sound microphone 23 attached to the subject to the arithmetic control unit 10.

  In the present embodiment, the blood pressure pulse wave measurement unit 200 as the measurement unit and the pressure control unit is provided with the upper limb measurement control unit 201 and the lower limb measurement control unit 202 independently. The control unit 201 and the lower limb measurement control unit 202 may be integrated. The blood pressure pulse wave measurement unit 200 is an oscillometric blood pressure pulse wave measurement unit, and has both functions of a blood pressure measurement unit and a pulse wave measurement unit.

  The upper arm measurement control unit 201 includes, in addition to the two pressure sensors 211R and 211L, a pump, an exhaust valve, a CPU, a memory, and a filter. The memory stores a program for controlling blood pressure measurement and pulse wave measurement by the pump, the exhaust valve, the upper right arm cuff 21R and the left upper arm cuff 21L, and setting information related to this control. The upper arm measurement control unit 201 executes a program according to the setting information by the CPU. The upper arm measurement control unit 201 uses a pump and an exhaust valve to introduce air into the rubber pouches 21aR and 21aL of the upper right arm cuff 21R and the left upper arm cuff 21L via the hose 21h, thereby causing the upper arm cuff 21R to enter. The left upper arm cuff 21L is pressurized while the upper right arm cuff 21R and the left upper arm cuff 21L are depressurized by discharging air from the rubber sac 21aR and 21aL. The upper right arm cuff 21R indicates a cuff wound around the upper right arm during use, and the left upper arm cuff 21L indicates a cuff wound around the left upper arm during use.

  In addition, the upper arm measurement control unit 201 holds the cuff pressures of the upper right arm cuff 21R and the left upper arm 21L after the cuff pressurization (that is, does not perform intake / exhaust to the rubber sac 21aR, 21aL). The cuff pressure vibration of the cuff 21R for the left upper arm and the left upper arm 21L is detected by the pressure sensors 211R and 211L as a pulse wave signal, and the detected pulse wave signal is supplied to the arithmetic control unit 10 to measure the pulse wave. The upper arm measurement control unit 201 outputs the pulse wave signal to the calculation control unit 10 after filtering the pulse wave signal using a filter. Since the pulse wave signal is used for waveform analysis for feature detection in the arithmetic and control unit 10, a digital filter of a type that can perform filtering without destroying the phase component of the pulse wave in order to ensure accurate waveform analysis Is preferably used.

  The upper arm measurement control unit 201 measures blood pressure during cuff decompression or cuff pressurization.

  In the case of blood pressure measurement during cuff decompression, the upper arm measurement control unit 201 detects the vibration of the cuff pressure of the upper right arm cuff 21R and the left upper arm cuff 21L by the pressure sensors 211R and 211L, and the vibration amplitude increases most. A significant cuff pressure is detected as systolic blood pressure, a cuff pressure with the most significant decrease in vibration amplitude is detected as diastolic blood pressure, and blood pressure signals indicating the detected systolic blood pressure and diastolic blood pressure are respectively calculated and controlled. By supplying to 10, blood pressure is measured. In this case, the upper arm measurement control unit 201 can separately perform measurement of the right blood pressure using only the upper right arm cuff 21R and measurement of the left blood pressure using only the left upper arm cuff 21L. .

  In the case of blood pressure measurement during cuff pressurization, the upper arm measurement control unit 201 increases the vibration amplitude while detecting the vibration of the cuff pressure of the upper right arm cuff 21R and the left upper arm cuff 21L by the pressure sensors 211R and 211L. The most prominent cuff pressure is detected as diastolic blood pressure, the cuff pressure with the most significant decrease in vibration amplitude is detected as systolic blood pressure, and blood pressure signals indicating the detected diastolic blood pressure and systolic blood pressure are calculated and controlled. By supplying to the unit 10, blood pressure is measured. In this case, the upper arm measurement control unit 201 can separately perform measurement of the right blood pressure using only the upper right arm cuff R and measurement of the left blood pressure using only the left upper arm cuff 21L. .

  Note that the systolic blood pressure and the diastolic blood pressure can be detected from the vibrating cuff pressure by the arithmetic control unit 10 instead of the upper arm measurement control unit 201.

  The lower limb measurement control unit 202 includes a pump, an exhaust valve, a CPU, a memory, and a filter in addition to the two pressure sensors 221R and 221L. The memory stores a program for controlling blood pressure measurement and pulse wave measurement by the pump, the exhaust valve, the right ankle cuff 22R and the left ankle cuff 22L, and setting information related to this control. The lower limb measurement control unit 202 executes a program according to the setting information by the CPU. The lower limb measurement control unit 202 introduces air into the rubber sac 22aR and 22aL of the right ankle cuff 22R and the left ankle cuff 22L through the hose 22h by using a pump and an exhaust valve, thereby causing the right ankle cuff 22R. The left ankle cuff 22L is pressurized while the right ankle cuff 22R and the left ankle cuff 22L are depressurized by discharging air from the rubber sac 22aR and 22aL. The right ankle cuff 22R indicates a cuff wound around the right ankle during use, and the left ankle cuff 22L indicates a cuff wound around the left ankle during use.

  In addition, the measurement control unit 202 for the lower limbs maintains the cuff pressure of the right ankle cuff 22R and the left ankle 22L after cuff pressurization (that is, does not perform intake / exhaust to the rubber sac 22aR, 22aL). The cuff pressure vibration of the cuff 22R for left and 22L for the left ankle is detected as a pulse wave signal by the pressure sensors 221R and 221L, and the detected pulse wave signal is supplied to the arithmetic control unit 10 to measure the pulse wave. The lower limb measurement control unit 202 outputs the pulse wave signal to the arithmetic control unit 10 after filtering the pulse wave signal using a filter. Since the pulse wave signal is used for waveform analysis for feature detection in the arithmetic and control unit 10, a digital filter of a type that can perform filtering without destroying the phase component of the pulse wave in order to ensure accurate waveform analysis Is preferably used.

  The lower limb measurement control unit 202 measures blood pressure during cuff decompression or cuff pressurization.

  In the case of blood pressure measurement during cuff decompression, the lower limb measurement control unit 202 detects the vibration of the cuff pressure of the right ankle cuff 22R and the left ankle cuff 22L by the pressure sensors 221R and 221L, while increasing the vibration amplitude. The most prominent cuff pressure is detected as systolic blood pressure, the cuff pressure with the most significant decrease in vibration amplitude is detected as diastolic blood pressure, and blood pressure signals indicating the detected systolic blood pressure and diastolic blood pressure are calculated and controlled. By supplying to the unit 10, blood pressure is measured. In this case, the lower limb measurement control unit 202 can separately measure the right blood pressure using only the right ankle cuff 22R and the left blood pressure using only the left ankle cuff 22L. .

  In the case of measuring blood pressure during cuff pressurization, the lower limb measurement control unit 202 increases the vibration amplitude while detecting vibrations of the cuff pressure of the right ankle cuff 22R and the left ankle cuff 22L by the pressure sensors 221R and 221L. Detects the most prominent cuff pressure as diastolic blood pressure, detects the cuff pressure with the most significant decrease in vibration amplitude as systolic blood pressure, and calculates blood pressure signals indicating the detected diastolic blood pressure and systolic blood pressure, respectively By supplying the control unit 10, blood pressure is measured. In this case, the lower limb measurement control unit 202 can separately measure the right blood pressure using only the right ankle cuff 22R and the left blood pressure using only the left ankle cuff 22L. .

  The systolic blood pressure and the diastolic blood pressure can be detected from the vibrating cuff pressure by the arithmetic control unit 10 instead of the lower limb measurement control unit 202.

  Next, arteriosclerosis degree calculation processing executed in the blood pressure pulse wave examination apparatus having the above configuration will be described with reference to FIG. Here, an example of processing for calculating CAVI will be described, but the calculation procedure may be variously changed. Other degrees of arteriosclerosis can be calculated by appropriately changing the calculation procedure and the like.

  As advance preparation for the degree of arteriosclerosis calculation, a user (physician, laboratory technician, etc.) first inputs necessary information such as identification information, height, and blood vessel length of the subject using the input / instruction unit 90. The input necessary information is taken into the storage unit 80 by the arithmetic control unit 10. Further, the user places the cuff 21R for the upper right arm, the cuff 21L for the left upper arm, the cuff 22R for the right ankle, the cuff 22L for the left ankle, the heart sound microphone 23, the electrocardiogram electrode part 24a for the limbs and the electrocardiogram electrode part 24b for the chest, respectively. At the predetermined position of the subject. At this time, the heights of the cuffs and the subject's heart are made substantially the same. Then, after confirming the resting state of the subject, the user performs a start operation using the input / instruction unit 90. As a result, an instruction signal to that effect is input to the arithmetic control unit 10, and the arithmetic control unit 10 starts overall control of the arteriosclerosis degree calculation process. In the initial state, each biological information measuring unit is assumed to stop measuring each biological information.

  First, in step S100, the arithmetic control unit 10 outputs a signal for starting an operation for electrocardiogram measurement to the electrocardiogram measurement unit 204, whereby the electrocardiogram measurement unit 204 measures the electrocardiogram of the subject, and the result An electrocardiogram signal indicating is generated. In parallel with this, the arithmetic control unit 10 outputs a signal for starting an operation for heart sound measurement to the heart sound measuring unit 203, and the heart sound measuring unit 203 measures the heart sound of the subject according to this, and the result A heart sound signal indicating is generated. The heart sound signal is taken into the storage unit 80 by the arithmetic control unit 10. Further, in parallel with these, the arithmetic control unit 10 outputs a signal for starting an operation for pulse wave measurement to the upper arm measurement control unit 201 and the lower limb measurement control unit 202, and according to this, the upper arm measurement control unit 201 and the lower limb measurement control unit 202 measure a pulse wave, and generate a pulse wave signal indicating each result. The generated electrocardiogram signal, heart sound signal, and pulse wave signal are taken into the storage unit 80 by the arithmetic control unit 10. Then, the arithmetic control unit 10 reads the signal taken in the storage unit 80 and performs waveform analysis. As described above, in waveform analysis, in waveform analysis, for example, the beginning of heart II sound, the rising part of the pulse wave at the upper arm, the rising part of the pulse wave at the ankle, the notch part of the pulse wave at the upper arm, etc. Is detected. Note that the pulse wave measurement includes a series of processes to be described later with reference to FIG. 3. When this series of processes is completed, the pulse wave measurement is completed and the waveform analysis is also terminated (step S200).

  In step S300, the arithmetic control unit 10 waits for a certain period (for example, 10 seconds) without changing the state of the cuff pressure at the end of step S200, and then proceeds to step S400.

  In step S400, the arithmetic control unit 10 outputs to the upper arm measurement control unit 201 and the lower limb measurement control unit 202 a signal for starting an operation for blood pressure measurement of the subject's right body (upper right arm and right ankle). Accordingly, the upper arm measurement control unit 201 and the lower limb measurement control unit 202 measure blood pressure using the upper right arm cuff 21R and the right ankle cuff 22R, respectively.

  Specifically, the upper arm measurement control unit 201 pressurizes the upper right arm cuff 21R and the lower limb measurement control unit 202 pressurizes the right ankle cuff 22R to an appropriate predetermined value higher than the systolic blood pressure to be measured. When the cuff pressurization is completed, the upper arm measurement control unit 201 gradually depressurizes the upper right arm cuff 21R, and the lower limb measurement control unit 202 depressurizes the right ankle cuff 22R. During cuff decompression, the upper arm measurement control unit 201 measures the systolic blood pressure and the diastolic blood pressure of the upper right arm, and the lower limb measurement control unit 202 measures the systolic blood pressure and the diastolic blood pressure of the right ankle. After the blood pressure measurement, when the cuff pressures of the upper right arm cuff 21R and the right ankle cuff 22R return to values corresponding to the non-pressurized state, the upper arm measurement control unit 201 and the lower limb measurement control unit 202 A blood pressure signal indicating the blood pressure value is output to the arithmetic control unit 10. The blood pressure signal is taken into the storage unit 80 by the arithmetic control unit 10. In this example, blood pressure measurement during cuff decompression is taken as an example. Alternatively, blood pressure measurement during cuff pressurization may be performed, or both blood pressure measurement during cuff decompression and blood pressure measurement during cuff pressurization may be performed. You may go.

  In step S500, the arithmetic control unit 10 outputs to the upper arm measurement control unit 201 and the lower limb measurement control unit 202 a signal for starting an operation for blood pressure measurement of the left half of the subject (left upper arm and left ankle). Accordingly, the upper arm measurement control unit 201 and the lower limb measurement control unit 202 measure blood pressure using the left upper arm cuff 21L and the left ankle cuff 22L, respectively. Regarding the specific procedure for blood pressure measurement on the left side, the target cuff to be pressurized or reduced in the procedure for blood pressure measurement on the right side is changed from the cuff 21R, 22R for the upper right arm and the right ankle to the cuff 21L, 22L for the left upper arm and the left ankle. It can implement | achieve similarly to right blood-pressure measurement by changing to.

  In step S600, the arithmetic control unit 10 calculates CAVI based on the analysis result and the numerical value indicated by the received biological information, for example, blood pressure.

  The CAVI thus obtained is displayed on the screen by the display unit 70 or printed on a recording sheet by the recording unit 75 as necessary.

  Here, a series of processing for pulse wave measurement executed in step S100 will be described with reference to FIG.

  First, the upper arm measurement control unit 201 and the lower limb measurement control unit 202 simultaneously start pressurization of all the cuffs 21R, 21L, 22R, and 22L (step S101). The pressurization of all the cuffs 21R, 21L, 22R, and 22L is continued until the cuff pressure reaches a pressure suitable for pulse wave measurement (here, 50 mmHg) below the general diastolic blood pressure (step S102). When the cuff pressure reaches 50 mmHg, the upper arm measurement control unit 201 and the lower limb measurement control unit 202 stop the pressurization of the cuffs 21R, 22R, and 22L except the left upper arm cuff 21L and hold the cuff pressures. (Step S103). The pressurization of the left upper arm cuff 21L is continued.

  The upper arm measurement control unit 201 measures the diastolic blood pressure and the systolic blood pressure using the left upper arm cuff 21L being pressurized (step S104).

  The continuous pressurization is performed until the pressure becomes equal to or higher than the systolic blood pressure measured so that the blood vessel is occluded (in this case, until the cuff pressure becomes higher by 20 mmHg than the systolic blood pressure) ( After that, the upper arm measurement control unit 201 stops the pressurization of the left upper arm cuff 21L and holds the cuff pressure (step S106).

  Thus, in order to continue pressurization while measuring blood pressure, a desired cuff pressure (here, systolic blood pressure + 20 mmHg is used, but it may be the same pressure as systolic blood pressure or systolic blood pressure + 40 mmHg). Thus, pressurization can be surely stopped.

  The blood pressure measurement is also performed in steps S400 and S500 described above, but the result of the blood pressure measurement performed in step S104 may also be taken in as a blood pressure signal and used for calculation of CAVI.

  In step S107, the upper arm measurement control unit 201 and the lower limb measurement control unit 202 measure pulse waves using all the cuffs 21R, 21L, 22R, and 22L in the state where the cuff pressures are held respectively. Do.

  After measuring the pulse wave for a certain period (for example, about 20 seconds), the upper arm measurement control unit 201 and the lower limb measurement control unit 202 start depressurization of all the cuffs 21R, 21L, 22R, and 22L (steps). S108). When these cuff pressures return to values corresponding to the non-pressurized state (step S109), the upper arm measurement control unit 201 and the lower limb measurement control unit 202 stop depressurizing all the cuffs 21R, 21L, 22R, and 22L. (Step S110).

  When the processing described with reference to FIGS. 2 and 3 is performed, a measurement result as shown in FIG. 4 is obtained, for example. Here, a case where the cuff pressure of the left upper arm cuff 21L is held at 140 mmHg is taken as an example.

  Since the cuff pressure is maintained at a pressure (here, 50 mmHg) that does not act on the blood vessel of the subject at all and other than the left upper arm, the measured pulse wave waveform has a certain quality. However, it does not sharply reflect the original waveform of the pulse wave. On the other hand, in the upper left arm, the cuff pressure is held at a pressure (in this case, 140 mmHg) that occludes the blood vessel of the subject, so the measured pulse wave waveform is very good reflecting the original waveform of the pulse wave sharply. The waveform is of good quality. For example, the notch portion in the region a does not appear sharply, but the notch portion in the region b appears sharply. This is because the pulse wave measurement is performed in the left upper arm without being affected by the pulse reflection from the peripheral blood vessel.

  Therefore, according to the present embodiment, it is possible to accurately detect the timing of the notch portion, and thus improve the reliability of the calculated CAVI.

  In addition, pulse wave measurement under cuff pressure higher than systolic blood pressure that occludes blood vessels is different from pulse wave measurement under cuff pressure less than diastolic blood pressure that does not compress blood vessels, and has an effect on the body. large. For this reason, in the present embodiment, the pulse wave measurement is performed while maintaining the high pressure only at one place instead of all the places. Therefore, it is possible to accurately detect the feature portion while minimizing the influence on the body.

  Also, because the artery to the upper arm is branched at the vena cava arch, it is very similar to the pulse wave at the aortic arch by holding the high pressure only at the left upper arm and measuring the pulse wave A waveform of a pulse wave can be obtained, and a characteristic part such as a notch can be detected more accurately.

  In this embodiment, the purpose of increasing the cuff pressure of only a part of the cuffs to a high pressure is to accurately detect the notch portion of the pulse wave, that is, the dichroic notch. It may be aimed at accurate detection. For example, it is possible to accurately detect the peak of the percussion wave of the pulse wave and the peak of the tidal wave.

  Moreover, although an example of the specific procedure was demonstrated about the pulse wave measurement in the said step S100 using FIG. 3, the pulse wave measurement procedure is not limited only to the above. Hereinafter, three modifications will be described with reference to FIGS. 5, 6, and 7.

  First, a first modification will be described with reference to FIG. In this example, blood pressure is measured not only during cuff pressurization but also during cuff decompression. In contrast to the procedure shown in FIG. 3, the example of FIG. 5 is different in that step S111 is added between step S108 and step S109.

  In step S111, the upper arm measurement control unit 201 measures the systolic blood pressure using only the left upper arm cuff 21L among all the cuffs 21R, 21L, 22R, and 22L during decompression, and measures the diastolic blood pressure. To do. The blood pressure signal indicating the measurement result here is taken into the storage unit 80 by the arithmetic control unit 10 and used for calculation of CAVI.

  Blood pressure is measured in steps S400, S500, and S104 described above. In the first modification, the blood pressure measurement result obtained in step S111 can also be captured as a blood pressure signal. Therefore, blood pressure measurement accuracy can be improved, leading to further improvement in the reliability of the calculated CAVI.

  Subsequently, a second modification will be described with reference to FIG. In the example of FIG. 3, only the left upper arm cuff 21L is pressurized to a high pressure, whereas in this example, the upper right arm cuff 21R is pressurized to a high pressure in addition to the left upper arm cuff 21L. Compared with the procedure shown in FIG. 5 that is more similar to FIG. 3, the example of FIG. 6 is different in that steps S103, S104, S106, and S111 are replaced with steps S112, S113, S114, and S115.

  In step S112, when the cuff pressure reaches 50 mmHg, the upper arm measurement control unit 201 and the lower limb measurement control unit 202 stop pressurizing the lower limb cuffs 22R and 22L except the upper arm cuffs 21R and 21L. Hold their cuff pressure. The pressurization of the upper arm cuffs 21R and 21L is continued.

  In step S113, the upper arm measurement control unit 201 simultaneously measures the diastolic blood pressure and the systolic blood pressure for the left and right upper arms using the upper arm cuffs 21R and 21L during pressurization.

  In step S114, the upper arm measurement control unit 201 stops the pressurization of the upper arm cuffs 21R and 21L and maintains the cuff pressure.

  Thus, since pressurization is continued while measuring blood pressure, pressurization can be reliably stopped at a desired cuff pressure (here, systolic blood pressure + 20 mmHg).

  Blood pressure measurement is also performed in steps S400 and S500 described above, but the result of blood pressure measurement performed in step S113 may also be taken in as a blood pressure signal and used for calculation of CAVI.

  In step S115, the upper arm measurement control unit 201 measures the systolic blood pressure of the left and right arms using only the upper arm cuffs 21R, 21L among all the cuffs 21R, 21L, 22R, 22L during decompression. Then, the diastolic blood pressure of both left and right arms is measured.

  The blood pressure signal indicating the measurement result in step S115 is taken into the storage unit 80 by the arithmetic control unit 10 and used for calculation of CAVI.

  The blood pressure is measured in steps S400, S500, and S113 described above. According to the second modification, the blood pressure measurement result performed in step S115 can also be captured as a blood pressure signal. In addition, in step S115, blood pressure measurement results for the left and right arms can be obtained. Therefore, blood pressure measurement accuracy can be further improved, leading to further improvement in the reliability of the calculated CAVI.

  Further, when the procedure shown in FIG. 6 is combined with the procedure shown in FIG. 2, after waiting for a certain period of time in step S300 in FIG. 2, the upper arm measurement control unit 201 is not operated, and the lower leg cuff 22R, The lower limb measurement control unit 202 may be operated so as to simultaneously measure blood pressure using 22L. Thereby, since the blood pressure measurement of the upper body and the blood pressure measurement of the lower body can be simultaneously performed, the blood pressure measurement process can be reduced without increasing the load on the body of the subject.

  Subsequently, a third modification will be described with reference to FIG. In the example of FIG. 3, the left upper arm cuff 21L is unconditionally pressurized to a high pressure, whereas in this example, the condition for pressurizing the left upper arm cuff 21L to a high pressure is applied. That is, in the third modification, step S103 is replaced with steps S116, S117, S118, S119, and S120 in the procedure shown in FIG. 3, and steps S104, S105, S106, and S107 are performed when a predetermined condition is satisfied. Step S104, S105, S106, S107 are skipped if the predetermined condition is not satisfied.

  In step S116, when the cuff pressure reaches 50 mmHg, the upper arm measurement control unit 201 and the lower limb measurement control unit 202 stop the pressurization of all the cuffs 21R, 21L, 22R, and 22L and hold the cuff pressures. To do.

  In step S117, the upper-arm measurement control unit 201 and the lower-limb measurement control unit 202 measure the pulse wave using all the cuffs 21R, 21L, 22R, and 22L in the state where the cuff pressure is held. After measuring the pulse wave for a certain period (for example, about 20 seconds), a pulse wave signal indicating the measurement result is taken into the storage unit 80 by the arithmetic control unit 10.

  In step S118, the arithmetic control unit 10 performs the same waveform analysis as in step S100 described above.

  In step S119, the arithmetic control unit 10 determines whether or not the detection of the pulse wave notch has failed in the waveform analysis. When the condition that the detection of the notch portion has failed is satisfied, it is necessary to further increase the cuff pressure and perform pulse wave measurement, so the pressurization of only the left upper arm cuff 21L is resumed (step S120). In other words, in step S120, secondary pressurization with respect to the primary pressurization performed in step S116 is performed. After step S120, the process proceeds to step S104 in FIG.

  On the other hand, if the cut portion is successfully detected, steps S104, S105, S106, and S107 in FIG. 3 are skipped to proceed to step S108 in order to avoid overloading the body by further increasing the cuff pressure. .

  Thus, according to the third modification, unnecessary load on the body can be avoided.

  The embodiment of the present invention has been described above. The above description is an illustration of a preferred embodiment of the present invention, and the scope of the present invention is not limited to this. That is, the description of the configuration of the apparatus and the operation at the time of use is an example, and it is obvious that various modifications and additions to these examples are possible within the scope of the present invention.

10 Arithmetic Control Unit 21R Cuff for Upper Right Arm 21L Cuff for Left Upper Arm 21aR, 21aL, 22aR, 22aL Rubber Sac 22R Cuff for Right Ankle 22L Cuff for Left Ankle 21h, 22h Hose 23 Heart Sound Microphone 24a Electrocardiogram Electrode for Limb 24b Electrode unit 200 Blood pressure pulse wave measurement unit 201 Upper arm measurement control unit 202 Lower limb measurement control unit 203 Heart sound measurement unit 204 Electrocardiogram measurement unit 211R, 211L, 221R, 221L Pressure sensor

Claims (4)

Multiple cuffs that can be wound around multiple locations on the subject;
A measurement unit that measures the pulse wave of the subject using the plurality of cuffs, and a pressure control unit that controls cuff pressure for each of the plurality of cuffs when measuring the pulse wave of the subject. Including a blood pressure pulse wave measurement unit,
A derivation unit that detects a characteristic part of the measured pulse wave and derives a degree of arteriosclerosis of the subject based on the detected characteristic part;
Have
The blood pressure pulse wave measurement unit pressurizes the at least one cuff from an unpressurized cuff pressure, measures the blood pressure of the subject using the at least one cuff during the pressurization, and measures the measured subject. The cuff pressure is stopped at a cuff pressure equal to or higher than the systolic blood pressure determined according to the systolic blood pressure of the examiner, and the subject is used with the at least one cuff in a state in which the cuff pressure at the stop is held. Measuring the pulse wave of
A blood pressure pulse wave inspection device characterized by the above. The blood pressure pulse wave measurement unit pressurizes the at least one cuff pressure from a cuff pressure in a non-pressurized state and stops the pressurization with a cuff pressure equal to or higher than the systolic blood pressure of the subject. Other cuffs different from the at least one cuff among the cuffs are pressurized from the cuff pressure in the non-pressurized state, and the cuff pressure is less than the diastolic blood pressure of the subject or the cuff pressure does not compress the subject's blood vessel. The pressure wave is stopped and the pulse wave of the subject is measured using the other cuff at the same time as the at least one cuff pressure is measured while the cuff pressure at the time of the stop is maintained. Measuring
The blood pressure pulse wave inspection apparatus according to claim 1. The at least one cuff includes an upper arm cuff wound around at least one of the upper right arm and the left upper arm of the subject.
The blood pressure pulse wave examination apparatus according to claim 1 or 2, wherein The at least one cuff is one upper arm cuff wound around only one of the upper right arm and the left upper arm of the subject, and the other cuff is other than the one upper arm cuff among the plurality of cuffs. All cuffs,
The blood pressure pulse wave inspection apparatus according to claim 2.

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