JPH084579B2 - Hemodynamic analyzer - Google Patents

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a hemodynamic analyzer, and more particularly to a hemodynamic system that can be used in a form that provides blood circulation information in a non-invasive manner using a bandage and provides this information for the convenience of diagnosis. Regarding the analysis device.

[0002]

2. Description of the Related Art Knowing how blood flows throughout the body is very important for diagnosing a disease. In order to analyze such systemic hemodynamics, it is effective to analyze whole-body images such as whole-body positron emitter images, nuclear magnetic resonance images, and infrared images in addition to blood pressure and electrocardiographic measurements. On the other hand, in addition to such Western medicine-based disease diagnosis methods, a method called so-called "pulse diagnosis" is known in Chinese medicine, but this is an inspection method based on the examiner's subjectivity and objective data. No analysis can be done.

[0003]

However, although the above-mentioned analysis apparatus for obtaining whole body images has the advantage of being able to provide precise objective data, it is a very expensive stationary large apparatus. Therefore, the reality is that it is only used for critically ill patients and research subjects. Also,
Since it is a complicated device, it takes time to train the inspection personnel and it is difficult to widely spread it.

Therefore, an object of the present invention is to provide a small and simple apparatus capable of analyzing hemodynamics over the whole body.

[0005]

[Means for Solving the Problems]

(1) The first invention of the present application is, in a hemodynamic analysis apparatus, a sound wave detector for detecting Korotkoff sound generated by compressing a living body with a binding band, and a sound wave detecting unit for detecting this sound wave. A waveform storage unit that stores the waveform of the Korotkoff sound detected by the detection unit in association with the pressure value at the time of detection, and the waveform stored in this waveform storage unit from the systolic pressure SP to the diastolic pressure DP. Placed on the pressure axis up to, to create a diagnostic envelope by connecting the peak positions of each waveform, and an envelope creation unit that outputs this
And a first envelope for diagnosis obtained by connecting the maximum peak positions of each waveform and a second envelope for diagnosis obtained by connecting the second largest peak position of each waveform. And a diagnostic third envelope obtained by connecting the minimum peak positions equal to or higher than the noise level of each waveform,
The above three types of diagnostic envelopes are created and output.

(2) A second invention of the present application is, in a hemodynamic analyzer, a sound wave detector for detecting a Korotkoff sound generated by compressing a living body with a bandage, and a sound wave detecting unit for detecting this sound wave. A waveform storage unit that stores the waveform of the Korotkoff sound detected by the detection unit in association with the pressure value at the time of detection, and the waveform stored in this waveform storage unit from the systolic pressure SP to the diastolic pressure DP. Placed on the pressure axis up to, to create a diagnostic envelope by connecting the peak positions of each waveform, and an envelope creation unit that outputs this
The pressure axis from the systolic pressure SP to the diastolic pressure DP is divided into a plurality of sections, each part of the living body is associated with each section, and a diagnostic envelope is set as a predetermined reference for each section. As compared with the envelope, for a section where the distance between them is more than a predetermined limit, a blood flow disorder site display section for displaying the site of the living body associated with the section as a blood flow disorder site is provided. Is.

(3) The third invention of the present application is, in the hemodynamic analysis apparatus according to the above-mentioned first or second invention, a diagnosis based on a Korotkoff sound waveform obtained when a binding band is attached to the upper right arm of a living body. The right envelope for diagnosis and the left envelope for diagnosis based on the Korotkoff sound waveform obtained when the binding band is attached to the upper left arm of the living body can be separately processed.

[0009]

[Operation] The basic idea of the present invention is that the envelope of the Korotkoff sound waveform arranged on the pressure axis from the systolic pressure SP to the diastolic pressure DP provides information on the whole body hemodynamics. It is based on the fact that the inventor of the present application has found that it includes. By using this device, the Korotkoff sound waveforms at various pressures from the systolic pressure SP to the diastolic pressure DP can be detected simply by attaching a binding band to the living body.
Moreover, the envelope creating unit automatically creates and outputs a Korotkoff sound waveform envelope. The inventor of the present application obtains information on hemodynamics of main organs from the systolic pressure SP to the diastolic pressure DP of the envelope, and information on the hemodynamics of the central and lower limbs below the diastolic pressure DP, respectively. Found out to contain. Therefore, displaying this envelope makes it possible to analyze the hemodynamics of the whole body.

The first invention of the present application is the first diagnostic application obtained by connecting the maximum peak positions of the respective waveforms of Korotkoff sounds.
The second envelope for diagnosis obtained by connecting the second largest peak position of each waveform has information corresponding to the “float” of the pulse diagnosis in Chinese medicine, and the second envelope for diagnosis in Chinese medicine is “ It was found that the third envelope for diagnosis obtained by connecting the minimum peak positions of each waveform with information corresponding to "medium" has information corresponding to "sinking" of pulse diagnosis in Chinese medicine. based on. In Kampo medicine, this "floating / in / out" information was treated as subjective tactile information obtained from the pulse of the patient, but according to the present invention,
It becomes possible to handle this as objective data.

As described above, the envelope represents the hemodynamic information of each part from the central side to the peripheral side of the living body. Therefore, in the second invention of the present application, the envelope is divided into a plurality of sections and each section of the living body is associated with each section. By comparing the envelope of each section with a predetermined reference envelope, it is possible to recognize the blood flow state of the body part associated with the section. In general, the Korotkoff sound observed in the sash of the upper arm is considered to be a sound generated by blood flowing under the sash that is superposed with a sound based on a reflected wave from each organ. That is, the heart is 1
When the heart beats, blood is pumped by the pumping action of the heart, and pressure fluctuation (pulse wave) propagates in the blood vessel. The individual organs located in each part of the aorta function as a resistance element to this pulse wave, and when the pulse wave collides with the organ, part of it returns to the original state as a reflected wave. This reflected wave contains information about the resistance component of the organ, that is, information about blood circulation disorder, and when the timing at which this reflected wave propagates to the sash of the upper arm matches the timing at which blood flows under the sash, Information on the reflected wave can be detected as Korotkoff sound. It is generally known that the speed at which blood actually moves (blood flow speed) is about 1/3 of the propagation speed of pressure fluctuation (pulse wave speed). However, when the blood vessel in the upper arm is pressed by the binding band to reduce the diameter of the blood vessel, the blood flow velocity becomes high and becomes 1/3 or more of the pulse wave velocity. Therefore, by changing the binding pressure, it is possible to select from which organ the reflected wave is superimposed on the Korotkoff sound. For example, the time required for the pulse wave and the reflected wave to propagate through a path of 180 cm in total length from the heart to the kidney to the upper arm, and the total length from the heart to the upper arm 6
The Korotkoff sound obtained when the banding pressure is maintained so that the time that blood travels through the 0 cm path matches
It will contain hemodynamic information about the kidneys. Therefore,
If the pressure axis is divided into a plurality of sections, the Korotkoff sounds obtained in each section can be associated with each part of the living body.

In the third invention of the present application, the left and right envelopes are processed separately in the hemodynamic analysis apparatus according to each of the above inventions. Therefore, it becomes possible to separately perform left and right hemodynamic analysis of the living body.

[0013]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS The present invention will be described in detail below with reference to illustrated embodiments. FIG. 1 is a block diagram showing the basic configuration of a hemodynamic analyzer according to an embodiment of the present invention. This device is roughly divided into a device main body 100 (enclosed by a chain line).
And a binding band 200. Bandage 200
Is used in a general sphygmomanometer, in which an ischemic sac 210 for occluding the upper arm and an sonic wave detection housed in the ischemic sac 210 while keeping airtightness And a device 220 (specifically, a microphone). The sound wave detector 220 is for detecting Korotkoff sound (arterial sound) in the upper arm, and when the binding band 200 is attached to the upper arm, the surface where the sound wave input hole is formed faces the skin surface of the upper arm. It is fixed in such a state. A conduit 2 for letting air pass from the ischemic sac 210 to the outside.
30 extends, and a conductive wire 240 for transmitting an electric signal extends from the sound wave detector 220 to the outside. As shown in FIG. 2, the binding band 200 is attached so as to be wound around the upper arm.

On the other hand, the apparatus body 100 has the following structure. First, the conduit 230 includes the conduits 101 and 1
02 is connected. The pipeline 101 is a pressure sensor 110.
The pressure sensor 110 detects the pressure inside the ischemic sac 210. This pressure sensor 1
The detection signal of 10 is amplified by the amplifier 111 and then A / D
It is converted into a digital signal by the converter 112. In addition, the electric signal transmitted through the conductor 240 is amplified by the amplifier 120, passes through the bandpass filter 121, and passes through the A / D
It is converted into a digital signal by the converter 122. The bandpass filter 121 has a frequency band of the Korotkoff sound (18 to
It is designed to pass 80 Hz). A / D converter 1
The digital signal converted by 12, 122 is CP
It is taken in by U130. The pipeline 102 is the air pump 1
40 and the leak valve 150. The air pump 140 and the leak valve 150 are the CPU 13
Controlled by 0. When the air pump 140 is activated, the ischemic sac 210 is passed through the conduit 102 and the conduit 230.
Air can be pumped in and the pressure in the bladder 210 can be increased. Conversely, the leak valve 150
When is activated, the air in the ischemic sac 210 can be leaked to the outside via the conduit 230 and the conduit 102, and the pressure in the ischemic sac 210 can be lowered.
Further, by stopping the air pump 140 and the leak valve 150, the pressure inside the blood flow blocking bag 210 can be maintained constant. After all, the CPU 130 can freely control the pressure in the blood flow blocking sac 210.

A memory 160 for storing data and programs, a display device 170 (for example, a liquid crystal display) for displaying data, and a printer 180 for outputting a hard copy of the data are connected to the CPU 130. . Further, a right side measurement start switch 191 and a left side measurement start switch 192 are connected to the CPU 130. In addition, a means for supplying power to each unit is also required, but the description thereof is omitted here.

Next, the measurement operation using this apparatus will be described. The operator first attaches the binding band 200 to one upper arm of the subject and presses the corresponding measurement start switch. For example, when it is attached to the upper right arm, the right measurement start switch 191 is pressed. Then, the CPU 130 starts the measurement process as shown in FIG. The measurement process will be described below based on the graph of FIG. The horizontal axis of this graph shows the elapsed time after the start of measurement, and the vertical axis shows the pressure in the ischemic sac 210 at each time (as described above, detected by the pressure sensor 110). First, the pressure is gradually increased from the point A on the graph until it reaches the predetermined pressure T (as described above, the air pump 140 is driven to increase the pressure). The pressure T is set to a value sufficient to block the upper arm of a healthy person (18 in this embodiment).
0 mmHg).

When the pressure in the ischemic sac 210 reaches a predetermined pressure T, the pressure is gradually decreased from there (as described above, the leak valve 150 is driven to decrease the pressure. In this embodiment. 3 mmHg / sec). That is, in the graph of the figure, the pressure decreases from point B to point C. CPU130
While decreasing the pressure in this manner, the sound wave detector 22
Monitor the output signal of 0. Then, Korotkoff sound is observed for the first time at point C in the figure. The pressure value at this time is known as the systolic pressure SP, and this phenomenon is used for blood pressure measurement. When the pressure is further lowered, the Korotkoff sound becomes louder and becomes maximum at the point D. The pressure value at this time is known as the aortic valve closing scar pressure DNP. When the pressure is further lowered, the Korotkoff sound gradually becomes smaller and disappears at point E (strictly below a predetermined level as will be described later). The pressure value at this time is known as the diastolic pressure DP, and this phenomenon is also used for blood pressure measurement.
In FIG. 3, in the section from the point C to the point E, the amplitude of the Korotkoff sound obtained at each pressure value and its envelope are entered in a direction orthogonal to the line of the graph showing the pressure drop, and as a pattern P1. It is displayed. It can be easily understood that the Korotkoff sound is generated at the point C, the amplitude thereof is maximized at the point D, and disappears at the point E.
If the pressure is further lowered to point F, leak valve 150
Thus, the air inside the ischemic sac 210 is evacuated all at once, and the air reaches the point G in a short time.

As described above, the operation from the point A to the point G is a total measurement operation for one upper arm (the upper right arm in this embodiment), whereby the systolic pressure SP to the diastolic pressure. This means that the Korotkoff sound waveform was measured for each pressure value up to DP. The CPU 130 stores the waveform of the Korotkoff sound obtained by the measurement in the memory 160 in association with the pressure value at the time of the measurement. This stored waveform will be used in the hemodynamic analysis process described later. Subsequently, the operator attaches the binding band 200 to the other upper arm (in this example, the upper left arm) of the subject, and presses the corresponding measurement start switch. That is, the left measurement start switch 192 is pressed. Then, the CPU 130 repeats the operation from the point A to the point G shown in FIG. 3 as described above. Thus, the Korotkoff sound waveform data obtained for the upper right arm and the Korotkoff sound waveform data obtained for the upper left arm are separately stored in the memory 160. With the above, all measurement operations for the subject are completed. The work to be performed by the inspector is to attach the binding band 200 to the right arm of the subject and to start the right measurement start switch 1
After pressing 91 to wait for the completion of the measurement process, the strap 200 is attached to the left arm of the subject and the left side measurement start switch 192 is pressed to wait for the completion of the measurement process.

Subsequently, the hemodynamic analysis process is performed based on the Korotkoff sound waveform data in the memory 160. Before describing the analysis process, another example of the above-described measurement process will be described. deep. In this example, a sick person is used as a subject, and as shown by the one-dot chain line in FIG. 3, points A to B ′ are reached, and C ′, E ′, F
The measurement is performed so as to pass each point of 'and G'. This sick person has the symptom of hypertension, the systolic pressure SP is higher than the predetermined set value T, and the Korotkoff sound is already heard at the point B in FIG. Therefore, the CPU 130 monitors the Korotkoff sound at the time when the pressure is increased to the predetermined set value T, and if the Korotkoff sound is already heard, the second set value T ″ (in this embodiment, , 50m further
The pressure is increased to the value (mHg increased), and B ″ in FIG.
Monitor the Korotkoff sound again at the points. If the Korotkoff sound is still audible, the pressure is further increased to the third set value T '(in this embodiment, the value further increased by 50 mmHg), and the Korotkoff sound is again emitted at the point B'in FIG. To monitor. In this way, when the pressure value at which the Korotkoff sound is not heard is reached, in other words, when the complete ischemic state is achieved, the pressure is gradually decreased to start the measurement. In the example shown by the alternate long and short dash line in FIG. 3, since Korotkoff sound is still audible at the point B ″, the measurement is started after the pressure is further increased to the point B ′. In this measurement, the Korotkoff sound first appeared at the point C'and disappeared at the point E '. The point where the Korotkoff sound becomes maximum cannot be determined. The point that when the pressure is reduced to the F ′ point and the pressure is lowered to the G ′ point at once is the same as in the measurement example of the healthy subject described above. According to the above-mentioned measurement result of a healthy person, the diamond-shaped Korotkoff sound pattern P1
In contrast to this, the irregular Korotkoff sound pattern P2 is obtained in the measurement result of the diseased person.

Now, the hemodynamic analysis processing by this apparatus will be described. This process is a process performed by the CPU 130 by using the Korotkoff sound waveform accumulated in the memory 160 by the above-described measurement process, and basically, the obtained Korotkoff sound pattern is compared with a predetermined reference pattern. It can be said to be processing. To make this comparison, we create three reference envelopes. Now, description will be continued assuming that the Korotkoff sound pattern P1 as shown in FIG. 3 is obtained. First, a graph in which points C to E of the pattern P1 are taken on the horizontal axis is defined as shown in FIG. C point is systolic pressure SP, E point is diastolic pressure D
Since they correspond to P and P respectively, the horizontal axis of this graph corresponds to the pressure axis. Then, as shown in FIG.
This pressure axis is divided into 5 equal parts, and sections I, II, III, IV, respectively from the systolic pressure SP side toward the diastolic pressure DP side.
Define V. Each of these sections will correspond to each part of the subject, as described below. Subsequently, three levels V1, V2 and V3 are set on the vertical axis of this graph. This vertical axis corresponds to the amplitude value of the Korotkoff sound waveform, and more specifically corresponds to the digital amount output by the A / D converter 122 in the apparatus shown in FIG. In this embodiment, these three levels V1, V2 and V3 are set as follows. First, the above-described measurement is performed on some healthy persons to obtain the Korotkoff sound wave pattern P1. Then, the maximum amplitude value of the Korotkoff sound (in this specification, the amplitude value means not the full amplitude but the half amplitude) is obtained from this pattern P1, and the maximum amplitude value of some healthy persons is calculated. Take the average. Then, this average maximum amplitude value is set to level V1, and 2/3 thereof is set.
Is set to level V2, and 1/3 is set to level V3. In this way, three levels V1, V2 and V3 can be set on the vertical axis of the graph shown in FIG. After all, these three levels V1, V2, V3 are the eigenvalues set in advance regardless of the subject.

Subsequently, as shown in FIG. 4, the ideal position of the aortic valve closing scar pressure DNP (pressure value at point D in FIG. 3) is determined on the horizontal axis (pressure axis) of the graph. This ideal position is also a matter to be determined as an empirical rule, but on the horizontal axis of the graph of FIG. 4, the pressure difference between SP and DNP and DNP
It is empirically known that the ratio to the pressure difference between DP and DP becomes approximately 2: 1. In this embodiment, the position of DNP is determined as the position where this ratio becomes 2: 1. Now, Fig. 4
In the graph of, when the position of DNP is determined on the horizontal axis, the points of level V1, V2, V3 at this position are
Let D1, D2 and D3 respectively.

Next, on this graph, the half amplitude component of the Korotkoff sound wave pattern P1 obtained by actual measurement is plotted. That is, a graph showing how much amplitude Korotkoff sound was obtained at each pressure is created. Then, the peak point C0 of the amplitude plotted at the position of the systolic pressure SP and the peak point E0 of the amplitude plotted at the position of the diastolic pressure DP are defined (points C0 and E0 in FIG. 4). In both cases, the level on the vertical axis is shown at the position of 0, and the points C0 and E0 coincide with the points C and E, respectively, but they are actually not 0 and have a minute level value). Thus, points D1, D2, D3, C0, E0
Then, the three reference envelopes are defined as follows. That is, the reference first envelope S1 (shown by a solid line in FIG. 4) is defined as a line connecting the points C0-D1-E0,
The reference second envelope S2 (shown by a chain line in FIG. 4) is a point C.
It is defined as a line connecting 0-D2-E0, and the reference third envelope S3 (shown by a broken line in FIG. 4) is defined as a line connecting points C0-D3-E0.

Here, these reference envelopes are not envelopes obtained from Korotkoff sound waveforms obtained by actual measurement (referred to as diagnostic envelopes in this specification), but are compared with these diagnostic envelopes. It should be noted that it is an ideal envelope for doing. For example, in the graph shown in FIG.
Since the pattern P1 (the Korotkoff sound waveform pattern obtained by the measurement of an ideal healthy person) is plotted, the reference first envelope S1 is the Korotkoff sound waveform itself plotted based on the actual measurement result. Although it matches the envelope curve of (diagnostic envelope), when the Korotkoff waveform pattern obtained as a result of actually measuring the subject is plotted, the diagnostic envelope and the reference envelope are Usually not a perfect match. This can be easily understood from the example shown in FIG. FIG. 5 is a graph created based on the Korotkoff sound wave pattern P2 for the sick person shown in FIG. The respective reference envelopes S1, S2, S3 are almost the same as those shown in FIG. 4 (the points C0, E0 are located at slightly higher level positions). On the other hand, the plotted envelope J1 (diagnostic envelope) of the Korotkoff sound waveform itself has a considerably irregular shape, and is considerably different from the reference first envelope S1.

From the above description, the reference envelope S1,
You can understand how to create S2 and S3.
Therefore, a method for obtaining a diagnostic envelope to be compared with the reference envelopes S1, S2, S3 will be described. This diagnostic envelope is "envelope obtained from Korotkoff sound waveform obtained by actual measurement", but in this embodiment, three types of diagnostic envelopes are obtained. This will be described with reference to FIG. In the graph of FIG. 6, the vertical axis corresponds to the pressure axis, and the systolic pressure SP is on the upper side and the diastolic pressure DP is on the lower side.
5 sections from V to V are defined. In addition, diastolic pressure D
A sixth section VI is defined below P, which will be described later. On the other hand, the horizontal axis represents the amplitude level of the Korotkoff sound. As described above, the three levels V1 and V
2 and V3 are defined. In this graph, the waveforms of all the amplitudes of the obtained Korotkoff sound are shown. The right half of the graph corresponds to the positive amplitude and the left half corresponds to the negative amplitude. Note that the Korotkoff sound is obtained for each heartbeat, and in FIGS. 3 to 5, the Korotkoff sound waveform for one heartbeat is shown by a single line for convenience of explanation, but in reality, a simple 1 The waveform is not a pulse but a complicated waveform including various frequency components as shown in the graph of FIG. Further, in the graph of FIG. 6, only the Korotkoff sound waveform for a total of 6 heartbeats is shown from the systolic pressure SP to the diastolic pressure DP, but in actual measurement, more heartbeats A Korotkoff sound waveform is obtained. Then, by connecting the maximum peak positions of the Korotkoff sound waveform in each heartbeat, the first diagnostic
An envelope J1 (solid line in the figure) is formed. Further, a second diagnostic envelope J2 (one-dot chain line in the figure) is formed by connecting the second largest peak position of the Korotkoff sound waveform at each heartbeat. Furthermore, by connecting the minimum peak positions of the Korotkoff sound waveform at each heartbeat, the third diagnostic envelope J3
(Dashed line in the figure). Here, the minimum peak means the minimum peak for signals other than noise. A noise component (see FIG. 6) is included in the output signal of the sound wave detector 220.
(Shown between each heart beat) is included, which means the smallest peak other than such noise. As the actual processing performed by the CPU 130, it is sufficient to perform an operation of extracting only a signal having a predetermined threshold value or more and finding the minimum peak position in the signal.

FIG. 7 is a diagram for explaining in more detail the process of obtaining such three diagnostic envelopes. For each heartbeat, if Korotkoff sound waveforms such as (a), (b), (c), (d), and (e) in the figure are obtained continuously, the envelope connecting each peak position As shown, the first diagnostic envelope J1, the second diagnostic envelope J2, and the third diagnostic envelope J
3 is obtained. In the waveforms shown in (a) and (e), only one peak is seen, but in such a case, this only peak is the maximum peak, the second peak, and the minimum peak. Should be treated as such. Further, when Korotkoff sound waveforms such as (f) and (g) in the figure are obtained, the second peak does not exist, but in such a case, the first envelope J1 for diagnosis as shown in the figure is obtained. It is also possible to define only the third diagnostic envelope J3 and not define the second diagnostic envelope J2.

Now, finally, referring again to FIG. 6, the sixth section VI will be described. In the above description, the Korotkoff sound disappears at a pressure equal to or lower than the diastole pressure DP, but strictly speaking, a Korotkoff sound having a small amplitude is observed even at a pressure equal to or lower than the diastole pressure DP. Generally, this is called "K5 sound", and it is observed up to a lower pressure in the younger than the elderly. In the device of the present embodiment, the fourth diagnostic envelope J4 connecting the peak values of this "K5 sound" is defined.

When the reference envelope and the diagnostic envelope are obtained as described above, they are displayed on the same graph.
An example of this display is shown in FIG. Similar to the graph of FIG. 6, the graph of FIG. 8 shows the pressure axis on the vertical axis and the amplitude level of the Korotkoff sound on the horizontal axis. However, in the graph of FIG. 6, the entire amplitude of the Korotkoff sound was displayed, but in the graph of FIG. 8, the half-amplitude of the measurement result for the upper right arm is in the right half of the graph, and for the upper left arm. The half amplitude of the measurement result of is displayed in the left half of the graph. As shown in FIG. 6, since the amplitude of the Korotkoff sound is almost symmetrical between the positive half-amplitude and the negative half-amplitude, only one of them (or the average of both) may be used for diagnosis. On the other hand, the measurement result for the upper right arm and the measurement result for the upper left arm are generally different, and the left and right measurement results are necessary to identify whether the diseased part is on the left or right. In the graph of FIG.
The sections RI to RV are defined on the right side and the sections LI to L on the left side.
V is defined. In this way, it is preferable to display the graph symmetrically with respect to the central axis so that the left-right balance can be easily confirmed. In this example, the reference first envelope S1 is a solid line, the reference second envelope S2 is a one-dot chain line, the reference third envelope S3 is a broken line, and the first diagnostic envelope J1 is a solid line.
The third diagnostic envelope J3 is shown as a dashed line, respectively (the second diagnostic envelope J2 is not defined in this example). In the graph of FIG. 8, “R” indicating the right or “L” indicating the left is added to the head of each symbol to distinguish the left and right. Actually, such a graph is output by the display device 170 or the printer 180 shown in FIG. It is preferable to distinguish each envelope by changing the color.

In order to analyze the hemodynamics based on such output results, each diagnostic envelope may be compared with each reference envelope. More specifically, the first diagnostic envelope J1 is compared with the reference first envelope S1, the second diagnostic envelope J2 is compared with the second reference envelope S2, and the third diagnostic envelope J3 is determined. It will be compared with the reference third envelope S3. Moreover, this comparison process is separately performed for each of the left and right measurement results. It has been experimentally confirmed that, in a healthy person, each diagnostic envelope substantially matches each reference envelope. In other words, the further away each diagnostic envelope is from each reference envelope, the more likely it is to indicate a disease that impairs blood circulation. Moreover, the site of the disease can be identified from this graph. That is, the right-side sections RI to RV and the left-side sections LI to LV can be considered to correspond to the respective parts of the subject as shown in FIG. Basically, sections IV are considered to indicate blood circulation information corresponding to the heart to the periphery. Specifically, section I is the heart, section II is the lungs, section III is the spleen and gastrointestinal tract, section IV is the liver and gall, section V is the hips and kidneys, and section VI is based on the "K5 sound".
Corresponds to the lower limbs and head. The left and right sides of the graph directly correspond to the left and right sides of the subject. However, the left and right sides of the head of section VI are reversed because the corpus callosum intersects. For example, in FIG. 8, the first diagnostic envelope LJ1 on the left side is relatively close to the reference first envelope LS1 in the sections LIII, LIV, and LV, but the section LII.
Indicates an extremely low level (the solid line is omitted because the level is the same as the third diagnostic envelope LJ3). This would indicate impaired circulation in the left lung. In addition, the first diagnostic envelope RJ1 on the right side shows a decrease in level over the entire section, indicating that the entire right half of the subject has a blood circulation disorder.

As described above, the disease state of each site can be recognized by confirming the distance between the diagnostic reference envelope and the corresponding reference envelope in each section. By the CPU 130,
This certification is automatically performed and the function to display the result is added. To find the distance between both envelopes quantitatively,
For example, as shown in the upper part of FIG. 9, a method of obtaining the area of the region (the hatched part in the drawing) surrounded by the diagnostic envelope J and the reference envelope S may be used, or the lower part of the same diagram. As shown in, a method of obtaining the distance d between the most distant points may be used. In this device, the distance between both envelopes is quantitatively calculated for each section, and when the distance exceeds a predetermined value, a display indicating that there is a disease at the site corresponding to the section is output. . This is for example shown in FIG.
The human body diagram as shown in 0 may be displayed, and some kind of mark may be added to the diseased part. Different marks may be attached according to the degree of separation to express the degree of disease. In addition, in section VI, since the corresponding reference envelope is not defined, in the present device, when the fourth diagnostic envelope J4 extends to a pressure value that is lower than the diastolic pressure DP by a predetermined value. In addition, I try to judge that there is a blood circulation disorder. Specifically, if the blood pressure is lower than the diastolic pressure DP by 5 mmHg, the blood flow is mild, and if the blood pressure is lower than the diastolic pressure DP by 15 mmHg, the blood pressure is moderate. It is determined that there is a disorder and a severe blood circulation disorder when the diastolic pressure DP is extended to a pressure value that is lower than the diastolic pressure DP by 25 mmHg.

As described above, in each section, by confirming the distance between the diagnostic envelope and the corresponding reference envelope, it is possible to recognize the hemodynamic disorder state of each site, which is the result of the hemodynamic analysis by this device. It is a basic concept. Then, as described above, the first diagnostic envelope J1 is the reference first envelope S1.
And the second diagnostic envelope J2 is compared to the reference second envelope S
2, the third diagnostic envelope J3 is compared to the reference third envelope S3. Therefore, the first envelope, the second envelope,
What is meant by the results of separate comparisons for the three envelopes, the third envelope. In fact, the use of such three types of envelopes is nothing but the ability to make a diagnosis associated with the so-called "pulse diagnosis" in Chinese medicine. In this "pulse diagnosis", the circulation information about the whole body can be obtained by taking the pulse of the subject. There are three known modes of compressing blood vessels when taking this pulse: "floating", "medium", and "sinking". "Float" does not block the flow of blood in blood vessels,
It is a form that very loosely touches blood vessels and takes a pulse, and "sinks"
Is a form in which the blood vessel is sufficiently compressed to take a pulse so as to prevent the flow of blood in the blood vessel, and the "medium" is an intermediate form. 11 to 13 are diagrams in which this is replaced with the relationship between the binding band and the artery. Both figures show artery 300
Shows a state in which the bandage is pressed by the binding band 200, and blood flows in the direction of arrow F. The binding band 200 has a pressure P
Thus, the pressure P is pressed against the artery 300, but the value of the pressure P is different for each figure, and corresponds to each form of “floating” in FIG. 11, “medium” in FIG. 12, and “sinking” in FIG. 13. Blood in the arteries flows in the form of pulse wave propagation. That is, the pulse wave W1 coming from the right side of the drawing passes under the pressure of the binding band 200 and travels to the left as a pulse wave W2. When this pulse wave passes, the vessel wall of the artery dilates. Pulse wave W before passing
1 is compared with the pulse wave W2 after passing, "floating" in FIG.
In the state of, the peak of the pulse wave W2 only has a gentle shape, whereas in the state of "sink" of FIG. 13, it can be seen that the pulse wave W2 after passing is considerably distorted.

The inventor of the present application, the first diagnostic envelope obtained by connecting the maximum peak positions of the respective Korotkoff sound waveforms includes blood circulation information obtained in the "floating" state shown in FIG. The second diagnostic envelope obtained by connecting the second largest peak position of each Korotkoff sound waveform contains the blood circulation information obtained in the "medium" state shown in FIG. It has been found that the third diagnostic envelope obtained by connecting the minimum peak positions includes the blood circulation information obtained in the "sunk" state shown in FIG. Generally, in “pulse diagnosis” in Kampo medicine, the pulse obtained in the form of “float” indicates vitality, self-recovery, and immune function, and the pulse obtained in the form of “medium” is physiological. It is said to indicate the required blood volume, and the pulse obtained in the form of "deposition" is said to indicate the basal circulating blood volume. Therefore, if there is a gap in the first envelope, it can be determined that a blood circulation disorder, such as a decrease in vitality, a decrease in self-recovery, or an immunodeficiency, has occurred in that part. Further, if there is a gap with respect to the second envelope, it can be determined that there is a blood circulation disorder in which the physiologically necessary blood volume is reduced. Furthermore, if there is a gap with respect to the third envelope, it is possible to determine that the relevant organ is in an extremely dangerous state because there is a blood circulation disorder in which the basal circulating blood volume is reduced. As described above, by using the three types of envelopes, it is possible to obtain information about the content of the blood circulation disorder that has occurred in each part.

In order to perform the blood circulation disorder display related to the "floating / chuning / sinking", for example, in the region display as shown in FIG. 10, the blood circulation disorder relating to "floating" obtained from the separation of the first envelope, 2 Blood circulation disorders related to "medium" obtained from the separation of the envelopes, blood circulation disorders related to "sinking" obtained from the separation of the third envelope, are displayed by distinguishing them with symbols or displayed in different colors. You could do something like that.

Finally, another embodiment will be described. This example is for eliminating an error due to respiratory variation when measuring the Korotkoff sound waveform and enabling a more accurate hemodynamic analysis. Since the living body makes a respiratory motion in a predetermined cycle, the pulse wave transmitted from the heart to the periphery contains respiratory fluctuations that change in the cycle of this respiratory motion. In the above-described embodiment, as shown in FIG. 3, from point B to point F (or point B ′ to point F ′),
The Korotkoff sound waveform is measured while lowering the pressure at a constant speed (3 mmHg / sec), but this measurement includes respiratory fluctuation. The influence of this respiratory variation can be reduced by performing the following measurement. That is, as shown in FIG. 14, the pressure is increased from the point A, and when the predetermined pressure value T is reached (point B), the pressure is gradually decreased. Up to this point, the measurement is similar to that in the above-described embodiment. When the pressure reaches the systolic pressure SP (point C), Korotkoff sounds begin to be heard. Therefore, at a pressure value P1 slightly lower than the systolic pressure SP, the pressure reduction is stopped for a while.
That is, the pressure value P1 is maintained from point D to point E in FIG. 14, and during this period, Korotkoff sounds for several heartbeats are detected. After a lapse of a predetermined time, the pressure is reduced again,
When the pressure value P2 is reached, this pressure value P2 is maintained for a predetermined time (F
(Point to G point), and Korotkoff sounds for several heartbeats are detected during this period. Then, the pressure is further reduced until the pressure value P
When it reaches 3, the pressure value P3 is maintained for a predetermined time (from the point H to the point I
(Point)), during which Korotkoff sounds for several heartbeats are detected, the pressure is further reduced (points J to K), and the measurement is terminated. When such measurement is performed, pressure values P1, P2, P
A plurality of Korotkoff sound waveforms corresponding to 3 will be detected. Then, the plurality of Korotkoff sound waveforms usually include respiratory variations. Therefore, the plurality of Korotkoff sound waveforms are averaged, and this average waveform is treated as a Korotkoff sound waveform at the pressure value. At this time, the period during which the pressure reduction is temporarily suspended (D in FIG.
Point to E point, F point to G point, H point to I point (hereinafter referred to as a constant pressure maintaining period) is set to be exactly equal to the cycle of respiratory variation, The average waveform at each pressure value does not include a respiratory variation component. In this way, more accurate hemodynamic analysis becomes possible.

In order to make the constant pressure maintaining period equal to the respiratory variation period, the apparatus of this embodiment performs the following processing. That is, the waveform of the pulse wave in which the respiratory fluctuation appears most remarkably is detected, and the period until the almost same pulse wave is detected again is determined as the respiratory fluctuation cycle.
As shown in FIGS. 11 to 13, since the pulse wave W1 collides with the binding band 200, a pressure fluctuation corresponding to this pulse wave occurs in the binding band 200, and this pressure fluctuation is generated by the device shown in FIG. Of the pressure sensor 110. That is, the device shown in FIG. 1 also has a pulse wave detection function. Therefore, the pulse wave detected at the beginning of the constant pressure maintenance period (for example, point D) is recorded as a reference pulse wave, and thereafter the pulse wave is continuously detected (each pulse wave is slightly changed due to respiratory variation). When the same pulse wave as the reference pulse wave is obtained again (actually, a pulse wave showing agreement within a predetermined error range is obtained), the respiratory fluctuation cycle has elapsed. Therefore, the pressure reduction may be started. In general, since the respiratory fluctuation period is 10 seconds or less, in this embodiment, it is 10
When the same pulse wave as the reference pulse wave is not obtained even after a lapse of seconds, the constant pressure maintaining period is ended and the pressure decrease is started.

In the embodiment shown in FIG. 14, the pressure values P1, P2 and P3 provided with the constant pressure maintaining period are the pressure values corresponding to the above-mentioned "floating", "medium" and "sinking", respectively. Ideally, for all pressure values, it is preferable to provide a constant pressure maintaining period and obtain the average waveform, but in such a case, the time required for measurement becomes very long. Therefore, in this embodiment, a constant pressure maintaining period is provided for the three pressure values P1, P2, and P3 to obtain the Korotkoff sound waveform with no respiratory fluctuation.

Although the present invention has been described above based on the illustrated embodiment, the present invention is not limited to this embodiment and can be implemented in various modes other than this.
For example, two sets of binding bands can be prepared and left and right measurements can be performed simultaneously. In addition, various other methods may be considered for displaying the blood circulation disorder site. Furthermore, in the above-described embodiment, three types of envelopes were created for Korotkoff sound waveforms and hemodynamic analysis was performed. However, analysis using only one type, only two types, or four or more types of envelopes was performed. You can also do it.

[0037]

As described above, according to the hemodynamic analyzer of the present invention, the envelope containing the systemic hemodynamic information of the subject can be obtained by the simple method of attaching the bandage to the subject. Obtainable. In addition, since three types of envelopes corresponding to “floating”, “medium”, and “sinking” of pulse diagnosis in Kampo medicine can be obtained, the information of “floating / medium / sinking” is treated as objective data. It will be possible. Further, since the envelope is divided into a plurality of sections and the envelope for each section is compared with a predetermined reference envelope, it is possible to recognize the blood flow state of the body part associated with the section. it can. Furthermore, since the left and right envelopes are processed separately, the left and right hemodynamic analysis of the living body can be performed separately.

[Brief description of drawings]

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

FIG. 2 is a diagram showing a state in which the binding band of the device shown in FIG. 1 is attached to a subject's upper arm.

FIG. 3 is a graph illustrating a measurement operation of the device shown in FIG.

FIG. 4 Korotkoff sound wave pattern P for a healthy person
3 is a graph showing a reference envelope created based on 1.

FIG. 5: Korotkoff sound waveform pattern P for a sick person
It is a graph which shows the reference envelope created based on 2.

6 is a diagram showing an example of a diagnostic envelope obtained by the apparatus shown in FIG.

7 is a diagram showing how to obtain three types of diagnostic envelopes by the apparatus shown in FIG. 1. FIG.

8 is a diagram showing an example of a comparison graph of a diagnostic envelope and a reference envelope output by the device shown in FIG.

FIG. 9 is a diagram showing a method for quantitatively obtaining the distance between the envelopes shown in FIG.

10 is a diagram showing an example of a blood circulation disorder site display output by the device shown in FIG.

FIG. 11 is a diagram illustrating “floating” in the pulse diagnosis of Chinese medicine.

FIG. 12 is a diagram illustrating “medium” in the pulse diagnosis of Chinese medicine.

FIG. 13 is a diagram for explaining “depression” in pulse diagnosis of Chinese medicine.

FIG. 14 is a graph illustrating a measurement operation in another example of the present invention.

[Explanation of symbols]

 100 ... Device main body 101, 102 ... Pipeline 110 ... Pressure sensor 111 ... Amplifier 112 ... A / D converter 120 ... Amplifier 121 ... Band filter 122 ... A / D converter 130 ... CPU 140 ... Air pump 150 ... Leak valve 160 ... Memory 170 ... Display device 180 ... Printer 191 ... Right side measurement start switch 192 ... Left side measurement start switch 200 ... Restraint band 210 ... Blood flow sac 220 ... Sound wave detector 230 ... Conduit 240 ... Lead wire 300 ... Artery DNP ... Aortic valve closing trace pressure DP ... diastolic pressure J, J1, J2, J3 ... diagnostic envelope S, S1, S2, S3 ... reference envelope SP ... systolic pressure W1, W2 ... pulse wave

Claims (3)

[Claims] 1. A sound wave detection unit for detecting Korotkoff sound generated by compressing a living body with a binding band, and a waveform of the Korotkoff sound detected by the sound wave detection unit at the time of detection. The waveform storage unit that stores the waveform values stored in the waveform storage unit in association with the pressure value of the waveform is arranged on the pressure axis from the systolic pressure SP to the diastolic pressure DP, Create a diagnostic envelope by connecting the peak positions,
An envelope creating unit that outputs this is provided, and the envelope creating unit determines a first diagnostic envelope obtained by connecting the maximum peak positions of each waveform and a second largest peak position of each waveform. 3 of the diagnostic second envelope obtained by tying and the diagnostic third envelope obtained by tying the minimum peak position of each waveform above the noise level
A hemodynamic analysis device, characterized in that it creates different types of diagnostic envelopes and outputs them. 2. A sound wave detection unit that detects Korotkoff sound generated by compressing a living body with a binding band while changing the binding band pressure, and a waveform of the Korotkoff sound detected by the sound wave detection unit at the time of detection. The waveform storage unit that stores the waveform values stored in the waveform storage unit in association with the pressure value of the waveform is arranged on the pressure axis from the systolic pressure SP to the diastolic pressure DP, Create a diagnostic envelope by connecting the peak positions,
An envelope creating section that outputs this is provided, and the pressure axis from the systolic pressure SP to the diastolic pressure DP is divided into a plurality of sections, and each section of the living body is associated with each section. For each section, the diagnostic envelope is compared with a predetermined reference envelope, and for sections where the distance between them is greater than or equal to a predetermined limit, the body part associated with that section is displayed as a blood flow disorder site. A hemodynamic analysis apparatus further comprising: a blood flow disorder site display unit that operates. 3. The hemodynamic analyzer according to claim 1 or 2, wherein the diagnostic right envelope based on the Korotkoff sound waveform obtained when the bandage is attached to the upper right arm of the living body and the upper left arm of the living body. A hemodynamic analyzer, wherein a diagnostic left envelope based on Korotkoff sound waveforms obtained when a tie band is attached can be processed separately.