WO2009145027A1 - 動脈硬化度を判定するための指標が得られる、血圧情報測定装置 - Google Patents
動脈硬化度を判定するための指標が得られる、血圧情報測定装置 Download PDFInfo
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- WO2009145027A1 WO2009145027A1 PCT/JP2009/058341 JP2009058341W WO2009145027A1 WO 2009145027 A1 WO2009145027 A1 WO 2009145027A1 JP 2009058341 W JP2009058341 W JP 2009058341W WO 2009145027 A1 WO2009145027 A1 WO 2009145027A1
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- fluid bag
- pulse wave
- pressure
- blood pressure
- measurement
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- 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
- A61B5/022—Measuring pressure in heart or blood vessels by applying pressure to close blood vessels, e.g. against the skin; Ophthalmodynamometers
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- 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
-
- 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
- A61B5/02007—Evaluating blood vessel condition, e.g. elasticity, compliance
Definitions
- the present invention relates to a blood pressure information measurement device and an index acquisition method, and more particularly to a device for measuring blood pressure information using a cuff containing a fluid bag and a method for acquiring an index for determining the degree of arteriosclerosis from the blood pressure information. .
- Measuring blood pressure information such as blood pressure and pulse wave is useful for determining the degree of arteriosclerosis.
- an apparatus for determining the degree of arteriosclerosis for example, Japanese Patent Laid-Open No. 2000-316821 (hereinafter referred to as Patent Document 1) determines the speed of propagation of a pulse wave ejected from the heart (hereinafter referred to as PWV)
- PWV pulse wave ejected from the heart
- PWV is equipped with cuffs that measure pulse waves at at least two locations such as the upper arm and lower limb, and simultaneously measures pulse waves, and the difference in the appearance time of pulse waves at each location and the cuff that measures pulse waves It is calculated from the length of the artery between the two points wearing the.
- the value of PWV varies depending on the measurement site. Typical PWV includes baPWV when the measurement site is the upper arm and the ankle, and cfPWV when the measurement site is the carotid artery and the femoral artery.
- Patent Document 2 Japanese Patent Application Laid-Open No. 2007-44362
- Patent Document 2 Japanese Patent Application Laid-Open No. 2007-44362
- Patent Document 3 Japanese Patent Application Laid-Open No. 2004-113593
- Patent Document 3 separates the ejection wave ejected from the heart and the reflected wave from the iliac artery bifurcation and the sclerosing site in the artery, respectively.
- Patent Document 3 Discloses a technique for determining the degree of arteriosclerosis based on the amplitude difference, amplitude ratio, appearance time difference, and the like.
- Patent Document 2 discloses a technique for determining the degree of arteriosclerosis from the pulse wave of the upper arm.
- Patent Document 2 has a device configuration having a dual structure of a blood pressure measurement cuff and a pulse wave measurement cuff.
- the reflected wave cannot be correctly separated only by the pulse wave measurement cuff because the reflection from the periphery is superimposed. Therefore, there is a problem that it is difficult to accurately determine the degree of arteriosclerosis.
- the present invention has been made in view of these problems, and provides a blood pressure information measurement device and an index acquisition method capable of obtaining an index for accurately determining the degree of arteriosclerosis from measured blood pressure information. Is one of the purposes.
- the blood pressure information measurement device includes an internal pressure of each of the first fluid bag and the second fluid bag, and the first fluid bag and the second fluid bag.
- a first sensor and a second sensor for measuring the pressure
- a first adjustment unit for adjusting the internal pressure of the second fluid bag
- an operation for calculating an index for determining the degree of arteriosclerosis and
- a control unit for controlling adjustment in the first adjustment unit, wherein the control unit is configured such that the first fluid bag is wound around the measurement site, and the second fluid bag is more distal than the first fluid bag.
- the first fluid in the first state is wound around the peripheral portion of the measurement site around which the second fluid bag is wound with the internal pressure higher than the maximum blood pressure.
- the calculation for calculating the index is performed using at least one of the first feature point and the second feature point extracted from the second pulse wave.
- the blood pressure information measuring device includes a first fluid bag and a second fluid bag, and a first fluid pressure measuring device for measuring an internal pressure of each of the first fluid bag and the second fluid bag.
- the second sensor, the first adjustment unit for adjusting the internal pressure of the second fluid bag, the calculation for calculating the index for determining the degree of arteriosclerosis, and the first adjustment unit A control unit for controlling the adjustment, wherein the control unit is configured such that the first fluid bag is wound around the measurement site, the second fluid bag is wound more distally than the first fluid bag, and the second fluid bag is wound around the measurement site.
- Calculation for detecting a pulse wave at the measurement site based on a change in internal pressure of the first fluid bag in a state where the fluid bag is compressing the distal side of the measurement site around which the first fluid bag is wound Is detected by comparing the internal pressure of the second fluid bag when the pulse wave is detected and the maximum blood pressure.
- the first pulse wave detected in the first state in which the internal pressure of the second fluid bag is compressing the distal side of the measurement site with a pressure higher than the maximum blood pressure 2 for calculating whether the internal pressure of the fluid bag 2 is the second pulse wave detected in the second state where the distal side of the measurement site is compressed at a pressure lower than the maximum blood pressure.
- For calculating an index using at least one of the first feature point extracted from the first pulse wave and the second feature point extracted from the second pulse wave Perform operations.
- the index acquisition method is a method for acquiring an index for determining the degree of arteriosclerosis from the pulse wave measured by the blood pressure information measurement device, and the blood pressure information measurement device includes: A first fluid bag and a second fluid bag; a first sensor and a second sensor for measuring respective internal pressures of the first fluid bag and the second fluid bag; and an internal pressure of the second fluid bag.
- a step of detecting a second pulse wave at the measurement site based on a change in the internal pressure of the first fluid bag in a state where the distal side of the measurement site is being pressed at a low pressure, and an index from the second pulse wave Calculating.
- an index for accurately determining the degree of arteriosclerosis can be obtained from the measured blood pressure information.
- blood pressure information refers to information related to blood pressure obtained by measurement from a living body, and specifically corresponds to a blood pressure value, a pulse wave waveform, a heart rate, and the like.
- a blood pressure information measuring device (hereinafter abbreviated as a measuring device) 1A according to a first embodiment is connected to a base 2 and the base 2 and is attached to an upper arm that is a measurement site. These are connected to each other by an air tube 10.
- a display unit 4 for displaying various information including measurement results and an operation unit 3 operated to give various instructions to the measuring apparatus 1 ⁇ / b> A are arranged.
- the operation unit 3 includes a switch 31 that is operated to turn on / off the power source and a switch 32 that is operated to instruct the start of measurement.
- the arm band 9 is wound around the upper arm 100 as the measurement site, as shown in FIG. 2A.
- blood pressure information is measured.
- the armband 9 includes an air bag as a fluid bag for compressing the living body.
- the air bag includes an air bag 13A that is a fluid bag used to measure blood pressure as blood pressure information, and an air bag 13B that is a fluid bag used to measure pulse waves as blood pressure information.
- the size of the air bag 13B is, for example, about 20 mm ⁇ 200 mm.
- the air capacity of the air bag 13B is 1/5 or less as compared with the air capacity of the air bag 13A as shown in FIG. 2B.
- Measurement apparatus 1A obtains an index for determining the degree of arteriosclerosis based on the pulse wave waveform as blood pressure information obtained from one measurement site.
- indexes for determining the degree of arteriosclerosis include Tpp (also expressed as ⁇ Tp), Tr (Traveling time to reflected wave), and AI (Augmentation Index).
- Tpp is an index represented by the time interval between the appearance time of the peak (maximum point) of the ejection wave, which is a traveling wave, and the appearance time of the peak (maximum point) of the reflected wave. In the waveform of FIG. 3, it is represented by the time interval between the points A and B.
- Tr is an index represented by a time interval between the appearance time of the ejection wave and the appearance time of the reflected wave where the traveling wave is reflected back from the bifurcation of the iliac artery. In the waveform of FIG. 3, it is represented by the time interval from the rising point of the ejection wave to the point A. As shown in FIG. 4, the index Tr and PWV have a correlation. When the measurement site is the upper arm and the reflected wave is a reflected wave from the ankle as the periphery, the correlation between the indicator Tr and baPWV, which is the PWV when the measurement site is the upper arm and the ankle, is an individual such as height and gender.
- AI is an index of a characteristic amount that reflects the reflection intensity of a pulse wave mainly corresponding to arteriosclerosis.
- the pulse wave reflection intensity is an index of the pulse wave reflection phenomenon, and represents the ease of blood delivery and the acceptability of blood flow.
- AI is an index represented by the ratio of the amplitude at the maximum point of the reflected wave to the amplitude at the maximum point of the ejection wave that is a traveling wave.
- the waveform of FIG. 3 is represented by the ratio of the amplitude P2 at point B to the amplitude P1 at point A.
- the peak of the ejection wave (point A in FIG. 3) and the peak of the reflected wave (point B in FIG. 3) are extracted from the measured pulse wave. Necessary. Point A and point B in FIG. 3 are inflection points of the pulse wave waveform, and these are referred to as “feature points”. The inflection points A and B are obtained by calculating a multi-order derivative (for example, a fourth derivative) of the measured pulse wave waveform.
- the above-described air bag for compressing a living body has a double structure including two air bags 13A and 13B arranged side by side along the direction of the artery of the measurement site.
- the air bag 13A is disposed on the distal side of the upper arm 100 (the side far from the heart).
- the air bladder 13B is disposed on the central side (side closer to the heart). After the upper arm 100 is compressed and fixed, the air bags 13A and 13B expand and contract.
- the air bag 13A is pressed against the upper arm 100 by inflating.
- the change in the arterial pressure is detected by being superimposed on the internal pressure of the air bag 13A.
- the air bag 13A is inflated to bring the peripheral side of the artery into a blood-feeding state.
- the air bag 13B is inflated to detect an arterial pressure pulse wave generated in the artery in the blood-feeding state. That is, pulse wave measurement is possible while driving the peripheral side. Thereby, it becomes possible to measure a pulse wave with high accuracy. As a result, feature points can be accurately obtained from the measured pulse waveform, and an accurate index can be obtained.
- the feature point may be difficult to see from the pulse wave detected by driving the peripheral side. That is, when a pulse wave as shown in FIG. 5 is detected, the point A1, which is the peak of the ejection wave, is extracted from “pulse wave 1” measured in the state of being driven. The point B1 that is the peak of the reflected wave is difficult to see and is not extracted. However, since “pulse wave 2” measured in a state where no blood is pumped has more influence than a state where a reflected wave from the peripheral side is driven, the reflected wave is reflected together with the point A2 which is the peak of the ejection wave. B2 point which is a peak is extracted.
- the generation time at the point A1 and the generation time at the point A2 are considered to be substantially the same.
- the generation time at point B1 and the generation time at point B2 are considered to be substantially the same.
- measuring apparatus 1A includes an air system 20A connected to air bag 13A via air tube 10, an air system 20B connected to air bag 13B via air tube 10, and a CPU ( Central Processing Unit) 40.
- CPU Central Processing Unit
- the air system 20A includes an air pump 21A, an air valve 22A, and a pressure sensor 23A.
- the air system 20B includes an air valve 22B and a pressure sensor 23B.
- the air pump 21A is driven by a drive circuit 26A that has received a command from the CPU 40, and sends compressed gas into the air bag 13A. Thereby, air bag 13A is pressurized.
- Open / close states of the air valves 22A and 22B are controlled by the drive circuits 27A and 27B that have received a command from the CPU 40.
- the open / close state of the air valves 22A and 22B the pressure in the air bags 13A and 13B is controlled.
- the pressure sensors 23A and 23B detect the pressure in the air bags 13A and 13B, respectively, and output signals corresponding to the detected values to the amplifiers 28A and 28B.
- the amplifiers 28A and 28B amplify the signals output from the pressure sensors 23A and 23B, respectively, and output the amplified signals to the A / D converters 29A and 29B.
- the A / D converters 29A and 29B digitize the analog signals output from the amplifiers 28A and 28B, respectively, and output them to the CPU 40.
- the air bag 13A and the air bag 13B are connected by a two-port valve 51.
- the 2-port valve 51 is connected to the drive circuit 53, and the opening and closing of the valve is controlled.
- the drive circuit 53 is connected to the CPU 40 and controls the opening and closing of the two valves of the two-port valve 51 in accordance with a control signal from the CPU 40.
- the CPU 40 controls the air systems 20A and 20B and the drive circuit 53 based on a command input to the operation unit 3 provided on the base 2 of the measuring device. Further, the measurement result is output to the display unit 4 and the memory 41.
- the memory 41 stores the measurement result. Further, a program executed by the CPU 40 is stored.
- the first specific example is an example of a measurement operation when an operation with the first operation algorithm is performed.
- the operation shown in FIG. 7 starts when a subject or the like presses a measurement button provided on the operation unit 3 of the base 2.
- This operation is realized by the CPU 40 reading a program stored in the memory 41 and controlling each unit shown in FIG. 8A shows the time change of the pressure P1 in the air bag 13B, and FIG. 8B shows the time change of the pressure P2 in the air bag 13A.
- S3 to S17 attached to the time axis in FIGS. 8A and 8B coincide with the respective operations of the measurement operation in the measurement apparatus 1A.
- the CPU 40 initializes each unit (step S1).
- the CPU 40 outputs a control signal to the air system 20A to start pressurization of the air bag 13A, and measures blood pressure in the pressurization process (step S3).
- a measurement method performed by a normal blood pressure monitor can be employed.
- the CPU 40 calculates the systolic blood pressure (SYS) and the diastolic blood pressure (DIA) based on the pressure signal obtained from the pressure sensor 23A.
- SYS systolic blood pressure
- DIA diastolic blood pressure
- the pressure P2 in the air bag 13A increases until it exceeds the maximum blood pressure in the section of step S3.
- the pressure P1 in the air bag 13B is maintained at the initial pressure in the section.
- step S3 When the blood pressure measurement in step S3 is completed, the CPU 40 outputs a control signal to the drive circuit 53 to open both the air bag 13A side valve and the air bag 13B side valve of the 2-port valve 51 (step S5). ). Thereby, a part of the air in the air bag 13A moves to the air bag 13B, and the air bag 13B is pressurized.
- the CPU 40 outputs a control signal to the drive circuit 27B to adjust the pressure P1 in the air bladder 13B to a reduced pressure (step S9).
- the amount of pressure reduction adjustment here is preferably about 5.5 mmHg / sec.
- the pressure is adjusted so that the pressure P1 is within a range of 50 to 150 mmHg, which is a pressure suitable for pulse wave measurement.
- the pressure P2 of the air bladder 13A is maintained at a pressure higher than at least the maximum blood pressure, which is the maximum compression pressure.
- the air bag 13A drives the artery on the distal side of the measurement site. This state is referred to as a blood-feeding state.
- the blood-feeding state refers to a state where the pressure P2 in the air bag 13A is pressing the peripheral side of the measurement site with a pressure that is at least higher than the systolic blood pressure.
- the CPU 40 measures the pulse wave by measuring the pressure P1 in the air bag 13B based on the pressure signal from the pressure sensor 23B, and extracts the feature point (step S11).
- step S ⁇ b> 11 a pulse wave 1 that is a pulse wave during blood driving is measured, and from the pulse wave 1, feature points A ⁇ b> 1 and B ⁇ b> 1 are extracted.
- the pulse wave measured in step S11 is referred to as pulse wave 1
- the extracted feature point is referred to as feature point 1.
- the CPU 40 When the feature point 1 is not extracted from the pulse wave 1 in step S11 (NO in step S13), the CPU 40 performs the following control.
- the CPU 40 outputs a control signal to the drive circuit 27A to further reduce the pressure P2 in the air bladder 13A (step S15).
- the air valve 22A may be opened.
- the CPU 40 adjusts the pressure so as to be, for example, about 55 mmHg so as to be lower than the maximum blood pressure if the pressure P2 is small.
- the air bag 13A is in a state in which no blood is pumped through the artery, or in a state of blood pumping at a pressure lower than that at the time of step S11.
- These states are referred to as non-blood-feeding states.
- the non-blood-feeding state refers to a state in which the pressure P2 in the air bag 13A is pressing the distal side of the measurement site with a pressure lower than at least the maximum blood pressure.
- the pressure P2 of the air bladder 13A decreases until it becomes lower than the maximum blood pressure in the section of step S15.
- step S17 the CPU 40 measures the pulse wave by measuring the pressure P1 in the air bag 13B based on the pressure signal from the pressure sensor 23B in the same manner as in step S11. Is extracted (step S17).
- the pulse wave 2 that is a pulse wave during non-feeding is measured, and feature points A ⁇ b> 2 and B ⁇ b> 2 are extracted from the pulse wave 2.
- the pulse wave measured in step S17 is referred to as pulse wave 2
- the extracted feature point is referred to as feature point 2.
- the CPU 40 may extract only the feature points not extracted in step S11 from the pulse wave 2.
- step S11 it is conceivable that point B1 is not extracted from pulse wave 1.
- the CPU 40 may extract only the B2 point as the feature point 2 from the pulse wave 2 in step S17. Steps S15 and S17 are skipped when all feature points 1 are extracted in step S11 (YES in step S13).
- the CPU 40 extracts the feature point 1 from the feature point 1 when the feature point 1 is extracted at step S11, and the feature point 2 when the feature point 2 is extracted at step S17 without extracting the feature point 1 at the step S11.
- the above-mentioned index is calculated and the degree of arteriosclerosis is determined (step S19-1).
- the CPU 40 outputs a control signal to the drive circuits 27A and 27B to open the air valves 22A and 20B, thereby releasing the pressure of the air bags 13A and 13B to atmospheric pressure (step S21).
- the pressures P1 and P2 in the air bags 13A and 13B are rapidly decreased to the atmospheric pressure in the section of step S21.
- the CPU 40 displays the measurement result such as the calculated maximum blood pressure (SYS) and minimum blood pressure (DIA), the measured pulse wave, the determination result of the degree of arteriosclerosis, and the like on the display unit 4 provided on the base 2. Is performed, and the measurement result is displayed (step S23).
- the measurement result such as the calculated maximum blood pressure (SYS) and minimum blood pressure (DIA), the measured pulse wave, the determination result of the degree of arteriosclerosis, and the like.
- the internal pressure P1 of the air bag 13B may be further reduced. That is, the decompression adjustment may be repeated until all feature points are extracted. Further, at that time, when the internal pressure P1 reaches a predetermined pressure, the measurement operation may be terminated, or the measurement operation may be terminated when the pressure reduction is adjusted a predetermined number of times.
- the pulse wave pulse wave 2 in the non-blood-feeding state is measured.
- the feature point (point B1) corresponding to the peak of the reflected wave is not extracted.
- the pulse wave is measured with the peripheral side in a non-blood-feeding state, so that it is particularly easy to extract feature points (point B2) corresponding to the peak of the reflected wave. Therefore, the index can be calculated with high accuracy, and an index useful for determining the degree of arteriosclerosis can be obtained.
- FIG. 9 A second specific example of the operation of the measuring apparatus 1A will be described with reference to FIG.
- the second specific example is an example of a measurement operation when computation is performed using the second computation algorithm.
- the operation shown in FIG. 9 is also started when a subject or the like presses a measurement button provided on the operation unit 3 of the base 2.
- This operation is realized by the CPU 40 reading a program stored in the memory 41 and controlling each unit shown in FIG.
- the same step numbers are assigned to the measurement operations similar to the measurement operations according to the first specific example shown in the flowchart of FIG. Therefore, S3 to S17 attached to the time axis in FIGS. 8A and 8B also correspond to the respective measurement operations shown in FIG.
- pulse wave 1 is measured in the blood-feeding state in step S ⁇ b> 11, feature point 1 is extracted from pulse wave 1, and then in step S ⁇ b> 15.
- the operation is performed, and the pressure P1 in the air bag 13B is further reduced.
- step S17 the pulse wave 2 is measured in the non-blood-feeding state, and the feature point 2 is extracted from the pulse wave 2.
- the CPU 40 detects the feature point 1 extracted in step S11 and the feature extracted in step S17.
- An average value with respect to the point 2 is calculated, and the above-described index is calculated from the average value to determine the degree of arteriosclerosis (step S19-2). That is, when calculating Tpp as an index, the CPU 40 calculates the average of the generation time of point A1 extracted from pulse wave 1 in step S11 and the generation time of point A2 extracted from pulse wave 2 in step S17, and step The average of the generation time of the B1 point extracted from the pulse wave 1 in S11 and the generation time of the B2 point extracted from the pulse wave 2 in step S17 is calculated, and Tpp is obtained by the difference between these.
- the CPU 40 calculates the average of the amplitude of the point A1 extracted from the pulse wave 1 in step S11 and the amplitude of the point A2 extracted from the pulse wave 2 in step S17, and the pulse wave in step S11.
- the average of the amplitude of the B1 point extracted from 1 and the amplitude of the B2 point extracted from the pulse wave 2 in step S17 is calculated, and AI is obtained by these ratios. Thereafter, the operations of steps S21 and S23 are performed.
- the feature points (A1 point, B1) extracted from the pulse wave (pulse wave 1) measured in the blood-feeding state The index is calculated using the average of the point) and the feature points (A2 point, B2 point) extracted from the pulse wave (pulse wave 2) measured in the non-feeding state. Therefore, a more accurate index can be calculated, and a useful index can be obtained by determining the degree of arteriosclerosis.
- FIG. 10 A third specific example of the operation of the measuring apparatus 1A will be described with reference to FIG.
- the third specific example is an example of a measurement operation when computation is performed using the third computation algorithm.
- the operation shown in FIG. 10 is also started when the subject or the like presses a measurement button provided on the operation unit 3 of the base 2.
- This operation is realized by the CPU 40 reading a program stored in the memory 41 and controlling each unit shown in FIG. 10, the same step numbers are used for the measurement operation according to the first specific example shown in the flowchart of FIG. 7 and the measurement operation similar to the measurement operation according to the second specific example shown in the flowchart of FIG. Is attached. Therefore, S3 to S17 attached to the time axis in FIGS. 8A and 8B also correspond to the measurement operations shown in FIG.
- pulse wave 1 is measured in the blood-feeding state in step S ⁇ b> 11, and feature point 1 is extracted from pulse wave 1, and then in step S ⁇ b> 15.
- the operation is performed to further reduce the pressure P1 in the air bag 13B.
- step S17 the pulse wave 2 is measured in the non-blood-feeding state, and the feature point 2 is extracted from the pulse wave 2.
- the CPU 40 extracts the feature point 1 extracted in step S11 and the step S17.
- the feature point 2 is compared, and it is determined whether or not these differences are greater than or equal to an allowable value (step S18A).
- the allowable value here is, for example, about 10 ms, and is stored in the CPU 40 in advance.
- registration or updating may be performed by a predetermined operation (for example, an operation method known only to a user designated in advance such as a doctor).
- the generation time at the point A1 and the generation time at the point A2 are considered to be substantially the same.
- the generation time at point B1 and the generation time at point B2 are considered to be substantially the same. For this reason, when the difference between the generation times is equal to or greater than the allowable value, it is considered that any one of the pulse waves is not correctly measured or the feature point is not correctly extracted.
- step S18A determines whether feature point 1 and feature point 2 is greater than or equal to the allowable value, or if either feature point 1 or feature point 2 is not extracted (step S18A). NO)
- the CPU 40 performs an operation for displaying on the display unit 4 a screen for notifying remeasurement. Then, after notifying the remeasurement (step S18B), the CPU 40 returns the measurement operation to step S5 and opens the 2-port valve 51 again.
- step S11 If feature point 1 is extracted in step S11, feature point 2 is extracted in step S17, and the difference between them is within the above-described allowable value (YES in step S18A), the CPU 40 Similar to the measurement operation according to the specific example, the average value of the feature point 1 extracted in step S11 and the feature point 2 extracted in step S17 is calculated, and the above-described index is calculated from the average value. Then, the degree of arteriosclerosis is determined (step S19-2). Alternatively, the above-described index may be calculated using either one of the feature point 1 extracted in step S11 and the feature point 2 extracted in step S17. The above-described index may be calculated using the feature point 1 extracted from the pulse wave 1 measured in step (1).
- the measurement operation according to the third specific example shown in FIG. 10 is performed by the measurement apparatus 1A, so that feature points (A1 point, B1 point) extracted from the pulse wave (pulse wave 1) measured in the blood-feeding state ) And the feature points (points A2 and B2) extracted from the pulse wave (pulse wave 2) measured in the non-starvation state are equal to or greater than an allowable value, remeasurement is performed. Therefore, a more accurate index can be calculated, and a useful index can be obtained by determining the degree of arteriosclerosis.
- the fourth specific example is an example of a measurement operation when an operation is performed using the fourth operation algorithm.
- the operation shown in FIG. 11 is also started when a subject or the like presses a measurement button provided on the operation unit 3 of the base 2.
- This operation is realized by the CPU 40 reading a program stored in the memory 41 and controlling each unit shown in FIG. 11, the measurement operation according to the first specific example shown in the flowchart of FIG. 7, the measurement operation according to the second specific example shown in the flowchart of FIG. 9, and the first measurement example shown in the flowchart of FIG.
- the same step numbers are assigned to the measurement operations similar to the measurement operation according to the third example. For this reason, S3 to S17 attached to the time axis in FIGS. 8A and 8B also correspond to the respective measurement operations shown in FIG.
- step S18A if it is determined in step S18A that the difference between feature point 1 and feature point 2 is greater than or equal to the allowable value, or feature point 1 and the feature. If neither of the points 2 is extracted (NO in step S18A), the CPU 40 performs a process for displaying on the display unit 4 a screen informing that the reliability of the determination result is low. Then, the CPU 40 notifies the fact (step S18C) and proceeds with the measurement operation. Similar to the measurement operation according to the second specific example and the measurement operation according to the third specific example, the CPU 40 has the feature point 1 extracted in step S11 and the feature point 2 extracted in step S17. Is calculated, and the above-mentioned index is calculated from the average value to determine the degree of arteriosclerosis (step S19-2).
- the characteristic points (A1 point, B1) extracted from the pulse wave (pulse wave 1) measured in the blood-feeding state Point) and a feature point (point A2, point B2) extracted from a pulse wave (pulse wave 2) measured in a non-starvation state is not less than the allowable value, the reliability is low. Is notified, and an index is calculated using these feature points. Therefore, for example, an index having lower reliability than the index obtained by the measurement operation according to the third specific example is calculated, but the remeasurement is not performed, and the index is calculated by one measurement operation. Therefore, the time required for determining the degree of arteriosclerosis can be shortened.
- the air bag 13A and the air bag 13B are connected via the two-port valve 51.
- the air in the air bag 13A is moved to the air bag 13B by opening the 2-port valve 51 in step S5.
- the 2-port valve 51 is opened, the air in the air bladder 13A rapidly flows into the air bladder 13B in order to eliminate the pressure difference.
- the time required for air to flow into the air bag 13B by the pump can be greatly shortened, and the entire measurement time can be shortened. Accordingly, the burden on the subject can be reduced.
- the length of time required for the measurement may cause the artery to be compressed for a long time, which may stimulate the sympathetic nerves and damage the blood vessel characteristics.
- the time during which the artery is compressed can be shortened. Furthermore, although the time required for measurement becomes longer, the possibility of occurrence of body movement increases, but by reducing the time required for measurement, the possibility of occurrence of body movement can also be suppressed. Thereby, the measurement accuracy of blood pressure information such as a pulse wave can be improved. In addition, the accuracy of the index of arteriosclerosis obtained from the measurement result can be improved.
- a mechanism for flowing air into the air bag 13B may not be mounted. Thereby, it can contribute also to size reduction, weight reduction, and price reduction of an apparatus.
- the above-described measurement operation can be performed not only by the measurement apparatus having the configuration as shown in FIG. 6, but also by the measurement apparatus having a normal configuration as shown in FIG. Therefore, as a second embodiment, a measurement operation in the measurement apparatus 1B having the configuration shown in FIG. 12 will be described.
- measurement apparatus 1B includes an air pump 21B in air system 30B in addition to 2-port valve 51 and drive circuit 53 in the configuration of measurement apparatus 1A shown in FIG. Includes a driving circuit 26B for driving the.
- the air pump 21B is driven by a drive circuit 26B that has received a command from the CPU 40, and sends compressed gas into the air bag 13B.
- the first specific example represents a measurement operation when an operation is performed using the first operation algorithm described in the first embodiment.
- the operation shown in FIG. 13 is started when a subject or the like presses a measurement button provided on the operation unit 3 of the base 2.
- This operation is realized by the CPU 40 reading a program stored in the memory 41 and controlling each unit shown in FIG. 14A shows the time change of the pressure P1 in the air bag 13B, and FIG. 14B shows the time change of the pressure P2 in the air bag 13A.
- S103 to S121 attached to the time axis in FIGS. 14A and 14B correspond to the respective measurement operations in the measurement apparatus 1B.
- step S101 the CPU 40 initializes each unit.
- step S103 the CPU 40 outputs a control signal to the air system 20B to pressurize the air bladder 13B until a predetermined pressure is reached.
- the pressure P1 in the air bladder 13B increases in the section of step S103.
- the pressure P1 is maintained.
- step S103 the pressure P1 is increased within a range of 50 to 150 mmHg, which is a pressure suitable for pulse wave measurement.
- step S105 the CPU 40 outputs a control signal to the air system 20A to pressurize the pressure P2 of the air bag 13A until the air pressure reaches the predetermined pressure, and the air bag 13A is used at the distal side of the measurement site. Is pressed (step S105).
- the pressure P2 in the air bladder 13A increases in the section of step S105.
- the CPU 40 pressurizes until the pressure P2 becomes higher than a general systolic blood pressure value.
- pressurization is performed until the pressure reaches the maximum blood pressure value +40 mmHg.
- the air bag 13A drives the artery.
- the CPU 40 outputs a control signal to the air system 20A and starts to reduce the pressure P2 in the air bag 13A (step S107).
- the amount of pressure reduction adjustment here is preferably about 4 mmHg / sec, and the pressure is gradually reduced.
- the CPU 40 detects the pressure sensor 23B until the pressure P2 in the air bag 13A reaches the maximum blood pressure from the maximum pressure (YES in step S111), that is, in the blood-feeding state.
- the pulse wave is measured by measuring the pressure P1 in the air bag 13B based on the pressure signal from and the characteristic points are extracted (step S109).
- step S109 pulse waves are measured and feature points are extracted.
- a pulse wave 1 that is a pulse wave during blood driving is measured, and a feature point A ⁇ b> 1 and a point B ⁇ b> 1 are extracted from the pulse wave 1.
- the pulse wave measured in step S109 is referred to as pulse wave 1
- the extracted feature point is referred to as feature point 1.
- step S113 When the characteristic point 1 is not extracted from the pulse wave 1 until the pressure P2 in the air bag 13A reaches the maximum blood pressure value in the process of reducing the pressure P2 in the air bag 13A (NO in step S113).
- the CPU 40 detects the pressure signal from the pressure sensor 23B.
- the pulse wave is measured by measuring the pressure P1 in the air bag 13B based on the above, and the feature point is extracted (step S115).
- step S115 pulse waves are measured and feature points are extracted.
- FIG. 14A and 14B In the example of FIG.
- step S ⁇ b> 115 the pulse wave 2 that is a pulse wave during non-feeding is measured, and the feature points A ⁇ b> 2 and B ⁇ b> 2 are extracted from the pulse wave 2.
- the pulse wave measured in step S115 is referred to as pulse wave 2
- the extracted feature point is referred to as feature point 2.
- Step S115 is skipped when all feature points 1 are extracted in step S109 (YES in step S113).
- the CPU 40 measures the blood pressure together with the measurement of the pulse wave in the depressurization process from around the time when the internal pressure of the air bag 13A reaches the maximum blood pressure value after step S109.
- a measurement method performed by a normal blood pressure monitor can be employed. Specifically, the CPU 40 calculates the systolic blood pressure (SYS) and the diastolic blood pressure (DIA) based on the pressure signal obtained from the pressure sensor 23A.
- the CPU 40 completes the blood pressure measurement when the maximum blood pressure value and the minimum blood pressure value are calculated, or when the internal pressure of the air bag 13A becomes lower than the minimum blood pressure value (step S117).
- the CPU 40 extracts the feature point 1 from the feature point 1 when the feature point 1 is extracted at step S109, and the feature point 2 when the feature point 2 is extracted at step S115 without extracting the feature point 1 at the step S109.
- the above-described index is calculated and the degree of arteriosclerosis is determined (step S119).
- the CPU 40 outputs a control signal to the drive circuits 27A and 27B to open the air valves 22A and 20B, thereby releasing the pressure of the air bags 13A and 13B to atmospheric pressure (step S121).
- the pressures P1 and P2 in the air bags 13A and 13B are rapidly decreased to the atmospheric pressure in the section of step S121.
- the CPU 40 displays the measurement result such as the calculated maximum blood pressure (SYS) and minimum blood pressure (DIA), the measured pulse wave, the determination result of the degree of arteriosclerosis, and the like on the display unit 4 provided on the base 2. Is performed, and the measurement result is displayed (step S123).
- the measurement result such as the calculated maximum blood pressure (SYS) and minimum blood pressure (DIA), the measured pulse wave, the determination result of the degree of arteriosclerosis, and the like.
- the measuring apparatus 1B By realizing the measurement operation according to the first specific example shown in FIG. 13 by the measuring apparatus 1B, it is difficult to see the feature points, and the feature points are extracted from the pulse wave 1 of FIG. If not, the pulse wave (pulse wave 2) in the non-blood-feeding state is measured. In particular, in a state where the peripheral side is driven, most of the reflected wave from the periphery is cut off, so there may be a case where the feature point (point B1) corresponding to the peak of the reflected wave is not extracted. However, in the measurement apparatus 1B, in this case, the pulse wave is measured with the peripheral side being in a non-blood-driven state, so that it is particularly easy to extract feature points (B2 points) corresponding to the peak of the reflected wave. Therefore, the index can be calculated with high accuracy, and an index useful for determining the degree of arteriosclerosis can be obtained.
- FIG. 15 A second specific example of the operation of the measuring apparatus 1B will be described with reference to FIG.
- the second specific example represents a measurement operation when an operation is performed using the second operation algorithm described in the first embodiment.
- the operation shown in FIG. 15 is also started when the subject or the like presses a measurement button provided on the operation unit 3 of the base 2.
- This operation is realized by the CPU 40 reading a program stored in the memory 41 and controlling each unit shown in FIG.
- the same step numbers are assigned to the measurement operations similar to the measurement operations according to the first specific example shown in the flowchart of FIG. 13.
- step S107 when the pressure P2 in the air bladder 13A is started to be reduced in step S107, the CPU 40 detects the pressure signal from the pressure sensor 23B in the pressure reduction process.
- the pulse wave is measured by measuring the pressure P1 in the air bag 13B based on (Step S108).
- the CPU 40 measures the pressure P2 in the air bladder 13A based on the pressure signal obtained from the pressure sensor 23A, and the measured pulse wave together with the pressure P2 in the air bladder 13A at the time of measurement is stored in a predetermined memory 41. Store in the area.
- step S108 corresponds to the section of steps S109 and S115.
- the CPU 40 acquires a systolic blood pressure (SYS).
- the systolic blood pressure (SYS) may be obtained by calculating based on a pressure signal obtained from the pressure sensor 23A, or obtained by receiving input from a predetermined button or the like provided on the operation unit 3. Alternatively, it may be stored in advance in the memory 41 as a general value and acquired from the memory 41.
- the CPU 40 compares the pressure P2 in the air bag 13A at the time of measurement stored in association with the measured pulse wave with the acquired systolic blood pressure, so that the measured pulse wave is measured in the state of blood pumping. It is discriminated whether it has been measured or measured in a non-congestive state.
- the systolic blood pressure is used as a threshold value for determining whether the state is a blood-feeding state or a non-feeding state.
- a case where the pressure P2 in the air bag 13A is lower than the minimum blood pressure (DIA) lower than the maximum blood pressure may be set as the non-starting state.
- the minimum blood pressure is also used as a threshold value and compared with the minimum blood pressure, so that it is determined that the measured pulse wave is measured in a non-congested state.
- the CPU 40 extracts feature points from the measured pulse wave (step S118), calculates the above-described index from the feature points, and determines the degree of arteriosclerosis (step S119).
- the CPU 40 extracts feature points from the measured pulse wave (step S118), calculates the above-described index from the feature points, and determines the degree of arteriosclerosis (step S119).
- an index is calculated using them. May be.
- the index may be calculated using the average of each of the point A2 and the point B2 that are feature points extracted from the wave 2.
- the characteristic points A1 and B1 extracted from the pulse wave 1 measured in the blood-feeding state and the pulse wave 2 measured in the non-blood-feeding state When the difference between the A2 point and the B2 point that are the feature points extracted from is within an allowable value, the index may be calculated using any one of the feature points or an average value thereof. Thereafter, the operations in steps S121 and S123 are performed.
- the air bag 13A is set so that the peripheral side of the measurement site is in a blood-feeding state or a non-blood-feeding state.
- the pressure P2 is reduced by a constant pressure reduction amount of about 4 mmHg / sec, for example, and the pulse wave measured in the process is compared with the pressure P2 at the time of measurement and the blood pressure value, so It is determined whether it is a wave (pulse wave 1) or a pulse wave (pulse wave 2) that is not being driven.
- a highly accurate index can be calculated without requiring complicated control, and a useful index can be obtained by determining the degree of arteriosclerosis.
- a useful index can be obtained by determining the degree of arteriosclerosis.
- the time for adjusting the pressure P2 is not necessary, the time required for the measurement operation can be shortened.
- the measurement operation as shown in FIG. 16 may be performed by the measurement apparatus 1B.
- a modification of the second specific example of the measurement operation represents a modification of the measurement operation when an operation is performed using the first calculation algorithm described in the second embodiment.
- the operation shown in FIG. 16 is also started when a subject or the like presses a measurement button provided on the operation unit 3 of the base 2.
- This operation is realized by the CPU 40 reading a program stored in the memory 41 and controlling each unit shown in FIG.
- FIG. 17A shows the time change of the pressure P1 in the air bag 13B
- FIG. 17B shows the time change of the pressure P2 in the air bag 13A.
- S103 to S121 attached to the time axis in FIGS. 17A and 17B coincide with the respective operations of the measurement operation in the measurement apparatus 1B.
- the pressure P1 in the air bladder 13B is in the range of 50 to 150 mmHg, which is a pressure suitable for pulse wave measurement.
- the pressure signal from the pressure sensor 23B is in a state before the air bag 13A compresses the distal side of the measurement site in step S105, that is, in a non-blood-feeding state.
- the pulse wave is measured by measuring the pressure P1 in the air bag 13B based on (Step S104).
- the pulse wave measured in step S105 is a pulse wave during non-feeding as described above. In the description, the measured pulse wave is assumed to be pulse wave 2.
- the pulse wave 2 is measured in the section of step S104.
- the pressure P2 in the air bladder 13A is maintained at the initial pressure without being pressurized in the section of step S104.
- the CPU 40 outputs a control signal to the air system 20A to pressurize the pressure P2 of the air bladder 13A until it reaches a predetermined pressure, and compresses the distal side of the measurement site with the air bladder 13A (step S105).
- the predetermined pressure is preferably a maximum blood pressure value +40 mmHg.
- the CPU 40 outputs a control signal to the air system 20A and starts reducing the pressure P2 in the air bag 13A (step S107).
- the amount of pressure reduction adjustment here is preferably about 4 mmHg / sec.
- the CPU 40 measures the pulse wave by extracting the characteristic point by measuring the pressure P1 in the air bag 13B based on the pressure signal from the pressure sensor 23B (step S108 ′). ). At that time, the CPU 40 measures the pressure P2 in the air bladder 13A based on the pressure signal obtained from the pressure sensor 23A, and the measured pulse wave together with the pressure P2 in the air bladder 13A at the time of measurement is stored in a predetermined memory 41. Store in the area. Note that the measurement operation in step S108 'has a main purpose of measuring the pulse wave 1 in the blood-feeding state since the pulse wave 2 in the non-blood-driven state is measured in step S104.
- step S108 ' is performed in a shorter section than in step S108, preferably until the pressure P2 in the air bag 13A reaches the maximum blood pressure from the maximum pressure.
- the pulse wave is measured in the section of step S108 '.
- the section of step S108 ' corresponds to the section of step S109 in the examples of FIGS. 14A and 14B.
- step S108 described above corresponds to the sections of steps S109 and S115 in the examples of FIGS. 14A and 14B. That is, as also shown in FIGS. 14 and 17, the measurement operation in step S108 'is performed in a shorter section than the measurement operation in step S108.
- the CPU 40 performs only blood pressure measurement. Therefore, in the decompression process after step S108 ', the CPU 40 increases the decompression adjustment amount.
- the reduced pressure adjustment amount is 4 mmHg / sec or more.
- step S118 feature points are extracted from the measured pulse wave (step S118), the above-mentioned index is calculated from the feature points, and the degree of arteriosclerosis is determined (step S119).
- the pulse wave 2 in the non-blood-feeding state is measured in step S104. Therefore, in step S118 ', the CPU 40 may extract the pulse wave 1 measured in the blood-feeding state from the pulse waves measured in step S108'. Thereafter, the measurement operations in steps S119, S121, and S123 are performed.
- the pulse wave measurement in the air bag 13A is completed after the pulse wave measurement is completed in step S108 ′.
- the pressure reduction speed of the pressure P2 can be increased. Therefore, the time required for the measurement operation can be further shortened.
- a third specific example of the operation of the measuring apparatus 1B will be described with reference to FIG.
- the third specific example represents a measurement operation when calculation is performed using the fourth calculation algorithm described in the first embodiment.
- the operation shown in FIG. 18 is also started when a subject or the like presses a measurement button provided on the operation unit 3 of the base 2.
- This operation is realized by the CPU 40 reading a program stored in the memory 41 and controlling each unit shown in FIG. 18, the same step numbers are used for the measurement operation according to the first specific example shown in the flowchart of FIG. 13 and the measurement operation similar to the measurement operation according to the second specific example shown in the flowchart of FIG. Is attached.
- CPU 40 measures the pulse wave in the process of reducing the pressure P2 in air bag 13A in the same manner as in step S108, and measures the air at the time of measurement. It is stored in a predetermined area of the memory 41 together with the pressure P2 in the bag 13A. Then, the CPU 40 compares the pressure P2 at the time of measurement with the systolic blood pressure (SYS) and the diastolic blood pressure (DIA) in the same manner as in step S109, so that the measured pulse wave is measured in the state of blood transfusion. It is discriminated whether it is measured in a non-congestive state. Then, feature points are extracted from the measured pulse wave (step S118).
- SYS systolic blood pressure
- DIA diastolic blood pressure
- the CPU 40 has the feature point 1 extracted from the pulse wave measured in the blood-feeding state and the pulse wave measured in the non-blood-feeding state. Is compared with the feature point 2 extracted from the above, and it is determined whether or not these differences are equal to or larger than an allowable value (step S118-1). If it is determined in step S118-1 that the difference between feature point 1 and feature point 2 is greater than or equal to the allowable value (NO in step S118-1), CPU 40 determines the result of the determination in the same manner as in step S18C.
- the display unit 4 performs a process for displaying on the display unit 4 that the reliability is low, and notifies that fact (step S118-2). Then, the measurement operation is advanced, and the measurement according to the second specific example is performed. Similar to the operation, the index described above is calculated from the extracted feature points, and the degree of arteriosclerosis is determined.
- the feature points (A1 point, B1) extracted from the pulse wave (pulse wave 1) measured in the blood pumping state Point) and a feature point (point A2, point B2) extracted from a pulse wave (pulse wave 2) measured in a non-starvation state is not less than the allowable value, the reliability is low. Is notified, and an index is calculated using these feature points. Therefore, since the remeasurement is not performed and the index is calculated by one measurement operation, the time required for determining the degree of arteriosclerosis can be shortened.
- the air bag 13A is used both for blood pumping and for blood pressure value calculation.
- the blood pressure value is calculated based on the change in the internal pressure of the air bag 13A, and the pulse wave is measured based on the change in the internal pressure of the air bag 13B.
- the air bag 13A may be used only for blood driving, and the blood pressure value may be calculated based on the change in the internal pressure of the air bag 13B.
- the feature point derived from the reflected wave may be difficult to extract from the pulse wave (pulse wave 1) measured in a state where the peripheral side of the measurement site is driven and the influence of the reflected wave is suppressed.
- the pulse wave (pulse wave 2) is measured in a non-blood-feeding state where the peripheral side is not driven, and features are obtained from the pulse wave in the non-blood-driven state.
- a point is to be extracted.
- a pulse wave waveform in which a reflection wave from the periphery such as the palm is combined with the ejection wave from the heart is measured.
- the length from the upper arm, which is the measurement site, to the palm varies depending on the subject.
- the length from the upper arm that is the measurement site to the palm affects the positional relationship between the ejection wave and the reflected wave, that is, the waveform of the measured pulse wave that is a composite wave. Thereby, the accuracy of the obtained index is affected, and it may affect the determination of the degree of arteriosclerosis.
- One method for suppressing this effect is to input the length from the upper arm, which is the measurement site, to the palm, where the large reflection occurs, by using the operation unit 3 or the like, and the pulse wave measured using the length. There is a method of correcting the above. As another method, there is a method of fixing the length from the measurement site to the reflection position to a predetermined length.
- the measuring apparatus 1C fixes the length from the measurement site to the reflection position to a predetermined length, and the ejection wave from the periphery that is defined by the measurement site from the measurement site.
- a cuff attached to the periphery is provided separately from the measurement air bag attached to the measurement site.
- the measuring apparatus 1C includes an arm band 8 wound around, for example, a wrist on the distal side of the measurement site.
- the armband 8 includes an air bag 13C as shown in FIG. 19B.
- the arm band 8 is attached to the wrist having a predetermined length on the distal side from the arm band 9 including the air bag 13A and the air bag 13B.
- the mounting position may be determined by a measurer.
- a member that can specify the mounting position of the armband 8 such as a belt having the predetermined length connecting the armband 8 and the armband 9 is included.
- the air bag 13C presses the wrist by expanding.
- measuring device 1C includes an air system 20C connected to air bag 13C via an air tube in addition to the configuration of measuring device 1A shown in FIG.
- the air system 20C includes an air pump 21C, an air valve 22C, and a pressure sensor 23C.
- the air pump 21C is driven by a drive circuit 26C that has received a command from the CPU 40, and sends compressed gas into the air bag 13C. Thereby, the air bag 13C is pressurized.
- the open / close state of the air valve 22C is controlled by a drive circuit 27C that receives a command from the CPU 40.
- a drive circuit 27C that receives a command from the CPU 40.
- the pressure sensor 23C detects the pressure in the air bladder 13C and outputs a signal corresponding to the detected value to the amplifier 28C.
- the amplifier 28C amplifies the signal output from the pressure sensor 23C and outputs the amplified signal to the converter 29C.
- the converter 29C digitizes the analog signal output from the amplifier 28C and outputs it to the CPU 40.
- the CPU 40 controls the air systems 20A, 20B, 20C and the drive circuit 53 based on a command input to the operation unit 3 provided on the base body 2 of the measuring apparatus.
- the measuring device 1C preferably includes a device for inputting the length of the artery from the air bag 13B to the air bag 13C.
- the length of the artery from the air bag 13B to the air bag 13C is simply the length of the arm from the air bag 13B to the air bag 13C, that is, the length of the arm between the arm band 8 and the arm band 9. Can do.
- the specific configuration of the device for inputting this length is not limited.
- a switch included in the operation unit 3 for inputting the length may be used. When the measurer inputs using the switch, the length is input.
- the arm band 8 and the arm band 9 may be connected by a belt and may be a mechanism for detecting a length provided on the belt. After the armband 8 and the armband 9 are mounted, the length of the arm between the armband 8 and the armband 9 is adjusted by the above mechanism by adjusting the length so that the belt does not loosen along the arm. Entered.
- the first specific example represents a measurement operation when an operation is performed using the first operation algorithm described in the first embodiment.
- the operation shown in FIG. 21 starts when a subject or the like presses a measurement button provided on the operation unit 3 of the base 2.
- This operation is realized by the CPU 40 reading a program stored in the memory 41 and controlling each unit shown in FIG. 22A shows the time change of the pressure P3 in the air bag 13C, FIG. 22B shows the time change of the pressure P1 in the air bag 13B, and FIG.
- the time change of the pressure P2 in the bag 13A is shown.
- S3 to S21 attached to the time axis in (A), (B), and (C) of FIG. 22 correspond to the respective operations of the measurement operation in the measurement apparatus 1C described later.
- measurement apparatus 1C operations similar to steps S1 to S13 in the first specific example of the measurement operation in measurement apparatus 1A are performed. Meanwhile, in the measuring apparatus 1C, as shown in FIG. 22A, the initial pressure of the pressure P3 in the air bladder 13C is maintained.
- the CPU 40 sets the pressure P2 of the air bladder 13A to be lower than the maximum blood pressure in step S15, for example, The pressure is adjusted to about 55 mmHg, and a control signal is output to the air system 20C to increase the pressure P3 in the air bag 13C to a predetermined pressure (step S16).
- the CPU 40 applies pressure so that the pressure P3 is at least higher than the maximum blood pressure, for example, the maximum blood pressure +40 mmHg.
- the air bag 13A does not drive the peripheral artery near the measurement site, and the air bag 13C drives the artery at the position of the arm band 8 attached to the position of a predetermined length from the measurement site. It will be in the state. After that, that is, in the state where the blood is not pumped by the predetermined length from the measurement site to the distal side, the CPU 40 measures the pressure P1 in the air bag 13B based on the pressure signal from the pressure sensor 23B in step S17. To measure pulse waves and extract feature points. Thereafter, the same measurement operation as that of the measurement apparatus 1A is performed.
- the same measurement can be performed for the measurement operation performed by the measurement apparatus 1C when the second calculation algorithm to the fourth calculation algorithm described in the first embodiment are performed.
- the measurement operations shown in these flowcharts are substantially the same as the measurement operations according to the second specific example to the fourth specific example of the measurement operation in the measurement apparatus 1A shown in FIGS.
- the pressure P3 in the air bag 13C is pressurized to be higher than at least the maximum blood pressure in step S16, and the air bag 13A is measured.
- the peripheral artery in the vicinity is not blood-driven, and the air bag 13C is in a state of blood-feeding the artery at the position of the arm band 8 attached to the position of a predetermined length from the measurement site.
- the measurement operation shown in FIG. 21 and FIG. 23 to FIG. 25 is realized by the measuring apparatus 1C, and the position where the ejection wave is reflected is adjusted when measuring the pulse wave (pulse wave 2) as a non-triggered state can do.
- the influence derived from the length from the waveform of the pulse wave measured in the non-pigmented state to the position where the ejection wave is reflected from the measurement site, which is different for each subject, can be suppressed. Therefore, the index can be calculated with higher accuracy, and an index useful for determining the degree of arteriosclerosis can be obtained.
- the upper arm is used as a measurement site, and an arm band including an air bag for blood transfusion is attached only to the wrist corresponding to a position of a predetermined length from the upper arm, but the measurement site is different. Then, a plurality of arm bands each including an air bag for blood transduction may be worn, for example, when a plurality of peripheral reflection positions are assumed. By doing so, the index can be calculated more accurately.
- the measuring device 1C includes an air bag 13C in addition to the configuration of the measuring device 1A.
- measuring device 1C may include air bag 13C in addition to the configuration of measuring device 1B.
- the pressure P2 in the air bag 13A is lower than the maximum blood pressure (NO in step S111), or when the pulse wave is measured in the pressurization process in step S104, the pressure P3 in the air bag 13C is set.
- the blood pressure is raised to at least higher than the maximum blood pressure, and is driven at a predetermined length from the measurement site.
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Abstract
Description
従来、動脈硬化度を判定する装置として、たとえば特開2000-316821号公報(以下、特許文献1)は、心臓から駆出された脈波の伝播する速度(以下、PWV:pulse wave velocity)を調べることによって動脈硬化度を判定する装置を開示している。動脈硬化が進むほどに脈波伝播速度は速くなるので、PWVは動脈硬化度を判定するための指標となる。PWVは、上腕および下肢などの少なくとも2箇所以上に脈波を測定するカフ等を装着して同時に脈波を測定し、それぞれの箇所での脈波の出現時間差と、脈波を測定するカフ等を装着した2点間の動脈の長さとから算出される。PWVは測定部位によって値が異なる。代表的なPWVとしては、測定部位が上腕と足首とである場合のbaPWV、頚動脈と大腿動脈とである場合のcfPWVが挙げられる。
図1を参照して、第1の実施の形態にかかる血圧情報測定装置(以下、測定装置と略する)1Aは、基体2と、基体2に接続され、測定部位である上腕に装着される腕帯9とを含み、これらがエアチューブ10で接続されている。基体2の正面には、測定結果を含む各種の情報を表示するための表示部4および測定装置1Aに対して各種の指示を与えるために操作される操作部3が配される。操作部3は電源をON/OFFするために操作されるスイッチ31、および測定の開始を指示するために操作されるスイッチ32を含む。
測定装置1Bの概観は、図1に示された測定装置1Aの概観と同様である。図12を参照して、測定装置1Bは、図6に示された測定装置1Aの構成のうち、2ポート弁51および駆動回路53に加えて、エア系30Bにエアポンプ21Bが含まれ、エアポンプ21Bを駆動するための駆動回路26Bを含む。エアポンプ21Bは、CPU40からの指令を受けた駆動回路26Bによって駆動されて、空気袋13B内に圧縮気体を送り込む。
測定部位の末梢側を駆血して反射波の影響を抑えた状態で測定された脈波(脈波1)からは、特に、反射波に由来する特徴点が抽出されにくい場合があるために、第1の実施の形態、および第2の実施の形態においては、末梢側を駆血しない非駆血状態で脈波(脈波2)を測定し、非駆血状態での脈波から特徴点を抽出するものとしている。その場合、心臓からの駆出波に掌部などの末梢からの反射波が合成された脈波波形が測定される。しかしながら、測定部位である上腕から掌までの長さは被験者によって異なる。測定部位である上腕から掌までの長さは、駆出波と反射波との位置関係、つまり合成波である測定される脈波の波形に影響する。これにより、得られる指標の精度が影響を受け、動脈硬化度の判定にも影響することもある。
Claims (8)
- 第1の流体袋(13B)および第2の流体袋(13A)と、
前記第1の流体袋および前記第2の流体袋のそれぞれの内圧を測定するための第1のセンサ(23B)および第2のセンサ(23A)と、
前記第2の流体袋の内圧を調整するための第1の調整部(21A,22A,26A,27A)と、
動脈硬化度を判定するための指標を算出する演算、および前記第1の調整部での調整を制御するための制御部(40)とを備え、
前記制御部は、
前記第1の流体袋が測定部位に巻き付けられ、前記第2の流体袋が前記第1の流体袋よりも末梢側に巻き付けられ、前記第2の流体袋が最高血圧よりも高い内圧で、前記第1の流体袋の巻き付けられている前記測定部位の末梢側を圧迫している、第1の状態での、前記第1の流体袋の内圧変化に基づいて前記測定部位の第1の脈波を検出するための演算と、
前記第1の流体袋が測定部位に巻き付けられ、前記第2の流体袋が前記第1の流体袋よりも末梢側に巻き付けられ、前記第2の流体袋が少なくとも最高血圧よりも低い内圧で、前記第1の流体袋の巻き付けられている前記測定部位の末梢側を圧迫している、第2の状態での、前記第1の流体袋の内圧変化に基づいて第2の脈波を検出するための演算と、
前記第1の脈波から抽出される第1の特徴点と、前記第2の脈波から抽出される第2の特徴点とのうちの少なくとも一方の特徴点を用いて前記指標を算出するための演算とを行なう、血圧情報測定装置。 - 第1の流体袋(13B)および第2の流体袋(13A)と、
前記第1の流体袋および前記第2の流体袋のそれぞれの内圧を測定するための第1のセンサ(23B)および第2のセンサ(23A)と、
前記第2の流体袋の内圧を調整するための第1の調整部(21A,22A,26A,27A)と、
動脈硬化度を判定するための指標を算出する演算、および前記第1の調整部での調整を制御するための制御部(40)とを備え、
前記制御部は、
前記第1の流体袋が測定部位に巻き付けられ、前記第2の流体袋が前記第1の流体袋よりも末梢側に巻き付けられ、前記第2の流体袋が、前記第1の流体袋の巻き付けられている前記測定部位の末梢側を圧迫している状態での、前記第1の流体袋の内圧変化に基づいて前記測定部位の脈波を検出するための演算と、
前記脈波が検出された際の前記第2の流体袋の内圧と最高血圧とを比較することで、前記検出された脈波が、前記第2の流体袋の内圧が最高血圧よりも高い圧力で前記測定部位の末梢側を圧迫している第1の状態のときに検出された前記第1の脈波であるか、前記第2の流体袋の内圧が少なくとも最高血圧よりも低い圧力で前記測定部位の末梢側を圧迫している第2の状態のときに検出された前記第2の脈波であるか、を判別するための演算と、
前記第1の脈波から抽出される第1の特徴点と、前記第2の脈波から抽出される第2の特徴点とのうちの少なくとも一方の特徴点を用いて前記指標を算出するための演算とを行なう、血圧情報測定装置。 - 前記制御部は、
前記第2の流体袋の内圧を少なくとも最高血圧よりも高くなるまで加圧させ、前記第1の状態とするための前記第1の調整部の制御と、
前記加圧の後、前記第2の流体袋の内圧を減圧させるための前記第1の調整部の制御と、
前記第1の状態のときに検出された前記第1の脈波から前記第1の特徴点が抽出されなかった場合に、前記減圧過程の前記第2の状態のときに検出された前記第2の脈波から前記第2の特徴点を抽出し、前記第2の特徴点を用いて前記指標を算出するための演算とを行なう、請求の範囲第1項または第2項に記載の血圧情報測定装置。 - 前記指標は、
駆出波の立ち上がりの出現時間と反射波の立ち上がりの出現時間との時間差であるTr(Traveling time to reflected wave)と、
駆出波のピークの出現時間と反射波のピークの出現時間との時間差であるTppと、
駆出波のピークでの振幅と反射波のピークでの振幅の割合であるAI(Augmentation Index)とのうちの少なくとも1つを含む、請求の範囲第1項または第2項に記載の血圧情報測定装置。 - 第3の流体袋(13C)と、
前記第3の流体袋の内圧を調整するための第2の調整部(21C,22C,26C,27C)とをさらに含み、
前記制御部は、前記第2の状態のときに、前記測定部位から末梢側に所定長さの位置に巻き付けられる前記第3の流体袋の内圧を少なくとも最高血圧よりも高い圧力として、前記測定部位から末梢側に前記所定長さの位置を圧迫するよう、前記第2の調整部を制御する、請求の範囲第1項または第2項に記載の血圧情報測定装置。 - 前記測定部位に巻き付けられた前記第1の流体袋から、前記測定部位から末梢側に巻き付けられた前記第3の流体袋までの、前記測定部位に連続する生体の長さを入力するための入力部(3)をさらに備える、請求の範囲第5項に記載の血圧情報測定装置。
- 前記測定部位としての上腕から、駆出波の反射位置としての掌までの長さを入力するための入力部(3)をさらに備える請求の範囲第1項または第2項に記載の血圧情報測定装置。
- 血圧情報測定装置(1)で測定された脈波より動脈硬化度を判定するための指標を取得する方法であって、
前記血圧情報測定装置は、
第1の流体袋(13B)および第2の流体袋(13A)と、
前記第1の流体袋および前記第2の流体袋のそれぞれの内圧を測定するための第1のセンサ(23B)および第2のセンサ(23A)と、
前記第2の流体袋の内圧を調整するための第1の調整部(21A,22A,26A,27A)とを含み、
前記第2の流体袋の内圧を、最高血圧よりも高い圧力にするよう制御するステップ(S5~S9)と、
前記第1の流体袋が測定部位に巻き付けられ、前記第2の流体袋が前記第1の流体袋よりも末梢側に巻き付けられ、前記第2の流体袋が最高血圧よりも高い内圧で、前記第1の流体袋の巻き付けられている前記測定部位の末梢側を圧迫している第1の状態での、前記第1の流体袋の内圧変化に基づいて、前記測定部位の第1の脈波を検出するステップ(S11)と、
前記第1の脈波より前記指標を算出するステップ(S11,S19-1)と、
前記第1の脈波より前記指標が算出されなかった場合に、前記第2の流体袋の内圧を減圧するよう制御するステップ(S15~S16)と、
前記第1の流体袋が測定部位に巻き付けられ、前記第2の流体袋が前記第1の流体袋よりも末梢側に巻き付けられ、前記第2の流体袋が少なくとも最高血圧よりも低い圧力で前記測定部位の末梢側を圧迫している状態での、前記第1の流体袋の内圧変化に基づいて、前記測定部位の第2の脈波を検出するステップ(S17)と、
前記第2の脈波より前記指標を算出するステップ(S17,S19-1)とを備える、指標取得方法。
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JP5151690B2 (ja) | 2013-02-27 |
RU2502463C2 (ru) | 2013-12-27 |
DE112009001264B4 (de) | 2023-10-05 |
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