WO1986000210A1 - Techniques d'obtention d'informations de formes d'onde associees a la pression sanguine d'une personne - Google Patents

Techniques d'obtention d'informations de formes d'onde associees a la pression sanguine d'une personne Download PDF

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Publication number
WO1986000210A1
WO1986000210A1 PCT/US1985/001121 US8501121W WO8600210A1 WO 1986000210 A1 WO1986000210 A1 WO 1986000210A1 US 8501121 W US8501121 W US 8501121W WO 8600210 A1 WO8600210 A1 WO 8600210A1
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WO
WIPO (PCT)
Prior art keywords
points
pulse
blood pressure
waveform
diastolic
Prior art date
Application number
PCT/US1985/001121
Other languages
English (en)
Inventor
William Trevor Link
Original Assignee
Norse Instruments, Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Norse Instruments, Inc. filed Critical Norse Instruments, Inc.
Publication of WO1986000210A1 publication Critical patent/WO1986000210A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
    • A61B5/021—Measuring pressure in heart or blood vessels
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
    • A61B5/021—Measuring pressure in heart or blood vessels
    • A61B5/02108—Measuring pressure in heart or blood vessels from analysis of pulse wave characteristics

Definitions

  • the present invention relates generally to blood pres- sure evaluation procedures and more particularly to noninvasive techniques for determining certain waveform information associated with blood pressure.
  • the systolic and diastolic pressures are determined by listening to certain sounds (Korotkoff sounds) which occur as a result of the cuff first being pressurized and then depressurized whereas oscillometry actually measures changes in pressure in the cuff as a result of changes in blood pressure as the cuff is first pressurized and then depressurized.
  • oscillometry actually measures changes in pressure in the cuff as a result of changes in blood pressure as the cuff is first pressurized and then depressurized.
  • the various embodiments of the present invention are based on oscillometry.
  • a more specific object of the present invention is to provide a different uncomplicated and yet reliable technique for generating non-invasively a waveform closely approximating an individual's true blood pres ⁇ sure waveform which, heretofore, has been obtainable by invasive means only.
  • Another particular object of the present invention is to provide a new way for measuring and calculating the mean arterial pressure of an individual.
  • a suitably sized cuff for example one which is 20 inches, long and 5 inches wide, is positioned around the upper arm of an individual, a human being specif ⁇ ically or a mammal in general (hereinafter referred to as the patient) and initially pressurized to a level which is believed to be clearly greater than the pa- tient's systolic pressure, for example 180 Torr. It is assumed that this pressure will also cause the patient's artery within the sleeve to completely col ⁇ lapse.
  • cuff pressure is gradually reduced toward zero during which time the cuff continuously changes in pressure in an oscillating fashion due to the combination of (1) the internal blood pressure changes in the patient's artery and (2) changes in cuff pressure.
  • the latter at any given time in the procedure is known and oscillaroty changes in cuff pressure can be readily measured, for example with an oscilloscope.
  • the typically 5" wide pressure cuff entirely surrounds a corresponding 5" length of artery.
  • the tissue of the arm is for the most part incompressible, and therefore any change in the volume of the artery, caused for example by pulsations of blood, results in a corresponding change in the volume of air in the air bladder which is within the cuff and therefore adjacent to the arm.
  • This change in air volume produces a small but accurately measurable pressure change in the air.
  • This equivalence of pressure pulsations in the cuff bladder to volume pulsations of the artery is the essence of oscillometry.
  • FIGURE 1 (corresponding to Figure 6 in United States Patent 3,903,872) diagram atically illustrates the shapes of successive cuff pressure versus time pulses (cuff pulses) as the measured cuff pressure changes from 90 Torr to 80 Torr to 70 Torr, assuming the patient has a diastolic pressure of 80 Torr;
  • FIGURE 1A diagrammatically illustrates a full series of cuff pulses corresponding to those in Figure 1 from a cuff pressure of 160 Torr to a cuff pressure of zero;
  • FIGURE 2 diagrammatically illustrates a curve corre- sponding to arterial or cuff volume (V) , that is, the volume of the patient's artery within the cuff (as measured by cuff volume) versus wall pressure (P ) across the artery wall within the cuff and, super ⁇ imposed on this curve, a curve which is intended to correspond to the actual blood pressure waveform of a patient, the two curves being provided together in order to illustrate the principles of oscillometry, as relied upon in the above-recited patents;
  • V arterial or cuff volume
  • P wall pressure
  • FIGURES 3 and 4 diagrammatically illustrate the cuff curve of Figure 1 in ways which display techniques for obtaining a given patient's systolic and diastolic blood pressures in accordance with the Link and Link et al patents recited above;
  • FIGURE 5 diagrammatically illustrates a compliance curve for the patient's artery, that is, a curve which displays the ratio ⁇ V/ ⁇ P against the arterial wall pressure P , where ⁇ V is the incremental change in the arterial volume correspongind to a preselected constant change in bloodpressure ⁇ P.
  • This curve is initially determined in order to 'provide the cuff or arterial volume curve (V/P curve) of Figure 2 by means of integration, as will be seen.
  • FIG. 1 this figure diagrammatical ⁇ ly illustrates three successive waveforms lOh, lOi and 10j which correspond to the change in volume in a pressurized cuff, as described above, at three differ ⁇ ent cuff pressures, specifically cuff pressures of 90 Torr, 80 Torr and 70 Torr.
  • cuff pulses a greater number of waveforms (hereinafter referred to as cuff pulses) are generated starting at a cuff pressure of 160 Torr and ending at a cuff pressure of zero, as will be seen in Figure 1A.
  • each waveform has what may be referred to as a systolic rise S at one end of the waveform, a diastolic decline D, at the opposite end and a maximum amplitude A.
  • the generally S-shaped curve 12 illustrated is shown within a horizontal/vertical coordinate system where the horizontal axis represents the wall pressure P across the artery wall of a given patient, within the confines of the applied cuff, and the vertical axis represents arterial volume V of the artery within the cuff, as measured by the internal volume of the cuff itself.
  • this V/P curve hereinafter merely referred to as an arterial or a cuff curve
  • Pw The wall pressure P of the artery of the patient at any given time is equal to the blood pressure P, of the patient within the artery at that time less the applied pressure of the cuff Pc.
  • Pw at any given point in time is equal to the blood pressure of the patient at that time.
  • Pw decreases (moves to the left along the horizontal axis) .
  • P at that time is equal to zero
  • the patient's actual blood pressure waveform 15 is superimposed on the V/P coordinate system in Figure 2 within the pulse pressure band 14. As seen there, this waveform is made up of a series of actual blood pressure pulses 16, each of which corresponds to a single beat of the patient's heart. Note that each pulse starts at a minimum pressure (the diastolic pressure of the patient) and sharply increases along its leading edge which is the systolic rise S until it reaches a maximum (the patient's systolic blood pressure) , at which time it drops back down along a trailing edge which includes a dichrotic notch and a diastolic decline D, to the minimum pressure again.
  • a minimum pressure the diastolic pressure of the patient
  • a maximum the patient's systolic blood pressure
  • the volume of the patient's artery and therefore the volume of the cuff is fixed by the arterial curve at the value indicated at V 1, .
  • each of the arterial pulses 10 in Figure 2 has a systolic rise S and a diastolic decline D, corresponding to the systolic rise and diastolic decline of each blood pressure pulse 16.
  • the 30 Torr value is determined by subtracting the cuff pressure P of 50 Torr from the diastolic blood pressure P b (D) of 80 Torr and the 70 Torr value is determined by subtracting the same P of 50 Torr from the systolic blood pressure " P b (°) °f 120 Torr.
  • P b (°) °f 120 Torr the entire 40 Torr band has merely been shifted to the left an amount equal to 50 Torr as indicated by the band 14'.
  • each cuff pulse LOl is greater than the amplitude of each cuff pulse lOq. This is because the 40 Torr band 14' at a cuff pressure- of 50 Torr is on a steeper part of the volume slope than the band 14 at a cuff pressure of zero. Indeed, as we increase the cuff pressure P (which decreases Pw) and therefore move the pressure band to the left on the horizontal axis, we first continue to move along steeper sections of the arte ⁇ rial curve and thereafter less steep sections. There ⁇ fore, the amplitude A (see Figures 1 and 1A) of the corresponding cuff pulses 10Q, 10L and so on will first increase to a maximum and then decrease again.
  • the entire 40 Torr band is moved a substantial distance to the left of the vertical axis, as indicated at 14*'' such that the resultant change in volume (amplitude of the corre ⁇ sponding cuff pulse 10a) is quite small.
  • the band is moved still further to the left, eventually producing very small changes in volume V.
  • this represents a collapsed artery.
  • sufficient cuff pressure P is being applied over and above the internal blood pressure P. to cause the wall of the artery to col ⁇ lapse.
  • the amplitude A of cuff pulse 10 e.g. ⁇ V
  • the volume curve which is used to determine the patient's systolic pressure in accordance with the previously recited Link et al patents, as will be described with regard to Figures 3 and 4.
  • a blood pressure increase causes an arterial volume increase.
  • This arterial volume increase causes a cuff bladder air volume decrease which in turn causes a cuff bladder air-pressure increase. Therefore a blood pressure increase results in a cuff air pressure increase.
  • a change in arterial volume ⁇ V (e.g., the amplitude A of a corresponding cuff pulse) which is approximately equal to one-half of the maximum change in arterial volume (e.g., max cuff pulse amplitude) .
  • a maximum change in volume ⁇ V max (and therefore a maximum cuff pulse amplitude Amax) results from a cuff pressure P of about 100 Torr (e.g. the pressure band 14" in Figure 2) .
  • the amplitude A of the resultant cuff pulse 10 is about one-half of the amplitude of the cuff pulse having a maximum amplitude. Therefore, a patient's systolic blood pressure can be determined by first generating a series of cuff pulses across the cuff pressure spectrum, as in Figure 1A. From these pulses, the one having maximum amplitude Amax is determined and then the cuff pulse having half that amplitude (at a greater cuff pressure) is found. The cuff pressure P used to generate that pulse corre ⁇ sponds to the patient's systolic pressure.
  • each pulse has its own systolic rise S and diastolic decline D,, as mentioned hereto ⁇ fore.
  • the arterial curve 12 dictates the relationship between V and P at each and every point on the waveform 15 of individual blood pressure pulse 16, not merely at the extreme diastolic and systolic end points of each pulse.
  • the measuring band e.g. the pressure difference between the two measuring points
  • band 14 is substantially narrower than band 14.
  • ⁇ V., ' is determined for a cuff pressure P of zero using the pressure band 18 which encompasses a small part of the diastolic decline of each blood pressure pulse 16.
  • ⁇ V-' is determined for a cuff pressure of P of 50 Torr by shifting the band to 18' and, ⁇ V,' is determined for a cuff pressure P of 80 Torr (e.g. the patient's diastolic blood pres ⁇ sure) by shifting the band to 18".
  • ⁇ V is maximum when the cuff pressure P is equal to the patient's diastolic blood pressure.
  • the one cuff pressure producing a maximum change will corre ⁇ spond to the patient's diastolic blood pressure.
  • the lowest pressure part of the diastolic decline D, forming part of each pulse 16 is particularly suitable for this purpose since it can be readily located during each cycle of the waveform. This is because it immediately precedes the systolic rise S which is readily distinguishable each time it appears. This procedure is described in more detail in the previous ⁇ ly recited Link Patent 3,903,872 along with means for carrying out this procedure electronically.
  • this curve represents incremental changes in volume with incremental changes in pressure or dV/dP ( Figure 5) .
  • FIGURE 6 diagrammatically illustrates an actual blood pressure pulse for a given patient
  • FIGURE 7 diagrammatically illustrates a plotted waveform which approximates the actual blood pressure pulse of Figure 6 and which is generated non-invasively in accordance with the present invention
  • FIGURE 8 diagrammatically illustrates an S-shaped cuff or arterial (PV) curve similar to the one illustrated in Figures 2-4 but exaggerated along the vertical slope with enlarged portions of the diastolic decline forming part of an actual blood pressure waveform superimposed thereon:
  • FIGURES 9 (a)-(d) diagrammatically illustrate four blood pressure waveforms haing different blood pressure constants.
  • FIGURE 10 schematically illustrates an arrangement for providing a curve which closely approximates a patients actual blood pressure waveform and also provides the patients mean pressure and blood pressure constant.
  • FIG. 6-8 attention is now direct ⁇ ed to a technique provided in accordance with the present invention for generating a waveform which closely approximates an individual patient's actual blood pressure waveform (for example, the blood pressure pulse 16 in Figure 2) without using an invasive device.
  • the assumed actual blood pressure pulse is shown graph- ically in Figure 6 at 20 where the patient's blood pressure (the vertical axis) is measured against time
  • the horizontal (time) axis can be made to represent the patient's diastolic blood pressure with t being provided at the vertical axis, indicating the beginning of the waveform and t ' a second point indicating the end of that waveform and the beginning of the next one.
  • a dotted horizontal line L- can then be drawn above the time axis at the patient's systolic blood pressure. A single point on this horizontal line can then be established as to"
  • a patient's diastolic blood pressure can be determined electronically by varying cuff pressure P and detecting the resultant change in cuff volume ⁇ V within the same pressure or measuring band (e.g., the band 18, 18' and so on in Figure 4) in the patient's actual blood pressure waveform, that is, along the diastolic decline just before the systolic rise.
  • the cuff pressure P resulting in a maximum change in arterial volume ⁇ Vmax corresponds to the patient's diastolic blood pressure.
  • These components include means serving as a generator for detecting the beginning of the patient's systolic rise and measuring back therefrom, for example 50 milliseconds, in order to provide repeated ⁇ ly a 50 millisecond measuring band. During that time the change in cuff volume ⁇ V is measured by cooperat ⁇ ing means for each cuff pressure P . Means are also provided for determining when ⁇ V is at a maximum and for reading out the cuff pressure P at ⁇ Vmax, this latter cuff pressure corresponding to the patient's diastolic pressure.
  • the genera ⁇ tor just recited is used to provide a series of identical measuring bands of width ⁇ t moving back in time from the systolic rise at t ' , specifically from
  • the cuff pressure Pc is varied in order to find the cuff pressure which results in a maximum change in cuff volume ⁇ Vmax. That cuff pressure corresponds to the patient's actual blood pressure, for example P.. at a time t., in the patient's waveform where t. is temporally the center point of the band 22. This can be repeated (preferably all in one run) for the measuring bands 22' and 22" and so on for providing pressure points P, _ and P. _ and so on corresponding to time t_ and time , and so on in the graph of Figure 7 where t_ and t..
  • any other position on the waveform at general time t can be located by Observing the general cuff pressure P (n) at which the slope of the cuff pressure pulse has a maximum at time tn.
  • the observed cuff pressure P (n) may then be plotted against t as a valid point on the waveform. This is made clear in Figure 7 in which the areas of the waveform which are unmeasurable or poorly measurable by this method are indicated by dotted lines.
  • FIG. 9a-d diagrammatically illustrate a number of waveforms having different mean values.
  • the mean pressure P ( ⁇ t) of a blood pressure waveform is equal to the diastolic blood pressure P fa (D) plus a particular fraction K of the pulse pressure which is the difference between the patient's systolic blood pressure p (S) an ⁇ 3 his diastolic blood pressure. Equation 2A shows this and equation 2B show the same thing in a convenient short hand notation.
  • the mean pressure M can be calculated by integrating the waveform (its amplitude pressure P) over time T (the duration of the waveform) so that:
  • the Figure 9a waveform can be shown to have a value (which is commonly referred to as the blood pressure constant) of about 0.50.
  • the Figure 9b waveform approximates a K value of 0.6 while the Figure 9c waveform approxi ⁇ mates a K value of 0.2.
  • a diagnostic tool can be provided which not only provides for a patient's diastolic and systolic blood pressures non-invasively but also a close approximation of the patient's actual blood pressure waveform as well as his mean pressure and blood pressure constant, again non-invasively.
  • This tool or arrangement is shown in Figure 10 including suitable cuff means generally indicated at 30 in position around the arm of a patient in the normal operating manner and maintained at different pressure levels from zero pressure to, for example, 160' Torr.
  • the resultant cuff pulses are monitored by transducer 34.
  • Suitable and readily providable electronic means 35 serve to receive these pulses and from this information can provide the patient's diastolic and systolic blood pressures along with his arterial pressure-volume curve in accordance with the Link and Link et al patents.
  • Means 35 also includes readily providable circuitry for providing the intermediate pressure points at times t., t_, t-, and so on from Figures 6-8 and with this information further readily providable circuitry for graphing the waveform in Figure 7 on an oscilloscope or monitor 38.
  • means 35 can also include circuitry for calculating the mean pressure P, (M) and blood pressure constant K from this waveform and equations 2-4 above.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Cardiology (AREA)
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  • Heart & Thoracic Surgery (AREA)
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Abstract

Des techniques pour déterminer différents paramètres associés à la pression sanguine d'une personne de manière non invasive comprennent la génération d'une forme d'onde de pression sanguine qui correspond à la forme d'onde réelle (20) de la personne, ce qui permet de calculer aisément la pression sanguine moyenne de la personne.
PCT/US1985/001121 1984-06-19 1985-06-17 Techniques d'obtention d'informations de formes d'onde associees a la pression sanguine d'une personne WO1986000210A1 (fr)

Applications Claiming Priority (2)

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US62221384A 1984-06-19 1984-06-19
US622,213 1984-06-19

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WO1986000210A1 true WO1986000210A1 (fr) 1986-01-16

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PCT/US1985/001121 WO1986000210A1 (fr) 1984-06-19 1985-06-17 Techniques d'obtention d'informations de formes d'onde associees a la pression sanguine d'une personne

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EP (1) EP0183829A4 (fr)
JP (1) JPS62500077A (fr)
WO (1) WO1986000210A1 (fr)

Citations (9)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3878833A (en) * 1973-10-09 1975-04-22 Gen Electric Physiological waveform detector
US4009709A (en) * 1975-05-15 1977-03-01 American Optical Corporation Apparatus and process for determining systolic pressure
US4137907A (en) * 1976-12-27 1979-02-06 American Optical Corporation Systolic pressure determining apparatus and process using integration to determine pulse amplitude
US4154238A (en) * 1976-12-27 1979-05-15 American Optical Corporation Apparatus and process using second derivative of oscillometric waveform for producing sphygmometric information
US4271843A (en) * 1978-10-10 1981-06-09 Flynn George J Method and apparatus for diastolic pressure measurement
US4349034A (en) * 1978-04-10 1982-09-14 Johnson & Johnson Automatic mean blood pressure reading device
US4360029A (en) * 1978-04-10 1982-11-23 Johnson & Johnson Automatic mean blood pressure reading device
US4367751A (en) * 1976-12-27 1983-01-11 Warner-Lambert Company Apparatus and process for producing artifact effect on sphygmometric information
US4408614A (en) * 1981-07-06 1983-10-11 Sri International Blood pressure measurement with Korotkov sound artifact information detection and rejection

Family Cites Families (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3903872A (en) * 1974-02-25 1975-09-09 American Optical Corp Apparatus and process for producing sphygmometric information

Patent Citations (10)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US3878833A (en) * 1973-10-09 1975-04-22 Gen Electric Physiological waveform detector
US4009709A (en) * 1975-05-15 1977-03-01 American Optical Corporation Apparatus and process for determining systolic pressure
US4074711A (en) * 1975-05-15 1978-02-21 American Optical Corporation Apparatus and process for determining systolic pressure
US4137907A (en) * 1976-12-27 1979-02-06 American Optical Corporation Systolic pressure determining apparatus and process using integration to determine pulse amplitude
US4154238A (en) * 1976-12-27 1979-05-15 American Optical Corporation Apparatus and process using second derivative of oscillometric waveform for producing sphygmometric information
US4367751A (en) * 1976-12-27 1983-01-11 Warner-Lambert Company Apparatus and process for producing artifact effect on sphygmometric information
US4349034A (en) * 1978-04-10 1982-09-14 Johnson & Johnson Automatic mean blood pressure reading device
US4360029A (en) * 1978-04-10 1982-11-23 Johnson & Johnson Automatic mean blood pressure reading device
US4271843A (en) * 1978-10-10 1981-06-09 Flynn George J Method and apparatus for diastolic pressure measurement
US4408614A (en) * 1981-07-06 1983-10-11 Sri International Blood pressure measurement with Korotkov sound artifact information detection and rejection

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
See also references of EP0183829A4 *

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EP0183829A4 (fr) 1988-01-26
JPS62500077A (ja) 1987-01-16
EP0183829A1 (fr) 1986-06-11

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