WO2006082286A1

WO2006082286A1 - Portable medical screening apparatus with triple stethoscopic, doppler and blood stream detection

Info

Publication number: WO2006082286A1
Application number: PCT/FR2005/000258
Authority: WO
Inventors: Hervé Bindefeld
Original assignee: Bindefeld Herve
Priority date: 2005-02-04
Filing date: 2005-02-04
Publication date: 2006-08-10
Also published as: EP1843699A1

Abstract

The invention concerns a portable medical screening apparatus for performing a triple stethoscopic, Doppler and blood stream detection, comprising an arterial parameter measuring device (70) characteristic of the blood stream and a stethoscope provided with a connecting line path (3) for audio transmission between at least one earphone and a housing (100) forming at least partly an ear trumpet. The housing is equipped with an ultrasonic probe (8) and a transducer capable of supplying, from a Doppler signal, an audio signal through a connection to a loudspeaker for stethoscopic listening, and/or a video signal through a connection to viewing means. Data transmitting means between the said parameter measuring device (70) and the housing are coupled to means for digital processing of said data in the housing to enable, through means for triggering storage (5) provided on the housing, the values of the arterial parameter to be recorded at predetermined times and viewing means (39) to be supplied with the computed results based on said arterial parameter values.

Description

PORTABLE MEDICAL SCREENING DEVICE WITH TRIPLE STETHOSCOPIC DETECTION, DOPPLER AND BLOOD CIRCULATION

The invention relates to a portable medical screening device for performing and analyzing a triple detection in order to provide such screening: a double detection of stethoscopic and / or Doppler type, combined with a measurement detection of a parameter of the circulation of the blood, especially blood pressure.

In order to study blood flow rates, there are stethoscopic listening devices and Doppler systems. The first allow the practitioner to directly estimate the contraction time of the heart to expel the blood in the arteries (systole) and blood filling of the heart (diastole), and the second detect these instants from an ultrasound signal emitted by a Doppler system.

In order to allow a more precise study of these detections, it has been proposed by the applicant, in an international application published under the number WO 03/079904 and incorporated herein by reference, an apparatus hereinafter referred to as stethoflux®. This portable device makes it possible to perform simultaneous double detection, in stethoscopic and Doppler mode, in the same zone. Thus, the position of the apparatus is not modified and detection by simple audio listening of stethoscopic type is possible, whether the detection is stethoscopic or Doppler, possibly combined with recording and analysis of the signals so as to provide information visually for diagnosis.

Stethoflux® is used to determine systolic arterial pressures in the elbow (humeral artery) stethoscopically and / or Doppler mode, and in the ankle or lower leg (tibial artery or more distal) mode Doppler only.

However, to quantify the arterial pressures with this device, it is necessary to have another medical device: a tensiometer-type pressure measuring device comprising a cuff coupled to a manometer. To measure systolic blood pressures, the blood pressure cuff causes a tourniquet effect and is then slowly loosened so that the user user (doctor, nurse, nurse, etc.) can observe the pressure values displayed on! the sphygmomanometer at the moment of contraction of the heart or filling of

In general, stethofiuκ® can be used to record systolic arterial pressures (PAS) in the lower and upper limbs. The ratio of these two values provides the clinical pressure index (SPI).

In order to provide IPS values, the stethoflux® case should be placed under arterial examination, under or near the blood pressure monitor, the PAS values should be read from the pressure gauge and stored in a calculator. to derive the IPS measurement.

This solution is a first practical approach, but is not satisfactory in terms of efficiency, reliability and speed.

The improvement according to the invention allows a direct and reliable storage of arterial pressures by transmitting the information to be memorized.

More specifically, the subject of the invention is a portable medical screening device for performing and analyzing a triple stethoscopic, Doppler and blood circulation detection, comprising a device for measuring an arterial parameter characteristic of blood circulation and a stethoscope provided with a sound transmission link conduit between at least one listening ear and a housing at least partially forming an acoustic horn, the housing being equipped with an ultrasound probe oriented to allow convergence and simultaneity in reception of ultrasonic signals and stethoscopic, and a transducer capable of providing, from a Doppler signal, an audio signal by a loudspeaker for stethoscopic listening, and / or a video signal by coupling to display means; in this apparatus, means for transmitting data between the parameter measuring device and the housing are coupled to digital processing means of these data in the stethoscope to allow, by means of triggering provided on the stethoscope, to record values of the arterial parameter at given times and to provide visualization means with results of calculations made from these arterial parameter values.

Preferably, the blood flow parameter is the blood pressure and the arterial pressure measuring device is a blood pressure monitor, but other physical quantities may also be used as parameters, such as the speed of circulation or the frequency of the signal Doppler in reception. The sphygmomanometer may be a conventional inflatable cuff and pressure gauge device or a structure integrated into the housing as shown below.

According to different embodiments:

the data transmission is carried out via electrical or optical cable links, by a bluetooth®-type wireless system or by an infrared system, antennas then being provided for transmitting and receiving waves processed by modulation / demodulation;

- The arterial measurement device and the transmission means are integrated in the housing, the blood pressure monitor being formed of a rod extended by a compression bead coupled to a dynamometer and capable of causing a tourniquet effect;

the compression rod is actuated manually or electrically, the casing being held by the speaker against the member to be tested;

- The probe is integrated in the housing and is optionally equipped with orientation and / or translation means, or is separated therefrom for manually adapted free orientation and is connected to the housing of the transducer by an electrical or optical cable connection , by wireless system of bluetooth® type or by infrared system; the digital processing means are programmed so that the speaker can start measuring the arterial parameter manually, when the speaker hears the stethoscopic sound signal or the Doppler signal converted by the transducer circuit and emitted by the loudspeaker, or again automatically, by the electrical signal transmitted by a microphone which locates and converts the stethoscopic sound signal;

the digital processing means are programmed so that the speaker can start storing a first pressure value P1, measured on an upper limb by a first support A1 on the memory triggering means, and then a second pressure value P2, measured on a lower limb by a second support A2 on the triggering means, the display module then displaying the index value IPS by the ratio P2 / P1 of the measured and stored pressures.

Under these conditions, the speaker can start storing a first pressure value measured on an upper limb and then a second pressure value measured on a lower limb, the device then displaying the value of the ratio of measured and stored pressures.

According to other characteristics:

the triggering means comprise a switch disposed on the housing and actuated when the intervener wishes to memorize a pressure value;

- The digital processing means are constituted in particular by a microprocessor mounted in a chip having at least one memory; the processor is programmed to allow the storage of pressure values in the detection mode by automatic recording, by pressing at the beginning of the deflation of the blood pressure cuff, the microphone then being activated and the value of the pressure automatically captured and memorized when the stethoscopic or Doppler sound signal reappears;

the display module comprises display means consisting of diodes or a liquid crystal display screen formed on the stethoscope, in particular on the housing so that the speaker can read directly the result of the pressure ratio corresponding to the value of the IPS, systolic pressure index.

A major advantage is the fast and reliable combination of two devices, stethoflux® housing and tensiometer, the storage of measured arterial pressure values and the direct calculation of a pressure ratio, the IPS in particular.

Another advantage is to have an apparatus whose measurements have a high reproducibility because the three detections being performed in the same area of the member to be tested, without changing the relative position of the detectors, the measurements made and the values deduced are directly comparable from one test to another.

Other advantages and characteristics of the invention will appear in the detailed description below, with reference to exemplary embodiments accompanied by the appended figures which represent, respectively:

- Figure 1, a sectional view of a screening apparatus housing according to the invention;

FIG. 2, an example of an apparatus according to the invention comprising the case according to FIG. 1 and the tensiometer connected by an electrical wiring; and

- Figure 3, a partially cutaway view of an exemplary apparatus according to the invention with a tensiometer integrated in the housing and a Doppler probe separated from the housing.

The housing illustrated in FIG. 1 shows some of the means of a stethoflux® case 100, namely: a sound transmission link connection 3 connected to earpieces (not shown);

an acoustic horn 1 equipped with a membrane 2;

an ultrasound probe 8 oriented to allow convergence in reception of ultrasonic and stethoscopic signals; and

a transducer circuit 37 capable of providing, from a Doppler signal supplied by the probe 8, an audio signal by coupling to a loudspeaker 34 for stethoscopic listening, and a video signal by coupling to a display module 39 having a liquid crystal display screen, on the upper face Fs in the example shown, and a display adapter for modulating the input signals.

The probe 8 is housed in the casing 100, out of the cone 1 in the shape of a cupola. Alternatively, the probe may be disposed in the horn 1. A switch 38 for tensioning the probe 8 is disposed on the housing.

The housing 100 has a turret-shaped, substantially cylindrical and ovoid section. The turret is limited by the upper outlet face Fs, in the center of which emerges the connecting connection 3, and by an open bottom face Fi application, where are placed the plane membrane 2 of the horn and the end face 8a of an extension 8b of the inclined probe 8. This extension is a solid or semi-solid material conductive ultrasonic waves, for example silicone gel. The end face 8a of the extended probe is covered with a gel 61 to form a continuous bonding layer between the end 8a and the skin of the patient. An insulating membrane 2 ', pierced so as to leave the end 8a free, can advantageously close the lower face of the turret. The gel is controlled by a piston 36 accessible from the upper face Fs. In this embodiment, the gel 61 comes from a reservoir 60 disposed in the housing. The gel is delivered through a flexible tube 6a by an ejection nozzle 6b, located in contact with the lower face Fi of the turret. The thrust of the piston 36 makes it possible to dose the adequate amount of gel delivered by the nozzle. The reservoir can be recharged through a hose 62 which connects the reservoir 60 to a restocking mouth 63 integrated in the housing.

The axis Y'Y of the probe 8 is inclined relative to the central axis X ¹ X of symmetry of the horn, at an angle (approximately 50 degrees with respect to the plane of the membrane 2 'in the example) allowing to realize a double convergent detection of the Doppler signals and the stethoscopic listening. The dual detection is convergent in the sense that the sound signals, namely stethoscopic and Doppler converted into audible signal by the speaker 34, are simultaneously channeled through the same connecting pipe 3 but their listening is successive. When the stethoscopic signal is converted into an electrical signal by the microphone 40, the stethoscopic and Doppler signals can then be processed simultaneously.

Convergence can also be done on the exploration site. However, the probe may be equipped with orientation and translation means (not shown) manually or electrically controlled (for example a micro-engine) to perform an exploration a few centimeters downstream.

Still in this example, the probe 8 is connected to the loudspeaker 34, mounted on an outer face of the horn 1 via the transducer circuit 37. Alternatively, the loudspeaker could be mounted on any location close to the propagation circuit of the sound constituted by the horn and the connection fitting. The Doppler signal is converted by the transducer circuit 37 to provide a sound signal through the speaker 34. Stethoflux® is used in sound or audio mode for the stethoscopic and Doppler signals.

In automatic mode, a microphone 40 is additionally affixed against the outer wall of the connector 3. Alternatively, it can be arranged in the connection duct, insofar as this position does not cause attenuation of the intensity of the sound signal. direct, or against the wall of the acoustic horn 1, or more generally on any appropriate location located on the sound path. This microphone makes it possible to collect and convert the sound stethoscopic signal and is connected to the transducing circuit 37 in order to transmit it as an input signal to a microprocessor 4 coupled to an integrated circuit memory 4a of a chip 4b and, at the output, to the display module 39. The Doppler signal received by the probe 8 is also converted into a video signal by the same path.

The reappearance of stethoscopic and / or Doppler signals, whether detected by listening (audio mode) or by recording (automatic mode), is coupled with the measurement of blood pressure as a parameter of the blood circulation. In the exemplary embodiment illustrated in FIG. 2, the voltage is measured by the pressure gauge 6 of an inflatable compression cuff tensiometer 7 and transmitted by wiring to the housing 100.

To do this, the pressure gauge is coupled to a pressure sensor K, for example a piezoelectric sensor, connected to an output 101 (FIG. 1) provided on the housing 100 by a flexible electric cable 11, itself coupled to the microprocessor 4 to Through the transducer circuit 37. Alternatively, transmission by radio or infrared waves is possible using transmitting / receiving antennas and adapted modulators / demodulators.

Pressure values are displayed by operating a switch 5 which is coupled to the processor 4 and the microphone 40 for automatic recording. The microprocessor is programmed so that this switch 5 makes it possible to trigger the input, storage and display of these values and reports of these values.

In the example, the processor is programmed to allow the storage of two pressure values, P1 and P2, identified as pressure values PAS at the upper and lower limbs, when the intervener M successively exerts two supports A1 and A2 on the switch 5 respectively corresponding to the positioning of the apparatus on an upper and lower limb artery. It is also programmed so that the second support then triggers the calculation of the ratio of these two values P2 / P1 to display an index value IPS by the display module 39.

In practice, the first support A1 is exercised by the speaker when he wants to start memorizing the value of a pressure, P1 or PAS to the upper limb.

In listening detection mode (audio mode), the recording is done manually by the support A1 exerted by the speaker M when he hears the sound signal, stethoscopic or Doppler converted by the speaker, to reappear at a moment precise, during deflation of the cuff of the tensiometer 7 effect tourniquet.

In the automatic recording detection mode, the support A1 is exerted at the time of deflation of the cuff 7. The microphone 40 is then activated and the reappearance of the sound signal (stethoscopic or Doppler) automatically triggers the capture and storage of the value of pressure.

In both detection modes, the start of the memorization of a first pressure value P1, PAS of upper limb is performed at the time of reappearance of the sound signal.

The triggering of the measurement of a second pressure value P2, NO lower limb, is performed in the same way by a second support A2 using only a Doppler detection for pressure measurement. The apparatus advantageously displays directly on the display screen the calculated value of the pressure ratio P2 / P1, defining the value of the index of IPS.

According to another exemplary embodiment illustrated in FIG. 3, the tensiometer and the transmission means are integrated in the casing 100. The tension meter 70 comprises a rod 71 terminated by a compression bead 72 and coupled to a dynamometer 73. The dynamometer may be spring, as in the example shown, blade or fluid. The dynamometer is coupled to a level sensor (not shown), by an optical sensor or a piezoelectric sensor, the output signal of which is transmitted to the transducer 37 (FIG. 1).

The rod can slide perpendicular to the surface of the test limb down the main axis X'X and causing a tourniquet effect by blocking the circulation of blood by compression exerted by the bead 72 on the artery. It is operated manually by the force exerted by the operator on its upper face Fa, or electrically through the action of an electric micromotor (not shown). The housing is in both cases maintained by the operator against the member to be tested.

The artery is then slowly decompressed so that the blood can re-circulate and trigger a stethoscopic and / or Doppler signal as before. The dynamometer is coupled or transducer circuit to provide pressure values.

In the example shown, the probe 8 is separated from the casing 100 and is connected thereto by an electrical cable connection 12 (other links: optical, by wireless system bluetooth® type or by infrared system are of course possible). Such separation allows for greater freedom of orientation and movement of the guided ^probe% then manually to adapt the location of the scanning region, for example a few centimeters downstream of the apparatus, depending on the displayed results . The cable 12 is provided with hooks 13 to hold the probe when not in use.

In sound mode, the stethoscopic and Doppler signals (at the elbow) or only Doppler at the ankle (or lower leg) allow the speaker to appreciate the instants of memorization of the pressures P1 and P2 provided by the dynamometer 72, stored in the chip by the supports A1 and A2 on the switch 5 and displayed as an IPS index (P2 / P1 ratio) by the display module 39.

In auto recording mode, the stethoscopic (microphone-recorded) and Doppler listening signals are also memorized and displayed as an IPS index. The invention is not limited to the embodiments described and shown. It is for example possible to provide, in the second embodiment, the microprocessor and the display module as arranged in the first embodiment, or to provide the diode display module in any example described above. The means for triggering the data storage may consist of one or more switches or by any other means (lever, touch pad, etc.). In addition, the display screen can be integrated into any part of the stethoscope: the case, the crossing of the ear cups, the battery case, etc.

It is also possible to record blood circulation parameters other than pressures (P1, P2) by means of measuring devices of these parameters in connection with or integrated into the housing of a stethoflux®, as in the examples for the tensiometer: Circulation velocities (V1.V2) using optical speedmeters or Doppler frequencies (F1, F2) using frequency meters to measure, in a similar way, V2 / V1 ratios or F2 / F1.

It is also possible to provide a probe integrated in the housing and a second sensor external to the housing, in flexible connection with the latter. The presence of two probes makes it possible to adapt the measurement to the type of analysis, for example to check a result by a measurement complementary to a few centimeters downstream of the stethoscopic auscultation site.

The invention also allows a comparative analysis between several arterial territories (humerai upper limb and tibial lower limb in particular).

Claims

A portable medical screening apparatus for performing and analyzing a triple stethoscopic, Doppler and blood circulation detection, comprising a measuring device (7, 70) for an arterial parameter characteristic of the blood circulation and a stethoscope provided with a connecting duct (3) for sound transmission between at least one listening ear and a housing (100) at least partially forming an acoustic horn, the housing being equipped with an ultrasonic probe (8) for convergence and simultaneity receiving ultrasonic and stethoscopic signals, and a transducer (37) capable of providing, from a Doppler signal, an audio signal by connection to a loudspeaker (34) for stethoscopic listening, and / or a video signal by coupling to display means (39), characterized in that data transmission means (11, 37) of the measuring device (7, 70) of the parameter and (37) are coupled to s digital processing means (4, 4a, 4b) of these data in the stethoscope to allow, by storage triggering means (5) provided on the stethoscope, to record values of the arterial parameter at given times and providing the display means (39) with calculation results from these arterial parameter values.

2. Screening apparatus according to claim 1, wherein the arterial parameter is selected from pressure, velocity and frequency.

3. Screening apparatus according to claim 1 or 2, wherein the data transmission is performed via electrical cable links (11) or optical, wireless or infrared system, antennas being provided for transmitting and receiving waves processed by modulation / demodulation.

A screening apparatus according to any one of the preceding claims, wherein the arterial parameter measuring device (70) and the transmission means (11) are integrated in the housing, the arterial measuring device is a blood pressure monitor a rod (71) completed by a compression bead (72) coupled to a dynamometer (73) and capable of causing a tourniquet effect.

5. Screening apparatus according to the preceding claim, the compression rod (71) is actuated manually or electrically, the housing being held by the speaker against the test member.

6. Screening apparatus according to any one of the preceding claims, wherein the probe (8) is integrated in the housing (100) and is optionally equipped with orientation and / or translation means.

A screening apparatus according to any one of claims 1 to 5, wherein the probe (8) is separated therefrom for a manually adapted free orientation and is connected to the transducer (37) of the housing (100) by a connecting means (12).

A screening apparatus according to any one of the preceding claims, wherein the measurement of the arterial parameter can be triggered either manually, when the speaker hears the stethoscopic sound signal or the Doppler signal converted by the transducer circuit (37) and output by the loudspeaker (34), or automatically, by the electrical signal transmitted by the microphone (40) which locates and converts the stethoscopic sound signal.

9. screening apparatus according to the preceding claim, wherein the digital processing means (4) are programmed so that the speaker can initiate the storage of a first pressure value P1 measured on an upper member by a first support A1 on the storage trigger means (5) and then a second pressure value P2 measured on a lower limb by a second support A2 on the same switch, the display module (39) then displaying the IPS index value by Ie ratio P2 / P1 of the measured and stored pressures.

The screening apparatus according to any one of the preceding claims, wherein the triggering means comprises a storage switch (5) disposed on the stethoscope, preferably on the housing (100), and actuated when the speaker wishes to memorize a pressure value.

11. screening apparatus according to any one of the preceding claims, wherein the digital processing means are constituted in particular by a microprocessor (4) mounted in a chip (4a) having at least one memory (4b).

12. Screening apparatus according to the preceding claim, wherein the processor is programmed to allow the storage of pressure values in detection mode by automatic recording, by pressing at the beginning of the deflation of the blood pressure cuff (7), the microphone (40). ) is then activated and the value of the pressure automatically entered and memorized when the stethoscopic or Doppler sound signal reappears.

The screening apparatus according to any one of the preceding claims, wherein the display module (39) comprises display means consisting of diodes or a liquid crystal display screen formed on the stethoscope, preferably on the housing (100) so that the speaker reads directly the result of the pressure ratio corresponding to the value of the IPS, systolic pressure index.