JPH07155303A - System for inspecting function of autonomic nerve - Google Patents

Abstract

PURPOSE:To enable more exact judgment by enabling the inspection of the autonomic nerves in real time, thereby enabling rapid and exact treatment and comparison of data at the time of resting and at the time of loading. CONSTITUTION:The electrocardiograms of a patient lying in rest are first measured by an electrocardiogram measuring instrument 100 and R-R interval fluctuations are measured by an R wave interval fluctuation measuring circuit 70 and are once stored in a memory 10a or external storage device 40. The electrocardiograms of the patient at the time of standing under load are then measured, and similarly, the R-R interval fluctuations are measured. The results of the measurement at the time of the rest and the results of the measurement at the time of the load are simultaneously outputted as the same screen by a display device 20 and/or printer 30. The trends of R-R time, R-R histograms, FFTs, etc., are included in addition to the statistical results of prescribed heart beat components in the R-R interval fluctuation.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an autonomic nerve function testing device.

[0002]

2. Description of the Related Art The relationship between a doctor and an autonomic nerve in a clinical setting is primarily due to vagal nerve reflex in intraoperative anesthesia management, coronary spasm due to sympathetic reflex stimulation, and blood pressure due to sympathetic nerve blockage due to spinal anesthesia or epidural anesthesia. Although there are prevention and suppression of bronchospasm in patients with bronchial asthma due to decrease or shock, and relative vagal hyperactivity, autonomic analysis before and after surgery as well as during such surgery is It tends to be neglected.

In recent years, among the people working in the information society in Japan, the number of patients who can be said to be an autonomic nervous system instability syndrome due to various stresses is increasing, which is one of the causes of social anxiety. Then, patients visiting hospitals have come to handle many related diseases not only in internal medicine and psychiatry but also in anesthesia department outpatient clinics that treat pain and neurological diseases. That is, besides autonomic dysfunction, it is also known that the vicious cycle of pain is deeply related to the sympathetic nerve, and sympathetic block therapy brings not only pain but also improvement of peripheral blood circulation disorder, and has a broad positive effect on all nerve functions. It is known.

[0004]

However, in recent years, the need for diagnosing patients with underlying autonomic nervous system disorders, including sympathetic and parasympathetic nerves, and determining the therapeutic effect has been increasing. Therefore, until now, no device has been found capable of comprehensively analyzing and diagnosing the autonomic nerve function by simply or easily utilizing these in the clinical field.

[0005]

The present invention has been made for the purpose of solving the above-mentioned problems, and has the following structure as one means for solving the above-mentioned problems. That is, an electrocardiogram information measuring means for measuring electrocardiogram information at rest and without load, and an analysis means for measuring and analyzing heartbeat interval fluctuations from at least resting and load electrocardiogram information measured by the electrocardiogram information measuring means, Output means for outputting at least the measurement and analysis result of the heartbeat interval fluctuations at rest and under load by the analysis means, and as a result of the output of the output means, the measurement analysis result of the heartbeat interval fluctuation is lower than the normal average value. Whether the autonomic nervous system control function is good or bad can be determined depending on whether the value is high or high.

[0006] For example, the resting electrocardiogram information is resting position and the load electrocardiogram information is standing upright electrocardiogram information. Alternatively, the electrocardiogram information is to measure the electrocardiogram lead II signal.

[0007]

With the above configuration, the autonomic nerve function can be measured easily and quickly, and the analysis result can be displayed, so that the proper autonomic nerve function test can be performed. Further, it is possible to perform the above test in real time, which enables more accurate autonomic nerve function test. Further, for example, it is possible to output the measurement and analysis result of the heartbeat interval fluctuation under load during resting position, which enables more accurate diagnostic treatment.

[0008]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS An embodiment according to the present invention will be described in detail below with reference to the drawings. [First Embodiment] FIG. 1 is a diagram showing the configuration of an autonomic nerve function testing apparatus according to a first embodiment of the present invention, in which 10 denotes various autonomic nerve function testing processes in the present embodiment.
A computer (personal computer) that outputs the inspection result from the display device 20 or the printer 30, and includes a memory 10a having a predetermined capacity. Reference numeral 20 denotes a display device for displaying and outputting various inspection results and the like, and in this embodiment, a CRT display is used. A printer 30 prints out various inspection results and the like, and an inkjet printer is used in this embodiment.

Reference numeral 40 denotes an external storage device for storing various types of subject information, inspection results, etc., and a hard disk device is used in this embodiment. Reference numeral 50 denotes an operation unit for inputting subject information and operation instructions of the apparatus of this embodiment. The operation unit 50
When the above is permanently installed in the personal computer 10, the operation unit permanently installed in the personal computer 10 may be substituted.

Reference numeral 60 is a timer circuit for precisely measuring the RR wave interval of electrocardiogram information indicating the heartbeat interval, which plays an important role in the examination of the autonomic nerve function in the apparatus of this embodiment.
Is an R wave fluctuation measuring circuit that measures the RR wave interval fluctuation of the electrocardiogram information using the timer circuit 60, and 80 is an electrocardiogram information analysis unit that analyzes the electrocardiogram information such as detecting the R wave from the electrocardiogram information. An external interface 90 controls the interface with the electrocardiogram measurement device 100.

Further, 100 is an electrocardiogram measuring device for measuring an electrocardiogram, 110 is an amplifier circuit for amplifying a minute signal detected by the biological electrode section 120, and 120 is a biological electrode section.
It is attached to the measurement site of the subject 200 and detects a biological signal from the subject. In the present embodiment, in order to be able to easily inspect even during outpatient treatment, it is configured with a triangular electrode plate,
The electrocardiogram information can be easily and quickly detected from the surface of the subject by simply applying this to the chest.

The basic principle of the autonomic nerve function measurement of the autonomic nerve function inspection apparatus of the present embodiment having the above configuration will be described below. The present embodiment is intended to continuously measure an electrocardiographic RR interval in which the influence of the autonomic nerve is very sensitively sensed, and determine the autonomic nerve function from the measurement result. In other words, the present invention aims to enable more RR interval fluctuation measurement values to be arithmetically analyzed and statistically processed from an electrocardiogram currently clinically available, and to appropriately output the results.
Specifically, an autonomic nerve function test is performed by the processing of FIGS. 2 and 3 described later, and the result is output.

First, in step S1 of FIG. 2, subject information is input from the operation unit 50. For example, the ID number, name, age group, age, sex, type of treatment, etc. of the subject are input.
This information is configured such that by inputting only the ID number, for example, the corresponding subject information stored in the external storage device 40 is read out, and the input of other items can be omitted. May be. This input result is stored in the memory 10a.
Is stored in a predetermined area. Then, in the subsequent step S2 and subsequent steps, first, a process of detecting electrocardiogram information in a supine position is performed. For this reason, first, the subject is placed in a resting position and the bioelectrode portion 120 (triangular electrode plate) is applied to a predetermined portion of the subject so that the electrocardiographic information can be collected. In the present embodiment, the bioelectrode section 120 is attached so as to detect the electrocardiographic II lead signal.

When the wearing of the electrodes on the subject is completed,
In step S3, an instruction is input from the operation unit 50 to start collecting electrocardiogram information in the resting position. This allows the computer 10
Activates the timer circuit 60 and activates the electrocardiogram measuring device 100 connected to the external interface 90 via the external interface 90. When the electrocardiogram measurement apparatus is activated by the computer 10, the amplifier circuit 110 is energized to amplify and capture the minute living body detection potential from the living body electrode section 120 as shown in step S4. The captured electrocardiogram information in the resting position is sent to the electrocardiogram information analysis unit 80 via the external interface 90.

The electrocardiogram information analysis unit 80 continues to step S.
In step 5, QRS wave detection processing is executed from the measured electrocardiogram to detect the R wave peak. Then, the R-wave detection circuit 70 is notified of the R-wave detection. The R-wave interval fluctuation measuring circuit 70
The R wave detection interval time of the electrocardiogram information analysis unit 80 is measured using the timer circuit 60. That is, the RR interval time of the R wave detection trigger pulse train from the electrocardiogram information analysis unit is measured in units of 1 mS.

The above description is based on the electrocardiogram measuring device 10.
The case where 0 does not have a function of detecting and simply outputting the electrocardiogram information from the living body has been described as an example. However, when this electrocardiogram measuring device has a function of detecting the QRS wave of the electrocardiogram and can directly output the R wave peak detection result, the electrocardiogram information analyzing unit 80 is not necessary, and the R from the electrocardiogram measuring device 100 is not necessary. The R-wave interval variation measuring circuit 70 may be directly activated by the wave detection signal. Further, when the electrocardiogram information measuring device has a function of measuring the R-wave interval time in detail, the R-wave interval fluctuation measuring circuit 70 becomes unnecessary, and in this case, the R-wave interval is directly measured by the computer 10. Just output the time. The above configuration is the same as in the electrocardiogram information collection during load described later.

The R-wave interval time in the resting position obtained by any one of these methods is sent to the computer 10, and the computer 10 stores the R-wave interval in the resting position in a predetermined area of the memory 10a in step S6. Remember. Then, in a succeeding step S7, the R-wave interval variation is checked, statistically processed, and the processing result is stored in the statistical result storage area of the memory 10a in the rest position. Specifically, first, the measurement result at resting position is developed into a pattern such that it can be displayed on a screen or the like in the form of RR trend and stored in the memory 10a, and the following statistical processing result is stored.

The contents of the statistical processing include (1) RR measurement values (maximum RR time, minimum RR time, average RR time, SD, maximum / minimum ratio), (2) HR measurement. Value (maximum H
R, minimum HR, average HR, SD, CV) are calculated.

In the measurement, the abnormal R wave is deleted and the above statistical processing is performed. Then, in the next step S8, it is determined whether or not the measurement processing of the required number of R waves in the prone position is completed. When the measurement processing of the predetermined number of R waves is not completed, the process returns to step S4 and the processing for the next R wave is continued. On the other hand, a predetermined number of R wave measurement processes, for example, “25
If "0" is measured, the electrocardiogram information measuring process in the resting position is ended, and the process proceeds from step S8 to step S9. Then, in step S9, the statistical result is displayed on the display device 20.

In a succeeding step S10, it is determined whether or not the measurement result is stored in the external storage device 40. When the measurement result is not stored in the external storage device 40, the process proceeds to step S12. On the other hand, when the measurement result is stored in the external storage device 40, the process proceeds from step S10 to step S11, and the measurement result and the statistical processing result are read from the memory 10a and stored in the external storage device 40. Then, the process proceeds to step S12. As a result, the previous measurement result can be read out and used at any time thereafter when measuring the electrocardiogram of the same subject.

In step S12, it is determined whether or not the measurement result is printed out by the printer 30 in the form of a report. Step S if you do not want to print out the report
Proceed to 15. On the other hand, when the statistical result is printed out as a report from the printer 30, the process proceeds to step S13,
The statistical result is printed out as a report from the printer 30. Then, the processing proceeds to step S15 and thereafter, and the measurement processing of the electrocardiogram information at the time of load is performed.

First, in step S15, a preparatory work for measuring the electrocardiogram information during standing up as the electrocardiogram information during load is performed. That is, the subject is made to stand upright and the bioelectrode section 120 is applied to the measurement site in the same manner as above to activate the electrocardiogram measurement apparatus 100. Then, in step S16, the electrocardiogram measuring device is the computer 10
When activated, the amplifier circuit 110 is energized to amplify and take in the minute living body detection potential from the living body electrode section 120. The captured electrocardiogram information in the resting position is sent to the electrocardiogram information analysis unit 80 via the external interface 90.

The electrocardiogram information analysis unit 80 continues to step S.
At 17, the QRS wave detection process is executed from the measured electrocardiogram, and R
Detect wave peaks. Then, the R-wave detection circuit 70 is notified of the R-wave detection. R wave interval fluctuation measuring circuit 70
Uses the timer circuit 60 to measure the R wave detection interval time of the electrocardiogram information analysis unit 80. That is, the R-R interval time of the R wave detection trigger pulse train from the electrocardiogram information analysis unit is set to 1 mS.
Measure in units.

The R-wave interval time during standing load thus obtained is sent to the computer 10, and the computer 1
In step S18, 0 stores the R wave interval during standing load in the predetermined standing load storage area of the memory 10a. Then, in a succeeding step S19, the R-wave interval variation is checked, statistically processed, and the processing result is stored in the statistical result storage area of the memory 10a at the time of standing load. Then, the result of the statistical processing is displayed so as to overlap the display screen of the display device 20 on which the statistical result at the time of resting is displayed. The statistical contents of this statistical processing are the same as those at rest in step S7 described above. As described above, according to the present embodiment, the RR trend at rest and at load can be displayed on the same screen in real time, and by comparing the two,
It enables quick and accurate diagnosis and treatment.

Then, in the next step S20, it is determined whether or not the measurement processing of the required number of R waves at the standing load is completed.
If the measurement processing of the predetermined number of R waves has not been completed, the process returns to step S164 to continue the processing for the next R wave.
On the other hand, when a predetermined number of R wave measurement processes, for example, “250”, are measured, a series of electrocardiogram information measurement processes are terminated and the process proceeds from step S20 to step S21.

In step S21, it is determined whether or not the measurement result is stored in the external storage device 40. When the measurement result is not stored in the external storage device 40, the process proceeds to step S23. On the other hand, when the measurement result is stored in the external storage device 40, the process proceeds from step S21 to step S22, and the measurement result and the statistical processing result are read from the memory 10a and stored in the external storage device 40. Then, the process proceeds to step S23.

In step S23, it is determined whether or not the measurement result is printed out by the printer 30 in the form of a report. If not printed out in the form of a report, the process ends. On the other hand, when the statistical result is printed out as a report from the printer 30, the process proceeds to step S24, and the statistical result is printed out as a report from the printer 30. Then, the process ends.

From the above measurement and statistical results, for example, the RR trend at rest and at load can be displayed on the same screen, so that a more accurate diagnostic treatment of the autonomic nervous system becomes possible by comparing both trends. The contents recorded in the external storage device 40 described above are stored in association with the subject information, the measurement data at rest before loading, the measurement data during loading, and the like. Therefore, for example, at a later date, arbitrary two data can be read out from the stored measurement result, and display output and report output can be performed. That is, it has a function of comparing with other subjects and comparing with past data of the same subject. This subject information can be modified during this output processing.

The contents displayed on the display screen of the display device 20 and the contents of the report output from the printer 30 are as follows. (1) "Subject information" of data at rest + (2) "Subject information" of data during load + "RR time table" (3) "Subject information" at rest and during load Examinee information ”+“ R
-R trend display "(4)" R-R histogram "of data at rest and load +" FFT analysis result "(5)" Subject information "+" RR time-axis trend of data at rest ""Display" (6) "Subject information" of data under load + "RR time axis trend display" (7) Simultaneous output of all the above contents The above output contents can be selected at any time, (7) It is also possible to output all, as described above, or select any one of (1) to (6) or output a combination of some of (1) to (6).

FIG. 4 shows an example of the output result of the entire contents of the measurement result in this embodiment. The uppermost row in FIG. 4 is the “subject information” output area at the time of resting and standing, and subsequently, at the time of resting and standing “RR time table (RR measurement value and Each of the above-mentioned statistical results of the HR measurement value, the maximum and minimum fluctuation rates, the output region of the measured R wave number), the third stage near the center is in the lying position, and the "RR trend when standing up". "Display" output area, 4th row is "RR histogram" + "FFT analysis result" output area when lying down, and "Bottom row" is "R-R histogram" + "FFT analysis result" output area when standing load Is. The “FFT analysis result” is a bar graph of the power spectrum obtained by Fourier analysis.

Note that the trend graph shown in FIG. 4 is an example of printing from the printer 30, and in the example of display on the display device 20, a long blue line in the center is a normal average value "R" between R and R regions. 0.86 to 0.9 "is drawn as a balance band, and the value of the RR trend is displayed so that it can be easily recognized as compared with this balance band. Then, for example, if the rest trend graph is displayed in yellow and the load trend graph is displayed in red on the same screen, the distinction becomes easier.

Further, this output is not limited to the above-mentioned real-time example, and the measurement result stored in the external storage device 40 is read out and reproduced on the screen, and the measurement of the time interval is also started if necessary. It becomes possible by specifying the heartbeat and end heartbeat. An example of the numerical values is shown at the right end of each display area in FIG. Next, the autonomic nerve function measuring method by analyzing the "fluctuation" of the RR interval will be described in more detail with reference to the output results of FIG. 4 and the like in the present embodiment.

(1) Judgment by RR time list "0.86 to 0.9" which is a normal average value of each value between RR
A lower value can be judged as a sympathetic nerve, and a higher value can be judged as a vagus nerve dominant state. And it is desirable to judge whether the autonomic nervous system control function is good or bad by referring to the RR trend graph of (2) described later. However, in order to estimate only by the numerical value, the maximum value at the standing load is It can be estimated by whether or not the average value in the supine position is reached. Note that C
A large V value indicates that the activity of the vagus nerve is active, and is found in the younger age group.

(2) Judgment by RR trend graph The above-mentioned balance band having the normal average value "0.86 to 0.9" in each region between RR is the balance band of sympathetic nerve and vagal nerve function. As shown in the determination example of the autonomic tone shown in FIG. 5, the vagus nerve is more dominant as the trend graph goes above this band, and the vagus nerve goes below this band. It can be judged that the sympathetic nerve is more dominant.

When the sympathetic nerve is excited by the standing load, the start position moves downward, but there are two examples in which the standing trend graph rapidly overlaps with the resting trend graph during the passage. It can be determined that the balance adjustment of the autonomic nerve is good. In the example of FIG.
It returns at the 98th heartbeat indicated by the arrow in the figure. However, if the person does not return to the resting position even after observing up to 250 heartbeats after standing load, it can be judged that the balance adjustment of the autonomic nerve is poor. Therefore, showing the display screen and the like of this embodiment to the subject at the bedside is very effective for explaining and convincing the necessity of treatment and prognosis. At this time, the result of the normal subject with good balance adjustment can be read out from the external storage device 40 and displayed, and the persuasive power for the subject to be explained can be increased.

(3) Judgment by Histogram The X-axis is the RR interval value and this value is the same as the above "0.86".
"-0.9", the sympathetic nerve became dominant when the graph moved to the left, and the vagus nerve became dominant when it increased and moved to the right. There is.
This state is shown in FIG. Therefore, by checking this histogram, the autonomic nerve function can be examined. (4) Judgment by FFT (Fourier analysis power spectrum frequency distribution) From the Fourier analysis power spectrum frequency distribution,
When there are many high-frequency components centered on "0.19 to 0.27" Hz, it indicates that the vagal nervous system has a strong influence, and when the sympathetic nervous system has a strong influence, "0.04 to 0.12" Hz Therefore, the low frequency frequency component increases especially in the standing position.Therefore, when the ratio of the area of the low frequency part to the area of the high frequency part is increased, it is inclined to the sympathetic nerve side. It is found that the inclination is to the side, which is shown in Fig. 7. Therefore, the autonomic nerve function can be examined by confirming the ratio of both frequency components.

As described above, according to the present embodiment, the RR interval value at rest is preliminarily measured based on the detected electrocardiogram information in the electrocardiogram measuring device 100 and stored in a predetermined memory, RR at the time of load, which is being measured from the detected electrocardiogram information in real time when the electrocardiogram at time is detected
Since the interval measurement result can be output on the same screen together with the RR interval measurement result at rest, the autonomic nerve function can be measured easily and quickly, and the analysis result can be displayed, and an accurate autonomic nerve function test can be performed. It will be possible.

Showing the display screen and the like of this embodiment to the subject at the bedside is very effective for explaining and convincing the necessity of treatment, prognosis and the like. Furthermore,
For example, it is also possible to output the measurement and analysis result of the heartbeat interval fluctuation during resting position or under load, which enables more accurate diagnostic treatment. [Other Embodiments] In the above description, the external storage device 4 is used.
However, the present invention is not limited to the above-described example, and the hard disk device is configured by a device such as a flexible disk device that can easily exchange media, for example, for each subject. It may be configured to allocate one magnetic disk medium.

Furthermore, as described above, when the electrocardiogram measuring device has the electrocardiogram analyzing function and has the function of detecting the R wave, it is sufficient to measure only the RR interval. A commercially available personal computer, a general commercially available display device and a printer are prepared, and the RR interval value statistics / output function of this embodiment is prepared in the form of a program, and the personal computer executes this function. The device is configurable. In this case as well, since general commercial products can be used, a practical, easy-to-use, low-cost configuration can be achieved, and the utility value is great.

Further, in the above description, the electrocardiogram measuring device 100, the display device 20 and the printer 30 have different configurations, but the present invention is not limited to the above examples, and the electrocardiogram measuring device is a page. When both the printer and the display device are provided, they can be omitted.

[0041]

As described above, according to the present invention, it becomes possible to output the RR interval measurement result at rest and under load in real time on one screen, and the autonomic nerve function can be easily and quickly provided. Can be measured and the analysis result can be displayed.
It enables accurate examination of autonomic nerve function.

Showing the display screen and the like of this embodiment to the subject at the bedside is very effective for explaining and convincing the necessity of treatment and prognosis. Furthermore,
For example, it is also possible to output the measurement and analysis result of the heartbeat interval fluctuation during resting position or under load, which enables more accurate diagnostic treatment.

[Brief description of drawings]

FIG. 1 is a block diagram showing a configuration of an embodiment according to the present invention.

FIG. 2 is a flowchart showing RR interval variation statistical processing in the present embodiment.

FIG. 3 is a flowchart showing RR interval variation statistical processing in the present embodiment.

FIG. 4 is a diagram showing an example of outputting an RR interval variation statistical result in the present embodiment.

FIG. 5 is a diagram for explaining determination of the degree of autonomic tone in the RR trend in the present embodiment.

FIG. 6 is a diagram for explaining the meaning of fluctuation of the RR histogram in the present embodiment.

FIG. 7 is a diagram for explaining the significance of the power spectrum by FFT in the present embodiment.

[Explanation of symbols]

 10 personal computer 10a memory 20 display device 30 printer 40 external storage device 50 operation unit 60 timer circuit 70 R wave interval fluctuation measurement circuit 80 electrocardiogram information analysis unit 90 external interface 100 automatic diagram measurement device 110 amplifier circuit 120 bioelectrode unit

 ─────────────────────────────────────────────────── ─── Continuation of front page (72) Inventor Yukio Goto 5-10-6, Kikuzonocho, Showa-ku, Nagoya-shi, Aichi

Claims (3)

[Claims] 1. An electrocardiogram information measuring means for measuring at least resting and load electrocardiographic information, and an analyzing means for measuring and analyzing heartbeat interval fluctuations from at least resting and load electrocardiographic information measured by the electrocardiogram information measuring means. And output means for outputting at least the measurement analysis result of the heartbeat interval fluctuation at rest and under load by the analysis means, and the output of the output means, the measurement analysis result of the heartbeat interval fluctuation is compared with the normal average value. An autonomic nervous function testing apparatus, which can judge whether the autonomic nervous system control function is good or bad depending on whether the value is low or high. 2. The autonomic nervous function testing apparatus according to claim 1, wherein the resting electrocardiogram information is resting position and the loading electrocardiogram information is standing upright electrocardiogram information. 3. The electrocardiographic information is information for measuring an electrocardiographic lead II signal, and claim 1 or claim 2.
The autonomic nervous function test apparatus according to any one of 1.