JP6671065B2 - Vascular endothelial function measurement device for brachial artery - Google Patents

Description

  The present invention provides an upper arm for fixing an upper arm of a living body, generating an ultrasonic cross-sectional image of a brachial artery in the fixed upper arm, and measuring endothelial function based on a change in the diameter of the upper arm artery in the ultrasonic image. The present invention relates to an arterial vascular endothelial function measuring device.

  In order to diagnose arteriosclerosis or the like based on the deformation amount of the arterial blood vessel of the living body, the arterial blood vessel in the upper arm of the living body is stimulated using external compression, and then the deformation amount of the arterial blood vessel exceeds Measurement is performed using a sound wave cross-sectional image. For example, the vascular endothelial function measuring device and the lumen diameter measuring device of the in-vivo tubular body described in Patent Literature 1 and Patent Literature 2 are those.

  For example, Patent Literature 1 and Patent Literature 2 propose an arterial endothelial function testing device. These endothelial function testing devices stop the artery by compressing the upper arm of the subject using a compression band, maintain the artery for, for example, 5 minutes, and when the hemostasis is released, are grasped using an ultrasonic image. The change in the cross-sectional shape of the brachial artery, for example, the maximum change rate of the lumen diameter of the blood vessel relative to the endothelial diameter before hemostasis is measured from the ultrasonic cross-sectional image, and the endothelial function of the arterial blood vessel is determined based on the maximum change rate of the blood vessel lumen diameter. I'm evaluating.

  Meanwhile, the ultrasonic probe used in the endothelial function testing apparatus includes an ultrasonic array in which a plurality of ultrasonic transducers (ultrasonic oscillators) made of piezoelectric ceramics or the like are arranged in a line. In the endothelial function test apparatus, the elbow between the upper arm and the forearm of the living body is placed on the elbow support member, and the back of the hand (upper) is placed on the hand back support member with the hand upward. After placing, the ultrasound array provided on the contact surface of the ultrasound probe is in contact with the skin on the brachial artery, and the ultrasound probe is fixed to the stand to acquire an ultrasound cross-sectional image Was.

JP 2007-061182 A JP 2007-195662 A

  However, the ultrasonic probe used in the above endothelial function test apparatus has a property that an ultrasonic image of an arterial blood vessel cannot be obtained due to a slight displacement with respect to a brachial artery, and therefore, the ultrasonic probe is attached to a forearm to block an artery. Since the skin is pulled by the compression and release by the compression band, the displacement of the ultrasonic probe that is in contact with the skin with respect to the brachial artery cannot be avoided, and one image is acquired and the vascular endothelium from the image is acquired. It has become difficult to maintain the ultrasonic probe at the optimum position where the diameter can be obtained, and operator skill and complicated rework are required. In addition, by repeatedly measuring the same living body to improve symptoms and evaluate drug efficacy, in order to obtain changes over time in the value of the blood vessel inner diameter and the rate of change in the blood vessel inner diameter, the upper brachial artery is required for each measurement. , It is necessary to position the ultrasonic probe at the same position, but it has been difficult to accurately position the ultrasonic probe at the same position on the brachial artery for each measurement.

  The present invention has been made in the context of the above circumstances, the purpose is, there is no displacement of the ultrasound probe relative to the brachial artery related to the pulling of the skin from the compression of the compression device, In addition, it is an object of the present invention to provide a vascular endothelial function measuring device for a brachial artery which can position an ultrasonic probe at the same site on a brachial artery for each measurement.

  The present inventors have conducted various studies in the background of the above circumstances, and while fixing the ultrasonic transmission plate material that can be ultrasonically transmitted to a part of an annular compression band wound around the upper arm to tighten the upper arm. The upper arm is positioned so as to be in close contact with the ultrasonic transmission plate material, and the ultrasonic probe is transmitted and received into the upper arm from the ultrasonic probe through the ultrasonic transmission plate material, and the rotating bracket on which the forearm of the living body is placed is mounted. Provided to be rotatable around a vertical line passing through the elbow rest that receives the elbow, and once bending the forearm on the rotating bracket with respect to the upper arm in a direction to embrace the ultrasonic transmission plate with the rotating bracket, By positioning the forearm linearly extended with respect to the upper arm, the ultrasonic probe is maintained at the optimal position that enables acquisition of an ultrasonic image and acquisition of the vascular endothelial diameter from the image. It can be, moreover been found to be able to position the ultrasonic probe at the same site on the brachial artery for each measurement. The present invention has been made based on such findings.

  That is, the gist of the first invention is (a) a vascular endothelial function measuring device for a brachial artery for measuring endothelial function of a brachial artery, and (b) a device wound around the upper arm to tighten the upper arm. An annular compression band, and an ultrasonic transmission plate member capable of transmitting ultrasonic waves provided so as to be able to adhere to the upper arm at a part of the compression band, and adjusting the tension of the compression band to adjust the tension of the compression band. An upper arm compression device having an actuator capable of changing the compression pressure on the upper arm, (c) a container fixed on a base and having an opening closed by the ultrasonic transmission plate, (d) the container An ultrasonic probe accommodated in a container and transmitting and receiving ultrasonic waves to and from the upper arm through the ultrasonic transmission plate; and (e) an elbow receiving an elbow between the upper arm and the forearm wound around the compression band. Connect the cradle and the forearm A pivot mounting bracket provided on the base so as to be rotatable around a rotation axis passing through the elbow support and perpendicular to the base, having palm rests for receiving the palm of the hand at both ends. And to provide.

  The gist of the second invention is that the container is a closed container filled with a liquid, and the ultrasonic probe transmits and receives ultrasonic waves to and from the upper arm through the liquid and an ultrasonic transmission plate member. .

  The gist of the third invention resides in including a control device that controls a compression pressure on the upper arm by the upper arm compression device based on a state of the brachial artery.

  The gist of the fourth invention is that the control device generates an ultrasonic cross-sectional image based on an ultrasonic signal received by the ultrasonic probe, and generates a brachial artery in the upper arm from the ultrasonic cross-sectional image. The lumen diameter of the upper arm artery is calculated sequentially, the maximum value of the lumen diameter of the brachial artery that expands after the temporary compression of the brachial artery by the upper arm compression device is determined, and before the compression by the upper arm compression device. It is to calculate and output the rate of change of the maximum value of the lumen diameter with respect to the lumen diameter.

  The gist of the fifth invention is that, when measuring the vasodilatory response of the upper arm, the control device collapses the artery in the living body in a part of one pulse wave cycle of the living body based on the ultrasonic sectional image. The present invention is to apply a shear stress to the brachial artery by controlling a compression pressure on the upper arm by the upper arm compression device so that a predetermined number of pulses are maintained.

  The gist of the sixth invention is that the control device determines the rigidity of the blood vessel in the upper arm based on the ratio between the change in the shape of the blood vessel in the upper arm based on the ultrasonic cross-sectional image and the change in the compression pressure by the compression device. It is to calculate and output an index indicating the stiffness.

  A first invention is (a) a vascular endothelial function measuring device for a brachial artery for measuring a cross-sectional image in an upper arm, and (b) an annular compression band wound around the upper arm to tighten the upper arm; A part of the compression band which is provided so as to be able to adhere to the upper arm and which is capable of transmitting ultrasonic waves; and adjusting the tension of the compression band to change a compression pressure of the ultrasonic transmission plate member with respect to the upper arm. (C) a container fixed on a base and having an opening closed by the ultrasonic transmission plate, (d) housed in the container, An ultrasonic probe for transmitting and receiving ultrasonic waves to and from the upper arm through an ultrasonic transmission plate; (e) an elbow rest for receiving an elbow between the upper arm and the forearm wound around the compression band; With a palm rest to receive the palm of the hand It has at both ends, and a hinge bracket provided on the base rotatably about a vertical pivoting axis of the elbow cradle respect as the base comprises. For this reason, according to the first invention, the upper arm is positioned by the compression band in a state where the forearm on the rotating bracket is once bent with respect to the upper arm in the direction to embrace the ultrasonic transmission plate together with the rotating bracket. This makes it possible to maintain the ultrasonic probe at the optimal position enabling acquisition of an ultrasonic image and acquisition of a vascular endothelial diameter from the image, and furthermore, the same region on the brachial artery for each measurement. , The ultrasonic probe can be positioned. In the upper arm positioned as described above, the biceps, which is a high-quality propagation medium for ultrasonic waves, is interposed between the ultrasonic probe and the brachial artery, so that the noise is accurate with less noise. Since an ultrasonic cross-sectional image is obtained, the accuracy of the cross-sectional image of the brachial artery and the lumen diameter measured therefrom is enhanced. Furthermore, the position of the cross-sectional image in the upper arm obtained through the ultrasonic transmission plate material by the ultrasonic probe coincides with the compression site in the upper arm by the ultrasonic transmission plate material of the upper arm compression device, so that the upper arm against the compression pressure by the upper arm compression device The shape of the cross-sectional image inside is accurately obtained.

  According to the second invention, the container is a sealed container filled with liquid, and the ultrasonic probe transmits and receives ultrasonic waves to and from the upper arm through the liquid and an ultrasonic transmission plate member. Since the attenuation is suppressed as much as possible, a more clear ultrasonic cross-sectional image can be obtained.

  According to the third invention, since the control device for controlling the compression pressure on the upper arm by the upper arm compression device based on the state of the brachial artery in the ultrasonic cross-sectional image is included, according to the cross-sectional shape of the brachial artery There is an advantage that a compressed pressure can be obtained. For example, the control device determines a state in which the blood vessel is crushed, for example, a state in which the blood vessel is crushed into an applanation (flat) shape, based on a cross-sectional shape of the blood vessel, and a part or the whole of one pulse cycle is crushed. The compression pressure on the upper arm by the upper arm compression device can be changed so as to be within the state.

  According to the fourth invention, the control device generates an ultrasonic cross-sectional image based on the ultrasonic signal received by the ultrasonic probe, and generates a lumen of the brachial artery in the upper arm from the ultrasonic cross-sectional image. Calculate the diameter sequentially, determine the maximum value of the lumen diameter of the brachial artery to expand after allowing the upper arm compression device to temporarily apply pressure to the brachial artery, the lumen diameter before compression by the upper arm compression device Is calculated and output. Thereby, FMD (blood flow-dependent vasodilation reaction) measurement is performed based on an accurate ultrasonic cross-sectional image, so that highly accurate measurement can be obtained.

  According to the fifth aspect, the control device is configured such that, when measuring the vasodilatory response of the upper arm, a state in which the artery in the upper arm is crushed in a part of one pulse wave cycle of the living body based on the ultrasonic cross-sectional image By controlling the compression pressure on the upper arm by the upper arm compression device so that the predetermined pulse is maintained for a predetermined number of times, shear stress is applied to the brachial artery. Is efficiently performed. For example, shearing stress is applied in a shorter time as compared with a conventional FMD (blood flow-dependent vasodilatory reaction) measurement in which shearing stress is applied by releasing an artery after being blocked for 5 minutes. . This makes it possible to perform FMD measurement in a short time.

  According to the sixth aspect, the control device determines the hardness (stiffness) of the blood vessel in the upper arm based on the ratio of the change in the shape of the blood vessel in the upper arm based on the ultrasonic cross-sectional image and the change in the compression pressure by the compression device. Is calculated and output. This enables a diagnosis based on the hardness of the arterial blood vessel. For example, a more accurate diagnosis of arteriosclerosis can be made by combining this with the expansion ratio of the artery in the upper arm after shear stress is applied to the artery.

It is a perspective view explaining the vascular endothelial function measuring device for brachial arteries which is one example of the present invention. FIG. 2 is a perspective view schematically illustrating a posture of an ultrasonic probe with respect to a blood vessel to be measured by the vascular endothelial function measuring device for a brachial artery in FIG. 1. FIG. 2 is an enlarged view schematically showing a multilayer structure of a blood vessel to be measured by the vascular endothelial function measuring device for a brachial artery in FIG. 1. 1 shows a configuration of an upper arm compression device obtained in the vascular endothelial function measurement device for the brachial artery shown in FIG. 1 with a part of a container accommodating the device being cut away, and a functional block diagram showing a main part of functions of an electronic control device FIG. When measuring the vasodilatory reaction by the vascular endothelial function measuring device for the brachial artery in FIG. 1, the upper arm, the elbow, and the extended right arm are stretched while the rotating bracket is positioned in a direction perpendicular to the longitudinal direction of the base. It is a side view explaining the state where the palm of the hand and the palm were placed on the upper arm rest, the elbow rest, and the palm rest, respectively. FIG. 6 is a plan view illustrating a state where the forearm is rotated together with the rotation bracket, following the state of FIG. 5. FIG. 7 is a plan view illustrating a state in which the right arm is extended, following the state in FIG. 6 in which the upper arm is restrained by the compression band. FIG. 7 is a perspective view illustrating a state in which the right arm is extended, following the state in FIG. 6 in which the upper arm is restrained by the compression band. FIG. 5 is a functional block diagram illustrating in detail a control function of a blood vessel state evaluation unit of the electronic control device in FIG. 4. 2 is a time chart illustrating a change in a vessel lumen diameter in an FMD evaluation operation of an arterial blood vessel performed by the arterial blood vessel evaluation device of FIG. 1. 5 is a flowchart illustrating an FMD measurement routine operation showing an FMD measurement operation of the blood vessel state evaluation unit in FIG. 4. 5 is a flowchart illustrating an arterial hardness measurement routine operation showing an arterial hardness measurement operation of the blood vessel state evaluation unit in FIG. 4.

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

  FIG. 1 shows a vascular endothelial function measuring device 10 for a brachial artery. The vascular endothelial function measuring device 10 for the brachial artery includes a longitudinal base 12 having a horizontal upper surface, a sealed container 16 fixed to one end of the base 12 and accommodating an ultrasonic probe 14, and a sealed container 16. An upper arm compression device 18 is provided, a display device 20 fixed to the other end of the base 12, and an electronic control device 22 disposed below the base 12.

  The ultrasonic probe 14 functions as a sensor for detecting biological information related to the brachial artery 29a in the upper right arm 29 of the living body, that is, a blood vessel parameter. As shown in FIG. The first short-axis ultrasonic array probe A and the second short-axis ultrasonic array probe B have a longitudinal shape in a direction orthogonal to their longitudinal directions, and their longitudinal central portions are arranged in the same direction. This is an H-type ultrasonic probe having a long-axis ultrasonic array probe C to be connected and a flat probe surface 46 on one plane. As shown in FIG. 4, the ultrasonic probe 14 is fixed to a multi-axis positioning device 48 fixed to a base member 46. The first short-axis ultrasonic array probe A, the second short-axis ultrasonic array probe B, and the long-axis ultrasonic array probe C are, for example, piezoelectric ceramics as shown in FIG. The ultrasonic transducers (ultrasonic oscillators) a1 to an constituted by are linearly arranged to be formed in a longitudinal shape, respectively.

  FIG. 2 shows a first short-axis ultrasonic array probe A and a second short-axis ultrasonic array probe B provided in parallel to the ultrasonic probe 14 and the first short-axis ultrasonic wave. A long axis ultrasonic array probe C provided between the longitudinal center portions of the array probe A and the second short axis ultrasonic array probe B so as to be orthogonal thereto; FIG. The multi-axis positioning device 48 is located parallel to the longitudinal direction of the first short-axis ultrasonic array probe A in the ultrasonic beam radiation direction of the first short-axis ultrasonic array probe A, and A first short-axis ultrasonic array probe is defined as a direction passing through or in the vicinity of 29a is defined as a y-axis, a direction parallel to the longitudinal direction of the long-axis ultrasonic array probe C and orthogonal to the y-axis is defined as an x-axis. When the z-axis is a direction passing through the intersection of the longitudinal direction of A and the longitudinal direction of the long-axis ultrasonic array probe C and orthogonal to the x-axis direction and the y-axis, the ultrasonic probe 14 performs multi-axis positioning. The device 48 enables translation in the y-axis direction and rotation about the y-axis and the z-axis.

  FIG. 3 is an enlarged view schematically showing a multilayer structure of a brachial artery 29a to be measured by the vascular endothelial function measuring device 10 for a brachial artery. The brachial artery 29a shown in FIG. 3 has a three-layer structure of the intima (endothelium) L1, the media L2, and the adventitia L3. Since the reflection of the ultrasonic wave generally occurs in a portion having a different acoustic impedance, in the measurement of the state of the brachial artery 29a using the ultrasonic wave, in practice, the boundary surface between the blood in the blood vessel lumen and the intima L1 and the medial layer L2 are measured. The boundary surface with the adventitia L3 is displayed in white, and the tissue is displayed in black and white groups.

  As shown in detail in FIG. 4, the container 16 has an opening 24 that opens to the side, and a pair of side walls 16 a and 16 b that are parallel to each other and flat and perpendicular to the base 12, and the acoustic impedance of the container 16 The opening 24 is liquid-tightly closed by an ultrasonic transmission plate 26 which is made of a similar material having a high ultrasonic transmission efficiency, for example, an organic material such as a resin such as vinyl acetate resin and which can transmit ultrasonic waves. Thereby, the inside of the container 16 is filled with an ultrasonic medium having a similar acoustic impedance to the living body and having a small propagation loss, for example, the oil 28. The ultrasonic transmission plate 26 is fixed to the container 16 so as to be perpendicular to the base 12, and the ultrasonic transmission plate 26 and the pair of side walls 16a and 16b are perpendicular to each other.

  As shown in detail in FIGS. 5 to 8, the upper arm compression device 18 is fixed to one end in the width direction at the central portion in the longitudinal direction of the base 12, and the upper right arm 29 is placed thereon. An upper arm mounting table 30 for supporting the upper arm 29 and an elbow fixed to the longitudinal center of the base 12 and the other end in the width direction and supporting the elbow 31 of the right arm when the elbow 31 is mounted thereon A base 32 provided at a position directly below the elbow support 32 of the base 12 and perpendicular to the upper surface of the base 12 and rotatably provided about a rotation axis C1 passing through the elbow support 32; And a palm on which the palm of the right hand 33 is placed and which is provided with a palm rest 34 for supporting the palm, and a rotating bracket that projects horizontally from the base 12 and rotates together with the forearm 35. 36, and a flexible belt 38, and the upper side of the opening 24 of the container 16 is opened. An annular compression band 40 comprising a flexible belt 38 attached to the edge and the lower opening edge, respectively, and the ultrasonic transmission plate 26 positioned between the upper and lower opening edges of the opening 24; An inflatable bag 42 is provided inside the band 40 and expands to increase the tension of the compression band 40 when inflated. The ultrasonic transmission plate 26 substantially constitutes a part of the compression band 40. In the upper arm compression device 18, when the inflation bag 42 is inflated by the supply of compressed air while the upper right arm 29 of the living body is wound by the compression band 40, the tension of the compression band 40 is increased, and The arm 29 is pressed against the ultrasonic transmission plate 26, and the upper right arm 29 of the living body is pressed by the ultrasonic transmission plate 26.

  Prior to the measurement of the endothelial function of the brachial artery 29 a in the vascular endothelial function measuring device 10 for the brachial artery, the upper arm 29 is fixed to the closed container 16 by the compression band 40. When the upper arm 29 is fixed, the ultrasonic transmission plate 26 mounted so as to close the opening 24 of the closed container 16 and the side wall 16a on the forearm 35 side of the pair of side walls 16a and 16b of the closed container 16 which are perpendicular to the ultrasonic transmission plate 26 are formed. Is fixed by the compression band 40 provided in the closed container 16 by the following highly reproducible positioning procedure using First, with the rotating bracket 36 positioned in a direction perpendicular to the longitudinal direction of the base 12, the extended upper arm 29, the elbow 31, and the palm of the hand 33 are extended to the upper arm mounting base 30, the elbow rest. It is mounted on the table 32 and the palm mounting table 34, respectively. FIG. 5 shows this state. At this time, the compression band 40 is not wound around the upper arm 29, or the compression band 40 is loosely wound, so that the upper arm 29 can move in the longitudinal direction.

  Next, as shown in FIG. 6, the forearm 35 is rotated around the elbow 31 until the forearm 35 comes into contact with the side wall 16a on the forearm 35 side of the sealed container 16, and a rotating bracket for supporting the forearm 35 is provided. 36 is also rotated about the rotation axis C1. Preferably, the forearm 35 is rotated until it comes into contact with the side wall 16a of the closed container 16 on the forearm 35 side. As a result, the position of the elbow 31 is determined with respect to the closed container 16, and the longitudinal position of the upper arm 29 located along the ultrasonic transmission plate 26 is reproduced with respect to the closed container 16 or the ultrasonic probe 14 therein. It is well defined. In this state, the compression band 40 wound around the upper arm 29 is tightened to some extent, whereby the upper arm 29 is restrained. FIG. 6 shows this state. When the endothelial function of the brachial artery 29a is measured by the vascular endothelial function measuring device 10 for the brachial artery, the rotating bracket 36 is rotated until the forearm 35 is linear with respect to the upper arm 29 as shown in FIGS. And the arm is extended.

  By the way, in the arm of a living body, even if the hand 33 and the upper arm 29 are fixed, the elbow 31 can be formed at a certain angle around the longitudinal axis of the arm. In a posture in which the elbow 31 is placed on the receiving table 32 and the upper arm 29 is placed on the upper arm placing table 30, the posture of the arm of the elbow 31 around the longitudinal axis varies. For this reason, a subcutaneous tissue containing fat with non-uniform acoustic impedance is interposed between the ultrasonic probe 14 and the brachial artery 29a, so that the ultrasonic cross-sectional image may be an unclear image with much noise. . On the other hand, when the upper arm 29 is fixed by tightening the upper arm 29 to the compression band 40 by the above-described positioning procedure, the inner side of the elbow 31 is bent by bending the forearm 35 with respect to the upper arm 29. Since the upper arm 29 is fixed in a posture facing the closed container 16, the biceps of the upper arm is positioned between the brachial artery 29a and the ultrasonic transmission plate 26. Therefore, when the forearm 35 is bent with respect to the upper arm 29 by the above-described positioning procedure, the upper arm 29 is fixed in a posture in which the inside of the elbow 31 faces the closed container 16, and the ultrasonic probe 14 has an acoustic impedance. Can transmit and receive ultrasonic waves to the brachial artery 29a through the uniform biceps brachii, so that a clear ultrasonic cross-sectional image of the brachial artery 29a can be obtained.

  The electronic control unit 22 in FIG. 4 is a so-called microcomputer having a CPU that processes an input signal according to a program stored in a ROM in advance while using a temporary storage function of a RAM. The electronic control unit 22 includes an ultrasonic drive control circuit 50 and a positioning motor drive circuit 52. In the measurement of the blood vessel state by the blood vessel evaluation device 10, when a drive signal is supplied from the ultrasonic drive control circuit 50 by the electronic control device 22, the first short-axis ultrasonic array probe A of the ultrasonic probe 14, Beam-like ultrasonic waves are sequentially emitted from the second short-axis ultrasonic array probe B and the long-axis ultrasonic array probe C by well-known beam forming drive. Then, reflected signals of ultrasonic waves are detected by the first short-axis ultrasonic array probe A, the second short-axis ultrasonic array probe B, and the long-axis ultrasonic array probe C. Input to the control device 22. The reflected wave signal input to the electronic control unit 22 is detected by the detection processing unit 82 and processed by the ultrasonic signal processing unit 84 as information that can be image-synthesized. Thereby, an ultrasonic two-dimensional cross-sectional image under the skin is generated and displayed on the display device 20 functioning as a monitor screen display device or an image display device.

  The multi-axis positioning device 48 includes a y-axis rotation mechanism for positioning the rotation position of the ultrasonic probe 14 around the y-axis in FIG. 2 by a y-axis rotation motor, and a y-axis translation mechanism shown in FIG. 2 and a z-axis rotation mechanism for positioning the ultrasonic probe 14 at a rotation position about the z-axis in FIG. 2 by a z-axis rotation motor. The positioning motor drive circuit 52 controls the y-axis rotation motor, the y-axis translation motor, and the z-axis rotation motor in accordance with a command from the electronic control unit 22.

  As shown in FIG. 4, the electronic control unit 22 includes a positioning motor drive control unit 78, an ultrasonic drive control unit 80, a detection processing unit 82, an ultrasonic signal processing unit 84, a compression pressure control unit 88, and a blood vessel state evaluation unit 90. , And a display control unit 92. These control functions are provided in the electronic control unit 22 functionally, but some or all of these control functions are configured as a control unit separate from the electronic control unit 22 and Control described in detail below may be performed by communicating information.

  The electronic control unit 22 extracts a blood vessel cross-sectional image from an ultrasonic cross-sectional image of the brachial artery 29a based on an ultrasonic reflected signal output from the ultrasonic probe 14 to the brachial artery 29a, and extracts the blood vessel cross-sectional image from the blood vessel cross-sectional image. An ultrasonic short-axis image showing a cross section orthogonal to the longitudinal direction is generated, and the inner diameter, the inner film thickness, the plaque, etc. are measured from the ultrasonic short-axis image, and further, FMD (Flow-Mediated Dilation: blood flow dependence) Evaluation of vasodilator response). In the evaluation of the FMD, the display device 20 displays the rate of change of the diameter of the intima in the brachial artery 29a with respect to the diameter before the application of shear stress, that is, the expansion rate R of the lumen diameter in a time-series manner. When evaluating the FMD, generating an ultrasonic image of the brachial artery 29a, and the like, the ultrasonic probe 14 repeatedly scans the skin on the brachial artery 29a to be measured.

  In the measurement of the vascular condition of the brachial artery 29a by the electronic control unit 22, the ultrasonic probe 14 radiates an ultrasonic signal to the brachial artery 29a of the living body below the skin of the upper arm 29 through the ultrasonic transmission plate 26. And receives the reflected wave. In this state, the positioning motor drive control unit 78 sets the first short-axis of the brachial artery 29a generated by the ultrasonic signal processing unit 84 from the ultrasonic reflected signal received by the first short-axis ultrasonic array probe A. Position of the axial cross-sectional image, position of the second short-axial cross-sectional image of the brachial artery 29a generated by the ultrasonic signal processing unit 84 from the ultrasonic reflected signal received by the second short-axis ultrasonic array probe B, Based on the position of the long-axis cross-sectional image of the brachial artery 29a generated by the ultrasonic signal processing unit 84 from the ultrasonic reflection signal received by the long-axis ultrasonic array probe C, the brachial artery 29a The ultrasonic array probe C for the long axis is located below the central part in the longitudinal direction of the ultrasonic array probe A for the axis and the second ultrasonic array probe B for the short axis, and the brachial artery 29a is parallel to the ultrasonic array probe C for the long axis. So that the ultrasonic probe 14 Dynamically positioned.

  The ultrasonic signal processing unit 84 performs time difference processing between the ultrasonic reflected signals reflected from the boundary due to the difference in propagation speed between the brachial artery 29a and other tissues, and performs the first short-axis ultrasonic array search. A first short-axis cross-sectional image that is an ultrasonic two-dimensional image immediately below the probe A, a second short-axis cross-sectional image that is an ultrasonic two-dimensional image immediately below the second short-axis ultrasonic array probe B, and a long axis Image data composed of a long-axis cross-sectional image, which is an ultrasonic two-dimensional image immediately below the ultrasonic array probe C, is repeatedly generated at a predetermined cycle, and the image data is sequentially stored.

  As shown in FIG. 1, the inflatable bladder 42 that increases the tension of the compression band 40 by inflating the air pump 58 and the pressure control valve 60 is controlled by a compression pressure control unit 88 provided in the electronic control unit 22. It is performed by For example, the original pressure from the air pump 58 is controlled by the pressure control valve 60 in accordance with a command from the electronic control device 22, and is supplied to the inflation bag 42 of the compression band 40 wound around the upper arm 29. Specifically, the compression pressure (compression pressure) in the inflatable bladder 42 is increased, so that the brachial artery 29a in the upper arm 29 is compressed. In this embodiment, a part of the compression band 40 is constituted by the ultrasonic transmission plate 26, and the ultrasonic probe 14 passes through the ultrasonic transmission plate 26 to the compression part of the brachial artery 29 a in the upper arm 29. Since the transmission and reception of the sound wave signal is performed, a cross-sectional image of the compressed region of the brachial artery 29a can be obtained.

  As shown in FIG. 9, the blood vessel state evaluation unit 90 includes a blood vessel shape calculation unit 100, a blood vessel dilation rate measurement control unit 102, and a blood vessel hardness measurement control unit 104. From the cross-sectional image of the brachial artery 29a generated as described above, the blood vessel shape calculation unit 100 calculates the outer diameter, wall pressure, or endothelial diameter (lumen diameter) d1, which is the diameter of the endothelium L1, etc. Is calculated.

  When the compression pressure control unit 88 compresses the upper arm 29 with a pressure higher than the venous pressure and lower than the minimum blood pressure value Pd, the blood vessel shape calculation unit 100 determines a plurality of tubular organs present in the ultrasonic cross-sectional image. A tubular organ that is not collapsed in the image shown is determined as the brachial artery 29a, and a process of specifying the same in the ultrasonic cross-sectional image is performed. As described later, the brachial artery 29a specified in this way has a diameter of the brachial artery 29a, an endothelial diameter (lumen diameter) d1, which is a diameter of the endothelium L1 of the brachial artery 29a, and FMD (blood) after ischemia-reactive hyperemia. Flow-dependent vasodilation reaction), the dilation rate (change rate) R (%) of the vascular lumen diameter of the brachial artery 29a, the systolic blood pressure value Ps and the diastolic blood pressure value Pd, and the stiffness representing the hardness of the brachial artery 29a. The measurement of the parameter β and the like is performed. Such artery specific image processing is also useful for puncturing.

The vascular dilatation rate measurement control unit 102 temporarily applies a shear stress using blood flow to the endothelium L1 of the brachial artery 29a using the compression band 40 wound around the upper arm 29, and then temporarily performs a blood flow-dependent vasodilation reaction. The endothelial diameter (lumen diameter) d1 and the like that sequentially expand are sequentially calculated, and the expansion rate (change rate) R (%) of the vascular lumen diameter representing FMD (blood flow-dependent vasodilation reaction) after shear stress is applied [= 100 × (d _MAX− da) / da] is calculated. “Da” in this equation indicates the diameter of the blood vessel lumen at rest (base diameter, rest diameter). The blood vessel state evaluation unit 90 also functions as a measurement unit of a dilation rate (change rate) R of a blood vessel lumen diameter representing FMD (blood flow-dependent vasodilation reaction) after shear stress is applied.

  In the measurement of the dilation rate (change rate) R (%) of the brachial artery 29a by the vascular dilatation rate measurement control unit 102, the measurement site in the living body, for example, the upper arm 29 is compressed by the compression band 40 of the upper arm compression device 18 and the brachial artery 29a is compressed. Is applied to the endothelium L1 of the blood vessel using the blood flow, thereby producing nitric oxide (NO) from the endothelium due to the increase of the shear stress on the endothelium L1 of the blood vessel wall. The endothelial function of the brachial artery 29a is determined by examining the endothelial diameter (lumen diameter) d1 depending on the state of relaxation of the smooth muscle depending on.

FIG. 10 is a time chart exemplifying a change in the vascular lumen diameter d1 after the opening of the ischemia (avascularization) in the FMD evaluation of the brachial artery 29a by the vasodilator measurement controller 102. In FIG. 10, the time t0 represents a rest period, the time t0 to the time t1 represents a shear stress application period, and the time after the time t1 represents a measurement period of the blood flow-dependent vasodilator reaction after the application of the shear stress. It is shown that the blood vessel lumen diameter d1 starts expanding from t2, and at time t3, the blood vessel lumen diameter d1 has reached its maximum value d _MAX . Therefore, the expansion rate R of the blood vessel lumen diameter d1 calculated by the electronic control device 22 becomes maximum at the time point t3.

  Here, in order to generate a vasodilatory reaction at the time of the FMD evaluation of the brachial artery 29a as described above, conventionally, a position upstream or downstream of a region for measuring an ultrasonic cross-sectional image of the brachial artery 29a is cuffed or the like. The pressure is increased by about 50 mmHg higher than the systolic blood pressure value for a predetermined time, for example, 5 minutes (ischemia), and then rapidly released to the atmospheric pressure in about 0.6 seconds, for example, to start the blood flow which was zero until then. Thus, shear stress is applied to the brachial artery 29a. In such a conventional method, the subject is forced to suffer from the pressure for 5 minutes at a pressure considerably higher than the systolic blood pressure value. However, in the ultrasonic cross-sectional image of the brachial artery 29a, the vascular dilatation rate measurement control unit 102 according to the present embodiment determines that the brachial artery 29a is in a collapsed state, for example, near the timing of the diastolic blood pressure Pd, for example, the brachial artery. From the ultrasonic cross-sectional image, an occlusion state in which the cross section of 29a is closed (for example, an applanation state in which the cross section of the brachial artery 29a is closed even when the cross section of the brachial artery 29a is not closed). By opening or closing the brachial artery 29a for each pulse by adjusting the pressure to maintain the predetermined compression pressure on the brachial artery 29a by the inflation bladder for a predetermined time T1 or a predetermined pulse rate as observed or determined. Since the application of the shear stress is repeated, the application of the shear stress is performed at a lower pressure and in a shorter period of time than in the related art.

  The above-mentioned predetermined compression pressure is to be referred to as a shear stress applying pressure for efficiently applying a shear stress to the endothelium L1 by repeatedly generating turbulent blood flow accompanying opening and closing of the brachial artery 29a for each pulse. The pressure is set within the pressure range P1 lower than the systolic blood pressure value and higher than the diastolic blood pressure value so that the brachial artery 29a is collapsed near a part of one pulse wave cycle, for example, at the timing of the diastolic blood pressure Pd. Further, the predetermined time T1 or the predetermined pulse rate is set to a value necessary and sufficient to generate a vasodilatory reaction in the FMD evaluation of the brachial artery 29a, for example, based on an experimental value. The predetermined time T1 or the predetermined pulse rate is set to, for example, several beats to several tens of beats, preferably 10 to tens of beats, or several to tens of seconds, and preferably 10 to tens of seconds. In short, in order to generate a vasodilatory reaction at the time of FMD evaluation of the brachial artery 29a, the compression by the living body compression device 18 was crushed at a predetermined time T1 in a part of one pulse wave cycle. The pressure may be controlled within the predetermined pressure range P1 so that the pulsation has a section.

  The compression pressure control unit 88 detects the compression pressure according to a signal from the pressure sensor 64 that detects the compression pressure in the inflation bag 42. In FIG. 10, for example, the compression pressure control unit 88 adjusts the compression pressure to the predetermined range T1 before the completion of the shear stress application period, that is, the predetermined range T1 before the time point t1, by applying the shear pressure having the pressure value P1 in the predetermined range. Pressure is applied, and at time t1, the pressure is immediately reduced to atmospheric pressure. The compression pressure control unit 88 also functions as a shear stress application control unit.

  Returning to FIG. 9, first, the blood vessel hardness measurement control unit 104 controls the shape of the brachial artery 29 a shown in the ultrasonic cross-sectional image generated by the ultrasonic signal processing unit 84 and the compression pressure control unit 88. After the compression, the systolic blood pressure Ps and the diastolic blood pressure Pd of the living body are determined. That is, the blood vessel stiffness measurement control unit 104 increases the compression pressure to a pressure increase value set higher than the systolic blood pressure value Ps of the living body, and then reduces the compression pressure at a predetermined pressure reduction rate, for example, 3 to 6 mmHg / sec. Then, the compression pressure at the time of generation of a pulse wave in which the cross section of the brachial artery 29a of the living body shown in the ultrasonic cross-sectional image is opened within one pulse wave cycle is determined as the systolic blood pressure value Ps, and the cross section of the brachial artery 29a is determined. Is determined as the diastolic blood pressure value Pd at the time when the blood pressure is not closed within one pulse wave cycle, and the vascular diameter Ds of the brachial artery 29a at the time of determining the systolic blood pressure value Ps and the brachial artery 29a at the time of determining the diastolic blood pressure value Pd Is stored together with the systolic blood pressure value Ps and the diastolic blood pressure value Pd.

Next, the blood vessel hardness measurement control unit 104 obtains the stiffness parameter β representing the hardness of the brachial artery 29a from the following stored equation (stiffness parameter calculation equation) to determine the stiffness parameter β at the time of determining the systolic blood pressure value Ps. The stiffness parameter β is calculated based on the blood vessel diameter Ds, the blood vessel diameter Dd of the brachial artery 29a at the time of determining the diastolic blood pressure value Pd, the systolic blood pressure value Ps, and the diastolic blood pressure value Pd.
β = (lnPs−lnPd) / ((Ds−Dd) / D0)

  D0 in the above equation for calculating the stiffness parameter should originally be the blood vessel diameter when no voltage is applied, but cannot be measured clinically. Therefore, when used as a clinical index, the blood vessel diameter including the blood vessel wall thickness ( = Dd + 2IMT). This IMT is, for example, the thickness of the composite of the intima and media.

  In general, the two-dimensional coordinates of the axis representing the blood vessel diameter D and the axis representing the blood pressure P have a non-linear relationship in which the increase in the blood vessel diameter D is saturated with respect to the increase in the blood pressure P. If the axis is represented by a semilogarithmic graph in which the axis representing the logarithmic value lnP of the blood pressure is replaced, it can be represented by a linear relationship. In this linear relationship, in the equation (Ep = ΔP / 2 (ΔD / D)) of the elasticity Ep that is established by the change rate ΔD of the blood vessel diameter D and the change amount ΔP of the blood pressure P, (lnPs−lnPd) is used instead of ΔP. In the relationship used, an index replacing the elastic modulus Ep is a stiffness parameter β.The stiffness parameter calculation formula is derived from the above relationship.

  The display control unit 92 calculates the diameter of the brachial artery 29a calculated by the vascular condition evaluation unit 90, the endothelial diameter (lumen diameter) d1, which is the diameter of the endothelium L1, and the FMD (blood flow-dependent blood vessel) after ischemia-reactive hyperemia. The expansion rate (change rate) R (%) of the inner diameter of the blood vessel of the brachial artery 29a representing the diastolic reaction), the systolic blood pressure Ps and the diastolic blood pressure Pd of the living body, the stiffness parameter β representing the hardness of the brachial artery 29a, and the like. Is displayed on the image display device 20.

  FIGS. 11 and 12 are flowcharts for explaining a main part of the control operation of the electronic control unit 22. FIG. 11 is an FMD measurement routine corresponding to the blood vessel state evaluation unit 90, and FIG. Each of the arterial stiffness measurement routines is shown. The above-described artery determination routine, FMD measurement routine, and arterial stiffness measurement routine may be executed in conjunction with the activation operation of the vascular endothelial function measurement device 10 for the brachial artery, but are executed in response to individual activation operations. Is also good.

  In the FMD measurement routine of FIG. 11 corresponding to the blood vessel state evaluation unit 90, in S11, the upper arm is obtained from an image specified as an artery in the ultrasonic cross-sectional image obtained by the ultrasonic signal processing unit 84 using, for example, a template. A cross-sectional image of the artery 29a is extracted.

  In S12, the diameter of the artery 29, for example, the endothelial diameter (lumen diameter) d1, which is the inner diameter of the endothelium L1, is measured from the cross-sectional image of the brachial artery 29a extracted in S11. Then, in S13, the endothelial diameter (lumen diameter) d1 measured in S12 is stored as the resting lumen diameter da. Time point t0 in FIG. 10 indicates this state.

  Next, in S14, the upper arm 29 is compressed by the upper arm compression device 18 so that the shear stress is applied to the endothelium L1 efficiently by the occurrence of turbulence of blood due to the repeated opening and closing of the upper arm artery 29a. Is pressed, and the application of shear stress based on the blood flow to the brachial artery 29a in the upper arm 29 is started. Time point t0 in FIG. 10 indicates this state. This shear stress is applied, for example, at a predetermined time T1 of several beats to several tens of beats or several seconds to several tens of seconds, the brachial artery 29a is collapsed within one pulse wave cycle, for example, flattened (closed flat). The compression pressure by the upper-arm compression device 18 is controlled within a predetermined pressure range P1 so that the pulsation has a section. For example, the pressure may be controlled so as to be maintained at a constant value set within a predetermined pressure range P1 within the predetermined time T1, but, for example, during a rising process or a decreasing process at about 5 to 6 mmHg / sec, the predetermined process is performed. The pressure range P1 may be controlled to pass through the predetermined time T1.

  Next, in S15, it is determined whether a predetermined time T1 has elapsed from the start of the application of the shear stress. While the determination in S15 is denied, S14 and subsequent steps are repeatedly executed. However, if the determination in S15 is affirmed, in S16, the same arterial blood vessel cross-section detection control routine as in S11 is executed. As described above, turbulence is repeatedly generated in the blood flow in the brachial artery 29a that is repeatedly opened and closed, and shear stress is repeatedly applied to the endothelium L1 of the blood vessel 29a at the measurement site. As a result, nitric oxide (NO) is produced from the endothelium L1 of the brachial artery 29a, and the smoothening of muscles dependent on the nitric oxide causes a temporary increase in the endothelial diameter of the brachial artery 29a.

In this state, in S16, the same arterial blood vessel cross-section detection control routine as in S11 is executed every time the ultrasonic probe 14 scans repeatedly at a predetermined cycle. Then, in S17, the diameter of the brachial artery 29a, for example, the endothelial diameter (lumen diameter) d1, which is the diameter of the endothelium L1, is determined for each scan from the cross-sectional image of the brachial artery 29a generated in S16, as in S12. The measured and sequentially measured endothelial diameter (lumen diameter) d1 is sequentially stored as the lumen diameter d1 after the release of hemostasis. This state is shown after time t1 in FIG. The measurement of the lumen diameter d1 after the release of hemostasis is performed until the lumen diameter d of the brachial artery 29a after the release of hemostasis reaches the maximum value d _MAX as shown at time t3 in FIG. S16 and subsequent steps are repeatedly executed.

However, when it is determined in S18 that the lumen diameter d of the brachial artery 29a after the application of the shear stress has reached the maximum value d _MAX , in S19, the maximum value d _MAX determined in S18 and the maximum value d _MAX are determined. FMD (blood flow-dependent vasodilator response) after ischemia-reactive hyperemia for evaluating endothelial function of brachial artery 29a based on lumen diameter da, which is the diameter of endothelium L1 of brachial artery 29a at rest expansion ratio of vessel lumen diameter representing the (rate of change) R (%) [= 100 × (d MAX -da) / da] is calculated, the display control unit 92, is displayed on the display device 20.

  In the arterial hardness measurement routine of FIG. 12 corresponding to the blood vessel hardness measurement control unit 104, in S20, after the compression pressure on the upper arm 29 is increased by the upper arm compression device 18 to a pressure higher than the systolic blood pressure of the upper arm, the compression is performed. In the process of reducing the compression pressure at a predetermined speed, for example, 3 to 6 mmHg / sec, the time of the first pulse wave in which the cross section of the brachial artery 29a shown in the ultrasonic cross-sectional image is opened within one pulse wave cycle Is determined as the systolic blood pressure value Ps, and the compression pressure at the time of generation of the pulse wave when the cross section of the brachial artery 29a is not closed within one pulse wave period is determined as the diastolic blood pressure value Pd. , Compression pressure is released. Next, in S21, the blood vessel diameter Ds of the brachial artery 29a at the time when the systolic blood pressure value Ps is determined and the blood vessel diameter Dd of the brachial artery 29a at the time when the diastolic blood pressure value Pd is determined are shown in the ultrasonic cross-sectional image. The cross section of the brachial artery 29a to be measured is measured. Next, in S22, it is determined whether the blood pressure measurement has been completed. While the determination in S22 is denied, S20 and the subsequent steps are repeatedly executed. If the determination is affirmative, in S23, the blood vessel diameter Ds and the diastolic blood pressure value Pd of the brachial artery 29a at the time when the systolic blood pressure value Ps is determined. The blood vessel diameter Dd of the brachial artery 29a at the time when is determined is stored together with the systolic blood pressure value Ps and the diastolic blood pressure value Pd.

  Next, in S24, the vascular diameter Ds and the diastolic blood pressure value Pd of the brachial artery 29a at the time when the systolic blood pressure value Ps stored at the above-mentioned S23 are determined from the aforementioned stiffness parameter calculation formula). The stiffness parameter β corresponding to the hardness of the brachial artery 29a is calculated based on the blood vessel diameter Dd of the brachial artery 29a, the systolic blood pressure value Ps, and the diastolic blood pressure value Pd. Then, in S25, the stiffness parameter β is displayed on the display device 20.

  As described above, according to the vascular endothelial function measuring apparatus 10 for the brachial artery of the present embodiment, the annular compression band 40 wound around the upper arm 29 and tightened, and the upper arm 29 And an inflatable bag (actuator) capable of changing the pressing pressure on the upper arm 29 of the ultrasonic transmission plate 26 by adjusting the tension of the compression band 40 by providing an ultrasonic transmission plate 26 provided so as to be able to adhere to the ultrasonic transmission plate 26. ) 42, a closed container 16 fixed on the base 12 and having an opening 24 closed by an ultrasonic transmission plate 26, and an ultrasonic transmission plate An ultrasonic probe 14 for transmitting and receiving ultrasonic waves to and from an upper arm 29 through 26, an elbow rest 32 for receiving an elbow 31 between the upper arm 29 and the forearm 35 wound around the compression band 40, and a hand connected to the forearm 35 3 A pivot mounting bracket provided on the base 12 so as to be rotatable about a rotation axis C1 passing through the elbow support 32 and perpendicular to the base 12 at both ends. 36. For this reason, with the forearm 35 on the rotating bracket 36 once bent with respect to the upper arm 29 in a direction to embrace the ultrasonic transmission plate 26 together with the rotating bracket 36, the upper arm 29 is wound around the compression band 40. Then, by extending the forearm 35 so as to be linear with the upper arm 29, the ultrasonic probe 14 is positioned at an optimum position that enables acquisition of an ultrasonic cross-sectional image and acquisition of a vascular endothelial diameter from the image. The ultrasonic probe 14 can be maintained with respect to the brachial artery 29a, and can be positioned at the same site on the brachial artery 29a for each measurement. In the upper arm 29 positioned as described above, the biceps, which is a good propagation medium for ultrasonic waves, is interposed between the ultrasonic probe 14 and the brachial artery 29a. Since a small and accurate ultrasonic cross-sectional image can be obtained, the accuracy of the cross-sectional image of the brachial artery 29a and the lumen diameter measured therefrom can be enhanced. Furthermore, the position of the cross-sectional image in the upper arm 29 obtained through the ultrasonic transmission plate 26 by the ultrasonic probe 14 and the position of the compression in the upper arm 29 by the ultrasonic transmission plate 26 of the upper arm compression device 18 coincide with each other. The shape of the cross-sectional image in the upper arm 29 with respect to the compression pressure by 18 is accurately obtained.

  Further, according to the vascular endothelial function measuring device 10 for the brachial artery of the present embodiment, the container in which the ultrasonic probe 14 is stored is the closed container 16 filled with liquid, and the ultrasonic probe 14 is formed of an oil (liquid) 28. Since ultrasonic waves are transmitted to and received from the brachial artery 29a through the ultrasonic transmission plate 26, attenuation of the ultrasonic waves is suppressed as much as possible, so that a more clear ultrasonic cross-sectional image can be obtained.

  In addition, according to the vascular endothelial function measuring device 10 for the brachial artery of the present embodiment, the electronic control device that controls the compression pressure on the upper arm 29 by the upper arm compression device 18 based on the state of the brachial artery 29a in the ultrasonic cross-sectional image ( Since the control device 22 is included, there is an advantage that a compression pressure according to the cross-sectional shape of the brachial artery 29a can be obtained. For example, the electronic control unit 22 determines a state in which the brachial artery 29a is crushed, for example, an applanation state, that is, a state in which the brachial artery 29a is crushed into a flat shape, based on the blood vessel cross-sectional shape of the brachial artery 29a. The shear stress can be applied by changing the compression pressure on the upper arm 29 by the upper arm compression device 18 so that the whole is in the collapsed state.

Further, according to the vascular endothelial function measuring device 10 for the brachial artery of the present embodiment, the electronic control device (control device) 22 generates an ultrasonic cross-sectional image based on the ultrasonic signal received by the ultrasonic probe 14. At the same time, the lumen diameter d1 of the brachial artery 29a in the upper arm 29 is sequentially calculated from the ultrasonic cross-sectional image, and the inner brachial artery 29a that expands after the temporary compression of the brachial artery 29a by the brachial compression device 18 is performed. The maximum value d _{MAX of the} lumen diameter is determined, and the expansion rate (change rate) of the maximum value of the lumen diameter (change rate) R (%) [= 100] with respect to the lumen diameter “da” at rest before compression by the upper arm compression device 18 is calculated. × (d _MAX −da) / da] is calculated and output. Thereby, FMD (blood flow-dependent vasodilation reaction) measurement is performed based on an accurate ultrasonic cross-sectional image, so that highly accurate measurement can be obtained.

  Further, according to the vascular endothelial function measuring device 10 for the brachial artery of the present embodiment, the electronic control device (control device) 22 performs the measurement of the vascular dilatation reaction of the brachial artery 29a based on the ultrasonic cross-sectional image. By controlling the compression pressure on the upper arm 29 by the upper arm compression device 18 so that a predetermined number of pulses in which the brachial artery 29a of the upper arm 29 is crushed in a part of one pulse wave cycle is applied to the upper arm artery 29a. Since the shear stress is applied, the shear stress is efficiently applied to the endothelium of the brachial artery 29a. For example, compared with the conventional FMD (blood flow-dependent vasodilatory reaction) measurement in which shear stress is applied by releasing the blood from the brachial artery 29a after being blocked for 5 minutes, the shear stress can be applied in a shorter time. Done. This makes it possible to perform FMD measurement in a short time.

  Further, according to the vascular endothelial function measuring device 10 for the brachial artery of the present embodiment, the electronic control device (control device) 22 changes the blood vessel shape of the brachial artery 29a in the upper arm 29 based on the ultrasonic cross-sectional image and compresses the upper arm. An index (stiffness parameter β) indicating the stiffness of the blood vessel of the brachial artery 29a is calculated from the ratio with the change in the compression pressure by the device 18, and is output. Thereby, diagnosis based on the hardness of the brachial artery 29a becomes possible. For example, a more accurate diagnosis of arteriosclerosis can be made by combining this with the expansion ratio of the brachial artery 29a after shear stress is applied to the artery.

  As mentioned above, although one Example of this invention was described based on drawing, this invention is applied also in another aspect.

  For example, in the above-described embodiment, the closed container 16 accommodates the ultrasonic probe 14, but the ultrasonic probe 14 may be accommodated by an open-type container. In this case, the ultrasonic transmission plate 26 is not provided in the opening 24 of the closed container 16, and the ultrasonic probe 14 is brought into direct contact with the upper arm 29.

  In addition, although the oil 28 is filled in the sealed container 16 in the above-described embodiment, a fluid such as water or a water-soluble fluid may be filled.

  In addition, the above-described ultrasonic probe 14 includes two rows of the first short-axis ultrasonic array probe A and the second short-axis ultrasonic array probe B, which are parallel to each other, and a central portion in the longitudinal direction thereof. Although an H-type hybrid ultrasonic probe having a long axis ultrasonic array probe C to be connected in one plane, at least a pair of ultrasonic arrays whose longitudinal directions intersect in one plane What is necessary is just to have a probe. The intersection angle between the pair of ultrasonic array probes is preferably a right angle, but may not necessarily be a right angle if the calculation becomes slightly more complicated.

  As described above, the preferred embodiments of the present invention have been described in detail with reference to the drawings. However, the present invention is not limited to these embodiments, and may be implemented with various changes made without departing from the spirit thereof. Things.

10: vascular endothelial function measuring device for brachial artery 12: base 14: ultrasonic probe 16: sealed container (container)
18: Upper arm compression device 20: Display device 22: Electronic control device (control device)
24: Opening 26: Ultrasonic transmission plate 28: Oil (liquid)
29: upper arm 29a: upper arm artery 30: upper arm mounting table 31: elbow 32: elbow support 33: hand 34: palm mounting table 35: forearm 36: rotating bracket 38: flexible belt 40: compression band 42: inflatable bag. (Actuator)
46: probe surface 46: base member 48: multi-axis positioning device 52: positioning motor drive circuit 58: air pump 60: pressure control valve 64: pressure sensor 78: positioning motor drive control unit 80: ultrasonic drive control unit 82: Detection processing unit 84: Ultrasound signal processing unit 88: Compression pressure control unit 90: Vascular condition evaluation unit 92: Display control unit 100: Vascular shape calculation unit 102: Vasodilation rate measurement unit 104: Blood vessel hardness measurement control unit A: First short-axis ultrasonic array probe B: Second short-axis ultrasonic array probe C: Long-axis ultrasonic array probe C1: Rotation axis

Claims (6)

A brachial artery vascular endothelial function measurement device for measuring endothelial function of the brachial artery,
An annular compression band wound around the upper arm to tighten the upper arm, an ultrasonic transmission plate material capable of transmitting ultrasonic waves provided so as to be able to adhere to the upper arm in a part of the compression band, and An upper arm compression device having an actuator that can change the compression pressure on the upper arm of the ultrasonic transmission plate member by adjusting the tension,
A container having an opening fixed on the base and closed by the ultrasonic transmission plate material,
An ultrasonic probe housed in the container and transmitting and receiving ultrasonic waves between the upper arm through the ultrasonic transmission plate material,
An armrest for receiving an elbow between the upper arm and the forearm wound around the compression band, and a palm rest for receiving the palm of a hand connected to the forearm are provided at both ends, and the base is passed through the elbow rest. A rotation bracket provided on the base so as to be rotatable about a rotation axis perpendicular to the table. A vascular endothelial function measuring device for a brachial artery, characterized in that: The container according to claim 1, wherein the container is a closed container filled with a liquid, and the ultrasonic probe transmits and receives ultrasonic waves to and from the upper arm through the liquid and an ultrasonic transmission plate. Vascular endothelial function measurement device. The vascular endothelial function measurement device for a brachial artery according to claim 1 or 2, further comprising a control device that controls a compression pressure on the upper arm by the upper arm compression device based on a state of the brachial artery. The control device generates an ultrasonic cross-sectional image based on the ultrasonic signal received by the ultrasonic probe, sequentially calculates the lumen diameter of the brachial artery in the brachial arm from the ultrasonic cross-sectional image, Determine the maximum value of the lumen diameter of the brachial artery that expands after allowing the brachial compression device to temporarily apply pressure to the brachial artery, and the lumen diameter of the lumen diameter relative to the lumen diameter before compression by the brachial compression device The vascular endothelial function measuring apparatus for a brachial artery according to claim 3, wherein the rate of change of the maximum value is calculated and output. When measuring the vasodilator response of the upper arm, the control device maintains a predetermined number of pulses in which the artery in the living body is in a collapsed state in a part of one pulse wave cycle of the living body based on the ultrasonic cross-sectional image. The vascular endothelial function measuring device for a brachial artery according to claim 3 or 4, wherein a shearing stress is applied to the brachial artery by controlling a compression pressure on the upper arm by the brachial compression device. The control device calculates and outputs an index indicating the hardness of the blood vessel in the upper arm from the ratio of the change in the shape of the blood vessel in the upper arm based on the ultrasonic cross-sectional image and the change in the compression pressure by the compression device. The vascular endothelial function measuring device for a brachial artery according to any one of claims 3 to 5, characterized in that:

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