JPS59501895A - electronic blood pressure monitor - Google Patents

Abstract

(57) [Summary] This bulletin contains application data before electronic filing, so abstract data is not recorded.

Description

[Detailed description of the invention] electronic blood pressure monitor Background of the invention This invention relates generally to methods and apparatus for measuring blood pressure and ventricular contractility, and more particularly to methods and apparatus for measuring blood pressure and ventricular contractility. For example, blood pressure and ventricular contractility can be easily measured quickly, accurately, and reliably. This invention relates to a new and improved electronic blood pressure monitor device.

In medical care such as hospitals and clinics, the characteristics of the so-called Korotkoff noise are used to determine the patient's blood pressure. To measure the patient's blood pressure by determining the ventricular systolic and diastolic values of Auscultation is usually used.

The Korotkoff method typically uses an inflated cuff that encircles part of the patient's upper arm. cormorant. When the cuff is fully inflated, the patient's brachial artery is occluded or completely closed. be done. Releasing the air and slowly deflating the cuff allows each heart cycle to For a very short period of time, a point is reached where the blocked artery begins to open up. In this regard, cufflinks The pressure is assumed to be approximately equal to the brachial artery blood pressure when using this method; This is the peak pressure achieved during the cycle, and this pressure is medically referred to as ventricular systolic blood pressure. It is known as.

The point at which the artery first opens is usually at the downstream end of the inflated cuff, where an ear canal is placed above the artery. The examination can be carried out by applying any suitable listening device, such as a medical instrument or a microphone. I can put it out. When the artery opens, there is pulsating blood flow, or blood flow below the blockage. The auscultatory sound caused by the turbulent flow of blood is detected by the listening device as a sudden influx of blood. This kind of sound is known in the medical field as the Korotkoff murmur. first inspect At the point where the decreasing cuff pressure balances the systolic blood pressure, the auscultation technique becomes familiar. Medical personnel can detect sudden blood flow in an artery and the onset of a Korotkoff murmur. The ventricular systolic blood pressure can be determined by

Korotkoff murmurs occur between successive cardiac cycles as cuff pressure continues to decrease. continues roughly in synchrony with the blood pressure pulses generated during However, in the end, cardiac psych A point is reached where the artery remains open throughout the entire length, at which point the Korotkoff murmur becomes I can't hear it at all. The cuff pressure at this point is the lowest blood pressure reached during the cardiac cycle. Roughly equal, the heart is roughly at rest, which is known as ventricular diastolic blood pressure. There is.

Therefore, decreasing cuff pressure can be compared to the Korotkoff noise output of a stethoscope or microphone. Correlating, the cuff pressure at the time of the first Korotkoff murmur is The cuff pressure at the time of the last Korotkoff murmur is approximately equal to the blood pressure measured. It will be clear that it is approximately equal to the ventricular diastolic blood pressure that occurs during the process.

Based on the above description, it is clear that a routine test using inflatable cuffs and suitable listening equipment can be used. It will be clear that conventional blood pressure measurement procedures have a number of important drawbacks. Regarding this By continuation, medical personnel making these measurements are aware that the Korotkoff noise is relatively small. ambiguous signals with amplitudes that are difficult to detect and are generated by artifacts and internal influences. Korotkov's Regarding the presence or absence of noise, L1 has to make rather difficult and sometimes very subjective judgments. There must be. These artifacts and noises can lead to cardiovascular irregularities and blood pressure changes. This may be due to an erroneous rise in blood pressure or patient movement during the measurement.

Furthermore, noise and artifact signals are generally more pronounced by sick patients than by healthy patients. It seems to be occurring more frequently. For this reason, there seems to be an extremely high demand for high accuracy. In such cases, this method is often more difficult to implement accurately. Sara K, Koro Determining the final points of start and end of a Tokoff noise pulse train is somewhat uncertain. Yes, and therefore requires considerable training and considerable experience on the part of skilled medical personnel. If so, there is a risk that the accuracy will become even worse.

Therefore, blood pressure measurement using a regular tonometer is difficult due to bias in past medical records and hearing loss. Good, poor operator technique, distraction, insufficient operator training, auscultation gap due to poor performance, ambiguity, arrhythmia and other cardiovascular irregularities. Confounds due to artifacts, misinterpretation of ventricular systolic pressure, especially Korotkoff murmurs. Errors in interpretation when stages 4 and 5 are unclear, and as explained earlier. Due to the large number of human heartbeats, there is a misinterpretation of the presence or absence of a heartbeat when the heartbeat is weak. Subject to error. There is a need to eliminate human error in such measurements, as well as increase the speed. Due to the need to reduce the difficulty of blood pressure measurement by automatically disabling blood pressure measurement. Research continues into new and improved invasive methods.

The required height for consistently accurate blood pressure measurements using normal manual auscultation techniques. Since the number of highly skilled and experienced personnel is relatively small, the measurement process can be mechanized and automated. Let's make it more mechanized so that poorly trained staff can measure blood pressure. According to K, if it is possible to remove the subjective factors that come into play when A seed that eliminates defects and makes it possible to distinguish artifacts and noise in some way. Various attempts have been made.

However, such automated devices that measure blood pressure and typically associated ventricular contractility generally overdoes the influence of spurious signals generated by artifacts and noise. Medical personnel using tried and true manual procedures that are proven to be effective. The accuracy is often lower. As a result, it is difficult to measure blood pressure by auscultation method. Automatic Korotkoff noise monitoring devices have only limited acceptance in the medical industry. Not yet.

Conventionally, in addition to auscultation, one-volume method, Doppler method or impedance method, and blood pressure wave Many methods of measuring blood pressure have been used in the past, such as the sway meter method that analyzes shape. Ru. The oscillometer method uses changes in cuff pressure to measure blood pressure. measure blood pressure Through comparison with other methods to determine the relative amplitude of blood pressure oscillations and ventricular systole and diastole It was found that a correlation exists between period and mean pressure. The average pressure is the pressure oscillation It is said to occur at the maximum point, and the ventricular systolic and diastolic blood pressures are said to occur at the peak amplitude. It is said that it typically occurs in the hands of people.

However, these points can only be regarded as approximations at best; they vary greatly depending on the individual. It can be changed.

Therefore, there is a need for methods and devices that can automatically or dynamically measure blood pressure. Despite the recognition of sexual Efforts have been made to improve the reliability of K, which can be implemented with conventional instruments of reasonable cost. No effective method could be found.

Recently, the efforts of the inventor of this invention have resulted in substantial improvements in automatic blood pressure monitoring devices. This is based on the detection of specific progenitors of specific C4 to C7 noises. Verify tocoff noise signals and eliminate artifacts and noise. This kind of blood pressure The measuring device is patent application No. 130,0 filed in 1978 on October 24, 1978. No. 81, the title of the invention "Electronic heart pressure monitor" K is stated.

In order to continue the efforts of the inventor, the basic device and equipment described in this patent application are The accuracy, reliability, and practicality of blood pressure and related measurements that can be achieved are further refined. This has substantially improved usability.

Therefore, those involved in the development and use of automatic heart pressure monitors in the medical field need to ensure that they are more accurate and reliable. In addition to providing reliable measurements of blood pressure and ventricular contractility, A modification of the 8-barometer device that does not require a high degree of skill or subjective interrogation knowledge on the part of medical personnel. We have long been aware of the continued demand for quality products. Of course, this invention This is in response to such requests.

Summary of the invention Briefly and generally speaking, the present invention provides a method for monitoring the ventricle of a patient being monitored during a measurement cycle. When accurately and reliably determining systolic and diastolic blood pressure and ventricular contractility, Accurately and reliably monitor the flow of blood pressure pulses and Korotkoff noise signals from various signal sources. New and improved methods and equipment to detect, analyze, verify and evaluate Provides an 8-pressure gauge device.

Fundamentally, the invention provides a highly reliable method for detecting Korotkoff noise signals and blood pressure signals. Verify and confirm the authenticity of the pulse.1 This pair of people is connected to the incoming data flow. From the tocoff noise signal and the blood pressure pulse, as well as various artifacts and noise signals, this An improved electronic system that separates true FLOTOCO7 noise signals and pressure pulses, such as Covers methods and apparatus. This includes all individual Korotkoff noise signals and each For the associated blood pressure pulse signal associated with the Korotkoff noise signal, the waveform solution is This is achieved by performing an analysis. Regarding this point, in this application, The genuine Korotkoff noise signal generated as the incoming data from the converter is It has a unique external engine in the form of a continuous progenitor waveform, and this waveform can be used to create a genuine Korotkov It is possible to distinguish a noisy signal from noise and artifacts, and 1. this waveform is false. It was found to have the appearance of a misleading quasi-Korotkoff noise signal.

Identify the genuine Korotkoff noise signal and separate this signal from artifacts and noise The main characteristics of the waveforms used for the receive knowledge. Waveform characteristics include waveform shape, size, and direction, which are extremely measured by magnitude, amplitude, slope, phase and timing.

In Patent Application No. 130,081 of 1973, a genuine Korotkoff noise signal was confirmed. to detect and exploit specific Korotkoff noise precursors to eliminate artifacts and noise. The basic equipment used is described. This device is a forerunner of the device of this invention. The device of the present invention further provides substantial novel improvements.

The device in the patent application cited above uses a single microphone with isotropic characteristics. Float murmur is detected by auscultation. This characteristic is called a Frotkoff event. It is not only the sudden rush of blood into the arteries that represents the blood pressure pulse of the heart cycle. It also responds to the expansion of the arm, which indicates the Both Korotkoff information and pressure pulse information are added to each generated Korotkoff noise signal. The two are superimposed. For this reason, the device of this patent application uses electricity from the microphone. The signal output is first processed and analyzed using an analog front screen device. This outfit @ke , has three analysis channels that process all incoming signal waveforms.

The front screen device processes the incoming data and divides it into time domain and blood pressure domain. The electrical output is a pulse train that correctly correlates the Tokoff noise signal and marks its location. Occur. Analog shaped screen equipment exhibits various artifacts and noise signals. In contrast to a waveform that accurately represents a true protofluorescent noise signal, a waveform consisting of a unique for all incoming signal waveforms based on the knowledge that certain characteristics are related. Perform waveform analysis. In this regard, in contrast to mere frequency characteristics, , the waveform characteristics of the incoming signal are typical of those associated with a genuine Korotkoff noise signal. From electrical signals that also include artifacts and noise signals that enter the frequency domain, This method has been found to be the most reliable means of accurately separating noise signals.

In the patent application cited above, is the blood pressure signal and Korotkoff noise signal superimposed? , the signal from the signal human data stream is associated with the Korotkoff noise signal channel. It is first separated into two connected precursor analysis channels. In this connection, , an analog shaped screen device measures the amplitude of the Korotkoff noise signal and calculates this A first spike channel that generates an output pulse proportional to the amplitude and a true core To show that a Rotkoff noise signal has occurred, we generalize the waveform of the incoming signal. The so-called ventricular diastolic channel, which correlates with the characteristics of the ventricular diastolic waveform precursor, In order to confirm that a genuine Flotco 7 noise signal was generated, all incoming Ventricular systolic analysis that correlates the signal waveform with the generalized ventricular systolic waveform precursor property I have a channel.

This invention is based on the basic equipment described in Patent Application No. 130,081 of 1978. The accuracy and reliability of blood pressure and ventricular contractility measurements that can be achieved by further refining the equipment and methods substantially improve performance and practicality.

In one aspect of the invention, the combined Or, instead of one signal stream with mixed information, Korotkoff noise signal sequence The relevant precursor in the form of a blood pressure pulse is first combined with another signal source to generate a pressure wave. A pair of input data signal streams are separated into separate channels as precursor and Korotkoff noise signals. feed the channel. Then both the Korotkoff noise signal and the pressure pulse waveform Waveform analysis is performed separately for do. The Korotkoff noise signal has a slope of sufficient magnitude that the associated genuine precursor occurs in the correct phase relative to the preload pulse and in the positive slope portion of the precursor waveform. If so, confirm that it is genuine.

Minimize the superposition of blood pressure pulse information by isotropic one microphone transducer In order to obtain a Korotkoff noise signal of various A specialized "longitudinal" bending transducer or deflection sensing device has been developed. This monitors the vertical axis line Placed in an inflatable cuff parallel to the brachial artery of the patient's arm. ! L, Sudden forward flow of blood into the brachial artery during each Korotkoff event. Improves the response to the wave front of the traveling wave that represents motion. This new and improved colo The Tokoff noise signal converter detects the overall arm expansion that occurs during each cardiac cycle. Relatively unaffected by exercise.

Furthermore, in this application, the brachial arteries are spaced apart at appropriate intervals along the longitudinal axis of the brachial artery. , - If the upstream and downstream transducers act together, Using a pair of conventional microphone transducers instead of one longitudinal transducer It turns out that it is possible.

Sensing the blood pressure pulse signal from cuff pressure fluctuations as well as the distinct Korotkoff noise Obtaining signal information improves the signal-to-noise ratio and improves the signal-to-noise ratio between the two The separation of the signal, i.e., the Korotkoff noise signal and the progenitor blood pressure pulse waveform, is much better. Ru. In this regard, each signal channel is It can be optimized for the frequency component of the specific signal to be processed. cuff pressure By sensing pulse signals from force, the entire arm expands and contracts with pressure fluctuations. Therefore, a signal with a much larger amplitude than the ventricular systolic pressure is obtained. Versus this In contrast, a typical mask placed at the downstream end of the inflatable cuff Because the cuff shuts off all blood flow, Ixyphon is I don't feel the expansion of my arm.

As mentioned earlier, special microphone transducers are used to detect arterial pressures that exceed the maximum cuff pressure. An artery that is created by a sudden influx of blood at the time when a Korotkoff event occurs. Optimized to best detect dimensional changes.

This involves making the transducer long and thin and placing it parallel to the brachial artery. achieved by. This configuration provides the microphone's sensitivity to blood pressure pulse fluctuations. It also tends to minimize the distortion, so this signal can be compared with different sources, Must be fed into a separate channel. Significantly improved channel separation This improves the perception of the noise level in the Korotkoff noise signal channel. Ru. Clean blood pressure pulse signal, Korotkoff noise signal and noise signal with reliable time Make it possible to gate into sections. Therefore, the device of this invention is a genuine copy. In addition to using novel progenitor properties and criteria to identify Rotkoff noise signals. has a much higher signal-to-noise ratio than the device described in the previously cited pending patent application. It gets better.

The device of this invention applies a cuff placed around a patient's arm to a pressure above the ventricular systolic level. and then at a relatively constant slow rate to the ventricular diastolic pressure level. Blood pressure is measured by deflating to a lower pressure. During the contraction cycle, Korotkoff noise signal from special microphone and progenitor blood pressure pulse from cuff The signal is analyzed in real time and then stored and analyzed again. For real-time analysis Therefore, once it is determined that a genuine heart pulse has occurred, after the contraction process is complete, The following data is stored in the storage device for analysis.

1. Time elapsed since the last progenitor fawn pressure pulse (to determine pulse rate) Maximum amplitude of λ precursor pulse waveform 3. Amplitude of the slope of the Korotkoff noise signal 4. Relative phase between Korotkoff noise signal and its associated pressure pulse precursor 5. Cuff closure pressure Real-time analysis of pre-preload force pulses and Korotkoff noise signals enables arm movement, muscle A noise detection criterion for preventing artificial effect signals due to meat twitching etc. can be obtained. this If any of the noise criteria is met, the contraction will be stopped and any further data will be stored. do not. When the noise signal disappears, if necessary, apply pressure to the pressure that interrupted the contraction process. After initially increasing the pressure of the fuss, contractions are resumed.

The progenitor blood pressure pulse waveform controls the output of the appropriate cuff pressure transducer and cuff deflation. is generated as a difference signal between the control signal and the control signal. During contraction, the progenitor pulse waveform Continuously analyzed in real time. The decision to store data in the data storage device is based on this Based on the results of the analysis. This analysis revealed that a true pulse (systole, ventricular contraction) occurred. The time is determined. When this event is detected, a genuine Korotkoff noise signal is present. Examine the spectrum of the previously stored microphone signal to see if there is any possibility of Ru. Analyze the slope, polarity and slope magnitude as well as the amplitude of the pressure pulse precursor waveform. In addition to the authenticity of the pressure pulse precursor versus artifacts and noise, Determine the location of the proton peak. After this, scan the Korotkoff noise signal storage is limited to a certain period before the peak of the pressure pulse in the positive gradient region of the precursor. Determine whether a genuine Korotkoff noise signal occurs within a suitable “window” period. You can. For this reason, a specified period before the peak of the progenitor waveform occurs. All signals from the Korotkoff noise signal converter generated within the system are stored in a storage device. It is necessary to keep it.

Korotkoff miscellaneous received from a special vertically bent microphone or equivalent. Differentiate the sound signal digitally and calculate the slope (depending on the polarity of the signal) that crosses the lowest amplitude threshold. (positive or negative). Furthermore, Korotkoff noise signal storage and blood pressure pattern The Korotkoff noise signal relative to the pressure pulse signal is determined by scanning the pulse precursor signal memory. Determine the phase of the signal. Output Korotkoff noise signal pulse flow and blood pressure precursor pulse The signal flow is further analyzed by a digital processing unit to Misleading quasi-Korotkoff noise pulses and passed as genuine blood pressure pulses Further removing noise and artifact signals and modifying this resulting data to make it more reliable. Confirm as present or suspected, ventricular contraction rate and ventricular systole and diastole. Determine the most probable value as the blood pressure level.

In this invention, a digital processing device detects a flow of Korotkoff noise pulses and a progenitor blood stream. In addition to further processing the pressure pulses, they can also be used to start up the device and proceed with the measurement process. and other new and improved control functions related to conditioning the device to perform carry out. This includes controlling the inflation of the cuff around the patient's arm. , a determination that the swelling has reached an appropriate level to ensure correct data is obtained. control, prevention of excessive inflation, initiation and control of contractions, and control of blood pressure and ventricular contractility. Pressure remaining in the cuff after sufficient information has been obtained to take all essential measurements This includes emitting. By releasing the pressure of this cuff, the measurement process It is best to occlude the patient's brachial artery for a longer period of time than is necessary to complete the procedure. can be kept to a minimum.

Occurs when cuff pressure is between approximately the oscillating ventricular systolic and diastolic pressures. Calculate the pulse rate by taking the average of all pulse periods. This kind of limit Pulse periods outside of are ignored. After calculating the average, the Compare all the periods that were calculated to this average. If you can find a period smaller than the average hand , reduce the number of periods used to calculate the average by 1, but leave the sum the same.

This means that a short cycle caused by an artifact may turn out to be another false cycle. Prevented. After this correction, the average period is calculated again and stored for later display. . If the number of periods determined in this way is less than the predetermined number, the calculation is stopped and the “low signal” Generate display.

Determination of blood pressure based on the amplitude of the Korotkoff noise signal stored in memory is performed using the following procedure. It consists of steps.

1. Calculate the Korotkoff threshold level.

2. Strike the Korotkoff noise signal above the threshold level, which corresponds to the highest cuff pressure. stop.

3. In order to compensate for resolution errors, interpolation is performed according to the present invention to calculate the ventricular systolic pressure. Determine.

4. Locate the Korotkoff noise signal above the threshold, corresponding to the lowest cuff pressure. .

5. Interpolate according to the present invention to compensate for errors in resolution, thus reducing ventricular dilatation. Determine the blood pressure at the stage.

The new and improved electronic 8-pressure gauge device of this invention is highly accurate, reliable, and Easy to use. This device eliminates the Korotkoff noise signal and the progenitor fawn pressure signal from artifacts and noise. A condition that indicates the presence of unreliable data that can be separated from the sound signal with high accuracy. If there is a problem, immediately notify medical personnel. Therefore, the device of this invention The time-consuming and error of manual methods for measuring blood pressure and ventricular contractility Minimize aspects that are likely to lead to The blood pressure and Substantially improves the speed, accuracy, reliability and practicality of and related measurements.

In addition to the above and other objects and advantages of this invention, the drawings showing the implementation side are as follows: It will become clear from the detailed explanation.

Drawing description Figure 1 is a longitudinal cross-sectional view of the patient's arm. It shows the pressure applied to the brachial artery, and also shows the pressure distribution on the surface of the arm and Illustrating internal pressure on an artery.

Figure 2 is a diagram similar to Figure 1, but the maximum occlusion pressure of the cuff is overcome. It shows a blocked artery trying to fully open.

Figure 3 is a longitudinal cross-sectional view of the patient's arm with the blood pressure bandage wrapped around the arm inflated, showing the inside of the artery. The movement of the upper arm when the blood pressure first exceeds the maximum occlusive pressure applied by the cuff. FIG. 4 shows the physical state of the Korotkoff signal longitudinal deflection sensing device parallel to the pulse.

Figure 3b is a view similar to Figure 3a, but with the brachial artery opening rapidly and blood flowing into it. Indicates the state of the deflection sensing device when the arm expands in response to a sudden and uneven flow of liquid. vinegar.

Figure 3c is a view similar to Figures 31 and 3b, after the artery has fully opened. Indicates the physical state of the deflection sensing device.

Figure 4a shows when the brachial artery moves from a completely occluded state to a completely open state. , the physical displacement of the longitudinal deflection sensing device shown in FIGS. 3a to 3C is plotted against time. The waveform shown is shown below.

Figure 4b shows a similar transducer installed lateral to the brachial artery rather than parallel to the artery. Indicates physical displacement.

Figure 4c is parallel to the brachial artery, obtained by differentiating the waveform in Figure 4a. 2 is a waveform showing the velocity sensed by a longitudinal sensing device.

Figure 4d shows the transverse transducer obtained by differentiating the waveform of Figure 4b. This is a waveform showing the sensed speed.

Figures 5a and 5b show one placed upstream and one downstream of the brachial artery. 1 shows lateral velocity waveforms of a pair of spaced apart lateral transducers.

Figure 5c shows the output from the pair of transducers represented by the waveforms of Figures 5a and 5b. This is a speed waveform that combines electrical output.

Figure 6 shows a pair of spaced apart elements arranged to generate the waveforms shown in Figures 51 to 5c. A longitudinal sensing device is shown.

Figure 7 is a diagram similar to Figure 6, and is used to include the signals in Figures 5a to 5C. The case is shown using a pair of ordinary microphones spaced apart from each other.

FIG. 8 is a block diagram of a device for extracting pressure pulse waveforms.

Figure 9 shows the idealized waveform of the blood pressure pulse that occurs during each cardiac cycle. This shows that the location of the Korotkoff noise signal (K-signal) can change; This is the Korotkoff noise signal when the occlusion pressure changes from ventricular systole to diastole bibel. represents the phase shift between the pulse waveform and the pulse waveform.

Figure 10 shows the intraarterial pressure that develops in the brachial artery during each cardiac cycle. Superimposed on the occlusion cuff pressure, the location of the Korotkoff event is shown and shown in Figure 9. The phase shift of the Korotkoff signal with respect to the pulse waveform detected by the cuff transducer Demonstrates functional rationale.

Figure 11 shows the idealized pulse waveforms from the cuff and Korotkoff noise signals. Using the relative amplitude of the pulse waveform and the Korotkoff signal, The mouth showing how to estimate the relative phase between Figures 12 and 13 are waveform diagrams similar to Figure 11, with respect to the pulse waveform. 3 illustrates another method of measuring the phase of a Korotkoff signal.

Figure 14 is a diagram showing a typical pulse waveform and is used for waveform analysis of pulse waveforms. It shows the various criteria that can be used.

Figure 15 shows the pulses stored in memory for later scanning to determine relative phase. Fig. 3 shows the spectrum of the Korotkoff signal and the S waveform.

FIG. 16 is a graph showing the distribution of pressure pulse amplitude with respect to pressure vector. .

Figure 17a shows the waveform of an idealized Korotkoff noise signal and shows the digital solution. This shows how the waveform is scanned for analysis.

Figure 17b records the location and amplitude of the detected Korotkoff noise signal. Diagrammatically shows a data storage register for digitally differentiating and storing the value. are doing.

Figure 18 shows the pulse pressure waveform and determines the period for detecting noise. shows.

Figure 19 shows the calculated threshold level used to determine ventricular systolic blood pressure. 3 is a graph showing the amplitude of a series of Korotkoff signals;

Figure 20 shows a typical Korotkoff noise signal confirmed by the device of this invention. FIG. Figure 21 is a graph similar to Figure 20, illustrating the interpolation method used to shows another aspect of the interpolation method used to determine ventricular systolic blood pressure.

Figure 22 shows the overall block diagram of a generalized 8-pressure gauge device incorporating the features of this invention. It is a diagram.

FIG. 23 is a block diagram of the overall heart pressure analyzer of the present invention.

Figure 24 shows the block diagram of the device that performs waveform analysis on the incoming precursor fawn pressure pulse signal. It is a lock diagram.

FIG. 25 is a block diagram of an apparatus for performing waveform analysis of signals during the contraction process.

Figure 26 shows the waveform analysis and processing performed by the equipment in Figures 24 and 25. The amplitude of the resulting pulse waveform and the amplitude of the Korotkoff signal are plotted in the cuff pressure domain. 3 is a graph shown in area and time domain.

Figure 27 is a flowchart showing the startup process for expansion and contraction by the digital processing device. It is a chart.

Figure 28 shows the 7-ray contraction control process carried out by the digital processing device. It is Yaat.

FIG. 29 shows the removal of the false Korotoko 7 signal by the digital processing device. It is a chart.

FIG. 30 shows another process for removing pseudo-Flotkoff signals by a digital processing device. This is a flowchart.

FIG. 31 shows the loop of the pulse amplitude spectrum as implemented by the digital processing device. It is a flowchart which shows the process of manipulating pulse amplitude data for extracting a shell.

Figures 32, 33 and 34 show data processing performed by a digital processing device. FIG.

FIG. 35 is a flowchart showing the determination of pulse rate by the digital processing device. .

FIG. 36 shows the determination of the threshold level of the Frotkoff signal by the digital processing device. It is a full chart.

FIG. 37 is a diagram showing the determination of ventricular systolic pressure by a digital processor. It is the default.

FIG. 38 is a diagram showing the determination of ventricular diastolic pressure by a digital processor. It is the default.

Figure 39 shows the Frotkoff signal interpolation process carried out by the digital processing device. This is a flowchart.

FIG. 40 is a graph further illustrating the Futokoff signal interpolation process.

Figure 41m is suitable for use in sensing Korotkoff noise signals according to the present invention. FIG. 3 is a side view of a vertical deflection transducer;

Figure 41b is a plan view of the transducer shown in Figure 41a.

Figure 42a is a side view of another embodiment of a suitable longitudinal deflection transducer.

Figure 42b is a plan view of the transducer shown in Figure 42a.

Figure 43a is a side view of yet another embodiment of the longitudinal deflection transducer of the present invention.

Figure 43b is a plan view of the transducer shown in Figure 43a, and the invention provides a high degree of reliability. Therefore, both the Korotkoff noise signal and the progenitor blood pressure pulse obtained from separate signal sources In addition to verifying and confirming the authenticity of Authentic colometry from sound signals, blood pressure pulses, and miscellaneous artifacts and noise signals. IMPROVED ELECTRONIC METHOD AND APPARATUS FOR SEPARATION OF COFF NOISE SIGNALS AND PRESSURE BULSES do. For this reason, all individually detected Korotkoff noise signals and Waveform analysis is performed on the accompanying blood pressure pulses associated with the noise signal. child , the true value generated as an incoming ultator from the sensing transducer (o) = +7 Noise signals always have a unique external structure in the form of an associated precursor waveform, and in this invention, This kind of external equipment can be utilized in a very effective and unique way, and in other cases, it can be used as a semi-copter. 7. From unrecognizable noise and artifact signals that take on the appearance of noise signals. Verify the genuine Korotkoff noise signal.

Identify genuine Korotkoff noise signals and separate these signals from artifacts and noise The characteristics of the main waveforms used to and recognition. These waveform characteristics include the shape, size and direction of the waveform; is measured by polarity, amplitude, slope, phase and timing.

In this invention, information such as that obtained from a single isotropic microphone transducer is Instead of providing a single combined signal stream, first separate signal sources Together with the Cough noise signal and the associated precursor in the form of a blood pressure pulse, the precursor pre-pressure waveform and the flow of a pair of input data signals into separate channels for the Korotkoff noise signal. supply this. After this, both individually and in conjunction with the Korotkoff noise signal Both the Korotkoff noise signal and the pressure pulse waveform also serve as a corresponding pair of precursor waveforms. Perform waveform analysis on.

The background of the auscultation process used to practice this invention is explained with reference to Figures 1 and 2. Specifically, the Korotkoff noise detected by the microphone transducer is An increase in blood pressure from the shrinking heart causes a bulge wrapped around the patient's upper arm. When overcoming the maximum occlusion pressure exerted by the cuff 100 that can be , thought to be caused by rapid movement of the arterial wall. in the collapsed part of the artery Due to the sudden influx of blood, a Frotkoff event causes the previously occluded area of the upper arm to open. The artery opens very quickly, especially at the downstream end of the cuff. Ru.

As best shown in Figure 1, the pressure exerted by the cuff on the surface of the arm is Although it is almost uniform, the chilly pressure on the brachial artery 10- is uniform depending on the cuff 10/. Not like that. There was occlusion pressure in 10 arteries in the upper arm, and the cuffs were inside the arteries. It is highest at the center of the area between the two ends, descending towards the ends, where it finally reaches has a magnitude of approximately zero. The pressure distribution on the brachial artery IO- is not uniform. , as a result of the action of the cuff lOO of finite length on the flexible tissue of the arm 10/ This is due to the so-called "edge" effect that occurs when

As best shown in Figure 2, the blood pressure upstream of the 10 brachial arteries increases. When the maximum occlusion pressure exerted on the artery at the center of the cuff is exceeded, the artery eventually opens. The first place to induce Korotkoff noise is the peak pressure at the center of the cuff lOO. Since it is a point, a sudden influx of blood occurs at high speed. Once the maximum occlusion pressure is exceeded, the The occlusion pressure gradually decreases in size as it moves downstream, and finally drops to zero at the edge, allowing high pressure blood to flow downstream into volume 8. child Therefore, the artery opens very quickly and generates traveling waves.

This traveling wave can be converted into ordinary noise by a suitable microphone converter. O can be easily detected The sudden opening of the brachial artery during a Korotkoff event results in a transient state, which Wide frequency spectrum with highest frequencies within the range of 5oH2 to 100]11z generates a file. Typically, the micro The phon is isotropic or non-directional in its sensing properties. This kind of microphone is Movement or shaking in the transverse direction, i.e. perpendicular to the arm 10/and artery 10 in FIG. They tend to be the most sensitive to motion.

Next, to explain Figures 3& to 3c in more detail, the downstream side of the cufflinks Place it under the cuff 100 that can be inflated at the end, and extend its length along the upper arm. A longitudinal deflection sensing device or bending transducer lOJ parallel to the artery 10- Korotkov was able to detect with great precision the "shock waves" that occur when blood flows into the arteries below. Indicates the occurrence of an event. At this point, as best shown in Figure 3 & Figure 1. The sensing device 103 is flattened over the collapsed part of the upper arm artery. The blood pressure on the downstream side increases when the cuff is closed, as shown by K when the left artery opens in Figure 3a. When the occlusion pressure is exceeded, the shock wave generated by the opening of the artery hits the arm just before the traveling wave. inducing a corresponding rapid expansion of 10/.

A deflection-sensing device is activated by arm expansion induced by the opening of 10 brachial arteries. The upstream edge of is physically displaced in a direction perpendicular to the arm 10/and artery 10. Then, the deflection sensing device 103 changes from the flat state shown in FIG. 3a to the concave state shown in FIG. 3b. It can be seen from FIG. 3b that this changes.

As best shown in Figure 3c, once the artery is fully open, the traveling wave can pass through. Then, the deflection sensing device 10J returns to its flat state. Therefore, each Korotkoff event The Korotkoff signal generated by the rapidly opening brachial artery lO is the deflection Sensing device 10J is subjected to a physical deflection or deformation cycle. This Psych A/ It starts out flat, curves into a concave shape, and then returns to a flat state.

Deflection sensing device @103ke, the progression induced by the sudden opening of the brachial artery io- The Korotkov miscellaneous With the required high sensitivity suitable for detecting sound signals, but with the pulse pressure of the cardiac cycle There is little sensitivity to global arm expansion representing the force waveform. In this way, the overall arm The reason for the lack of sensitivity to expansion is that such global expansion bending shapes that affect the parts in the same way and at the same time and thus generate the output signal of the transducer without flexing one part of the sensing device relative to another so as to induce distortions in the equation. , because it moves the sensing device as a whole.

In contrast, the same bend or deflection sensing device lO3 has a length dimension parallel to the artery. This sensing device can be placed lateral to or perpendicular to the 10 arteries. The expansion of the arm 10/ due to an increase in the overall diameter, as in the horizontal case shown in Figure 6, to sense.

A commonly used four-phone transducer receives both the arm expansion signal and the Korotkoff noise signal. Usually, it picks up the combination of the two sides, but mainly picks up the signal of the expansion of the arm.

Next, regarding FIGS. 4a to 4d in more detail, the "length direction" (movement direction) Longitudinal deflection sensing devices placed ``parallel to the pulse'' and ``lateral'' (perpendicular to the artery) The signal generated by the position is obvious. All converters ultimately It uses a derivative of the form , and therefore responds to the velocity of motion rather than to the displacement signal.

FIG. 4a shows the longitudinal deflection sensing device 103 shown in FIGS. 3&, 3b, and 3c. shows the waveform of physical displacement versus time. The vertical axis in Figure 4a indicates concave deflection.

When the brachial artery changes from completely occluded to completely open, the waveform reaches its peak. It can rise to a large value and then fall to zero when the sensing device returns to a flat state. I understand.

Figure 4b is not parallel to the arteries, but lateral to or against the 10 brachial arteries. It shows the physical displacement of the same longitudinal transducer mounted vertically with a Slowly increases the main arm expansion signal due to changes in blood pressure in the cycle. It is shown as a waveform that goes down.

Figure 4c shows the velocity detected by the deflection sensing device 10J parallel to the brachial artery. This can be obtained by differentiating the waveform in Fig. 4. Fourth The waveform shown in Figure c is considered to be an idealized waveform of the Korotkoff noise signal.

Figure 4d shows the transverse transducer obtained by differentiating the waveform of Figure 4b. The typical Korotkoff noise shown in FIG. While the signal has a quasi-sine wave or double spike type external signal, it has one negative peak. have.

Artificial effects caused by arm movement and muscle flexure K Signal Length parallel to the brachial artery It is much larger for lateral deflection sensing devices than for directional deflection sensing devices. It seems to give influence. This is caused by the flexure of the arm muscles in Figures 4a and 4c. over a very short section of deflecting the longitudinal transducer so as to generate the signal shown in the figure. explained by the fact that more diameter changes occur over the length of the muscle than changes in diameter be done.

For example, by using two transverse transducers (Fig. 6) approximately 1.5 cm apart, one The same result is obtained as the deflection sensing device 10J arranged in the longitudinal direction. related to this Figures 5a and 5b show the inside of the inflatable cuff. A pair of separated transverse transducers, one upstream and one downstream of the brachial artery. The lateral velocity waveforms are shown. Figure 5 & Figure 5 shows the upstream lateral velocity signal electrically. Figure 5c shows the downstream lateral velocity signal. conversion Due to the physical distance between the two signals, the phases of the two signals are shifted.

By adding the speed signals of the two transducers shown in Figures 5a and 5b, we get Figure 5c. By generating the combined waveform shown in Figure 4c, these two signals are A waveform that is very similar to that obtained from a single deflection sensing device placed along its length. It can be seen that a shape is generated.

Therefore, a pair of transverse transducers can be used in combination to generate a suitable Korotkoff noise signal waveform. You can get the shape. Therefore, the combination of these two lateral transducers will reduce the movement of the upper arm. Sensing the moving wave crest of the pulse, the effect of changes in muscle diameter becomes even more nagging ψ. This is 2 This is because when the expansion signals of the two arms coincide in time, they cancel each other out. this Therefore, the waveforms in Figures 5a and 5b are not generated by the advancing wave crest. Although only the noise signal is temporally displaced, these waveforms represent the overall arm expansion signal. is not displaced in time. This arm expansion causes both lateral transducers to simultaneously, thus eliminating the phase shift of the signal outputs of the two converters.

In other words, using a pair of spaced apart transducers as shown in Figures 6 and 7, the progress This increases the sensitivity to the directionality of the detected signal, such as a wavefront moving along the arm. of the detected signal, as characterized by global expansion signals and artifacts. Sensitivity to non-directionality is reduced, thus improving the signal-to-noise ratio of the electrical output .

FIG. 6 shows the downstream end of the cuff 100 spaced apart along the 10 brachial arteries. 2 shows a pair of lateral deflection sensing devices located at the lateral deflection sensor. For each Korotkoff event On the other hand, the upstream transducer 10Ja generates the waveform of the fifth breath diagram, and the downstream transducer 10 Jb produces the waveform of Figure 5b, and their combination produces the waveform of Figure 5c.

Furthermore, as seen in FIG. 7, instead of one longitudinal deflection sensing device 10J, a pair of universal Microphone transducers l0Qa and 10db are placed on the vertical axis of the 10 brachial arteries. If provided at appropriate intervals along the axis, a pair of lateral transformations N10Ja, 10 shown in FIG. I found out that it can be used in the same way as Jb. Microphone 1olIB is upstream It can be used as a converter on the side of microphone 10Q, and as a converter on the downstream side of microphone 10Q. together produce a Korotkoff noise signal as shown in Figure 5c.

Using two lateral transducers or two conventional microphone transducers can be By providing a pair of short, solid sections separated by Simulating the knowledge device 103 is exactly the same.

Using the type of Korotkoff signal transducer described above, the device of the present invention Cufflinks LO arrived on October 1st.

inflate to a pressure above the ventricular systolic level, then compare approximately 5 mHg/sec. ventricular contraction at a constant slow rate to a pressure below the diastolic pressure level Determine blood pressure. Korotkoff noise signal from the cuff during the contraction cycle Analyzes and blood pressure pulse signals in real time, stores them, and analyzes them again later. do.

As mentioned before, a special deflection sensing device 10J is used to detect when the arterial pressure reaches the maximum cuff pressure. brachial artery caused by a sudden influx of blood beyond which a Korotkoff event occurs It is optimized so that the sensitivity to dimensional changes in io- is maximized. For this reason, The deflection sensing device or bending transducer is made long and thin and attached to the brachial artery IO- Place it parallel to the cuff lOO inside the cuff lOO. This configuration is suitable for Korotkoff noise signals. increases sensitivity, but minimizes transducer sensitivity to variations in blood pressure pulses and A separate channel and transducer is required to capture the pressure waveform. But 1 channel Due to the improvement in the Le minute M, Korotkoff noise appears in the signal channel. It also improves the perception of noise levels. The blood pressure pulse waveform has become even more “clean” , the Korotkoff noise signal and the noise signal can be analyzed appropriately. It is possible to gate to the r1jj partition when reliable. For this reason, Korotkoff noise The device of the invention uses separate channels for the signal and precursor pulse waveforms. , confirming the genuine Korotkoff noise signal with a significantly better signal-to-noise ratio. This makes it possible to better utilize the properties of the precursors.

Real-time analysis of pressure pulses and Korotkoff noise signals to detect arm movements and muscle strain. Noise detection criteria for artifact signals caused by compression etc. can be obtained. Koui If the noise criteria are met, the contraction process is stopped and no further data is stored. stomach. When the noise signal disappears, put on cuff 10O first, if necessary.

After the contraction is increased to the pressure at which it was first interrupted, the contraction is resumed.

The precursor pulse waveform controls the output of the appropriate cuff pressure transducer and deflation of the cuff 100. is generated as a difference signal between the control signal and the control signal. The pulse waveform is of cuff 100. It is sensed by picking up subtle pressure fluctuations in the sac. This kind of pressure pulse Waveform fluctuations occur under the cuff 100 due to pressure fluctuations during each cardiac cycle. This occurs due to a change in the volume of the arm 10/.

The amplitude of the fluctuations in the blood pressure pulse waveform varies significantly depending on the cuff pressure. cuffs Inflate 10° to a value higher than the ventricular systolic pressure and then slowly deflate it. , the amplitude of the pulse pressure waveform is midway between the ventricular systolic and diastolic pressure levels (3i I increase to the maximum value of the ventricular diastolic level (closer to the button) and then decrease again. However, it does not fall to zero.

The reason why the amplitude of the pulse waveform changes as described above is as follows. Ventricular contraction Or, every time the heart contracts, the blood pressure upstream of the cuff 10O increases. cufflinks within 100 If the pressure is higher than the ventricular systolic level, most movement to the upstream edge of the cuff will occur. My pulse collapses. However, rising blood pressure always causes some blood to flow, at least Open the artery over a short distance. This is connected to the brachial artery IO- by the cuff. The resulting pressure is not uniform and, as previously explained in connection with FIGS. 1 and 2, This is because it drops to zero at both edges of the cuff. In this way, blood flows through 100 cuffs. As it penetrates into the area below, the arm lO7 expands somewhat, thus causing the cuff to The pressure inside increases.

Slowly deflating the cuff increases the distance blood enters during each cardiac cycle. The cuff becomes wider and the fluctuations of the cuff pressure pulses increase. ventricular systole and diastole At a point where the pressure level is such that the brachial artery IO- is fully open during each cardiac cycle, Almost completely collapsed again. Pressure within the cuff increases further towards ventricular diastolic levels. As it decreases, the collapsed part of the brachial artery gradually becomes shorter, causing a change in the volume of the cuff. correspondingly becomes smaller.

Below the ventricular diastolic pressure level, the ten brachial arteries remain open at all times. , the volume change sensed by the cuff is only due to the flexibility of the artery wall. Ru.

This K causes a small expansion and contraction, but the artery does not collapse.

The above-mentioned fluctuation in cuff pressure is used in blood pressure measurement using the so-called oscillation measurement method. Other blood pressure measurements Through comparison with method 5, the amplitude of pulse waveform oscillation and ventricular systole, diastole and normal It was found that a correlation exists between the pressure levels of Hitoshi.

The mean pressure is said to occur at the point where the oscillation of the pulse waveform is maximum, and is said to occur during ventricular systole and The diastolic level is said to occur where vibrations are approximately ♀ minutes of peak amplitude. this species An example of the pulse waveform amplitude spectrum of is shown in FIG. This will be explained in relation to digital analysis. Natural L1 In this invention, blood pressure measurement using the sway measurement method The ventricular systolic and diastolic levels determined by the Recognizing that pulse pressure waveforms can vary significantly, the invention therefore The main method for measuring blood pressure is to use it as a precursor to confirm the Korotkoff noise signal. , relies on an auscultation process using a Korotkoff noise signal that has been verified as authentic.

Referring to Figure 8, the pulse waveform changes the output of the pressure transducer and the deflation of the cuff. It is generated as a difference signal between the control signal and the control signal. Essentially this is a pumping device is the same as the error signal that controls the opening and closing of the leakage valve, but the leakage valve signal is The difference is that it has a frequency-sensitive component that stabilizes the .

As best shown in Figure 8, the pressure of the cuff 100 placed around the patient's arm The force is controlled by appropriate input signals from pressure controller 11O. This signal is It is in the form of a linear gradient and is supplied via @/ / / and approximately 5ssHg7 represents the pressure drop in seconds. This signal is passed through the fluid conduit llS at the error summing point ll. A suitable pressure transducer 1llI to measure the actual pressure of the cuff 100 transmitted by M//, 7 is compared with the electrical output transmitted through M//, 7.

The electrical output of the pressure transducer is greater than the control signal and the cuff pressure is too high. , the signal sent to the amplifier and shaping circuit via line //4 is leaking. A control output is generated through line its to cause valve l-0 to open wider, thus opening the cuff. More air is released from the SlOO sac every second.

The fluctuation of the cuff pressure caused by the pulse, that is, the precursor pulse waveform, is caused by the difference in the connection point. A pressure pulse signal is output from the output of circuit l/co to line lco/! This is the 2nd one This is a new type of precursor waveform.

Of course, the pressure pulse signal is affected by the leakage valve's attempt to react to fluctuations in the pulse waveform. It also affects the leakage valve in a similar way. However, the mechanical Since the response time is slow, the pulse waveform is not noticeably smoothed.

Simply AC couple the electrical output of the pressure transducer l/da to offset large cuff pressures. By suppressing the waveform component and amplifying only the health waveform component, approximately the same pressure pulse can generate waveform signals. At this time, the pulse waveform is the cuff pressure There is a small ripple signal on top of a large DC offset, which is used to determine the time of the servo loop. The number tends to compensate for large DC offsets, but does not seem to follow ripples. Therefore, the ripple signal remains as a precursor pulse waveform.

In this invention, a pair of detected signals, namely the Korotkoff noise signal and the precursor pattern Rus waves are related to each other in terms of their relative occurrence times in the time domain. It turns out.

The pulse waveform is continuously analyzed in real time during contraction.

The decision to store data in data storage is based on the results of this analysis. This analysis determines when a true pulse occurs in the cardiac cycle. Such a thing is detected when the deflection sensing device signal is detected to see if a genuine Korotkoff noise signal is present. Inspect. In addition to analyzing the slope, polarity, and magnitude of the slope of the pressure pulse precursor waveform. , we also analyze the pulse wave precursor itself in contrast to artifacts and noise, but this is not true. This is followed by scanning the Korotkoff noise signal memory. In the region of positive slope of the precursor, a suitable period of time precedes the peak of the pressure pulse. A genuine noise signal is generated within the window and it can be determined whether it is a coincidence or not. This is to make you feel better. Therefore, the characteristic before the pressure pulse precursor peak occurs. All signals from the Frotkoff noise signal converter generated during a period of time are stored in a storage device. It is also necessary to store the precursor waveform itself.

Korotkoff noise signals always appear at the rising edge of the pulse waveform. Figure 9 shows each An idealized waveform of the blood pressure pulse waveform that occurs during the cardiac cycle is shown and It is also shown that the location of the Koff noise signal (K-signal) can vary. This is the upper arm Korotkoff's arterial occlusion pressure decreases from ventricular systolic to diastolic levels. Represents the phase shift between the noise signal and the pulse waveform.

Detected with fluctuating cuff pressure, #! 8. The output of Figure 8 is the precursor preload pressure pulse signal. The pulse wave taken out as a has a direct relationship to blood pressure and is a direct result of the waveform within the arterial blood vessels. This point , Figure 10 shows the intraarterial pressure waveform that occurs in the brachial artery during each cardiac cycle. This waveform is shown superimposed on the occlusion cuff pressure. Figure 10 shows the The location of the 7 events is determined by the intersection between the two waveforms in the rising part of the waveform in the arterial blood vessel. It is shown as a cluster of points, and also a copy of the pulse waveform inside the cuff shown in Figure 9. ) shows the functional basis for the phase shift of the Cobb signal.

To explain both FIG. 9 and FIG. 10, the pulse wave shown in FIG. The pulse pressure inside the cuff is as shown in Fig. 10 when the pressure inside the arterial blood vessel increases. The pulse wave rises at any time, and falls whenever the pressure in the arterial blood vessels decreases. Ru. For this reason, the pulse pressure waveform and the pressure waveform in the arterial blood vessel are virtually unrelated to each other. However, depending on the shape of the arm, the size of the cuff, the tightness of the cuff, the condition of the patient's tissues, etc. Due to the large number of variables, the exact relationship cannot be predicted. Natural L1 All the 4 things and 7 miscellaneous things The sound appears during a period of increased pressure within the cuff.

In addition to the above, when cuff pressure is lowered by slow deflation, the ninth There is a distinct phase shift that occurs between the pulse wave and the Korotkoff noise signal in the figure. ventricular systole At pressure levels, the Korotkoff noise signal occurs later in the rising pressure waveform, at the peak of the waveform. appears near or at this peak. Korotkoff noise as pressure decreases The signal appears gradually earlier, and at the level of ventricular diastole, it reaches the bottom of the rising waveform in Figure 9. appear nearby.

The reason for the phase shift between the pulse wave and the Korotkoff noise signal in Figure 9 is as follows for Figure 10. It's best to explain.

As mentioned earlier, during the rising portion of the pressure waveform in the arterial blood vessel, the pressure in the arterial blood vessel is When the occlusion pressure of the brachial artery K is exceeded, a Korotkoff noise signal appears. occlusion When the pressure is high and close to the ventricular systolic pressure level, this is the pressure waveform in the arterial blood vessels. The Korotkoff noise signal is closer to the peak of the arterial blood pressure in Figure 1. It appears closer to the peak of both the waveform and the pulse waveform of FIG. cuff As the occlusion pressure decreases, the Korotkoff noise signal becomes faster in both waveforms. appear. In other words, when the occlusion pressure decreases, the phase shift of the Flotco 7 noise signal is To the left in Figure 10, toward the trough of the waveform represented by ventricular diastolic pressure. move gradually.

In this invention, the phase relationship between the Korotkoff noise signal and the precursor pulse waveform described above is The staff is used to eliminate artifacts. There are several ways to get an idea of this phase relationship. . The preferred method of measuring the phase between the Korotkoff noise signal and the pulse wave is the Korotkoff The amplitude of the pulse wave at the point where the Coff noise signal is generated is measured, and this amplitude and the The purpose is to determine the ratio between the peak amplitude and the peak amplitude of the proton pulse wave. This phase measurement method A dimensionless number between 0 and 1 is obtained that is independent of the distribution and pulse amplitude. On this point, the 11th The figure shows idealized pulse waveforms from cuff and Korotkoff noise signals, Use the relative amplitudes X and Y to determine the relative position between the pulse waveform and the Korotkoff signal. In order to obtain a rough estimate of the phase and use it in the subsequent analysis of the Korotkoff signal, it is dimensionless in the form of the ratio X/Y. A preferred method of generating a phase signal is shown.

Figures 12 and 13 are waveform diagrams similar to Figure 11, with respect to the pulse waveform. 3 illustrates another method of measuring the phase of a Korotkoff signal. Figure 12 stands up The absolute value from the time the Korotkoff noise signal occurs to the peak of the pulse wave on the pressure waveform. It shows how to measure relative phase by measuring time. 13th The figure shows the absolute distance from the steepest slope point of the pulse wave until the Korotkoff noise signal is generated. Indicates the measurement of phase relative to time. As mentioned before, The phase measurement method using the ratio shown in FIG. 11 is preferred.

The device of this invention uses Korotkoff signal deflection sensing in determining blood pressure and ventricular contraction rate. Device 10J (Figures 3a to 3c) and pressure pulse signal output l-1 (Figure 8 Record all Korotkoff noise signals and precursor pulse waves received from ). contraction During the cycle, all these signals are analyzed in real time, stored, and then analyzed again. Ru.

When real-time analysis shows that a genuine pulse has occurred, the contraction process is completed. The following data is stored in storage for further analysis later.

1. Time elapsed since the last blood pressure pulse (to determine pulse rate).

Maximum amplitude of two precursor pressure pulses.

3. The amplitude of the slope of the Korotkoff noise signal.

4, = ro) relative position between the core noise signal and its associated pressure pulse precursor phase.

5. Cuff occlusion pressure.

Real-time analysis of pre-preload force pulses and Korotkoff noise signals enables arm movement, muscle A noise detection criterion is obtained that prevents artifact signals caused by meat twitching, etc.

If any of these noise criteria are met, the contraction process is temporarily stopped and its No more data will be stored. When the noise signal disappears, the contraction process resumes.

Another feature of real-time signal analysis is reliable blood pressure and ventricular flow during the measurement cycle. The goal is to determine when enough data has been collected to allow a reduction rate determination.

This causes ventricular dilatation to occur before the cuff pressure reaches completely zero, i.e., before the pressure in the cuff reaches zero. As soon as the initial pressure level has fallen sufficiently, the contraction process can be terminated.

During the contraction part of the measurement cycle, the precursor pulse wave is analyzed continuously in real time. De The decision to store the data in the data storage device is based on the analysis of this pulse wave.

This analysis will tell you when a true pulse or a true contraction occurs and that When it happens, from the deflection sensing device 1O3 of jJ7slOO (Figures 3& to 3C) Check in the storage device whether a genuine Korotkoff signal has occurred in the differential output of .

Figure 14 shows a typical precursor pulse wave and waveform analysis of one precursor pulse waveform. It shows the various criteria used in the evaluation. In this respect, the pulse wave signal in Fig. 14 is the most It is first differentiated to determine the polarity of the slope of the waveform. The slope of the precursor waveform is now negative. Or, whenever the slope of the slope becomes positive, store the absolute value of the slope in the storage device. Ku. This is done by determining the bottom of the valley, as shown by point A in Figure 14, and making the first baseline. This is to set the amplitude reference level.

When the pulse wave signal becomes positive, the updated current value and the first baseline value are The difference in amplitude between is continuously tested against an amplitude threshold. If this amplitude threshold is exceeded, , unless the slope of the waveform becomes too steep after this, the pulse wave can be considered a real heartbeat. It will be done. The amplitude threshold value is shown at the level of point B of the pulse wave in FIG.

The steepness of the slope of the pulse waveform is also monitored, and if the amplitude of the differential wave exceeds the maximum threshold, this The time pulse wave is considered to be an artifact and no data is stored. the steepest detected A steep slope establishes the location of point C in FIG.

The amplitude of the slope of the pulse wave in Figure 14 is continuously compared with the previous value during the monitoring process. and stores only if the most recent value of the gradient amplitude is greater than all previous values. to set a new location for point C. A larger value of the slope is found, and the waveform becomes more uniform. When indicating a steep rise in a layer, occurring at any time and a specified period before the maximum slope. The amplitude of the new waveform, as shown by the dots in Figure 14, is the new second baseline value. and store it.

64 as a suitable period prior to point C to determine the second baseline for scoring. The period of m5 was determined empirically for practicing this invention. The subsequent process is for standardization. A type of trough that often occurs and lasts several hundred milliseconds before the actual heartbeat occurs. A slow positive rise or pedes in the progenitor waveform signal that may have a pause. This prevents false pulse amplitudes from being generated. For this reason, standardization The order minimizes amplitude scattering in the data.

Continuously update the amplitude of the precursor pulse wave in Figure 14 to the highest value detected, and Find the peak amplitude of the pulse wave of E. The pulse wave signal changes from the maximum value at point E to point F ( This corresponds to very small predetermined amplitudes (only a few milliseconds apart in the time domain). When the amount decreases, it is determined that a pulse wave has actually occurred and one data is stored. After The reason to check the peak at point E after detecting point F is because there is a small movement in the precursor waveform. This is to avoid detection of false peaks that could occur if there were any false peaks.

From Figures 9, 11, and 14, it is said that data is stored at point F in Figure 14. By the time a decision is made, it is clear that the Korotkoff noise signal has already occurred. Ru. Therefore, at a predetermined period before the authentic precursor pulse waveform is verified at point F. It is necessary to store all generated signals from the deflection sensing device in a storage device. It is. In this invention, this storage period was empirically determined to be approximately 250 m5. 1st Determining the phase between the Korotkoff noise signal and the precursor pulse waveform shown in Figure 1, the same It is necessary to store the pulse wave signal for a period of time.

Figure 15 stores one pulse in memory for later scanning to determine relative phase. The generated pulse waveform and K-Flotoff 7 signal spectrum stored in the storage device are It shows. In this regard, the information received from the deflection sensing device @to3 (Figures 3a to 3c) The Korotkov signal occurred a short time earlier, such as 8mm from the current value. To calculate the difference between the values of K, K is first differentiated digitally. this Differential calculations are typically performed every 2 mm and represent the slope of the Korotkoff signal. The one difference value is stored in the memory for 248 ms.

Only the negative slope values of the Korotkoff noise signal that exceed the lowest amplitude threshold are stored.

Next, FIG. 17a and FIG. 17b will be explained.

FIG. 17a shows an idealization of the Korotkoff noise signal received from the deflection sensing device W103. This waveform is shown in the figure below to determine the maximum negative slope. It is shown how the shape is scanned every 2 mm for digital analysis. this invention Although the preferred embodiment uses a negative slope, reversing the polarity reduces the Korotkoff signal. It will be appreciated that a positive signal will be used for analysis. K anyway, negative slope If we choose to monitor the distribution of the Korotkoff signal, we will Also determined by the good part.

Figure 17a shows an idealized Korotkoff signal waveform whose amplitude is periodically sampled. In order to do this, it is shown that vI is divided into several time slits of 2 mm. point -1°1.2.3.4.5.6 shows seven successive samplings of amplitude. this The 2 ms resolution of the Korotkoff noise signal waveform is much larger than that shown in Figure 17a. That's high.

The illustration shown in this figure should be considered as an illustrative example only.

Figure 17b records the location and amplitude of the detected Korotkoff noise signal. A data storage register or R for digitally differentiating a signal and storing its value. AM is shown diagrammatically. Here, RAM has 128 memory slots as columns. shown as a vertical stack of cuts. Digital related to RAM The processing unit has a pointer P1, which points to another register somewhere in storage. and scans the RAM stack.

17a) When sampling a noise signal, pointer P in Figure 17b The amplitude value is stored in the memory location corresponding to the 1 position. The second pointer P2 is RA It lags pointer P1 in M by 8 ml or 4 storage locations.

The operation of the device transfers the amplitude stored at the location of pointer P1 to a point 8 ms earlier. The amplitude at pointer P2 is subtracted from the amplitude at pointer P2, and the difference value is transferred to the adjacent memory at pointer P21C. Store in slot. This difference value spans the 8ms period between the two This is a guideline for the average slope. In Figure 171, this is the point 1 and point on the float control 7 signal waveform. This is indicated by the line drawn between 5. For this reason, there are four memory slots between Pl and P2. Only point 5.4.3.2 in Figure 17a has RAMIC amplitude information. The other 124 storage slots have pointers Pi and P2 that point to the RAM storage slots. It has slope data that is continuously updated as it repeatedly scans the tack. child Therefore, the slope data enters 124 locations in RAM at 2ms per location. The total scanning period before the peak of the pulse pressure waveform is as shown in Figure 15. Then, the Korotov 7 noise signal spectrum becomes 248 mmK.

Once the decision is made to store data at point F in Figure 14, it is confirmed that a heartbeat has occurred. , 248 m5) Scan the signal storage to find the maximum negative slope amplitude. and find its position in the spectrum of the Kotkov signal during the scanning period. this The amplitude of the gradient, shown as a value 2 in FIG. 15, is recalled and stored. Furthermore, The amplitude of the precursor pulse wave at the same point in the time domain is also read from the pulse wave signal storage device. and set it to the value X shown in FIGS. 11 and 15. The value X is the maximum of the Korotkoff noise signal. The amplitude of the precursor pulse wave at the point where a large slope was found and the point in Figure 14, It is determined by calculating the difference from the previously determined second baseline value. Before The value Y in FIGS. 11 and 15, which represents the maximum amplitude of the pulse waveform, is the value Y in FIG. 14. Take the difference between the maximum pulse wave amplitude at point E and the second baseline value of the point. and K.

At the end of the scanning process of the precursor pulse waveform and Korotkoff noise signal, the contraction process is completed. The following data will be stored for later analysis.

1. Period 0 since the last storage command Amplitude of two pulse waves (value Y in FIGS. 11 and 15).

3. The amplitude of the maximum negative slope of the Kota Tokoff signal (value 2 in Figure 15).

4. Phase signal (ratio X/Y).

5. Pressure at cuff lO0 at point F in Figure 14.

Real-time determination of the authentic precursor pulse waveform and Korotkoff noise signal generated In addition to measuring the 0 to monitor both channels for pulse wave and Flotoco7 noise signals FIG. 18 shows the peak confirmation point F1 in FIG. 14, the first baseline A, and the amplitude threshold. A pulse pressure waveform including B is shown. Furthermore, one point 72m5 before threshold B A pair of times: period and second period 160 ms after point F on the previous pulse wave But the noise threshold is The noise detection period is determined to determine the noise detection period. The Korotkoff noise signal is based on the precursor pulse waveform. Due to the fact that it occurs only in the positive gradient part, the time between the precursor pulse waveforms During the interval, noise caused by artifacts such as arm movements or muscle twitches Flotov 7 signal channels can be monitored. This temporal separation results in The noise signal can be clearly separated from the Korotkoff noise signal, and the Korotkoff noise It is possible to set a noise threshold that is substantially unrelated to the amplitude of the sound signal.

During the time when the pulse waveform has a negative slope or exceeds the amplitude threshold B, the All signals (differentially negative) of the ptco7 signal channel are averaged with a time constant of about 1 second. , very short spikes and large spikes are averaged and compared to the overall noise threshold. ensure that the impact of 160m from the peak of the previous last pulse wave When monitoring after a and 72 ms before the first amplitude threshold level of the next pulse waveform The Korotkoff murmur signal or the very early stage with ventricular diastolic pressure levels can be to prevent the ringing of the Korotkoff noise signal from interfering with the threshold determination.

During the off-time of the noise detector, the 1 second time constant i does not act to lower the threshold level; For this reason, the noise threshold is simply kept constant.

If the calculated noise threshold level exceeds the maximum amplitude threshold for noise, the digital The cuff device issues a command to stop further deflation of the cuff, and the noise threshold causes the cuff to deflate again. Data collection will be stopped until the data has been reduced to a satisfactory level where the data can be opened. Temporarily freezes, and if it does not go down, stop the measurement cycle.

Besides the noise routine of the Korotkoff noise signal, the precursor pulse waveform is also subject to artifacts and noise. Monitor for sounds. In this regard, using both positive and negative slope thresholds for the pulse wave, Detects sudden changes in cuff pressure due to movement or muscle twitching. Furthermore, the precursor Positive and negative amplitude thresholds are also used on the child waveform signals to determine the actual cuff pressure and desired cuff pressure. Detect large pressure offsets between pressures. What does this mean for the precursor pulse waveform? If either threshold is exceeded, deflate the cuff until the noise is reduced to an acceptable level. cancel.

The digital processing device 11 of the present invention has a flow of Korotkoff noise pulses and a precursor. In addition to performing further analysis on the flow of blood pressure pulses, the device startup and measurement Other new and improved controls related to conditioning the device to allow the process to proceed He also performs His functions. This includes controls for inflating the cuffs around the patient's arms. It is determined that this swelling has reached an appropriate level to obtain appropriate data. control, prevention of over-inflation, initiation and control of contractions, and required blood pressure and ventricular contractility. Release any remaining pressure on the cuff after you have enough information to make all decisions. It includes putting out. The release of cuff pressure just described completes the measurement process. Minimize prolonged occlusion of the patient's brachial artery for longer than necessary .

Measuring blood pressure according to the invention involves a measurement cycle consisting of three parts: It is carried out between

(1) Pumping stage.

(2) Contraction and data collection stage.

(3) Data analysis and calculation stage of blood pressure and ventricular contraction rate〇Explaining from the pumping stage , an external “start” signal or an internally generated automatic time base Make initial settings for regular cycles. The cuff starts an automatic pump and inflates. Four front panel switches (not shown) typically 15G, 20G , 250 or 300sIIHX until a preselected value is reached. Monitor cuff pressure. Automatically starts pumping when maximum pressure of preselected value is reached. Stop.

After this, monitor the cuff pressure for about 3 seconds to see if there is a leak in the cuff or cuff piping. do. If the pressure drops below a predetermined minimum level, reenergize the pump and Repeat leak test. If the device fails the second leak test, it will stop measuring and An "artificial effect" signal is generated to inform the user of this situation. If it passes the leakage test , the device is initialized for the contraction phase during the measurement cycle.

The control of contraction is divided into several successive steps, during which decisions must be made. Must be.

During the first 3.5 seconds of the contraction, the device tests for the occurrence of a Korotkoff noise signal. experiment. If no Korotkoff noise signal is detected, contraction control is moved to the data collection stage. Switch. If the device detects the Korotkoff noise signal, it will zero out the 3.5 second period. set and start a new test period. If more than two Korotkoff noise signals are detected If so, stop the contraction and start the pump again to increase the pressure by 5 Q: 811Hg pumped to a high pressure level. The device presses to a higher pressure the second time. If a transmission is attempted, the measurement cycle is stopped and the user is informed of the "artifact" condition. Ru. This occurs if the cuff starting pressure level is not higher than the ventricular systolic pressure level. prevent the measurement from proceeding.

In the data collection phase, the actual data collection and storage begins. At the same time, cufflinks Monitor pressure. The digital controller determines the cuff pressure at the beginning of the measurement cycle. This step continues until the pressure drops below 100%.

When the cuff pressure drops to a level below the cuff starting pressure, the device: Search for the end of contraction while continuing to analyze the precursor pulse waveform and Korotkoff noise signal. vinegar. While in this phase, the device first counts the number of stored Korotkoff signals. . If the number of stored signals is less than 5, the pressure is equal to /4 of the starting pressure of the cuff. Continue to contract until it drops. At this latter pressure level, the detected Korotkoff If there are fewer than 5 noise signals, end the measurement cycle and use the "low signal" condition inform the person. In contrast, the number of detected Korotkoff noise signals is If 5 or more deflate to a level of 1/4 of the starting pressure, the device Test the amplitude of the precursor pulse waveform. Amplitude weighting of pulse pressure for amplitude testing Calculate the average. This weighted average is calculated based on the current pulse wave and the previous two pulse waves. It consists of the amplitude calculated from the last three pulse waves of . This weight is the current The weight of the pulse wave is multiplied by 1 cI, and the two previous pulse waves are each given a weight of 1 cI. This is done by multiplying the weight by 1/2 and taking the average. The current average If it is greater than /2 of the previous maximum average, start a 3 second timer. 3 seconds If another pre-pressure pulse signal is detected within \, the device continues to deflate. However, pressure If no pulse is detected, the deflation phase is terminated, the remaining pressure in the cuff is released, and this Begin the calculation part of the step.

If the weighted amplitude of the pressure pulse is smaller than the average of the previous LTh maximum, the 3 second timer Start now. In this case, if the Korotkoff noise signal is detected within 3 seconds, The device continues to deflate. However, if the Korotkoff noise signal is not detected, the contraction process , then release the cuff pressure and begin the first calculation part.

By detecting one artifact at any time during the measurement cycle, the contraction section is It is possible to refuse. When such an artifact is detected, the contraction process stops immediately. and the device waits for artifacts or noise signals to disappear. Artifacts or noise signals If it does not disappear within the 10 second time limit, it will stop the measurement cycle and display an “artifact” condition. do. On the other hand, if the artifact or noise signal disappears before the 10 second period elapses, the counter Test the fuss pressure. If the cuff pressure is sufficient, you can simply restart the deflation process. Ru. If cuff pressure is not sufficient, reenergize the pump and interrupt the L1 contraction for the first time. Inflate the cuffs to the level of pressure you feel when you are licked. At that point, the contraction process resumes.

Data collected and stored in storage during the data analysis and calculation phase of the measurement cycle. Analyze the data and calculate the ventricular systolic and diastolic blood pressure levels and the average pulse rate during the measurement cycle. Calculate and display the number or otherwise inform the user as appropriate. mentioned before Similarly, one data is stored in the storage device based on the analysis of the precursor waveform. This analysis Each time what appears to be a genuine heartbeat is detected, various parameters are displayed. A set of five numbers is stored in the memory. These numbers always check the corresponding numbers. They are stored in groups so that they can be identified. stored for each heartbeat The individual numbers are as follows.

fil Time elapsed since the last heartbeat.

(2) Amplitude of pressure pulse waveform.

(3) The amplitude of the slope of the Korotkoff signal.

(4) Phase between pulse waveform and Korotkoff noise signal.

(5) Cuff pressure.

A heartbeat occurs, and the Korotkoff noise signal is detected using the criteria described above. If not, 0 is stored for the Korotkoff noise signal and phase, but the elapsed time, pulse wave Shape amplitude and cuff pressure, i.e. items 1.2 and 5 are still stored in memory. be done.

The next step in the digital analysis performed by this invention is the pseudo-Korotkoff noise It is to eliminate the signal. The first analysis is to check for artifacts and noise. Or, to test the Korotkoff noise signal.

At the beginning of this analysis, the Korotkoff noise signal corresponding to the highest cuff pressure is used.

The corresponding phase signal of the Korotkoff noise signal, i.e. the ratio X/Y (Fig. 15), is If it is less than the lowest threshold, reject the Korotkoff signal and remove it from one memory. phase If the signal exceeds a predetermined minimum threshold, Korotkoff corresponds to the next lowest cuff pressure. Check for noise signals. The magnitude of the phase signal corresponding to this Korotkoff signal is the minimum threshold Successive Korotkoff noises corresponding to successively lower cuff pressures, if not greater than the value The search continues to test for signals.

If a Korotkoff noise signal with a phase signal of acceptable magnitude is found , check the difference between this Korotkoff signal and the original Korotkoff noise signal. this pressure If the force difference is less than 151111 Hg/JS, then both Korotkoff noise signals are Accept, for pseudo-Korotkoff signals at the ventricular systolic or high-pressure end of the data. Finish the analysis.

However, if the pressure difference is greater than 15 ■Hg, the higher cuff pressure will be used first. The Korotkoff signal with an acceptable phase signal value is centered. A pair of Korotkoffs with a cuff pressure difference of less than xsmHg in the 7-signal spectrum. Continue searching until the noise signal is located.

At the low-pressure end of the data spectrum, the corresponding cuff pressure is also the lowest. We perform the same type of analysis starting with the Cough noise signal and working our way up. This analysis Now, the phase signal must be less than a predetermined maximum threshold for it to be accepted. No. At all other points, a pseudocolumn at the low pressure end of the data spectrum. The analysis of the Tokoff signal is symmetrical to the analysis at the high voltage end of the spectrum.

The following calculation examines the amplitudes of all pulse waves stored in memory and calculates the pulse wave Determine the center region of the amplitude of. As mentioned before, the amplitude of the pulse wave is a relatively low value. , increases to a peak between ventricular systolic and diastolic blood pressure levels; After that, the cuff pressure was increased from above the ventricular systolic pressure to below the ventricular diastolic pressure. When gradually contracting to a new value, it decreases again.

The purpose of pulse wave amplitude analysis is to measure the three normal oscillation measurements on the cuff pressure scale. It's about pinpointing the point.

These points are the peak amplitude point of the pulse wave and one on both sides of the peak amplitude. One is above the peak, the other is below it, and the amplitude of the pulse wave is determined by the peak value. Create a "model" of the contour of the rise pressure, connect the amplitudes with a straight line, and create a model as shown in Figure 16. , a smoothing routine is used to generate a substantially smooth pulse wave amplitude curve. smooth song The positions of a pair of points that correspond to the amplitude of the line peak and the peak can be determined as follows.

These three points are stored in storage for further analysis later in connection with pulse rate calculations. If desired, a so-called sway meter can be used according to the usual sway measurement method for blood pressure evaluation measurement. It can be displayed corresponding to the measured mean, ventricular systolic and diastolic blood pressures.

In this invention, the cuff pressure is adjusted immediately during the ventricular systolic and diastolic pressures of the oscillation measurement method. The peak amplitude occurs between the values of the peak amplitude on either side of the average of the sway measurement method. Measures the average period of all pulse waves, representing the elapsed time between the peaks of the pulse waves. Calculate the pulse rate from K. The pulse period occurring outside these limits is ignore.

After calculating the average pulse period, all the periods used to calculate the average are added to this average. Compare with average. If the period is less than the calculated average, it is necessary to calculate the average. Reduce the number of periods used by 1, but the sum of all periods between the limits remains the same. I'll keep it. This method allows short periods caused by artifacts and noise to be falsely This prevents extra cycles from occurring. After this correction, the average period is calculated again and Store it for display. If the number of pulse periods found in this way is less than 4 - If so, the pulse rate calculation process is stopped and a "low signal" condition is appropriately displayed.

The determination of blood pressure according to the invention is based on the amplitude of the Korotkoff signal stored in a memory device. Make. First, calculate the threshold level for the Korotkoff noise signal. This threshold Calculated from the amplitude of the smoothed Korotkoff signal. In the first step, the trick signal Average all amplitudes of .

Next, all Korotkoff beliefs that are equal to or greater than the first mean obtained in one calculation are Calculate the second average from the amplitude of the signal. The average determined later is 6 (preferably Lψ used in the example) (determined empirically for the purpose of Store as threshold value.

When determining ventricular systolic blood pressure, all amplitudes of the Korotkoff signal can be calculated first. As shown in Figure 19, the threshold value associated with the highest cuff pressure was Check the Korotkov signal.

Interpolation to determine ventricular systolic pressure consists of several steps. The first process is The next Korotkoff signal associated with higher cuff pressure is to examine. like this There exists a Korotkoff signal, which will be lower than the calculated threshold), The period between two Korotkoff signals (rather than the Korotkoff signal spectrum) If it is 0.5 to 1.5 times the average period of the pulse pressure waveform, then the following Determine the high cuff pressure as the ventricular systolic blood pressure: (see Figure 19).

The Korotkoff signal of higher cuff pressure cannot be located or the period is outside the limits. If so, perform the second calculation step. First, the average per one average precursor pulse period Calculate pressure drop. Since the rate of contraction is known to be 5-Hg/sec, successive pulses Calculating the IC to accommodate the pressure drop during the pressure waveform comes to $/fj. Figure 20 Button number one As is well shown, 1. A straight line passing through the amplitude peaks of the first two Korotkoff signals. Calculate. Define the new pressure value where this line intersects the horizontal axis of cuff pressure. Melt.

This pressure is related to the highest cuff pressure rather than the average pressure drop per pulse period. Keeping in mind that the closer to the first Korotkoff signal, which is higher than the equivalent value, in the calculation Select ventricular systolic blood pressure.

On the other hand, as shown in Figure 21, the intersection point with the axis of one cuff pressure is The first corot above the threshold associated with the highest cuff pressure than the average pressure drop. Further away from the Cough noise signal, the average pressure drop is reduced to the first column above the threshold. cuff pressure associated with the cuff signal to determine ventricular systolic blood pressure.

Complementary opening to determine ventricular diastolic blood pressure, interpolation to determine ventricular systolic blood pressure Similar to what was said above for The difference is that finding a lower pressure. Furthermore, we use it as a starting point for this interpolation. , the procedure of locating the first Korotkoff murmur signal above the threshold determines the ventricular systole. This is different from the case of Regarding this point, the peak of the pulse pressure waveform (Fig. 16) Starting from the cuff pressure associated with The tokoff noise signal is sequentially examined to determine if the pseudo-corotk is higher than and before the calculated threshold. The condition that the phase signal is lower than the threshold value of the phase signal used in connection with the process of removing the noise signal. Locate the first Korotkoff noise signal that also satisfies .

If a Korotkoff noise signal that satisfies both of these criteria cannot be located, this excess stop the process and display "Low Signal".

Once the desired Korotkoff noise signal is located, move downward along the axis of cuff pressure. (The generation of the precursor pulse wave is The amplitude of the calculated gradient (using it as a marker of where Rotkoff noise signals may occur) Locate a first Korotkoff noise signal with a value below a threshold or zero. Like this Once the location of the Korotkoff signal is determined, the next Korotkoff in the direction of increasing cuff pressure The Koff noise signal (this is the last Korotkoff signal above the calculated threshold) for determining ventricular systolic pressure, using it as a landmark to start the interpolation process. Determine ventricular diastolic blood pressure as previously described.

The interpolation routine described above eliminates errors in time resolution caused by relatively fast contraction rates. Make smaller.

Figure 22 shows the overall block diagram of a generalized 8-pressure gauge device for carrying out this invention. A diagram is shown. The device shown in Figure 22 is an inflatable cap of an ordinary heart pressure monitor. It includes Fusco 00, which connects the automatic air source 07 to the fluid conduits 07 a, 0 Flexible sac through cob.

-008 can be inflated by filling it with air. Cafusco OO The pressure in the brachial artery of the patient with Cuffsco OO wrapped around that arm is the monitored by a suitable pressure transducer ko03 via the body conduit -Okob, -〇-〇 . When performing the auscultation method for detecting Flotoco7 noise using the extraction valve Co0da. , during the contraction process, the cuff-〇〇 Extract air from the 'mcoa.

Microphone 10 stacked on cuffcoat oo at the downstream end of the cufflink <Figure 3a to 3c, 6 or 7) detects the floatco7 noise, The corresponding electrical output signal is sent to the analog-to-digital converter via line 13. It looks like it will be sent to. Digital output of analog-to-digital converter Koda is sent to the input of digital processing unit 16 via line ko/j. This processing equipment performs analysis on the signal and identifies the true Korotkoff noise signal and the pressure wave precursor. Good isolation from artifacts and noise. The processing unit 16 is accessed via MaJ/'l. Sends a signal back to the analog-to-digital converter to perform its timing function. Controls the operation of the included converter. Furthermore, the processing device-16 calculates the ventricular contraction rate, the ventricular In determining systolic and diastolic blood pressure levels, multiple Perform data manipulation and testing.

The control of inflating the force 7 oocr>ymyu 00a is controlled by the processing device 16. Ralii! This is done via Ko1g.

The processing device controls the automatic air source-Ol to selectively turn the source on or off. Make it possible to rotate. In addition, 1 processing unit 16 will be explained with reference to FIG. As shown above, by electric power from line 19 to digital/analog converter 10. , controls the extraction valve -〇da.

Converter-10 sends an analog input to the error contact point-here via the line here, and this A connection point receives input from pressure transducer-03 via @213.

The processing unit 16 extracts the information necessary for performing this kind of control from the air source. Receive from Benco 041. For this purpose, the pressure transducer-03 is connected to the The analog-to-digital converter is connected from the difference connection point Cococo to the Iiiico λ3. i1! The processing unit receives electrical information via line /3 and then line /3.

As a result of this control, a linear gradient is generated in the pressure of the cuffcoat θO.

Processing in which the digital to analog converter COCO0 represents the desired pressure of the cuffco OO The signal from the device 16 is sent to the error connection point - here. Cuff pressure is less than desired pressure If it is high, the output sent from the error connection point to the extraction valve 0II via line 6 The extraction valve releases air and matches the cuff pressure with the ramp signal.

The electrical output from the error connection point Kokoko to the line KokojK is (pressure pulse signal lko in Figure 8) ) is the precursor pressure pulse signal.

In this invention, 16 digital processing devices F1 and an analog/digital conversion device are used. An analysis of the Korotkoff noise signal and the pressure pulse precursor received from the In addition to starting the entire device and allowing the measurement process to proceed, It also performs other control functions related to conditioning. This kind of conditioning and control The operation includes controlling the inflating of the cuff 200 wrapped around the patient's arm, and controlling the starting pressure. The level is high enough so that the force is higher than the pressure at which the Korotkoff noise signal first appears. Inflating the cuffs by ensuring that they are fully inflated until the end of the cuffs Determine when you have reached the appropriate level and prevent excessive swelling. stop, initiate and control contractions, and make all necessary decisions on blood pressure and ventricular contractility. This involves releasing any remaining pressure in the cuff after sufficient information has been obtained. This card Due to the release of fuss pressure, the upper arm of the patient is removed for more than the time required to complete the measurement process. long-term occlusion of arteries is minimized. This is continuously monitored by the patient. This is especially important if measurements are to be repeated frequently.

Processing device/4Fir start pushbutton, control device to set the desired starting pressure, automatic Also includes multiple external controls 30, such as a dynamic timer, automatic mode and manual mode selection. Contains. The processing device 16 is connected to an optional display device Wt through a line 31. Information can also be provided.

Control unit 30 and display unit 3 are of conventional design.

Figure 23 shows the overall heart pressure analyzer, especially the functions performed by the digital processor-16. It is a pull diagram showing the functions in detail.

Cuff microphone 10 connects to analog/digital converter via line/J The pressure transducer-03 sends electrical information to the converter co/da through the line cocoda. Sends cuff pressure information to. As mentioned before regarding Figure 22, 1 ana 4g digital Tal converter ko/41 also receives the precursor pulse waveform signal via lIJ koko 5.

In contrast, the analog-to-digital converter CO/41 converts the digital The digitized information is supplied to the data processing device 14 via the line 15. . In this invention, the digital processing device KO/6 performs the following operations.

il+control of inflation, including initiation and termination.

(2) Control of contractions including initiation, termination and release of cuff pressure0 (3) Waveform analysis of the four microphone signals to obtain the four four seven signal spectra.

(4) Waveform analysis of precursor pulse pressure waveform.

(5) Data storage.

(6) Whether or not there are artifacts in the Korotkoff noise signal and the precursor pulse wave signal inspection.

(7) Calculation of the amplitude contour of the pulse wave.

(8) Peak in smoothed data represented by pulse wave amplitude contour and determination of the location of the peak hand amplitude.

(9) Calculation of ventricular contraction rate.

a1Coptoko7 Calculation of the threshold of the noise signal.

aυ By interpolating the Korotkoff noise signal data, the ventricular systolic and diastolic blood pressures are calculated. To calculate.

In performing the aforementioned functions, the digital processing unit 76 is configured to perform the measurement process. generates multiple outputs. The ventricular systolic and diastolic blood pressure outputs are respectively line 3j.

13AK was generated, and the ventricular contraction rate calculated from the average progenitor pulse period was Generated as output.

A person whose digital processing device is in the core noise signal or precursor waveform If it is determined that the measurement process is unreliable due to too much human effect or noise, An output is generated at tiA, 3t, indicating that a condition exists, and this overmeasurement Exclude the process. Similarly, the amplitude of the Korotkoff noise signal data is suitable for the measurement process. If the output is too small to be reliable, the output representing a "low signal" condition will be The measurement process is also excluded.

In this way, the entire 8-barometer system can be used at any time when the data is determined to be reliable. Produces accurate outputs representing blood pressure and ventricular contractility, but the data may be unreliable. When possible, do not generate misleading output. In the latter case, the device may overmeasure. Usually, the operator knows what kind of problem the operator has. This process can be repeated until reliable data is obtained.

Figure 24 shows a device that performs waveform analysis on the incoming precursor blood pressure pulse signal. It is shown. Of course, the device shown in Figure 24 can be implemented using hardware or software. The various functions of this device may be implemented using software. A microprocessor with a built-in microprocessor is preferred.

The pulse signal knee S is sent to the positive slope detector 2Q/ via the line O. This detection The device determines when the pulse signal waveform is on a positive rising edge. Is the slope detector rich? A device in which the output output from the parallel line Kokuko maintains the first baseline (point A in Figure 14) Sent to Koku J. The baseline device also receives the pulse signal itself via the wire. take. The output of the positive slope detector 1 is also sent to the maximum slope detector 46 via the line 3. Sent. This detector also receives the pulse signal 23 as an input on line 47. inspection FIG. 14 shows that the output voltage is the steepest slope on the positive rising edge of the precursor pulse waveform. Locate point C. The maximum slope detector Koku6 is 64m from the steepest point. Previous 0Put a line g on the device Kokuwo to determine the new baseline (point D in Figure 14). Send input via

The electrical output obtained by determining the first baseline is passed through the line 30 to a threshold value test. Sent to S/.

This detector is monitored via the first baseline signal at point A in FIG. Determine the difference between the amplitude of the pulse signal and the amplitude of the pulse signal. The threshold test is at point BK in Figure 14, shown, which accepts the pulse signal to confirm its authenticity. This is one of the criteria for deciding whether or not to accept the application.

The pulse signal is also sent to the peak detector 24III via line 33. This detection The device determines the location of point F in FIG. for both Korotkoff noise signals and pressure pulse signals. The device is scanned in reverse for approximately 250 m5.

Based on the output sent from the threshold detector 37 via the control device λS6 It is enabled.

The pulse amplitude device Coj-& receives the pulse signal waveform from the line Co. 39 and the #I roller 3. Measures the difference between a second baseline standard and is constantly updated to determine the maximum Generate a reading 1 and thus determine the magnitude of the amplitude of the waveform at point E in Figure 14. . The output of the pulse amplitude device is fed via wire roller 0 to the input of the data storage device roller 1. be done. Of course, the data storage device roller 1 scanning controller 36 can control the line roller. scanned through.

To explain Figure 25 in more detail, this figure shows the pressure that causes the pressure cuff to inflate. A block diagram of a device for waveform analysis of the signal during the contraction process immediately following the delivery phase is shown. has been done.

FIG. 25 shows that the pulse waveform analyzer Kokuco is connected to the device shown in FIG. Further details are shown in connection with L. Pulse signal, 2 pieces 5 are error connections in Figure 22 It is obtained as a difference signal between the outputs from point to here. This connection point, respectively, wires --l, --J Via the digital-to-analog converter - 10 contraction gradient and pressure transducers The electrical output from 203 is received as electrical power.

In addition to being sent to the pulse waveform analyzer 63, the pulse signal is sent to the memory device 63. It will also be sent to 4. This storage device is a first-in, first-out storage device, and is approximately 250m5 Store the pulse waveform between. Similarly, the electrical output from the Korotkoff sensing device =/- The force is sent to the negative slope detector CO&A;VC via the line conductor. At this point, the slope detector It should be appreciated that can be negative or positive depending on the electrical polarity of the waveform.

The output of the gradient detector roller 5 is sent to the memory device 6 via the wire roller 6. This record The storage device stores the Korotkoff noise signal spectrum and is also a first-in, first-out system. It is a storage device, and for this reason only the information of the largest bale, 250m5, is stored. This information Updated constantly.

In the presently preferred embodiment of the invention, the Korotkoff noise signal is approximately 2 Although the pulse wave signal is stored at a sampling rate of once every millisecond, the pulse wave signal is stored approximately every 8 milliseconds. Stored once.

The control device COLOG scans the stored data of amplitude and phase (phase ratio signal X/Y). Pulse waveform analyzer - Controlled from the wolfberry through the rays, each line -75, -76 to memory device 6 and scan the data stored in roller 4. . The scanning controller Korog sends amplitude and phase information to the storage device Kokoo through Im Koroq. supply to. The storage device Koku O is connected to the pulse waveform analyzer = 7- through the wire core 3. information, and also receives the signal from pressure transducer-03 via line 1. . Thus, the amplitude of the slope of the Korotkoff noise signal, the amplitude of the pulse signal, the phase ratio signal , the period of the pulse signal and the cuff pressure are later analyzed by a digital processor. stored for future use.

FIG. 26 shows the waveform analysis and processing performed by the apparatus shown in FIGS. 24 and 25. The amplitude and co-result of the cuff pressure domain and time domain pulse waveforms obtained as a result of 3 is a graph representing the amplitude (amplitude of gradient) of a Rotkoff noise signal. Figure 26 is Pal In addition to showing the relationship between the amplitude of the wave wave and the amplitude of the Korotkoff noise signal, The time when the sound signal is generated and the peak amplitude point on the contour of the pulse amplitude roughly correspond to each other. The graph shows what happens. Furthermore, FIG. 26 shows the Korotkoff noise signal and the pulse The amplitude of the cuff waves changes in the same way in the time domain and cuff pressure domain, and they occur almost synchronously. 0 exemplifying that Figure 26 may seem like proof of the accuracy of the sway measurement method for measuring blood pressure. , the sway measurement method using a point on the contour of the pulse amplitude with an amplitude equal to the peak It was understood that when determining ventricular systolic and diastolic blood pressure, it is at best an approximation. stomach. In this respect, measurements at individual points can vary significantly, leading to data scattering. The auscultation method used in this invention to determine blood pressure provides a more accurate measurement. It is clear that it is consistently more reliable in determining the

Figure 27 is a flowchart showing the process of starting inflation and deflation using a digital processing device. It is a chart.

In step 30/, the power of the device is turned on, and the next step J0 turns off the display device, Turn on the “Ready” light to indicate that the instrument is ready to begin a measurement cycle. Inform Perator. The process JOJ activated the start button (not shown) Check for the presence of a "start" signal generated at the time of the test. Until the “start” signal is finally received. The process does not proceed any further. Automatic air pump when receiving "start" signal is started in process 3θ under the control of a digital processor, and the cuff wrapped around the patient's arm is Swelling up. Typically, the "inflate" light is energized. (22) to inform the operator of the particular stage of the measurement process being carried out.

After the inflating process is started in step JO'l, in step 30S, the starting pressure selection switch is turned on. The pressurized gas continues to inflate to the pressure set by the switch. Selection Typical values are 150, 200, 250 or 300 wKg. process At 306, ask if the starting pressure for inflation has been reached. . If the answer is no, ask the JO if the 15 seconds have passed; If so, test the inflation pressure again at 304 and wait 115 seconds or This is done until the inflation pressure actually reaches the predetermined pressure level.

If 15 seconds elapse before the inflating pressure reaches a sufficient level, answer question 30. The answer is yes, indicating that there are some problems with inflating.

For this reason, the device proceeds to step 30g, stops the pump at and, and releases air pressure from the cuff. is released and the measurement process is stopped. The equipment returns to the "ready" state for the process JO. Start a new measurement cycle.

If the answer to question JO4 is YES and the preselected pressure to inflate is 1 If the indication is reached within less than 5 seconds, step 309 turns the pump off. do. The device then waits 3 seconds at step 310 after turning the pump off. 3 seconds This is sufficient time for the pump to coast to a stop and for the transient to decay. After this, measure the pressure again in step J// to see if there was a significant pressure drop. Determine.

If the answer to question 3// is yes, then step 31 indicates that there is a pressure drop. Ask them if they are the first to do so. If the answer is yes, the pump should be Start again at step 3 and pump again to the desired pressure for inflation. like this again The need for pressure-feeding is because, for example, a large amount of air is forced into the inflation layer of the cuff, and this is why During the pumping process, the air is heated and then cooled, causing a pressure drop. It can happen in some cases. In such cases, it is common to re-pump a small amount.

The answer to question 31 is negative, indicating that there is some problem with the inflating cycle. If this indicates that the air pressure in the cuff is discharge and return the device to the "ready" state of step 30. This is essentially a leak check. This is an output subroutine.

If no pressure drop is detected in step 37/, step 3/! starts the contraction process, Ask Jl& whether the Korotkoff signal was detected in the first 3 seconds. question If the answer to 3/6 is no, the device proceeds to step J/7 and continues the shrinking process. . On the other hand, if the answer to question 376 is yes, then the detected Korotkoff signal is Ask Jll if it is the first detected signal. This #1 Koroto If so, the device returns to step 314 and waits for a second Korotkoff signal. most If there is a second Korotkov signal within the first 3 seconds, the answer to the question Jet is no. Yes, the device proceeds to step J/9 and the pressure for inflation is allowed by this device. Ask if the pressure is equal to 300wHg for maximum inflation. quality If the answer to question J/9 is yes, continue the contraction in step 31.

If the pressure for inflating is lower than 300tllHg, the 300mHg test is the first test. Ask the students on a score of 3-0 whether it has been done for the first time. If it is the first time, it will swell in step 3. Add 50-Hg to the pressure storage device, restart the pump in step J/, 7, and the device Return to step JO4 to determine whether the inflation pressure has been reached.

Judging from step 3, the J/9 test was conducted more than once and the 501 1111 (If it indicates that there was an auxiliary pumping of H, start process J/II again. to stop the pump, release cuff air pressure, and reload for a new measurement cycle. Return the setting to step 30.

FIG. 28 is a diagram illustrating in detail the shrinkage control process performed by the digital processing device. It is a low chart. At step 315, the previously described shrinkage process takes place, and of course the final Korotkoff noise signals occurring within the first 3 seconds are monitored at step 314. Korotkov miscellaneous If the sound signal is detected within the first 3 seconds, the subsequent step 3-3 is to further raise the cuff. This is a simplified version of the procedure shown in Figure 27, which determines whether to use r pressure or release it. be.

If the answer to question 3it is negative and within the first 3 seconds after starting the contraction process If the Korotkoff signal did not appear, the brachial artery leading to hyperemia in the arm. To protect the patient from long-term occlusion, we will check whether the 4-minute time limit has been exceeded. Ask a question at step 3.

4 minute timed test continuously protects the patient from excessive occlusion during long measurement cycles Therefore, it can be seen from step 3 that the process is repeated in multiple subroutines.

If the 4 minute time limit is exceeded, the answer to questions 3-6 is yes and the device is out of process. Proceed to step 3-7 and release pressure from the cuff.

If the time limit of 4 minutes is not exceeded in step 3, the device will "hold" the next step 3. Ask if it is in the format. This is the Korotkoff signal or the preload pressure waveform. If a murmur is detected in either case, the contraction process has stopped but the cuff pressure is released. It means not released. If the answer to question 31g is yes, step 3 = 9 asks if there is still a noise while the device is on hold, 1 if there is a noise. If it exists, a time limit of 10 seconds is determined in process JJO. 10 second time limit for noise If so, the device then proceeds to step J where it releases cuff pressure. noise If the 10 second time limit for circle.

During "hold" the noise disappears, so if the answer to questions 3 and 9 is no, In step 7.7/, the actual pressure of the cuff at the point where it enters the "hold" mode Compare with. If the pressure drops below this point for any reason, the device will skip step 3. Pressurize again with J- to correct the pressure, restart the contraction in step 333, and proceed to step 3 of step 4. Return to minute timed exam.

If the pressure test in step 33/ is good, the device proceeds directly to step 333 and deflates. resume. If the process J-S finds that the equipment is not in the "hold" mode, it may be noisy. If the status is queried at 3341, and if so, at step 33S the device enters the contraction hold mode; Return to the 4-minute timed test 3, which is the center of the loop.

If it is determined in step 33 that there is no noise, the pressure is determined to be a fraction of the starting pumping pressure. Ukaga is asked on 336. If the pressure has not fallen below this reference level, the installation Then go back to step 3 and repeat the loop. On the other hand, if the pressure is below this level If so, step 33 asks whether 5 Korotkoff signals were detected. do. If the answer is no, whether the pressure has fallen below the initial pumping pressure of 14 Ask in 33g. Unless the pressure is lower than the initial pumping pressure of 14, The device returns to step 3.26 and goes through this loop again.

On the other hand, if the pressure is less than the pumping pressure of 14, the apparatus proceeds to step 339; and \ to release cuff pressure and display "low signal".

If the answer to question 33 is yes, then the pulses observed so far Ask in 3 dao whether the amplitude of the precursor pulse is smaller than the peak amplitude . If the answer is no, the device searches for another pulse in step 3D. another pulse If detected, reset the 3 second timer at step 741, and Repeat this loop. If another pulse is not detected within 3 seconds in step 3 da 3, the The position goes to the calculation stage of this process in step 3 Dada. If the 3 seconds haven't expired yet , the loop is repeated through step J-colo.

If the amplitude of the pulse is greater than or equal to the maximum amplitude, then the answer to question 3 is yes. Then, 31I! determines whether the Korotkoff signal and pressure wave were detected within the 3 second period. ; is asked. If the answer is yes, reset the 3 second timer in step 3da6, Step 3 Repeat this loop through the rollers. If the answer to question 3 is no , as mentioned earlier for the case where only another pulse is evaluated. Time limits apply. Therefore, if the device is smaller than the maximum pulse amplitude b and within 3 seconds If no further Korotkoff signals and simultaneous pressure pulses are detected, the The position exits from this routine to the ``calculate'' mode.

FIG. 29 is a flowchart showing the removal of pseudo Korotkoff signals by a digital processing device. This represents the beginning of the calculation process. The routine starts at 310, In step 33/, a record of the Korotkoff signal corresponding to the highest cuff pressure is stored in the storage device. Find out.

In step 35, examine the phase of the Korotkoff signal with respect to the associated precursor pulse waveform. However, if the phase test fails, this Korotkoff signal is not considered further in step 3s3. removed from memory, but not removed from storage.

If the phase of the Korotkoff signal is good, step 3S will store more signals in the storage device. Ask whether there is a record of. If the answer is no, run the routine in step 3S3. Stop and display "Low Signal". If there are more signals, in step 356 the next command is The test may progress toward the core signal (in the direction of decreasing cuff pressure).In this case, the phase test Testing is performed in step 3L. If you fail this test, this particular The blank signal is removed from further consideration in step 3S3. Pass the phase test If so, the question can be answered at 81 whether there were two good Korotkov signals. The answer is no -, then the device uses Process J! Back to da.

If the answer to question 35g is yes, then the two good Korotkov signals are 15gm ) Is the process Jj separated by less than ig? Ask a question. for this question If the answer is yes, then use these commands to determine the ventricular systolic pressure. a) A signal is accepted at the top of the pressure vector. 15 Korotkov signals If it is far away from Hg, the topmost FLOTOCO 7 signal will be a pseudo signal in step 36/. , and the device returns to step 33B and proceeds to the next Korotkov signal. phase Two Korotkovs separated by less than L, 15 ms +)ig passed the test This process continues until the signal is located.

If an acceptable pair of Korotkoff signals cannot be located, the device will Process J from 33q! r! Moves to IIC, completes routine, and displays "low signal" .

Once the test in step 3j is completed successfully, the apparatus moves to step 36θ, which is the 30th test. As shown in Figure 29, Repeat the process shown in .

As shown in Figure 30, at the ventricular diastolic end of the spectrum there is a separation of only 15 min Hg and The process of finding a pair of acceptable Korotkoff noise signals that are not Virtually identical to the process on the systolic side of the ventricle, but not in the direction of decreasing cuff pressure. The search is performed in the direction of increasing cuff pressure and different thresholds for phase testing. The difference is that they use . In this regard, steps 35a to JA/a in Fig. 30 are similar to those in Fig. 29. This corresponds to processes 3S to 3i and ir, and process JA/a is If the Korotkov signals are separated by more than 15 H, the lowest Korotkov signal (process 361, but not at the top). Ventricular diastolic end of pressure vector Once a pair of Korotkoff noise signals is found that can be accepted by Starting from step 36, further calculations are performed.

Figure 31 shows the pulse amplitude obtained by smoothing the data as shown in Figures 32 to 34. The pulse amplitude data is used to derive the contour of the pulse amplitude spectrum in order to generate the contour of the pulse amplitude spectrum. This is a frame yard that shows the process of operating the data.

The routine starts at step OO and stores for pressure pulse data in one step qoi. Determine the storage position of the device, move to step IIO, and at a pressure increment of lsIIHg, Enter the pulse amplitude at the position corresponding to the cuff pressure. The process center is essentially a pressure area. generates the graph of FIG. 32 regarding the pulse amplitude spectrum in the region, The resolution on the horizontal axis is the pressure of IIIllIHg.

In step 03, the bar graph in Figure 32 is changed by linear interpolation between adjacent pulses. Then, the continuous song MK conversion shown in FIG. 33 is performed.

In the process, the contour in Figure 33 shows the average over 8 positions or 8 strokes of Hg on the horizontal axis. The smoothing process is repeated in step 1Ioz to repeat the smoothing process. After returning, the pulse amplitude contour shown in FIG. 34 is generated.

In step 406, the peak and half-peak peaks are calculated for the pulse amplitude contour shown in FIG. The amplitude of the minute is ascertained in the same manner as in the oscillation measurement method, and the routine can be used to exit the process. Ku.

Figure 35 is a 7-char F showing the determination of pulse rate by a digital processing device. . The pulse rate determination routine starts at step DAIO and moves to step DA//Vc, where the previous between the peak pulse amplitude determined by the routine of Figure 31. 0 to list all pulse periods Step Q/co adds all the periods in this list, and step 4113 rewrites the sum. Find a preliminary average by dividing by the number of items in the list. In the process folder, go through the list from the top. Scan and compare each item in the list to the average calculated in step 13. Process da 15, to determine whether each item is less than half of the previously calculated average. will be tested. If you have two pulses that are very close together, this is an artifact. Therefore, if the answer to question D7.1 is yes, then in step D16, Subtract one pulse period from the number of items in the list.

If there are more items as determined by the process I/I, the equipment will be able to perform the next item in the process I/I. Move on to the process! Return to the loop and test the next item.

If the answer to the question is no and the particular pulse period tested is preliminary If there are no more items that indicate greater than half of the average, then more than three items Check whether the pulse period item remains? Ask a question. If the answer is no, "Low signal" is displayed in process D10.

If the answer to step 19 is yes and there are more than three pulse period items, The device proceeds to step D1/, where it calculates the sum of the pulse periods in a new section of the remaining items. Then, calculate the average of the corrected pulse periods. In step II here, corrected pulse frequency The routine calculates the ventricular contraction rate expressed in beats per minute by dividing the average of the periods by the number 60. Go out from Hodako 3.

FIG. 36 is a diagram illustrating the determination of the flop signal threshold level by the digital processing device. It is a low chart. The routine begins at step 30 and moves to step 113/IIC. Then, the amplitudes of all Korotkoff signals are averaged. In process 413, process Q, All Korotkoff signals equal to or greater than the first average calculated in 7/ Find the average of the amplitudes of. In step 3J, divide the second average by the number 6 to calculate the ventricular constrictor and The threshold level of the Korotkoff signal is used in the subsequent calculation process to determine the dilator blood pressure. Decide on the bell. After this, the routine exits the process.

FIG. 37 is similar to FIGS. 19 to 21 previously described, and FIGS. Further details on the figureDigital when performing the determination of ventricular systolic blood pressure ◇ is a flowchart showing the determination of ventricular systolic blood pressure by the processing device. The ventricular systolic blood pressure determination routine starts at steps 1j, t and continues to steps lIJ & Then, the memory device again locates the Flotco 7 signal corresponding to the highest cuff pressure. Melt. Process D3 has this value for the calculated thresholds previously described with reference to FIG. Test the Korotkoff signal.

If the Korotkoff signal is less than the calculated threshold, the machine advances Examine the next smallest Korotov noise signal and again test this signal against the threshold .

If the Korotkoff signal is larger than the calculated threshold, the same field as this Korotkoff signal If the pulse period at a certain point passes the test, the device is in process Dada O and the pulse period is higher than the threshold value. The data located one recording position higher in the storage device than the Korotkov signal. Regardless of the amplitude of this Korotkoff signal (higher or lower than the calculated threshold) regardless of whether a core signal is present at this memory location. Ask a question in 1. If such noise signals exist, the equipment will be damaged by the process. In this step, the location of this Korotkoff signal is determined to be the ventricular systolic blood pressure (Figure 19). Identified, the 1 routine exits from step 4CJ.

If the answer to question lI/ is no, the column is placed in the next highest recording position in storage. If it indicates that there is no tocof signal, then it is A limit equal to the recording pressure of the pulse wave is generated in the process. The reason for doing this is , the first time that the ventricular systolic pressure is higher than this pressure limit and the calculated threshold. This is because it is thought to be between the front and the front signals.

Until the process, the memory has a Korotkoff signal higher than the threshold calculated by the equipment. Move to the next lowest recording position in the device. After that, in step 41 da 6, the corot of process da da S A linear interpolation between the Coff signal and the adjacent Korotkoff signal is performed to determine the cuff pressure. Locate the intersection with the axis of

Test the intersection of the step Dada 7 levers to ensure that the pressure previously determined in step lIqda Decide whether it is higher or lower than the limit. If it is higher than the limit, step 4/41Iff The limit of is selected as the ventricular systolic blood pressure. Even if the test result of step 4III is negative For example, the intersection of the cuff pressure with the axis is considered to be the ventricular systolic blood pressure.

The determination of the ventricular systolic blood pressure in the process daq is performed using the graph shown in Figure 19. In contrast, the ventricle shown in steps Dada g and Dada 4+9 The determination of systolic blood pressure corresponds to the graphs shown in Figures 21 and 20, respectively. It is.

If the test result in step 39 of FIG. 37 is negative, the Korotkoff signal is higher than the threshold. If the pulse period at location is not within the limits, the pressure limit set in the process da SO will be Add the average pressure drop per pulse period to the pressure at the location of this Korotkoff signal. It is something that has been learned. The routine then proceeds to the interpolation process in step tIda6, as previously described. The ventricular systolic blood pressure is determined as follows.

FIG. 38 is a flowchart showing determination of ventricular diastolic blood pressure by a digital processing device. It is the default. The routine begins at step 1I40, moves to step 1I&/, and then Starting from the precursor pulse wave corresponding to the highest cuff pressure, Examine the pulse wave recording.

The amplitudes of these pulse pressures are examined one after the other, each pulse amplitude being tested in turn in step 4. 16 were tested and it was found that the pulse of the oscillation measurement method was on the curve of Figure 34. Determine whether it is higher or lower than the peak. The test of 6 process devices ended with a negative result, and the pulse If the amplitude is higher than the peak, the device moves to step 114J where the cuff pressure is lowered. Move on to recording the next lowest pulse amplitude in the downward direction, and use the process die 6 to record this next pulse amplitude. Test the amplitude. This continues until the amplitude of the pulse eventually falls below the peak location. It is done.

Once a pulse amplitude lower than the pressure location corresponding to the peak amplitude is located, the question The answer to D6 is affirmative, and the routine moves to step D64, where the calculation is equal to or greater than the Korotkoff signal threshold. If the answer is yes, In step 63, the phase of this Korotkoff signal is checked. The phase of the Korotkoff signal is full. If not, the device returns to step 463 and moves to the next lower pressure pulse. Ru.

If the phase is good in the process 63, flag A is set in the process 66, and then process I is started. Move to IAJ and examine the location of the next low pressure pulse. Therefore, the pressure being tested Korotkoff signal equal to or greater than the calculated threshold at the location of the force pulse flag A is set, and this same Korotkov signal is sent to the process da It also passes the phase test.

In the step All, the device runs until it encounters a Korotkoff signal that is lower than the calculated threshold. Continue scanning the pressure downward. After this, in step 6, this is the first time lower than the threshold. The question is whether this is the Korotkov signal. This leads to the associated pulse precursor The first column below the threshold, including the zero value at the corresponding storage location. If it is a Korotkoff signal, the device will continue to run until it encounters a second Korotkoff signal of this type below the The position goes through this loop again by returning to step 4+63. In that point, Inquires whether process da6S\i flag A is set. This is effectively , as the pressure decreases before encountering a pair of Korotkoff signals below a calculated threshold. , a Korotkoff signal that is above the threshold and has an acceptable phase has been identified. It is to ask whether. If the answer to question 46g is no, stop the calculation. Therefore, "low signal" is displayed in step 6 of the process.

If the test in step 4cA& determines that flag A is set, the step Due to the change in pressure, the device moves one recording position upwards on the pressure scale to the next pressure pulse. Move to Su. At step dl, whether there is an actual Korotkoff signal, at step d7 Test the location determined by θ. If there is a Korotkov signal at this particular location, then The specific location of is determined to be the ventricular diastolic blood pressure in the process, and the routine Leave from 4L73.

If there is no Korotkov signal at the recording position of the storage device determined by process dak O, the device moves from process dak/ to process 1I741, moves to the next highest recording position, and then moves to process Moving to duct 3, the pressure at the position determined in the process duct is calculated per pulse period. Calculate the lower limit of ventricular diastolic blood pressure as the value minus the mean pressure drop. the The subsequent steps 1I74 to D7 are as shown in FIG. 37 to determine the ventricular systolic blood pressure. Using the same interpolation process as the corresponding steps 4Ida6 to 11Q9 described earlier, Determine ventricular diastolic blood pressure.

Figure 39 shows the calculation routine shown in Figures 37 and 38 for ventricular systole and diastole. A french yard showing the flotco7 signal interpolation process used to determine the blood pressure of 40 is a graph showing the Korotkoff signal interpolation process of FIG. 39.

The interpolation routine begins at step SO and moves to step lit/. This is ventricular contraction During the diastolic and diastolic routines, the first time the cuff pressure Pi is higher than the calculated threshold. This is the process of identifying the Korotkoff signal Kl. At the next process, pressure beak P2 and the next lowest (for ventricular systole) or next highest (for ventricular diastole) in the device. The search for records continues. Each recording position is tested in step IIga, and this Determine whether a Korotkoff signal exists at the position and determine whether a Korotkoff signal exists. If not, the loop returns to step S- until a position with the Korotkov signal is found. Ru.

Once the Korotkoff signal is located in the process DAG, it is tested in the process DAG. , whether the two pressures P1 and P2 are separated by more than 3111IIHg. judge.

If the pressures P1 and P2 are too close, the equipment will be forced to adjust the new P2 pressure at the process daguer. Continue searching for values. A position that satisfies the pressure difference test of process dag II was finally found. Then, the amplitude of the Korotkoff signal at that position becomes the third one determined in step S3. The amplitude in Figure 7 is 2.

Step 6 draws a straight line between the peaks of amplitude 1 and 2 to determine the axis of cuff pressure. By calculating the interpolation with the line, the process Dada 6 of FIG. Determine the intersection point on the axis of cuff pressure as described in Step 6.

High signal-to-noise ratio, blood pressure pulse and whole arm superimposed on FlotoCo7 noise signal Figure 3a provides a clean Korotkoff noise signal with virtually no expansion signal. Since the deflection sensing device 10.3 in FIGS. 3c to 3c is important, in order to carry out this invention, provides various new and improved longitudinal deflection sensations as shown in FIGS. 41a to 43b. designed a knowledge device.

41a and 41b show a narrow strip of metal or other spring material jtO/ The blood flowing into the brachial artery when the Korotkoff signal occurs When the strip bends in response to a traveling wave of A deflection sensing device is shown with a gauge S placed on a strip. Strain gauge S Kuko has a directional response characteristic, and therefore its response bends approximately in the longitudinal direction of the transducer. It is only for

Figures 42a and 42b show the same strip 40/ of metal or other suitable spring material. Another example of a deflection sensing device that has been used frequently is shown. Above this strip is a piezoelectric voltage at the center of the strip. 60 converters are installed. 60 piezoelectric transducers are typically relatively fragile A suitable elastic pad 1.03, such as rubber, is placed between the strips 601 of the transducer 60. has been done.

Figures 43i and 43b show further embodiments of suitable deflection sensing devices. , which connects the piezoelectric transducer to two flat surfaces of metal or any other suitable construction material. 0 flat parts! Ra, 70! Elastic pad installed in gap 70II between rb Supported by Ku03. The member Oj a r703b is combined and relatively Forms elongated strips. If desired, a gap Oda in the center of the strip may be used. Since flexibility can be obtained, the material is relatively stable.

qosb may be relatively rigid rather than elastic.

From the above explanation, a person skilled in the art in the field of data processing can understand the method and apparatus of the present invention. In order to implement many of the analysis and evaluation methods performed by It is clear that a wide range of computer instrumentation can be used in both software and software. That's it. For example, 1 This invention was developed by Intel Corporation in California. The 8085 type microphone setter device manufactured by Three EFROs of type 2716, such as those available from Mostic Corporation of M device, two input/output ports of type 8255A and one RAM device (1024X 8) can be used as a driven device to implement the present invention. of the device of this invention The software required to operate the Model 8085 and its associated peripherals to perform its functions. The software instructions are attached as Appendix A for convenience.

The new and improved electronic heart pressure monitoring device of this invention is extremely accurate and reliable. , easy to use. This device combines genuine Korotkoff noise signals and pressure pulse signals with artificial effects. The accuracy of separation from noise and noise signals is high, indicating that the data is unreliable. If there is a condition, immediately notify medical personnel of the condition. Therefore, the device of this invention The time-consuming and error-prone nature of manual methods of measuring blood pressure and ventricular contractility in humans Medical IIs personnel who must perform such measurements while minimizing points that are likely to cause differences. There is no need for a high level of skill or subjective interrogation knowledge on the part of the person involved.

From the foregoing description, it will be appreciated that while a particular form of the invention has been illustrated and described, the scope of the invention is It goes without saying that various changes can be made within this range. Therefore, this invention is a patent claim. Please be aware that you are limited only by the scope of.

Hand-lettered dictionary JE book (method) August 23, 1980 Mr. Manabu Shiga, Commissioner of the Patent Office 1.Display of the incident PCT/US 82101491 , name of invention electronic blood pressure monitor 3. Person who makes corrections Relationship to the case: Applicant Name: I-Bac Corporation 5, date of amendment order: August 2, 1982 Day 6, subject to correction (1) Column ■ Translation of international application application based on the Patent Cooperation Treaty (2) Engraving of the entire specification (but (3) Power of attorney and translation 7. Contents of correction As per attached sheet 8. Attached documents (1) 1 copy of translated international application N based on the Patent Cooperation Treaty (2) 1 copy of engraving specification international search report

Claims (1)

[Claims] 1) In an electronic manometer, means for supplying Korotkoff noise detected as an electrical signal from a first source, and means for supplying a related Korotkoff noise precursor as an electrical signal from a second source. wherein the Korotkoff noise precursors are each associated with only a separate Korotkoff noise signal associated with that precursor, and further comprising means for analyzing the waveforms of all said electrical signals to obtain a predetermined waveform. It has analytical means to determine whether the characteristics are isomorphic, and thus an electrical signal with a waveform representing genuine Korotkoff noise is a genuine Korotkoff noise. An electronic heart pressure monitor that separates coff noise from electrical signals that do not represent it. 2) The electronic manometer according to claim 1, wherein the analysis means includes means for measuring the amplitude of the waveform of the progenitor. 3) In the electronic heart pressure monitor as set forth in claim 1), the analysis means includes means for measuring the slope of the waveform of the progenitor. 4) As set forth in claim l) In the electronic heart pressure monitor, the analysis means is An electronic tonometer including means for measuring the slope of the Coff waveform. 5) The electronic heart pressure monitor according to claim 1), wherein the analyzing means includes means for measuring the phase of each Korotkoff waveform with respect to the associated precursor waveform. 6) Claim fi2 ) In the electronic heart pressure monitor described in K, the analysis means an electronic tonometer including means for rejecting progenitor waveforms that exceed a certain threshold; 7) The electronic manometer according to claim 3, wherein the analyzing means includes means for excluding a progenitor waveform whose slope exceeds a predetermined threshold value. 8) Range of M requirements The electronic manometer described in 4), wherein the analyzing means includes means for excluding Korotkoff waveforms having a slope magnitude lower than a predetermined noise threshold. 9) Range of M Determination In the electronic manometer described in 1), the analysis means includes a means for determining the Korotkoff waveform having the maximum slope during the rising portion of the associated precursor waveform. Electronic heart pressure monitor. 10) Range of M requirements In the electronic heart pressure monitor described in 5), the measuring means is An electronic tonometer including means for measuring both the peak amplitude of the progenitor waveform and the amplitude of the progenitor waveform at the time the Korotkoff waveform occurs. 11) In the electronic heart pressure monitor described in claim 8), the analysis means is An electronic tonometer including means for determining said noise threshold only during periods during which Korotkoff waveforms are unlikely to occur between pulse waveforms. 12) In the electronic manometer according to claim 9), when a predetermined position within the precursor waveform is detected, the analysis means analyzes both the precursor waveform and the Korotkoff waveform over a predetermined period. An electronic tonometer including a means for scanning. 13) The electronic manometer according to claim 10, wherein the measuring means also includes means for determining the ratio of both amplitudes. 1'4) An electronic manometer according to claim 5), comprising means for eliminating Korotkoff waveforms whose phases are outside a predetermined threshold limit. 15) In the electronic heart pressure monitor according to claim 5), the measuring means An electronic manometer comprising: means for determining the time of occurrence of the Korotkoff waveform relative to the time of occurrence of the peak of the progenitor waveform. 16) In the electronic heart pressure monitor described in claim 5), the measuring means Korotkoff wave for the occurrence of the point where the slope is steepest in the rising part of the proton waveform An electronic manometer including a means for determining when a shape occurs. 17) In the electronic heart pressure monitor described in claim 11), the magnitude of the noise threshold value is electronic manometry including means for aborting the measurement process if a predetermined maximum value is exceeded; 18) A first means for detecting Korotkoff noise, and the first means independently detects Korotkoff noise. a second means for detecting Coff noise precursor waveforms, each precursor waveform being related only to the individual Korotkoff noise associated with the waveform; Means for providing the Korotkoff noise and associated Korotkoff noise precursor waveforms as two separate streams of electrical signals; is isomorphic to the planned waveform characteristics. selectively determining whether the Korotkoff noise signal is true and an analytical means for correlating the Korotkoff noise signal with the precursor waveform. One true Korotkoff noise is isolated from electrical signals that do not represent positive Korotkoff noise. An electrical signal with a waveform representing a Koff noise precursor represents a genuine Korotkoff noise precursor. An electronic heart pressure monitor designed to be isolated from unreliable electrical signals. 19) Korotkoff noise generated by the auscultatory blood pressure measurement process and associated The Korotkoff noise is used in electronic heart pressure monitors that analyze the Korotkoff noise precursor waveform. a first means for providing sounds and associated Korotkoff noise precursor waveforms as separate input electrical signals from separate sources, each Korotkoff noise precursor waveform having a separate Korotkoff noise precursor waveform associated with it; 1. Analyzes the waveforms of all human-powered electrical signals representing the Frotkoff noise and selectively determines whether the waveform characteristics are the same as the expected waveform characteristics. and a third method of analyzing the waveforms of all human-powered electrical signals with respect to the associated Korotkoff noise precursor waveforms and selectively determining whether they are isomorphic to the expected waveform characteristics. and related to the Korotkoff noise and the associated Korotkoff noise precursor waveform. fourth means for analyzing and correlating the waveforms of all input electrical signals to selectively determine whether they are isomorphic to each other; True Korotkoff noise and genuine Korotkoff noise and a fifth means for selectively generating an output electrical signal in correlation with only the input electrical signal corresponding to the sound precursor, so that genuine Korotkoff noise and genuine Korotkoff noise are generated. input electrical signals representing noise precursors are separated from artifacts and noise signals. Electronic heart pressure monitor. 20) means for providing Korotkoff noise detected as an electrical signal from a first source; and means for providing an associated Korotkoff noise precursor as an electrical signal from a second source, each Korotkoff noise precursor The child is only concerned with the individual Korotkoff noise signals associated with the progenitor, and has means for analyzing the waveforms of all electrical signals to determine whether they are isomorphic to the expected waveform characteristics. For this reason, genuine Electrical signals with waveforms representing Rotkoff noise and genuine Korotkoff noise precursors are true. Electrical signals that do not represent positive Korotkoff noise and associated Korotkoff noise precursors? The ventricular systolic and diastolic pressures can thus be determined. Electronic heart pressure monitor. 21) Korotkoff noise from the first source and associated Korotkoff noise from the second source It has human power means to supply the sonic precursors as separate input electrical signals, so that each corotoko the Korotkoff noise precursor is associated only with the individual Korotkoff noise signal to which it is associated; so that each individual input electrical signal the presence or absence of such isomorphism, the presence of an input electrical signal related to said Korotkoff noise, and the presence or absence of said Korotkoff noise. A wave that produces an electrical output that represents its correlation with an electrical signal related to a noise precursor. shape analysis means and, in response to the electrical output from the waveform analysis means, a genuine Korotkoff noise. An output that produces an output electrical signal that represents only the input electrical signal that indicates that sound has occurred. An electronic heart pressure monitor having a force means. 22) means for providing an electrical waveform representative of Korotkoff noise from a first source; The related components are such that each of them is related only to the individual Korotkoff noise signal to which the protons are associated. second means for providing an electrical waveform representative of a Rotkoff noise precursor from a second source; third means for analyzing the amplitude of the slope of a portion of the waveform representing Korotkoff noise to produce an output representing the magnitude of the slope of such waveform as well as its occurrence; fourth means for determining the slope and amplitude of the waveform representing the associated Korotkoff noise precursor; fifth means for determining the phase of a waveform representing the Coff noise; and in response to the analysis by said third means, fourth means and fifth means, true Korotkoff noise has been generated. and a seventh means for analyzing the electrical output of the sixth means to determine blood pressure. 23) Korotkoff murmur and related Korotkoff noises generated by the auscultatory blood pressure measurement process In electronic manometers that analyze Tokoff noise precursors, Korotkoff noise from the first source is sound and associated Korotkoff noise precursors from a second source with separate input electrical signals. each Korotkoff noise precursor is associated only with the individual Korotkoff noise signal with which it is associated; selectively pre-screening the input electrical signal relating to the Korotkoff noise from the first means to determine if there is an input electrical signal relating to the sound precursor; An output electrical signal representing an input electrical signal corresponding to the occurrence of a positive Korotkoff event. an electronic tonometer having second means for generating a signal; and third means for analyzing an output electrical signal from the second means to determine blood pressure. 24) first means for providing an electrical waveform representative of Korotkoff noise from a first source and providing an electrical waveform representative of a blood pressure signal defining an associated Korotkoff noise precursor from a second source; A Korotkoff noise progenitor is related only to the individual Korotkoff noise signal to which it is associated, and is further associated with a wave representing said Korotkoff noise. A second means of selectively analyzing parts of the shape and representing the associated Korotkoff noise precursors. a third means for selectively analyzing a portion of the electrical waveform; Selectively determine the presence of Korotkoff noise precursors identified by gender correlations to distinguish them from artifacts and noise signals and represent only true Korotkoff events. 25) a fourth means for generating an electrical output; means for converting the noise and associated Korotkoff precursors into electrical signals; Locate each Korotkoff noise at the rising slope part of An electronic manometer having an analysis means for detecting true Korotkoff noise, thereby separating an electrical signal having a waveform representing true Korotkoff noise from an electrical signal not representing true Korotkoff noise. 26) first signal source means for detecting Korotkoff noise and differentiating the noise to create a flow of noise signals; a second signal source means for detecting as a Korotkoff noise precursor waveform; each precursor waveform is associated only with the individual Korotkoff noise signal with which it is associated; means for supplying the Korotkoff noise precursors as two separate streams of electrical signals; selectively determining whether the Rotkoff noise signal and each individual precursor waveform are isomorphic to the expected waveform characteristics to convert each genuine Korotkoff noise signal to its associated precursor waveform; It has an analysis means that correlates with the proton waveform, and thus represents the true Korotkoff noise. electrical signals with waveforms that do not represent genuine Korotkoff noise. and wherein electrical signals having waveforms representative of genuine Korotkoff noise precursors are separated from electrical signals not representative of genuine Korotkoff noise precursors, and further comprising means for determining blood pressure from said genuine Korotkoff noise precursors. Electronic heart pressure monitor. 27) an elongated base strip of resilient material and a strain gauge mounted in the center of the elongated strip and adapted to sense deflection along the longitudinal axis of the strip and the gauge; For this purpose, place the transducer with the vertical axis parallel to the artery in the subject's upper arm. By attaching a coat that increases the response to the occurrence of Korotkoff events in the artery. Rotkoff noise converter. 28) an elongated base strip of elastic material, an elastic pad attached to the base strip, and a longitudinal axis on the elastic pad attached to the center of the elongate strip; , a piezoelectric transformer adapted to sense the deflection of the pad and transducer; a Korotkoff noise transducer, the noise transducer being mounted with the vertical axis parallel to the artery of the upper arm of the subject, thereby increasing the response to the occurrence of a Korotkoff event in the artery. 29) an elongated base strip including a pair of spaced apart elements defining a central gap therebetween; a resilient pad overlapping the gap and mounted on the base strip; a piezoelectric transducer mounted above the pad at the center of the elongated strip and adapted to sense deflections along the longitudinal axis of the strip, the pad, and the transducer; By installing the transducer with the longitudinal axis parallel to the artery of the subject's upper arm, a Korotkoff miscellaneous system is created that increases the response to the occurrence of a Korotkoff event in the artery. sound transducer. 30) In an inflatable cuff of the type used in heart pressure monitors, the cuff is adapted to be attached to the patient's arm around the patient's brachial artery; an inflatable transducer having a first transducer adjacent the end of the cuff on the flow side and a second transducer separated from said first transducer by a small distance along the axis of the brachial artery. cuffs. 31) A means for inflating the cuff, a means for deflating the cuff, and a means for deflating the cuff. Korotkoff noise is present during this time. An electronic tonometer having means for monitoring the presence of a Korotkoff signal, and means for stopping a contraction in response to early detection of a Korotkoff signal after initiating a contraction. 32) A means for inflating a cuff, a means for deflating a cuff, and a means for deflating a cuff. an electronic tonometer having means for monitoring whether a noise signal is present during the period of contraction, and means for temporarily halting contractions in response to detection of an excessive noise signal. 33) Converting the detected Korotkoff noise and blood pressure pulse precursors from separate sources into separate waveform signals and analyzing all waveforms to combine the pressure pulse waveform signal and the corona Including the correlation of Tokov waveform signals, whether they are isomorphic with the expected waveform characteristics. The method includes the step of determining whether a waveform representing genuine Korotkoff noise is separated from a waveform representing genuine Korotkoff noise. 34) Inflate the cuff wrapped around the patient's arm, deflate the cuff, monitor the presence of the Korotkoff signal during deflation, and inflate the scheduled number of cuffs within a predetermined period of time after starting one deflation. A method for measuring blood pressure comprising the step of inflating the cuff to a higher pressure in response to the detection of a Korotkoff signal. 35) Inflate the cuff around the patient's arm, deflate the cuff, and keep it clean during deflation. A method of measuring blood pressure consisting of monitoring the presence of an acoustic signal. 36) generating a stream of pulses representing a blood pressure waveform that is a precursor to a Korotkoff noise signal; generating a stream of pulses representing a Korotkoff noise signal; In response to the Korotkoff signal, only while the Korotkoff signal is unlikely to occur. A blood pressure measurement method comprising the step of generating a noise threshold. 37) In a method of analyzing the flow of Korotkoff pulses to determine blood pressure, Generate a stream of pulses representing a Tokoff noise signal and represent the associated Korotkoff noise precursors. generating a corresponding pulse stream and locating a first pair of adjacent Korotkoff signals above a maximum amplitude threshold adjacent either end of the blood pressure spectrum; moving away from the pair of Korotkov signals in the direction of one selected end of the vector. The first FlotoCo7 noise signal lower than the threshold value encountered when A method consisting of the steps of setting up 38) In a method of analyzing the flow of Korotkoff pulses to determine blood pressure, a pulse flow representing a Korotkoff noise signal is generated in the blood pressure region, and the related corona is detected in the blood pressure region. generating a corresponding stream of pulses representative of Tokoff noise precursors, locating a first pair of adjacent Korotkoff signals adjacent to either end of the blood pressure spectrum that is greater than a lowest amplitude threshold; interpolate the amplitudes of the blood pressure spectrum to determine the extreme value of the blood pressure in the direction of one selected end of the blood pressure spectrum; pulse between periods If the distance is less than the equal pressure change, set the above extreme value as the blood pressure limit. A method consisting of the steps of 39) In the method of analyzing the flow of Korotkoff pulses to determine blood pressure, Generate a pulsed flow representing a Korotkoff noise signal in the pressure domain and Generate a corresponding pulse stream representing a Rotkoff noise precursor and select a first pair of adjacent rollers that are greater than the lowest amplitude threshold at either end of the pressure spectrum. Korotkoff signals are determined and the amplitudes of the pair of Korotkoff signals are interpolated to obtain the blood pressure spectrum. determining the extreme value of the blood pressure in the direction of the chosen l end of the vector, and determining the value of the pressure produced by said extreme value from said pair of Korotkoff signals with a pulse frequency between successive progenitors. If the difference is greater than the average pressure change per phase, the value of the blood pressure beyond the pair of Korotkoff signals is set toward a selected end of the pressure vector by another pressure equal to the average pressure change. A method consisting of a process of setting limits. 40) providing a signal representing a Korotkoff noise waveform as an electrical input from a first source, and providing a signal representing an associated Korotkoff noise precursor waveform as an electrical input from a second source separate from said first source; , each Korotkoff noise precursor waveform is related only to the individual Korotkoff noise signal waveform to which that precursor is associated, and the waveform of the signal representing said Korotkoff noise is analyzed to determine the waveform of the signal related to the associated Korotkoff noise precursor. Analyzing the waveforms of all signals and selectively determining the existence of identified Korotkoff noise precursors and that the precursors are isomorphic to Korotkoff noises, and generating genuine Korotkoff noises. A blood pressure measurement method that consists of separating a waveform that represents true Korotkoff noise from a waveform that does not represent true Korotkoff noise. 41) An inflatable cuff; the cuff is arranged so that when the cuff is wrapped around the patient's arm and inflated, the longitudinal axis of the sensing device is approximately parallel to the patient's brachial artery. an elongated deflection sensing device disposed in the L1, thereby increasing the sensitivity to the occurrence of Frotkoff events in the artery. Engraving (contents (no changes))