JPH08173390A - Diagnostic instrument - Google Patents

Abstract

PURPOSE: To provide a diagnostic instrument to perform diagnosis by considering the periodical condition change original to a living body. CONSTITUTION: This diagnostic instrument is equipped with a pulse wave detecting part 200, a memory 1, and a microcomputer 5. The microcomputer 5 records the circulatory movement parameters of a living body obtained at a plurality of time points every day in the memory 1 by using the pulse wave detecting part 200, and is functioned to judge whether a current parammeter is within the fluctuation range at the same time point of a past day within a past designated period based on the stored contents in the memory 1, and to output an alarm when it is not within the fluctuation range.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a diagnostic device for making a diagnosis by measuring a pulse wave or the like.

[0002]

2. Description of the Related Art In the current stressful situation, sudden death and the like have been highlighted as social problems. Under such circumstances, attention has been focused on pulse diagnosis for diagnosing the state of the human body based on pulse waves. Such pulse diagnosis has a possibility of obtaining detailed information about the human body, and is expected as a means for detecting in advance signs of sudden death and the like.

[0003]

By the way, it is known that the state of the living body, particularly the state of the circulatory system, not only fluctuates due to a load such as stress but also fluctuates according to a certain rhythm. In addition, it has been reported that the state of a living body repeats periodic fluctuations with one day as one cycle. Recently, sudden death has become a hot topic, but the probability of sudden death also fluctuates cyclically with one day as one cycle, and it is reported that there are high and low times of death occurrence. Has been done. FIG. 24 exemplifies a diurnal variation in the number of sudden deaths. In addition, FIG. 25 exemplifies a diurnal variation in the number of cases of acute myocardial infarction. These data are available in the literature Muller JE, et al: Circulation. 79: 733.
~ 734,1989. These reports are
It may be closely related to the periodicity of the state of the living body and will be a subject for future research.

As described above, since the state of the living body exhibits a natural variation in accordance with a certain rhythm, it is difficult to accurately determine the state of the living body only by making a diagnosis even at a certain time. Is. For example, even if a good result is obtained when a patient's pulse is diagnosed at a certain time, it cannot be concluded that the patient's medical condition has been cured. It is because there is a possibility that such a result was obtained because the diagnosis happened during the time period when the condition of the living body was in good condition. In addition, when a patient is diagnosed at a certain time, even if the cardiac output is rather high, for example, such a result is obtained because the diagnosis is made during the time when the cardiac output happens to be high. However, there is a possibility that there is no particular concern about the patient's condition. On the other hand, when the state of the living body changes unnaturally different from the natural change in everyday life, for example, when the cardiac output increases during the time when the cardiac output should decrease, Something may have happened and we need to address it quickly.
The present invention has been made in view of the above circumstances,
An object of the present invention is to provide a diagnostic device capable of accurately detecting a change in the state of the living body in consideration of the periodical state change of the living body.

[0005]

According to a first aspect of the invention, the process of measuring the state of a living body and calculating a parameter representing the state of the living body based on the measurement result is repeated to calculate the parameter. The diagnostic device is characterized by comparing the parameter with a parameter obtained in the past for each time and outputting the result. The invention according to claim 2 has a measurement means, a storage means, and a control means, the measurement means measures the state of the living body at a plurality of times every day, and the control means controls the plurality of the states. At the time, the parameter representing the state of the living body is calculated based on the measurement result by the measuring unit and recorded in the storage unit, and the parameter at the current time is the same as the one in the past fixed period based on the stored content of the storage unit. It is a diagnostic device characterized by determining whether or not it is within a fluctuation range at time, and notifying when it is not within the fluctuation range.

The invention according to claim 3 has a measuring means, a storage means, and a control means, and the measuring means is
Measuring the state of the living body at a plurality of times, the control means, at the plurality of times, while calculating the parameter representing the state of the living body based on the measurement result by the measuring means and recording in the storage means, The diagnostic device is characterized by displaying an error between a parameter at time and a reference parameter calculated from parameters at the same time within a certain past period. The invention described in claim 4 is the diagnostic apparatus according to any one of claims 1 to 3, wherein the parameter is a hemodynamic parameter. According to a fifth aspect of the present invention, in the diagnostic device according to any one of the first to third aspects, the parameter is an amplitude or a phase of a harmonic component of a pulse wave.

According to a sixth aspect of the present invention, in the diagnostic apparatus according to the second or third aspect, the control means performs interpolation calculation using each parameter stored in the storage means within a certain past period. Thus, the parameter at the same time as the current time within a certain past period is calculated, and the variation range is determined based on the calculation result. The invention according to claim 7 has a measuring means, a storage means, and a control means, and the measuring means comprises:
Each day, the state of the living body is measured at a plurality of times, and the control unit calculates a parameter representing the state of the living body based on the measurement result by the measuring unit at the plurality of times and records the parameter in the storage unit. Along with this, the mode of change of each parameter calculated on the same day is obtained and recorded in the storage means, and the mode of change of the parameter at the current time is based on the stored contents of the storage means It is a diagnostic device characterized by determining whether or not it is in accordance with the aspect of No. 1, and notifying that it is not in accordance with the aspect of past changes.

The invention according to claim 8 has a measuring means, a storage means, and a control means, and the measuring means is
The pulse wave of the living body is measured at a plurality of times, and the control means, at the plurality of times, calculates a parameter representing the state of the living body based on the measurement result by the measuring means and records the same in the storage means on the day. Based on each calculated parameter, each time when the parameter becomes maximum or minimum is obtained and recorded in the storage means, and based on the stored contents of the storage means, the mode of the change of the parameter at the current time is within the past certain period. It is a diagnostic device characterized by determining whether or not it is in accordance with the mode of change of parameters at the same time, and notifying it if it is not in accordance with the mode of change in the past. The invention according to claim 9 is
The diagnostic device according to any one of claims 1 to 8, wherein the control means obtains a correlation of intraday fluctuation waveforms of parameters on a plurality of days and outputs the result. The invention described in claim 10 is claim 1
The diagnostic device according to any one of items 1 to 9 is characterized in that it is provided with means for creating and outputting a graph in which intraday fluctuation waveforms of parameters on a plurality of days are overlaid and displayed.

The invention according to claim 11 is the diagnostic apparatus according to claim 1 or 2, wherein the measuring means measures the pulse wave of the living body, and the control means is the arterial system of the human body. When an electric signal corresponding to the pressure wave at the aortic origin is applied to an electric circuit simulating the system from the central part to the peripheral part, the output waveform corresponding to the pulse wave obtained by the measuring means is the electric wave. The value of each element of the electric circuit is calculated so as to be obtained from the circuit, and part or all of the calculation result is used as the parameter.
According to a twelfth aspect of the present invention, in the diagnostic apparatus according to the eleventh aspect, the electric circuit includes a first resistance corresponding to a vascular resistance due to blood viscosity in the central part of the arterial system, and a central part of the central part of the arterial system. Between the pair of input terminals, having an inductance corresponding to the inertia of blood, a capacitance corresponding to viscoelasticity of blood vessels in the central part of the artery, and a second resistance corresponding to vascular resistance in the peripheral part. Is a four-element lumped constant model in which the series circuit including the first resistance and the inductance and the parallel circuit including the capacitance and the second resistance are sequentially inserted in series. is there.

[0010]

According to the first aspect of the present invention, since the comparison result of the parameter obtained at present and the parameter obtained in the past can be obtained, it is possible to confirm the change of the state of the living body.
According to the invention of claim 2, it is possible to confirm whether or not the parameter at the current time is within the variation range of the parameter at the same time within the past fixed period.
You can know when there is a change between your physical condition on that day and your physical condition for the last few days. According to the invention of claim 3, since it is possible to know the difference between the parameter at the current time and the reference parameter at the same time within the past fixed period, it is possible to accurately know the physical condition of the day. .

According to the invention of claim 6, even when the parameter corresponding to the current time is not stored in the storage means within the past fixed period, the parameter corresponding to the current time is It is obtained by interpolation calculation. Therefore, it is possible to deal with a situation in which it is difficult to measure the state of the living body on time. According to the invention according to claim 7 and the invention according to claim 8, an alarm is output when the manner of change such as increase or decrease of the parameter does not follow the manner of change in the past, so that the state of the living body is unnatural. You can catch change. According to the invention of claim 9 and the invention of claim 10, it can be confirmed whether or not the rhythm of the state of the living body has changed. According to the invention of claim 11 and the invention of claim 12, changes in the state of the circulatory system of the human body can be objectively grasped.

[0012]

Embodiments of the present invention will be described below with reference to the drawings. A. Prior Examination The present inventor conducted an experiment on the periodic behavior of a human pulse wave when designing the device according to the present embodiment. Hereinafter, the details will be described. (1) Device configuration for the experiment Figure 1 shows the configuration of the device used for the experiment. In this figure, reference numeral 200 denotes a pulse wave detection unit, which detects a radial artery waveform through a pressure sensor attached to the right wrist of the subject and detects blood pressure through a cuff band attached to the upper arm of the subject. , An electrical signal representing a waveform obtained by calibrating the radial artery waveform with blood pressure is output. Reference numeral 300 is a stroke volume measuring unit, which measures a stroke volume (the amount of blood discharged by one beat) based on the so-called systolic area method, and outputs an electric signal representing the result. To do. In addition to the above devices, a personal computer (not shown) that controls these devices and analyzes the measurement results was used.

(2) Measurement conditions For 13 healthy adult men (age 21 ± 9), 2
They had the same behavior in the same facility for 36 hours a day. Also, the temperature is 24.0-24.5 ° C, and the humidity is 40-
I kept it at 50%. Figure 2 shows the schedule of the experiment. As shown in this figure, food was provided at noon and 6 pm. Also, the same menu for two days will be about 17 per day.
He was given a meal of 00 Kcal. He went to bed at midnight and woke up at 6:00 the next morning to get 6 hours of sleep. Then, using the apparatus shown in FIG. 1, the radial artery waveform and the stroke volume were measured every two hours. At the time of measurement, the subject was allowed to sit in a resting position for 15 minutes before the measurement, and during the measurement, the subject was allowed to sit at a resting position of 0.
A steady breath was taken in accordance with the 25 Hz metronome. Then, an average addition waveform for one beat was obtained from 10 heartbeats from 20, 30, 40, and 50 seconds after the start of measurement, and was used as an analysis target described in the next section.

(3) Analysis The inventor of the present application assumes that the circulatory dynamics parameters of the human body constitute the four-element lumped parameter model shown in FIG. I decided to check if it would change. This four-element lumped parameter model is one of the hemodynamic parameters that determine the behavior of the circulatory system of the human body. Inertia by blood in the central part of the arterial system, vascular resistance (viscous resistance) by blood viscosity in the central part, and This is modeled as an electric circuit by paying attention to four parameters of blood vessel compliance (viscoelasticity) and peripheral blood vessel resistance (viscous resistance). The correspondence relationship between each element constituting the four-element lumped constant model and each of the above parameters is as follows.

Inductance L: Inertia of blood in central part of arterial system [dyn · s ² / cm ⁵ ] Capacitance C: Compliance (viscoelasticity) of blood vessel in central part of arterial system [cm ⁵ / dyn] Compliance is a quantity that represents the softness of blood vessels, and is viscoelasticity. Electric resistance R _c : Vascular resistance due to blood viscosity in the central part of the arterial system [dyn · s / cm ⁵ ] Electric resistance R _p : Vascular resistance due to blood viscosity in the peripheral part of the arterial system [dyn · s / cm ⁵ ]

The currents i, i _P and i _c flowing through the respective parts in this electric circuit are the blood flow [cm ³ / cm ^3] flowing through the corresponding parts.
s]. The input voltage e applied to this electric circuit corresponds to the pressure [dyn / cm ² ] at the origin of the aorta.
The terminal voltage v _P of the capacitance C corresponds to the pressure [dyn / cm ² ] in the radial artery. Further, generally, the pressure waveform at the aortic origin is as shown in FIG.
This pressure waveform is approximated by the triangular wave shown in FIG. In FIG. 5, E _o is the minimum blood pressure (diastolic blood pressure), E _o +
E _m is the systolic blood pressure, t _P is the time of one beat, and t _{P 1} is the time from the rise of the aortic pressure until the pressure reaches the minimum blood pressure value. Then, the inventor of the present application, when the radial artery wave measured from each subject and the hemodynamic parameter corresponding to one stroke, that is, the triangular wave shown in FIG. 5 is given to the four-element lumped constant model, the radial artery wave Each element R _c of the four-element lumped constant model as a condition for obtaining the same waveform as at both ends of the capacitance C,
The values of R _p , C and L were obtained. From the radial artery waveform and the stroke volume, each element R _c of the four-element lumped constant model,
A method for mathematically obtaining the values of R _p , C, and L has been disclosed in Japanese Patent Application No. 5-1431 filed by the present applicant.

(4) Results Comparison between the first day and the second day. FIG. 6 shows the elements R _c , R _p , C and L of the four-element lumped parameter model.
The figure shows the state of the temporal change of the value of 2 over 2 days. In the figure,
The plot with black circles represents the average value of the values of each element for 13 subjects collected on the first day, and the plot with square circles represents the average value of the values of each element collected on the second day. There is. According to FIG. 6, it can be seen that the values of the respective elements of the four-element lumped constant model have substantially the same temporal change on the second day as on the first day.

Rhythm analysis of diurnal variation Rhythm analysis of the temporal change of the average value of 13 subjects regarding resistance R _c was performed. The result is shown in FIG. 7. As shown in the figure, the diurnal fluctuation waveform of the resistance R _c is composed of a fundamental spectrum having a period of about 20 hours and its harmonic spectrum. Although not shown, the basic spectrum of the diurnal fluctuation waveform of the other elements R _p , C, and L has a cycle of about 20 hours, like the resistance R _c . FIG. 8 shows the waveform of the fundamental wave spectrum of the diurnal fluctuation waveform of each element R _c , R _p , C, L of the four-element lumped constant model for each subject. From this figure, it can be seen that the diurnal variation of hemodynamics has individual differences in both amplitude and phase. FIG. 9 is a diagram showing the average value of 13 subjects, the fundamental wave spectrum and the second harmonic spectrum obtained by the rhythm analysis, for each of the elements R _c , R _p , C, and L of the four-element lumped parameter model. It is shown in contrast with the intraday fluctuation waveform.

Characteristics of Diurnal Fluctuation of Circulatory Dynamics According to the above-mentioned experimental results, the diurnal fluctuation waveforms of the circulatory dynamic parameters R _c , R _p , C and L have individual differences, but are common to all subjects. It has the characteristics of. That is, the values of R _c , R _p , and L are large in the morning, gradually decrease in the daytime, and again rise after a small peak in the evening. The value of C tends to be high in the first half of the day and decrease in the second half.

B. First Embodiment As described above, the circulatory dynamics of humans fluctuate during the day, and there are individual differences in the manner of the fluctuations. The diagnostic apparatus according to the present invention is capable of catching a change in the health condition of a patient and sufficiently informing the diagnostician of the patient, with due consideration of such diurnal circulatory dynamics. That is, the device according to the present example, the hemodynamic parameters are collected from the patient at a plurality of times every day, and each time this sampling is performed, the collected hemodynamic parameters at the present time are the hemodynamic parameters at the same time within the past certain period. It is determined whether or not it is within the fluctuation range of, and if it is out, the notification is given.

FIG. 10 is a block diagram showing the arrangement of the diagnostic apparatus according to this embodiment. As shown in the figure, in the present embodiment, the pulse wave detection unit 200 and the stroke volume measurement unit 300 described above are connected to the control unit 100. The pulse wave detection unit 200 and the stroke volume measurement unit 300 are means provided to measure the radial artery waveform and stroke volume from the patient. As shown in FIG. In addition to the configuration using the band, the pulse wave detecting unit 200 and the stroke volume measuring unit 300 may share one cuff band as shown in FIG. 11. Control unit 100
Is a memory 1, an input unit 2, an output unit 3, a waveform extraction storage unit 4
And a microcomputer 5. Memory 1 is a battery-backed RAM
It is a non-volatile memory configured by (random access memory) and the like, and is used for temporary storage of control data when the microcomputer 5 controls other units. Further, in a predetermined storage area of the memory 1, the hemodynamic parameters measured at a plurality of different times are stored for each patient.

The input section 2 is a means provided for inputting commands to the microcomputer 5, and is composed of, for example, a keyboard. The output unit 3 is
The printer, the display device, and the like are configured to record and display information such as hemodynamic parameters obtained from the patient under the control of the microcomputer 5. Under the control of the microcomputer 5, the waveform extraction storage unit 4 takes in the pulse wave signal output from the pulse wave detection unit 200 and extracts the pulse wave of one wavelength (one beat) from the taken-in signal. Remember. Here, the configuration of the waveform extraction storage unit 4 will be described with reference to FIG. In FIG. 12, reference numeral 101 is an A / D (analog / digital) converter, which converts the pulse wave signal output by the pulse wave detection unit 200 into a digital signal in accordance with a sampling clock φ having a constant cycle, and outputs the digital signal. Reference numeral 102 denotes a low-pass filter, which performs a process of removing components having a predetermined cutoff frequency or higher on the digital signals sequentially output from the A / D converter 101, and sequentially outputs the result as a waveform value W. Reference numeral 103 is a waveform memory configured by a RAM, and sequentially stores the waveform value W supplied via the low-pass filter 102. Reference numeral 111 is a waveform value address counter, which is a waveform sampling instruction STA from the microcomputer 5.
While the RT is being output, the sampling clock φ is counted, and the count result is supplied to the address input terminal of the waveform memory 103 as the waveform address ADR1 in which the waveform value W is to be written. Also, this waveform address ADR
1 is monitored by the microcomputer 5.

Reference numeral 121 is a differentiating circuit, which calculates and outputs the time derivative of the waveform value W sequentially output from the low-pass filter 102. A zero-cross detection circuit 122 outputs a zero-cross detection pulse Z when the time derivative of the waveform value W becomes zero. More specifically, the zero-cross detection circuit 1
Reference numeral 22 denotes a circuit provided for detecting peak points P1, P2, ... In the waveform of the pulse wave illustrated in FIG. 13, and zero crossing is performed when the waveform value W corresponding to these peak points is input. The detection pulse Z is output. Reference numeral 123 denotes a peak address counter, which counts the zero-cross detection pulse Z while the waveform sampling instruction START is output from the microcomputer 5 and outputs the count result as the peak address ADR2. Reference numeral 124 denotes a moving average calculation circuit, which calculates the average value of the time differential values of the predetermined number of waveform values W output from the differentiating circuit 121 up to the present time, and the result is the slope of the pulse wave up to the present time. Is output as inclination information SLP. A peak information memory 125 stores the peak information listed below in the table format shown in FIG.

(Contents of Peak Information) Waveform Value Address ADR1: Write address ADR1 output from the waveform address counter 111 when the waveform value W output from the low pass filter 102 reaches a maximum value or a minimum value, that is, It is a write address in the waveform memory 103 of the waveform value W corresponding to the maximum value or the minimum value. Peak type B / T: Information indicating whether the waveform value W written in the waveform value address ADR1 is the maximum value T (Top) or the minimum value B (Bottom). Waveform value W: A waveform value corresponding to the maximum value or the minimum value. Stroke STR: Change in waveform value from the immediately preceding peak value to the peak value. Slope information SLP: An average value of the time derivative of a predetermined number of waveform values in the past up to the peak value.

The microcomputer 5 controls each part in the apparatus 100 according to a command input via the input part 2. Further, the microcomputer 5 has a built-in clock circuit, and whenever any one of a plurality of preset times comes, a. Measurement of radial arterial waves and stroke volume b. Calculation of hemodynamic parameters c. Judgment of whether or not the current hemodynamic parameter is within the fluctuation range of the hemodynamic parameter at the same time within the past certain period d. Perform each processing such as alarm output when a negative result is obtained for the above judgment.

The operation of this embodiment will be described below with reference to the flow chart shown in FIG. As described above, the present embodiment includes the clock circuit, and the current time designated by this clock circuit is set to a plurality of preset times, for example, 6 o'clock,
If any one of 8 o'clock, 10 o'clock, 12 o'clock, and ~ is matched, the processing shown in FIG.

First, the process proceeds to step S1 to execute the process for sampling the radial artery waveform. This process will be described in detail. First, the waveform sampling instruction START is output from the microcomputer 5, and the reset of the waveform address counter 111 and the peak address counter 123 in the waveform extraction storage unit 4 is released. As a result, the waveform address counter 111 starts counting the sampling clock φ, and the count value is the waveform address ADR.
1 is supplied to the waveform memory 103. Then, the radial artery waveform detected by the pulse wave detection unit 200 is A / D.
The signal is input to the converter 101 and sequentially converted into a digital signal in accordance with the sampling clock φ, and the low pass filter 1
The waveform value W is sequentially output via 02. The waveform value W output in this manner is sequentially supplied to the waveform memory 103, and is written in the storage area designated by the waveform address ADR1 at that time. With the above operation, a series of waveform values W corresponding to the radial artery waveform illustrated in FIG.
Are stored in the waveform memory 103.

On the other hand, in parallel with the above operation, peak information is detected and written in the peak information memory 125 as described below. First, the low-pass filter 102
The time differential of the waveform value W output from the differential circuit 121 is calculated, and the time differential is calculated.
2 and the moving average calculation circuit 124. The moving average calculation circuit calculates the average value (that is, moving average value) of a predetermined number of time differential values in the past each time the time differential value of the waveform value W is supplied in this way, and the calculated result is the slope information S.
Output as LP. Here, when the waveform value W is increasing or has finished increasing and is in a maximum state, the inclination information S
A positive value is output as LP, and a negative value is output as the slope information SLP when the vehicle is descending or has finished descending and is in a minimum state.

Then, for example, when the waveform value W corresponding to the maximum point P1 shown in FIG. 13 is output from the low-pass filter 102, 0 is output from the differentiating circuit 121 as a time differential, and the zero-cross detecting circuit 122 outputs zero-cross. Pulse Z
Is output. As a result, the microcomputer 5 causes the waveform address ADR1, which is the count value of the waveform value address counter 111 at that time point, the waveform value W, and the peak address A, which is the count value of the peak address counter.
DR2 (ADR2 = 0 in this case) and tilt information SL
P is captured. Further, the count value ADR2 of the peak address counter 123 becomes 1 by outputting the zero-cross detection signal Z.

Then, the microcomputer 5 determines the peak type B / based on the code of the acquired inclination information SLP.
Create T. The waveform value W of the maximum value P1 as in this case
Since the positive slope information is being output at that time when is output, the microcomputer 5 sets the value of the peak information B / T to the maximum value. Then, the microcomputer 1 uses the peak address ADR2 (ADR2 = 0 in this case) fetched from the peak address counter 123 as it is as the write address ADR3.
Waveform value W, waveform address ADR1 corresponding to this waveform value W, peak type B / T, slope information SLP
The peak information memory 125 as the first peak information.
Write in. In the case of writing the peak information for the first time, stroke information is not created or written because there is no immediately preceding peak information.

After that, when the waveform value W corresponding to the minimum point P2 shown in FIG. 13 is output from the low-pass filter 102, the zero-cross detection pulse Z is output in the same manner as described above, and the write address ADR1 and the waveform value W, Peak address ADR
2 (= 1), the inclination information SLP (<0) is fetched by the microcomputer 5. Then, the microcomputer 1 determines the peak type B / T (in this case, the bottom B) based on the inclination information SLP, as described above. Further, the microcomputer 5 supplies an address smaller by 1 than the peak address ADR2 to the peak information memory 125 as the read address ADR3, and the waveform value W written in the first time is read.
Then, the microcomputer 5 calculates the difference between the waveform value W captured this time from the low-pass filter 102 and the first waveform value W read from the peak information memory 125 to obtain the stroke information STRK. Then, the peak type B / T and the stroke information STRK thus obtained are other information ADR1, W, SLP.
Together with the peak information memory 1 as the second peak information
It is written in the storage area corresponding to 25 peak addresses ADR3 = 1. After that, the same operation is performed when the peak points P3, P4, ... Are detected. When a predetermined time has elapsed, the microcomputer 5 stops outputting the waveform sampling instruction START, and the sampling of the waveform value W and the peak information ends. Next, in step S2,
The microcomputer 5 controls the stroke volume measurement unit 300 to measure the stroke volume of the patient. In this way, the information necessary for calculating the hemodynamic parameters was prepared.

Next, in step S3, the microcomputer 5 executes a circulatory dynamics parameter calculation process.
First, the microcomputer 5 sequentially reads the tilt information SLP and the stroke information STRK corresponding to the respective peak points P1, P2, ... From the peak information memory 125. Next, the stroke information corresponding to the positive inclination (that is, the corresponding inclination information SLP has a positive value) is selected from the stroke information STRK, and the stroke information having the larger value is selected from the stroke information. The upper predetermined number is further selected. Then, the one corresponding to the median value is selected from the selected stroke information STRK, and the rising portion of the pulse wave for one wavelength from which the waveform parameter is to be extracted, for example, STR in FIG.
Stroke information of the rising portion indicated by KM is obtained. Then, the peak address that is one before the peak address corresponding to the stroke information, that is, the peak address of the start point P6 of the pulse wave for one wavelength for which the waveform parameter is to be extracted is obtained. Next, the waveform value of the pulse wave for one wavelength starting from the peak address of the start point is converted by the microcomputer 5 into the waveform memory 103.
Is read from. Then, the pulse wave for one wavelength thus read and the one measured in step S2
The values of the respective elements R _c , R _p , C, and L of the four-element lumped constant model are calculated based on the stroke volume, and written in the memory 1 as the circulatory dynamics parameter at that time.

Next, in step S4, the microcomputer 5 determines that the circulatory dynamics parameter at the present time obtained in step S3 is within the fluctuation range of the circulatory dynamics parameter stored in the memory 1 at the same time within the past certain period. It is determined whether it is within the range. More specifically, assuming that the current time is 8:00 am, the microcomputer 5
Refers to the hemodynamic parameters at 8:00 am one day before, two days before, and three days before, and the average value (that is, moving average value) E of these hemodynamic parameters and the standard deviation σ
To calculate. Then, it is determined whether the hemodynamic parameter at the current time is within the range of E ± 3σ.

In the above judgment, the hemodynamic parameter R
_{If even one of c} , R _p , C, and L deviates from the range of E ± 3σ of the parameter within the past fixed period, step S
5, the alarm is output via the output unit 3 and the process is terminated. When all types of hemodynamic parameters are within the range of E ± 3σ of the parameters within the past fixed period, the process is terminated without outputting an alarm. According to the present embodiment, when the patient's condition changes and a sudden change in the circulatory dynamic parameter that is unacceptable as a diurnal change occurs, this can be detected promptly.

C. Second Embodiment In the above-described first embodiment, the physical condition abnormality is detected based on the change of the circulating body parameter, but the physical condition abnormality can also be detected based on the spectrum of the pulse wave. . According to the experiment, in particular, the phase of the fourth harmonic (the phase with reference to the rise of the pulse wave) greatly changes according to the change in the physical condition. On the other hand, the spectrum of the pulse wave also changes periodically with one day as one cycle. FIG. 16 (a)-
(C) is a graph showing an example of diurnal variation of the phases of the second, third, and fourth harmonics. In addition, FIG. 17A shows an example of diurnal variation of the amplitude of the third harmonic, and FIG. 17B shows an example of diurnal variation of the normalized amplitude of the third harmonic. From the above, in the second embodiment, the current pulse wave spectrum is detected, and the physical condition abnormality is detected by comparing with the past spectrum at the same time.

FIG. 18 is a block diagram showing the structure of the second embodiment. 10 is different from that shown in FIG. 10 in that the stroke volume measuring unit 300 in FIG.
Is not provided and a frequency analysis unit 7 is newly provided. FIG. 19 is a block diagram showing details of the frequency analysis unit 7. This frequency analysis unit 7
The waveform value WD of the pulse wave is received in beat units from the waveform memory 103 of the waveform extraction storage unit 4 via the microcomputer 5, and the received waveform value WD is repeatedly reproduced at high speed.
Frequency analysis is performed for each beat to calculate the spectrum that constitutes the pulse wave. Further, the frequency analysis unit 7 first obtains the pulse wave fundamental spectrum and then the second harmonic spectrum.
Each spectrum forming the pulse wave is calculated by the next division.

When the microcomputer 5 outputs the first waveform value WD of the pulse wave for one beat to the frequency analysis unit 7, the synchronization signal SYNC and the waveform value W contained in the beat.
The number N of D is output and the select signal S2 is switched. Further, the microcomputer 5 synchronizes with the delivery of each waveform value WD while the waveform value WD for one beat is output, and changes the write address ADR5 from 0 to N-1.
Are sequentially output. Buffer memories 201 and 202
Is a memory provided for accumulating the waveform value WD output from the microcomputer 5 in this way. The distributor 221 outputs the waveform value WD of the pulse wave supplied from the waveform extraction storage unit 4 via the microcomputer 5 to the select signal S2 of the buffer memory 201 or 202.
Output to the one specified by. Also, the selector 222
Selects the buffer memory designated by the select signal S2 from the buffer memory 201 or 202, and outputs the waveform value WH read from the buffer memory to the high-speed reproducing unit 230 described later. The selectors 211 and 212 are the write address ADR5 or the high-speed reproducing unit 2.
The read address ADR6 (described later) generated by 30 is selected according to the select signal S2, and the buffer memory 201 is selected.
And 202 respectively.

The distributor 221 and selector 22 described above
2, 201 and 202 are switching-controlled based on the select signal S2, so that the buffer memory 201
While data is being written to the buffer memory 20
2 is read and supplied to the high-speed reproducing unit 230, and while data is being written in the buffer memory 202, data is read from the buffer memory 201 and supplied to the high-speed reproducing unit 230. The high speed playback unit 230
It is a means for reading the waveform value corresponding to each beat from the buffer memories 201 and 202, and is a read address ADR.
6 is output in the range of 0 to N-1 (where N is the number of waveform values to be read). More specifically, the high-speed playback unit 230 generates the read address ADR6 while the waveform value WD corresponding to a certain beat is written in one buffer memory, and corresponds to the beat before the beat. All waveform values WD are repeatedly read from the other buffer memory a plurality of times. At this time, the generation of the read address ADR6 is controlled so that all the waveform values WD corresponding to one beat are always read within a fixed period. The period during which all waveform values corresponding to one beat are read is switched according to the order of the spectrum to be detected,
When detecting the fundamental wave spectrum, it is T when the second harmonic spectrum is 2T, and when the third harmonic spectrum is 3T.
It can be switched to T ,. In addition, the high-speed playback unit 230 has an interpolator built-in, and the buffer memory 201
Alternatively, the waveform value WH read from 202 is interpolated and output as a waveform value of a predetermined sampling frequency m / T (m is a predetermined integer).

The bandpass filter 250 is a bandpass filter in which the center frequency of the pass band is a predetermined value 1 / T. The sine wave generator 240 is a variable frequency waveform generator, and corresponds to the order of the spectrum to be detected under the control of the microcomputer 5 and has a cycle of T, 2T, 3
T, 4T, 5T and 6T sine waves are sequentially output. The spectrum detection unit 260 determines the amplitude H ₁ of each spectrum of the pulse wave based on the output signal level of the bandpass filter 250.
To H ₆ detects a bandpass phase theta ₁ through? ₆ of each spectrum based on the difference of the sine wave of phase the phase and sine wave generator 240 outputs the output signal of the filter 250 detects the. The above is the details of the frequency analysis unit 7. The amplitudes H1 to H6 and the phases θ1 to θ6 detected by the frequency analysis unit 7 described above are stored in the memory 1, and basic data for detecting physical condition abnormality is created based on the stored data, as in the case described above. To be done. Then, the physical condition abnormality is detected by comparing the current detection data with the basic data. In the frequency analysis unit 7, the amplitudes H1 to H6
And not detecting all the phases θ1 to θ6, for example,
Of course, it is of course possible to detect only the phase θ4 in which the change in physical condition is well represented.

D. Other Embodiments The embodiments of the present invention have been described above, but the present invention is not limited to these and can be implemented in the following modes, for example. (1) The radial artery wave and the prediction of the stroke volume are performed by a chime or the like at a predetermined time before the time when the stroke volume is measured. In this way, the patient can wear the cuff band and take measurements when the forecast sounds, so that the patient can take off the cuff band or the like and take a free action at all times. In addition, a metronome sound source is installed in the diagnostic device, and 0.25 is set before measurement.
A Hz metronome sound may be generated to cause the patient to take a steady breath. Alternatively, the patient may be provided with a portable radio paging receiver, and the portable radio paging receiver may be called up when the measurement time of the radial artery wave or the like is close.

(2) In order to make an accurate diagnosis, it is preferable to measure the radial artery wave and the like by observing a fixed time every day. However, it may be difficult in some cases, so that the measurement can be performed even at a time out of time. For example: At the time when the measurement should be performed, the diagnostic device notifies the patient by chime or the like. The patient responds to this as quickly as possible, puts on a cuff band or the like, and inputs a command for instructing the diagnostic device to measure a radial artery wave or the like. The diagnostic device executes the processing whose flow is shown in FIG. 15 as in the above embodiment. However, in this modified example, the time at which the actual measurement is performed in step S3 is written in the memory 1 together with the hemodynamic parameter. Further, by doing so, the collection time of the circulation dynamics parameter in the memory 1 becomes different depending on the day, so in step S4, the determination process is performed as follows.

For example, assume that the measurement is performed at 8:20 am. In this case, of the hemodynamic parameters of the previous day stored in the memory 1, several parameters before and after the time taken before and after 8:20 am are read out. And
An interpolating curve (for example, a quadratic curve) between the plots when these hemodynamic parameters are plotted on two-dimensional coordinates in which the horizontal axis represents time and the vertical axis represents the value of the hemodynamic parameter is obtained. Then, the value of this interpolation curve at 8:20 am is obtained. The same processing is performed for the hemodynamic parameters of 2 days before, 3 days before, and, and each hemodynamic parameter at 8:20 am in the past fixed period is obtained by interpolation calculation. Then, the average value E and the standard deviation σ of each hemodynamic parameter obtained by the interpolation calculation in this way.
And the same judgment as in the above-mentioned embodiment is performed.

(3) It is judged whether not the parameter itself but the mode of change of the parameter follows the mode of change at the same time in the past fixed period. Hereinafter, this embodiment will be described in detail. Also in this embodiment, the process proceeds according to the flow shown in FIG. However, in the present embodiment, the circulatory dynamics parameter at each time recorded by the microcomputer 1 at each time is read from the memory 1 in the midnight time when the measurement of the radial artery wave or the like is not performed. Then, which of the following states each hemodynamic parameter corresponds to is determined, and the determination result is added to the hemodynamic parameter and returned to the memory 1. B: It is a minimum value. U: It is rising. T: It is a maximum value. D: It is descending.

Then, step S of the flow shown in FIG.
In the judgment of 4, it is first judged whether the change from the previously determined circulatory dynamic parameter to the currently calculated circulatory dynamic parameter is an increase or a decrease, and this determination result is the circulatory dynamics at the same time within the past certain period. It is determined whether or not the trend of parameter changes is followed. That is, for example, when focusing on the tendency of change at 8:00 am, it is assumed that the hemodynamic parameter has an increasing tendency (U) on most of the past 10 days. In this case, when the hemodynamic parameter obtained at 8:00 am on the day of the day is higher than the hemodynamic parameter obtained immediately before that at 6:00 am, the way of changing the hemodynamic parameter is that of the variation during the past 10 days. It can be said that it is normal according to the method. On the contrary, when the hemodynamic parameter obtained at 8:00 am on the day of the day is lower than the hemodynamic parameter obtained at 6:00 am immediately before that, the way of changing the hemodynamic parameter is that of the variation in the past 10 days. It can be said that it is an abnormal thing against the way. Therefore, in this case, the process proceeds to step S5 in FIG. 15 and an alarm is output.

(4) The unnatural movement of the current parameter is detected based on the maximum value generation time and the minimum value generation time of the past parameter. In the above (3), the mode of change such as rising or falling for each parameter obtained on the day was obtained, but in the present embodiment, the time at which the value becomes maximum and the time at which the value becomes minimum for each parameter obtained on the day are obtained. Write to memory 1. Then, for example, each range of the minimum value and the occurrence time of the minimum value in the past 5 days is calculated, and the section between them is calculated. The following can be said about each range thus obtained. a. A section between the range of the minimum value occurrence time and the immediately adjacent range of the maximum value occurrence time is a section where the parameter should rise. If the parameter rises in this section, it is normal, and if it falls, it is abnormal.

B. A section between the range of the maximum value generation time and the immediately adjacent range of the minimum value generation time is a section in which the parameter should be lowered. If the parameter falls in this section, it is normal, and if it rises, it is abnormal. In the present embodiment, when the current time corresponds to the above section, the above a and b are determined with respect to the parameter at that time. The time of occurrence of the maximum and minimum values is the maximum value of the actual parameter,
In addition to adopting the sampling time of the minimum value, the daily fluctuation curve of the parameter may be obtained by rhythm analysis, and the occurrence times of the maximum value and the minimum value in this daily fluctuation curve may be adopted. (5) The memory 1 stores the parameters obtained every day until the present. In this embodiment, an XY plotter is used as the output device. By controlling the XY plotter, the control unit plots the intraday fluctuation curve of the parameter on the coordinate system in which the horizontal axis represents time and the vertical axis represents the value of the parameter. In addition, the intraday fluctuation curves of the parameters for a plurality of days are overlaid and plotted according to the user's designation. According to this embodiment, the change in the patient's condition can be visually recognized.

(6) Correlation between intraday fluctuation curves on a plurality of days is calculated and output according to the designation of the user. By doing so, changes in the rhythm of the living body can be captured. The correlation with the daily fluctuation curve of the previous day may be obtained every time the collection of the parameters for one day is completed and the daily fluctuation curve of the parameter of the day is fixed every day. By doing so, it is possible to detect the breakdown of the rhythm of the living body by detecting the breakdown of the correlation. (7) In the first embodiment, each value of the circulatory moving body parameter is calculated based on the measurement results of both the radial artery waveform and the stroke volume, but it is necessary to use a cuff to detect the stroke volume. However, it is very troublesome when going out. Therefore,
It is also possible to measure only the radial artery waveform and obtain each value of the circulating moving body parameter from the measurement result.

That is, there is a fairly strong correlation between the distortion rate of the radial artery waveform and each value of the circulating body parameter. FIG. 20 shows the results of examining the above correlation for 120 cases. Therefore, the pulse wave spectrum is analyzed by the circuit of FIG. 18, and the result is used to obtain the pulse wave distortion rate d by the following equation. d = √ (I ₂ ² + I ₃ ² + ... + I _n ² ) / I ₁ However, I ₂ , I ₃ ... Are the amplitudes of the second and third harmonics of the pulse wave. Next, the value of each element is obtained from the correlation equation (see FIG. 20) between the distortion rate d and each value of the circulating-body parameter. Note that the correlation may be stored as a table in the memory instead of the calculation using the correlation equation.

(8) The first embodiment may be used for diagnosing internal desynchronization. Hereinafter, this application example will be described. First of all, when living in a time isolation laboratory where there are no time cues, the human organizing function free-runs in a cycle of about 25 hours, but with long time isolation, sleep-wake rhythm and rectal temperature rhythm are dissociated, The phenomenon that the rhythm fluctuates in a period of about 30 hours for the former and about 25 hours for the latter is often seen. This phenomenon is called internal desynchronization. Recently, there are many situations in which people are placed in a time-separated state even in their daily lives, and internal desynchronization often occurs in their daily lives without conducting a time-separation experiment. For example, shift work such as night shift, movement to a remote place with different world time using an aircraft (so-called jet lag), and other irregular life. When internal desynchronization occurs, it may lead to diseases such as autonomic imbalance.
Therefore, when internal desynchronization occurs, it is necessary to detect it early.

By the way, the rectal temperature rhythm is generally synchronized with the hemodynamic parameter. According to the first embodiment described above, it is possible to detect the diurnal fluctuation rhythm of the hemodynamic parameter that reflects the rectal temperature rhythm. Therefore, by detecting the disturbance of the diurnal fluctuation rhythm, the sign of internal desynchronization is diagnosed. be able to. In this case, there is an advantage that diagnosis can be performed without using a deep body thermometer. (9) The circulatory dynamics parameter has a gentle rhythmic fluctuation (annual fluctuation) with a cycle of one year. For example, the compliance C is high in summer and low in winter. FIG. 21 is a graph showing an example of annual fluctuations in circulating moving body parameters,
Further, FIG. 22 is a graph showing the results of spectrum analysis of the viscous resistance Rc of the central portion. Therefore, in the first embodiment described above, the hemodynamic parameters obtained by the measurement may be corrected in consideration of the variation within the year. For example, in the case of compliance C, the correction is made to reduce the measurement result at a constant rate in summer, and the correction is made to increase in winter. By doing so, the accuracy of diagnosis can be improved.

(10) In the first and second embodiments, an alarm is issued when the current measured value of the circulating fluid parameter or the like deviates from the average of past measured values by a certain amount or more. Instead of this, the parameter value may be displayed in analog (or digital) form. 23 shows a liquid crystal display timepiece in which the control unit 400 of FIG. 18 is incorporated, the pulse wave detection unit 200 is attached to the back side of the band, and the display unit 9 is provided on the dial. Here, the display unit 9 displays the difference between the current measured value and the average value of the past measured values of the circulating-body parameters Rc, Rp, L, and C as a bar graph. The broken line indicates the caution level. In addition,
The display may be ± display shown in the figure, or may be an absolute value display. According to such a configuration, a fixed time (for example, 15
It becomes possible to measure the circulatory moving body parameter for each minute and display the measurement result, and the user can always check his / her physical condition. In the past, the only way to easily know your physical condition was to measure body temperature, but by attaching this device to your arm, you can always know your physical condition more accurately than body temperature, which is a mysterious business. It is extremely useful for man etc.

Instead of displaying the circulatory dynamics parameter described above, the difference between the phase or amplitude of the pulse wave and the past average value may be displayed. In addition, the parameters Rc, Rp,
The difference between the total value of L and the past average value may be displayed. In this case, the smaller the values of the parameters Rc, Rp, and L, the better the physical condition, but the larger the value of the parameter C, the better the physical condition. Therefore, it is preferable to display the total value of the other parameters except the parameter C. Also, instead of the bar graph display, a display with a pointer may be used. (11) In the above-described embodiment, the reference data for determining the physical condition may be average data for the past three days or average data for the past week. Further, the data of a day when the physical condition is good may be used as the reference data. In this case, it is necessary to correct the data according to the season, taking into account the intra-year fluctuations mentioned above. Further, since it is considered that the major cause of the yearly fluctuation is temperature, the reference data may be corrected according to the temperature.

[0053]

As described above, according to the present invention, it is possible to make a diagnosis in consideration of the periodical state change of the living body, and it is possible to accurately detect an unnatural change in the state of the living body. The effect of being able to be obtained is obtained.

[Brief description of drawings]

FIG. 1 is a diagram showing a device configuration of an experiment conducted prior to the present invention.

FIG. 2 is a diagram showing a schedule of the above experiment.

FIG. 3 is a circuit diagram of a four-element lumped constant model.

FIG. 4 is a diagram illustrating an arterial waveform at the aortic root.

FIG. 5 is a model waveform of the arterial waveform at the aortic root used in the preliminary examination of the present invention.

FIG. 6 is a diagram showing diurnal variation of hemodynamic parameters.

FIG. 7 is a diagram showing a spectrum of a diurnal fluctuation waveform of a hemodynamic parameter.

FIG. 8 is a diagram showing a fundamental wave spectrum of a diurnal fluctuation waveform of a hemodynamic parameter.

FIG. 9 shows diurnal variation of hemodynamic parameters.

FIG. 10 is a block diagram showing a configuration of a diagnostic device according to a first embodiment of the present invention.

FIG. 11 is a diagram illustrating a usage state of the embodiment.

FIG. 12 is a block diagram of a waveform extraction storage unit 4 in the same embodiment.

FIG. 13 is a diagram illustrating a radial artery waveform.

FIG. 14 is a diagram showing stored contents of a peak information memory.

FIG. 15 is a flowchart showing the operation of the embodiment.

FIG. 16 is a diagram showing an example of intraday variation of each phase of the second harmonic wave, the third harmonic wave, and the fourth harmonic wave of the pulse wave.

FIG. 17 is a diagram showing a diurnal variation example of the amplitude of the third harmonic of the pulse wave and a diurnal variation example of the normalized amplitude of the third harmonic.

FIG. 18 is a block diagram showing a configuration of a second exemplary embodiment of the present invention.

FIG. 19 is a block diagram showing a configuration of a frequency analysis unit 7 in the embodiment.

FIG. 20 is a diagram showing a correlation between hemodynamic parameters and pulse wave distortion.

FIG. 21 is a diagram showing annual fluctuations in hemodynamic parameters.

FIG. 22 is a diagram showing a frequency analysis result of a circulation dynamics parameter Rc.

FIG. 23 is a diagram showing a display example of hemodynamic parameters.

FIG. 24 is a diagram showing an example of a situation of sudden death.

FIG. 25 is a diagram exemplifying a situation of occurrence of acute myocardial infarction.

[Explanation of symbols]

200 ... Pulse wave detector, 300 ... Stroke volume detector,
100 ... Control unit.

Claims (12)

[Claims] 1. A process of measuring a state of a living body and calculating a parameter representing the state of the living body based on the measurement result is repeated, and each time the parameter is calculated, the parameter is compared with a parameter obtained in the past. And a result output. 2. A measuring unit, a storage unit, and a control unit, wherein the measuring unit measures the state of a living body at a plurality of times every day, and the control unit, at a plurality of the times, The parameter representing the state of the living body is calculated based on the measurement result by the measuring unit and recorded in the storage unit, and the parameter at the current time changes at the same time within the past certain period based on the stored content of the storage unit. A diagnostic device, characterized in that it is determined whether or not it is within the range, and when that is not the case, it is notified. 3. A measuring means, a storage means, and a control means, wherein the measuring means measures the state of a living body at a plurality of times every day, and the control means, at a plurality of the times, The parameter representing the state of the living body is calculated based on the measurement result by the measuring means and recorded in the storage means, and the error between the parameter at the current time and the reference parameter calculated from the parameter at the same time within the past certain period. A diagnostic device characterized by displaying. 4. The diagnostic device according to claim 1, wherein the parameter is a hemodynamic parameter. 5. The diagnostic device according to claim 1, wherein the parameter is an amplitude or a phase of a harmonic component of a pulse wave. 6. The control unit calculates a parameter at the same time as the current time within a past fixed period by performing an interpolation calculation using each parameter within the past fixed period stored in the storage unit. The diagnostic apparatus according to claim 2 or 3, wherein the variation range is determined based on the calculation result. 7. A measuring means, a storage means, and a control means, wherein the measuring means measures the state of a living body at a plurality of times every day, and the control means, at a plurality of the times, A parameter representing the state of the living body is calculated based on the measurement result by the measurement means and recorded in the storage means, and a mode of change of each parameter calculated on the day is obtained and recorded in the storage means, and stored in the storage means. Based on the content, it is determined whether or not the mode of parameter change at the current time is in accordance with the mode of parameter change at the same time within a certain past period, and it is not in accordance with the mode of past change. In some cases, a diagnostic device that notifies that fact. 8. A measuring unit, a storing unit, and a controlling unit, wherein the measuring unit measures a pulse wave of a living body every day at a plurality of times, and the controlling unit at a plurality of times. The storage unit calculates the parameter representing the state of the living body based on the measurement result by the measurement unit and records the parameter in the storage unit, and also obtains each time when the parameter becomes maximum or minimum based on each parameter calculated on the day. Recorded on, based on the storage content of the storage means, to determine whether the mode of change of the parameter at the current time is in accordance with the mode of change of the parameter at the same time within a certain past period,
A diagnostic device characterized in that when it does not comply with the aspect of past changes, the fact is notified. 9. The diagnostic apparatus according to claim 1, wherein the control unit obtains a correlation between intraday fluctuation waveforms of parameters on a plurality of days and outputs the correlation result. 10. The diagnostic apparatus according to claim 1, further comprising means for creating and outputting a graph in which intraday fluctuation waveforms of parameters on a plurality of days are displayed in an overlapping manner. 11. The measuring means measures the pulse wave of the living body, and the controlling means initiates the aorta with respect to an electric circuit simulating a system from a central portion to a peripheral portion of an arterial system of a human body. The value of each element of the electric circuit is calculated so that an output waveform corresponding to the pulse wave obtained by the measuring means can be obtained from the electric circuit when an electric signal corresponding to the pressure wave of the part is given, The diagnostic device according to claim 1 or 2, wherein a part or all of a calculation result is used as the parameter. 12. The electric circuit comprises a first resistance corresponding to a blood vessel resistance due to blood viscosity in the arterial center, an inductance corresponding to blood inertia in the arterial center, and an arterial center. A series circuit having a capacitance corresponding to the viscoelasticity of the blood vessel and a second resistance corresponding to the blood vessel resistance at the peripheral portion, and a series circuit including the first resistance and the inductance between a pair of input terminals. The diagnostic device according to claim 11, wherein the diagnostic device is a four-element lumped constant model in which the parallel circuit including the capacitance and the second resistor is sequentially inserted in series.