CN102046069A - Method and system for monitoring a health condition - Google Patents
Method and system for monitoring a health condition Download PDFInfo
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- CN102046069A CN102046069A CN2009801189249A CN200980118924A CN102046069A CN 102046069 A CN102046069 A CN 102046069A CN 2009801189249 A CN2009801189249 A CN 2009801189249A CN 200980118924 A CN200980118924 A CN 200980118924A CN 102046069 A CN102046069 A CN 102046069A
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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
- A61B5/145—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue
- A61B5/1455—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue using optical sensors, e.g. spectral photometrical oximeters
- A61B5/1459—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue using optical sensors, e.g. spectral photometrical oximeters invasive, e.g. introduced into the body by a catheter
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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
- A61B5/02007—Evaluating blood vessel condition, e.g. elasticity, compliance
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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
- A61B5/145—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue
- A61B5/14542—Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissue for measuring blood gases
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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
- A61B5/48—Other medical applications
- A61B5/4887—Locating particular structures in or on the body
- A61B5/489—Blood vessels
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/04—Measuring blood pressure
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/06—Measuring blood flow
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/12—Diagnosis using ultrasonic, sonic or infrasonic waves in body cavities or body tracts, e.g. by using catheters
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
- A61B8/44—Constructional features of the ultrasonic, sonic or infrasonic diagnostic device
- A61B8/4483—Constructional features of the ultrasonic, sonic or infrasonic diagnostic device characterised by features of the ultrasound transducer
- A61B8/4494—Constructional features of the ultrasonic, sonic or infrasonic diagnostic device characterised by features of the ultrasound transducer characterised by the arrangement of the transducer elements
Abstract
A system and method for monitoring a health condition are disclosed. The system includes a patient management application, a data store and a monitoring device. The monitoring device includes an optical sensor, a Doppler sensor, and a computing device adapted to provide health parameter values including oxygen saturation of the blood, blood flow, blood pressure, heart rate, and cardiac output.
Description
Priority request
The application requires the U.S. Patent application that is entitled as " optical sensor arrangement and using method thereof " submitted on May 12nd, 2008 No. 12/119315, No. the 12/119339th, the U.S. Patent application that is entitled as " Doppler motion sensor device and using method thereof ", No. the 12/119325th, the U.S. Patent application that is entitled as " integrated cardiac monitoring equipment and using method thereof ", the priority that is entitled as No. the 12/206885th, No. the 12/119462nd, the U.S. Patent application of " method and system that is used to monitor health status " and the U.S. Patent application that is entitled as " Doppler motion sensor device and using method thereof " that JIUYUE in 2008 was submitted on the 9th, all these patent applications are to be proposed by identical inventor, and its full content merges to herein by reference.
Technical field
The present invention relates to health monitor system and method, more specifically, relate to the system and method that comprises the equipment that is used to monitor the heart behavior.
Background technology and summary of the invention
Cardiovascular disease is big, as a to increase health problem in worldwide.Some studies show that about 15% the Western countries is suffering one or more cardiovascular disease.In the U.S., annual almost 25% population is affected, and causes more than six million people's hospitalization.
Exist different equipment to be used to monitor some parameter relevant with cardiac performance.In some cases, patient's live body parameter may need to be monitored a period of time.The arrhythmia of heart changes causing that cardiac pumping spreads all in the normal sequence of electric pulse of health.Because changing, unusual heartbeat may only take place occasionally, so the supervision that may need to continue detects arrhythmia.By the supervision that continues, the medical worker can describe cardiac condition and set up the suitable treatment course of treatment.
A prior art equipment of measuring heart rate is Medtronic (Minn. Minneapolis city) " demonstration " monitor.This equipment comprises implantable cardiac monitor, is used for for example determining whether patient faint (fainting) is related with rhythm of the heart problem.Should monitor constantly that the speed of heart and the rhythm and pace of moving things reached 14 months by " demonstration " monitor.After waking up from the phase of fainting, the patient is placed into recording equipment the skin outside on " demonstration " monitor of implantation, and presses button data are sent to recording equipment from monitor.Described recording equipment is offered the doctor, and the information of this doctor's analyzing stored in recording equipment is to determine whether the unusual rhythm of the heart is recorded.The use of recording equipment is neither automatically neither be autonomous, and therefore to need the patient be conscious or need another people's interference that information is sent to recording equipment from monitor.
Another known type of implantable sensing equipment is the type equipment of replying, wherein the implanted patient of responder and being read with the non-intruding form by hand-held electromagnetism reader subsequently.An example of a back type of equipment has been described in No. the 5833603rd, United States Patent (USP).
In many cases, the medical worker is interested for collecting the polytype data relevant with the behavior of heart and patient's situation.In addition, as the above mentioned, it is ideal not needing the patient to visit health care supplier (HCP) and obtain related data as much as possible.Relevant information can comprise the electrical activity (being used to produce electrocardiogram (ECG) data) and the body temp of the oxygen saturation grade that flows through aortal blood flow, blood pressure, heart rate, blood flow, stroke volume, cardiac output, heart.
A kind of method and system that is used to monitor health status is here disclosed.In an embodiment according to system of the present invention, this system comprises surveillance equipment, patient monitoring application program and data storage.Described surveillance equipment comprises doppler sensor, optical pickocff and computing equipment.Pick off and computing equipment are encapsulated in the shell.The patient monitoring application program receives and is stored in the data storage from the parameter value of monitor application and with parameter value.
In one embodiment, provide a kind of method that is used to monitor health status.This method comprises providing as the step of the surveillance equipment of description in back to back the preceding paragraph falls with by surveillance equipment calculates one or more hemodynamic parameters.This method further comprises based on the step of hemodynamic parameter diagnosing health situation and this health status of response carries out function.
In another embodiment, the method that is used to monitor health status comprises provides the step of surveillance equipment as described above, and further comprises communication equipment.This method further comprises and sends order to the step of surveillance equipment and respond this command execution function.
By in conjunction with the following drawings with reference to following description to the embodiment of the invention, feature of the present invention and realize that the mode of these features will become more obvious, invention itself will be more readily understood.
Description of drawings
Fig. 1 and Fig. 2 are the sketch maps of system according to an embodiment of the invention.
Fig. 3 is the schematic side view of surveillance equipment according to an embodiment of the invention.
Fig. 4 is the conceptual view of computing equipment according to an embodiment of the invention.
Fig. 5 and Fig. 6 are the conceptual representation of therapeutic scheme that is used to carry out the embodiment of the method according to this invention.
Fig. 7 is a flow chart according to a further embodiment of the method according to the invention.
Corresponding drawing reference numeral has been indicated the corresponding component that spreads all over several views.Although accompanying drawing has been represented embodiments of the invention, in order better to illustrate and explain the present invention, accompanying drawing is not necessarily to scale and some feature may be by exaggerative.Here Chen Shu example has been illustrated the embodiments of the invention of several forms and such example and has been limited scope of invention never in any form.
The specific embodiment
Embodiment discussed below be not intended be limit or limit the invention to disclosed precise forms in the following detailed description.But embodiment selected and that describe makes others skilled in the art can use their invention.
Fig. 1 and Fig. 2 show system according to an embodiment of the invention.System 100 comprises: be positioned at the surveillance equipment 1 on the patient 102, and external communication device 120, for example personal digital assistant or blackberry device.External communication device can be any equipment that is suitable for receiving wireless or Internet traffic, for example respectively by the communication equipment 110,132 and 142 of TU Trunk Unit, phone and computer example.Communication equipment 120 and 132 and optional 110 wirelessly transmits information by communication network 130.Communication equipment 110 also can comprise the Bluetooth adapter that is used for not using communication network 130 and wirelessly communicates with surveillance equipment 1 or other adapter.Communication network 130 is operably connected to the Internet with numeral 140 representatives, and described the Internet is sent to communication equipment 142 with the information from telecommunications network network.In one embodiment, system 100 further comprises and contains webpage and be present in website (not shown) in the server 144.In another embodiment, system 100 also comprises the heart equipment 150 that is suitable for providing treatment to patient 102 heart.
System 100 comprises: case control's application program 200 and data storage 210.Case control's application program 200 is to be configured to from surveillance equipment 1 with other computing equipments reception data and with the program of data storage data storage 210.Case control's application program 200 may reside in the server 144.Case control's application program 200 can be a client-server application, and its client-side program is present in the communication equipment, can be by access to the Internet.The data that data storage 210 storage and patient 102 are relevant.Data can comprise patient's profile (profile) 212, and this patient's profile 212 comprises the patient information that is used for patient 102 interrelated with specific surveillance equipment 1 and makes it possible to visit for example address, insurance information, contact details and the device identifying information of sensing equipment.Data also can comprise value 214, and this value 214 comprises reference, measurement and the parameter value that obtains from dependent surveillance equipment 1.Case control's application program 200 show value is by different way helped HCP managing patient health.Data also can comprise therapeutic scheme 216.
Case control's application program 200 has many functions.This case control's application program obtains data from surveillance equipment 1.It is updated reference values and therapeutic scheme also.It sends order also for surveillance equipment 1.In one embodiment, case control's application program 200 sends to surveillance equipment 1 and surveillance equipment 1 this command execution function of response with order.In another embodiment, HCP uses external communication device to communicate with customer account management application program 200 and communicates by letter in response to HCP, and customer account management application program 200 communicates with surveillance equipment 1.In another embodiment, HCP is by can patient access managing application program 200 by the website of access to the Internet.
The surveillance equipment 1 that Fig. 3 describes generally includes a plurality of parts.One or more parts can be integrated in the surveillance equipment 1 to be fit to the application of the method according to this invention.Surveillance equipment 1 can comprise computing equipment 20, communication equipment 30, energy storage device 40, optical sensor module 2, comprise ECG pick off (hereinafter it being called ECG pick off 50 together), doppler sensor 60 and the temperature sensor 70 of probe 50A and 50B that each parts is installed on the plate 80 and with computing equipment 20 and carries out telecommunication.These parts are encapsulated in the shell 90.
System 100 operationally is connected with one or more being suitable for surveillance equipment 1 with the communication equipment of surveillance equipment 1 swap data.Data comprise order, measurement, parameter and reference value and therapeutic scheme.Surveillance equipment 1 obtains measured value, handles measured value according to therapeutic scheme, this comprise in many cases measured value and reference value done and the profile of diagnosis to the unusual situation of diagnosis recently, carry out function based on diagnosis according to the profile that responds then.
Order is the instruction that offers computing equipment 20 from external communication device.Usually, order is the instruction that is used to carry out function.Function comprises the transmission data, carries out treatment, updated reference values and renewal therapeutic scheme.
Reference value is represented the normal or stable situation of patient.Surveillance equipment 1 can be programmed or can be programmed to and collect measured value when equipment being positioned on the patient 102 with reference value, and storing initial measured value or parameter value are as with reference to value.Describe in detail as following, about computing equipment 20, parameter value comprises the hemodynamic parameter of for example pulse rates, oxygen saturation, cardiac output and blood pressure and temperature.
Reference value can comprise desired value and acceptable excursion or restriction.In the time of beyond parameter value is fallen reference target value or scope, parameter value can be indicated unusually.In certain embodiments, parameter value can produce for example statistic of moving average, and when parameter statistic and reference statistical amount different during greater than desired amount, will detect unusual.
The medical conditions of an abnormality is the arrhythmia of heart.Computing equipment 20 can be configured to carry out determines to the analysis of measured value for example whether the rhythm of the heart is that indication is ARR irregular.Other unusual situation comprises low oxygen saturation, low cardiac output and high or low blood pressure.Other unusual situations can depend on the combination of different hemodynamic parameter values.
Therapeutic scheme comprises diagnosis and response profile.The diagnosis profile be computing equipment 20 be provided for diagnosing anomalous condition the decision standard.The response profile is the instruction that computing equipment 20 is provided for carrying out in response to diagnosis function.At first, one or more therapeutic schemes may be programmed in the surveillance equipment 1.Response profile in initial therapeutic scheme can indicate computing equipment 20 to switch to second therapeutic scheme in response to anomalous condition.In one embodiment, can be downloaded to computing equipment 20 by communication equipment 30 therapeutic schemes.
1. surveillance equipment
Spread all over the application, refer to here by above-mentioned reference surveillance equipment 1 that merge, that in the application of " integrated equipment ", describe about quoting of surveillance equipment 1.Equally, refer to here by above-mentioned reference optical sensor module 2 that merge, that in the application of " optical sensor arrangement ", describe about quoting of optical sensor module 2.In addition, refer to by above-mentioned reference doppler sensor 60 that merge, that in the application of " Doppler motion sensor device ", describe about quoting of doppler sensor 60.To no longer repeat complete description in this application to surveillance equipment 1, optical sensor module 2 and doppler sensor 60.
The signal of communication meaning is such signal, and it has one or more its features and has been set up or has changed with the information in the coded signal.For example, but be not limited to this, signal of communication comprise acoustics, radio frequency, ultrared, other wireless medium and above-mentioned any combination.TU Trunk Unit 110 is positioned at the outside of patient body, for example, is clipped on patient's the belt.TU Trunk Unit 110 can comprise and be used to receive from the receptor of the emission of communication equipment 30 and be used for sending once more to another external communication device the emitter of signal of communication.TU Trunk Unit 110 also can be fixed and hardwired, is used to the computer that is connected to the Internet or is directly connected to the health care supplier.Similarly, TU Trunk Unit 110 can receive from health care supplier's signal of communication and to communication equipment 30 and send signal.
ECG pick off 50 detects the signal of telecommunication that causes cardiac pumping.Patient's temperature is measured in temperature sensor 70.According to the different embodiment of method disclosed herein, energy storage device 40 provides electric power to computing equipment 20, each pick off and communication equipment 30, described communication equipment 30 be configured to send collection data or with the relevant information of data of gathering.Pick off, computing equipment 20, communication equipment 30 and energy storage device 40 are encapsulated in the shell 90.
Be integrated in the surveillance equipment 1 with a plurality of pick offs with at other parts mentioned above, the individual equipment that allows to be installed in a position of patient body is accurately measured and is comprised kinemic, relevant with the behavior of the heart comprehensive parameter of a cover.In addition, different with output initial data other sensing equipment of being used for analyzing by another equipment, the analysis that surveillance equipment 1 can execution parameter and analyze in response to " on the plate " and to carry out function.As shown above, surveillance equipment 1 also wirelessly communicates with miscellaneous equipment, otherwise information is provided and receives order and data.So, need not any manual intervention, data are gathered, analyze and transmitted to surveillance equipment 1.
The meaning with " patient " is the mankind or animal.In according to one embodiment of present invention, surveillance equipment 1 implanted patient body subcutaneous.Yet, should be understood that and use different implanted prosthetics that surveillance equipment 1 can implanted different position.For example, the thoracic cavity of surveillance equipment 1 under can implanted rib cage.Shell 90 can form the shape of circle or oval disc, and its size is similar roughly to two 25 stacked cent coins.More particularly, shell 90 thickness that can be approximated to be three centimetres diameter and be approximately one centimetre.Certainly, depend on application, shell 90 can be configured to other difformity and size.Optical sensor module 2, doppler sensor 60, ECG pick off 50 and temperature sensor 70 are positioned towards inside, and the energy coupler part side of energy storage device 40 is to the outside.
Integrated can combining with heart equipment by the parts with surveillance equipment 1 described above finished.If heart equipment comprises computing equipment, for example realize that the algorithm of the function according to the present invention can be integrated in the computing equipment of heart equipment, rather than increase by second computing equipment.In a similar fashion, energy accumulator can merge to avoid repetition and to reduce cost with communication equipment.
Under the help of the outside mapped system of for example ultrasound machine, surveillance equipment 1 can be implanted or be positioned on the patient.Suitable placement has guaranteed that for example aortal interested blood vessel is positioned at the sensing range of each pick off of surveillance equipment 1.What for example, surveillance equipment 1 can be located in patient's thoracic cavity or back can reduce the interferential position of rib to the measurement that obtains in mode as described herein.
If detect unusual situation, especially determine it is serious or dangerous situation, computing equipment 20 can be configured to make communication equipment 30 to send alarm.Diagnosis profile in the active therapeutic scheme provides standard to determine that situation is normal or unusual, and if abnormality is determined the order of severity.Response profile in the therapeutic scheme provides standard to come response diagnostics.The transmission of alarm is an example of response.Alarm can be used to start report to the police or the alarm patient takes remedial action.Remedial action can be the activity that stops or reduce health.Alarm also can provide global location (GPS) information for emergency services.With reference to Fig. 1, when finding to present anomalous condition, alarm also can be displayed on external communication device 110,120,132 and/or 142.Alarm can comprise text message or with the corresponding sign indicating number of situation.According to therapeutic scheme, computing equipment 20 also can begin new measuring period and measure constantly in response to the detection of anomalous condition.
Parameter value and/or out of Memory can communicate with external equipment.Parameter value can be stored in the memorizer 26 and by communication equipment 30 and wirelessly be sent.The order that receives in response to the situation of abnormality, in response to the outside, be determined when being low, activate the signal of communication (for example, once a day, inferior on every Mondays) of communication equipment 30 termly when the use of memorizer surpasses predetermined amount or energy storage levels; Set up next two kinds of situations with the data degradation that prevents memorizer and overflow or energy loss causes.Be to be understood that also surveillance equipment 1 can comprise the communication equipment except that communication equipment 30.For example, if communication equipment 30 is modems of honeycomb, surveillance equipment 1 also can comprise backup bluetooth or radio frequency (RF) communication equipment.This alternate device is ideal in the following cases, and after one or many was attempted, clearly cellular modem can not transmission information (for example, because the network coverage of low available horsepower, difference etc.).In this case, computing equipment 20 can activate backup communication equipment with transmission information or alarm to alternative external communication device.
Alternately or except that transmission described above, send the information of the data of the data of request or representative request by making communication equipment 30, computing equipment 20 can be programmed to respond the request of data that is received by communication equipment 30.
By can receiving communication signal near patient's equipment with the warning status of patient, perhaps by health care supplier, relative or other the predetermined acceptance person received signal of remotely (for example passing through network).
Be to be understood that in optical sensor module 2, doppler sensor 60, ECG pick off 50 and the temperature sensor 70 each or some can be modular in design.Like this, a plurality of different doppler sensor 60 for example can produce different Performance Characteristics (for example, different output frequency).Depend on application, any in a plurality of pick offs can be installed in the performance to obtain to want on the surveillance equipment 1.In case surveillance equipment 1 is equipped with selected pick off, computing equipment 20 can be programmed to different algorithms made amendment and adapt to selected pick off.By this way, what comprise that the basic surveillance equipment 1 of computing equipment 20, communication equipment 30 etc. can be in various pick offs is made up arbitrarily " customization ", and is programmed to operate with selected pick off.
Although being to be understood that here optical sensor module 2, doppler sensor 60 and the temperature sensor 70 described is activated to obtain measured value when preserving energy by relative (at least under normal condition) infrequently, along with the improvement of battery technology, can increase the activation frequency of these pick offs.Therefore equally, when surveillance equipment 1 was worn on the outside, adapter 85 can be used to provide power supply to sensing equipment 85, had eliminated the worry of relevant energy loss and had allowed frequent or even successive operation to these pick offs.In addition, adapter 85 can be used to operationally other pick off is connected with surveillance equipment 1.
In one embodiment of the invention, communication equipment 30 is bi-directional communication devices, for example, and by cell phone system and/or gps satellite system, for example Nokia's kpattern number KNL1147-V.In alternative embodiment, communication equipment 30 can send information, but can not receive information or order.
In according to one embodiment of present invention, can be provided for recharging the system of energy storage device 40.Computing equipment 20 is from energy storage device 40 received energies.Energy storage device 40 comprises for example energy storage member of battery.Alternatively, surveillance equipment 1 also can comprise and being used for from the energy coupler of external source received energy so that energy storage device 40 is charged.
An example of energy coupler is the electromagnetic equipment of inductance coil for example, is used to receive the external electromagnetic signal and electromagnetic signal is converted to electric flux be used for energy storage member is recharged.External electromagnetic equipment produces electromagnetic signal, and this electromagnetic signal receives and be converted into electric flux by energy storage device 40.Energy storage device 40 can provide charging signals to computing equipment 20.Computing equipment 20 can compare charging signals and reference charge signal, and the low charging of generation signal of communication is used for reporting to the police to patient and/or health care supplier.Alternately, for example the detector of voltage sensor can be used to monitor the electric weight of energy storage device 40, and drops to when being lower than threshold values when electric weight, provides signal to computing equipment 20.Electromagnetic equipment can be disposed adjacent surveillance equipment 1 so that energy storage device 40 is charged.
Energy can replace or additionally be provided with the form of ultrasonic vibration.For example, in surveillance equipment 1, can introduce piezoelectric sender.Ultrasonic vibration can externally provide.When driving by ultrasonic vibration, the changer generating.As shown here, energy or power also can be provided to surveillance equipment 1 by adapter 85.
2. diagnosis and operation
It is important diagnosing heart rightly.Inappropriate diagnosis can cause inappropriate treatment, and this treatment can cause patient's dead or serious nonvolatil deformity.Because potential harm, fully careful is nature.Yet, the sufficient careful medical expense that increased, being as general as society has increased expense.Appropriate diagnosis can reduce medical expense, also may improve patient's situation.
Heart failure can be caused by heart imbalance any structure or function, the ability that the blood of its infringement heart pump q.s spreads all over health.Heart failure is caused by any situation, the efficient of the myocardium that these situations have reduced by infringement or over loading, comprise myocardial infarction (wherein myocardial ischemia and damaged) and hypertension (it has increased the contractility that needs pump blood and has often caused myocardium thickening, causes the flesh changing function).
Except the supervision or the abnormal conditions that make an immediate response, the physiology history that develops the patient who has chronic heart failure is to prevent that potential fatal accident from being important.Heart failure can be chronic and hyperemia, and is perhaps Decompensated.When patient's chronic heart failure developed into acute symptom, Decompensated heart failure took place.Symptom can be based on the side of the heart that relates to, promptly the right or the left side, depleted type, be diastole or heart contraction, whether be because the abnormality that low cardiac output causes, and the degree (based on the classification of function) of the function loss that causes by abnormality.
The diagnostic criteria that has not had to be accepted for heart failure generally.Different standards comprises Framingham, Boston and Duke standard (by relevant research name).New York heart association functional classification has been carried out classification with the seriousness of symptom and can be used for assessing response to treatment.Patient in the grade I is unrestricted and do not have symptom in common activity in any activity.Small, the slight activity restriction of patient experience in the grade II is comfortable when rest still or slight effort is arranged.Patient in the grade III is limited and be comfortable when rest only in any activity.Patient in the grade IV stands discomfort and symptom is also arranged when rest in any physical exertion.Patient's classification can be programmed and can be used to discern therapeutic scheme and come response diagnostics.
Along with the time, the situation that increases the heart working load will produce heart itself and change, so monitor that it is important that cardiac performance changes, this variation can cause the classification again to the patient, and changes in treatment.Heart changes and to comprise because the end systolic volume of the stroke volume of the contractility of the minimizing that the overburden of ventricle causes or contractility, minimizing, increase (being caused by the contractility that reduces usually), the end-diastolic volume (ventricular filling by damaged causes usually) that reduces, the spare capacity that reduces and in order to keep the increase of cardiac output by the heart rate that sympathetic activity stimulated that increases.
The depleted significant respiratory symptom in left side is when effort or breathes hard (dyspnea) during rest and tired easily.Other symptoms are included in when lying down the rapid breathing that increases and serious rapid breathing, several hours after going to bed usually when sleep.The poor circulation of health causes dizzy and chaotic.The right side pump deoxygenated blood of heart and the depletion on right side cause the obstruction of surrounding tissue.Owing to concurrent disease, myocardial infarction, arrhythmia and uncontrolled hypertension and other reason, the easy decompensation of heart failure.Indicate the common sign of possible heart failure to comprise apex beat to the side displacement (because cardiac enlargement), the fast pace (extra heart sounds) under the decompensation situation and as cause (as aortic stenosis) or because cardiac murmur heart failure, that may show valvular heart disease.Ultrasoundcardiogram can be used to discern these common signs of potential heart failure.
The heart failure that is caused by the contractile function disorder is the depletion of cardiac pumping function.Heart failure is feature (be less than 50%, and often reduce significantly) with the ejection rate that reduces.Usually, ejection rate should be between 50% to 70%.The weakened of ventricular systole and be inadequate for producing competent stroke volume causes inadequate cardiac output.Because ventricle is not by emptying fully, so ventricular diastole end of term pressure and volume gain.In the left side of heart, the pressure of increase causes pulmonary edema.On the right side of heart, the pressure of increase causes the peripheral edema that relies on.Doppler sensor 60 can be used to determine the important determiner-stroke volume (SV) of cardiac function.
The heart failure that is caused by the diastolic function disorder is the depleted of the abundant diastole of ventricle and has typically indicated hard ventricle wall.Cause inadequate ventricle filling like this, caused inadequate stroke volume.The depletion of ventricular diastole also causes the end diastolic pressure that raises, and this end diastolic pressure causes edema.If contractile function has obtained maintenance, the diastolic function disorder may not can oneself appears, unless under physiological extreme case, therefore, the patient does not have clinical symptoms fully.Yet the diastolic function disorder is super-sensitive to the increase of heart rate and blood pressure.A burst of unexpected tachycardia can be caused by effort, fever or dehydration.ECG pick off 50 is by contrasting the increase that can follow the trail of heart rate with heart rate and reference value.Elevated blood pressure can be discerned with doppler sensor in a similar manner.Parameter can be correlated with in time, to diagnose the diastolic function disorder potentially.
The scheme that to describe hypothesis below proves therapeutic scheme in response to the heart failure incident for example.This scheme is based on the symptom of hypothesis.
In first example, the patient is 65 years old and suffered before incident two years of anterior myocardial infarction.In that year, he suffers congestive heart failure before incident, be characterized as exert oneself slightly, dyspnea when tired and rare breathing hard during in rest.His New York heart association functional classification is defined as II-III level.He accepts to comprise the drug of topical application of the ACE inhibitor, receptor blocking agent and the spironolactone that cause some improvement in functionality.After experience weakness and some dyspnea generally, the patient calls out his HCP and passes on his symptom.
In base case, the patient does not benefit from use surveillance equipment 1.Under usual condition, symptom will almost cause HCP to suspect Decompensated heart failure definitely.Typical response will be to send mobile reinforcement nursing unit to accept the patient for medical treatment.If Decompensated heart failure does not exist, it will be unnecessary accepting the patient for medical treatment.Yet, if Decompensated heart failure exists really, and the patient after incident more than arriving health care facilities in two or three hours, later treatment may be dangerous and occasionally, be life-threatening.
Illustrate below in the alternative case according to the different embodiment of the inventive method, the patient benefits from use surveillance equipment 1.Before incident, HCP programmes to surveillance equipment 1 with therapeutic scheme, and this therapeutic scheme is corresponding to patient's history and New York heart association functional classification or other classification.This therapeutic scheme can upgrade every now and then.
In first scheme, in case the call that receives, the outside communication equipment of HCP visit comes to obtain pulse rate data by communication equipment 30, to determine whether any arrhythmia exists.Then, HCP obtains the oxygen saturation measurements value.Common saturation (＞98%) will almost be got rid of serious incident definitely.In order to finish inspection, HCP sat quietly two to three minutes by phone indication patient, and the surveillance equipment of HCP order afterwards 1 calculates cardiac output and blood pressure.This information will be competent for determining whether that patient suffers decompensation really.If he suffers decompensation, then can avoid unnecessarily coming the stroke of health care facilities.
In this scheme, HCP uses outside communication equipment to send order to surveillance equipment 1.HCP can select the order from case control's application program 200, and case control's application program 200 can comprise the website that is exclusively used in the such communication of support.Alternately, external communication device can be a phone 132, and order can comprise the telephone number of appropriation in accessing communication equipment 30, in the case, telephone modem input is used to visit the digital access code of the data on the surveillance equipment 1, and input subsequently be used to obtain data, corresponding to the digital code of therapeutic scheme.Therapeutic scheme can be meant independent parameter or more than one parameter.Surveillance equipment 1 responds each order by sending a string data.
With reference to Fig. 5, show typical therapeutic scheme group.HCP activates therapeutic scheme A to obtain pulse and oxygen saturation data.Because these parameters are obtained by low-power equipment ECG pick off 50 and optical sensor module 2, need not consume a lot of energy so obtain these values.If the patient has the TU Trunk Unit 110 that comprises display screen, therapeutic scheme B also can be activated patient directions to have a rest two or three minutes.Finally, HCP activates therapeutic scheme C to obtain cardiac output and pressure value.These are that the doppler sensor 60 of multipotency is obtained by consume more than optical sensor module 2.Alternately, the patient may have a rest always and before activating therapeutic scheme C HCP may not need to wait for.
In second kind of scheme, shown some automatic operations, in case receive call, HCP visit external communication device is to activate diagnoses and treatment scheme D.Therapeutic scheme D can cause that then computing equipment 20 (a) sends pulse and oxygen saturation data, (b) waits for and sends " wait " message and give TU Trunk Unit 110, and (c) send cardiac output and blood pressure data.In other words, therapeutic scheme D activates therapeutic scheme A-C automatically.When sending order and activate therapeutic scheme D and externally receive information on the communication equipment, patient HCP can keep conversation with the patient.If the patient does not have TU Trunk Unit, then HCP can indicate the patient to have a rest.
In the third scheme, shown more operation automatically, the patient is fill order on TU Trunk Unit.TU Trunk Unit 110 can be to send the communication equipment of wireless command to surveillance equipment 1.For example, TU Trunk Unit 110 can comprise the button of specifying as " fear " button, and this button can be pushed under the situation of patient or others' worry.Experience generally weakness and during rapid breathing, patient 102 pushes alarmed button and activates therapeutic scheme E with order surveillance equipment 1.Therapeutic scheme E instructs computing equipment 20 to activate therapeutic scheme D and also can activate therapeutic scheme F and notify the alarmed button of HCP to be pressed.HCP can send the text message of the extra instruction that is used for the patient to TU Trunk Unit 110 from communication equipment, perhaps takes other to act on one's own.Therapeutic scheme E has saved the patient and has called out HCP and HCP activation required time of therapeutic scheme D.
With reference to Fig. 6, in the scheme of the 4th kind of displaying full automatic working, the unusual function of also carrying out according to therapeutic scheme F of surveillance equipment 1 diagnosis.Diagnosis profile in surveillance equipment 1 instructs equipment to monitor the change of combination of change, cardiac output, oxygen saturation or these parameters of heart pulse rate at interval with preset time.Surpassed scheduled volume if change, then this profile also instructs equipment will change with reference value and makes contrast and the unusual situation of indication.The response profile instructs the function of equipment execution in response to anomalous condition.In one embodiment, if in the scope that do not coexist of value and reference value, then surveillance equipment 1 sends message or data to HCP.In another embodiment, if value has exceeded scope, indicating emergency, then surveillance equipment 1 sends alarm to HCP.This alarm also can be sent to patient's specified keeper, perhaps even send alarm to health care facilities, ambulance service or fire fighting department.In addition, surveillance equipment 1 can send the TU Trunk Unit 110 that message can be read to patient 102.For example, TU Trunk Unit can show information such as the indication patient sits, has a rest, drinks water.
Under second kind of situation, 60 years old patient has experienced incident in two weeks after coronary bypass.His health status is fine, walking every day 45 minutes and begin to be in and do some office works.He experienced palpitate from nervousness, some rapid breathing and dizzy.Symptom can be owing to atrial flutter/fibrillation, and these former weeks after by-pass operation are often to send.Diagnosis in this case needs pulse, blood saturation, blood pressure and cardiac output data.If contrast reference value data show is normal, the patient is instructed to have a rest and cardiac parameters is checked in one or two hour once more.Checking for the second time and not to need call to get in touch the patient by the HCP execution.If all parameters be stable and the patient feel good-he can stay at home.
Under the third situation, the patient has the ICD (defibrillator) of implantation.After waking up from the respite in afternoon, the patient has a few puzzled and has some thoracic cavity discomforts again.He worries that ICD may charge (charged) and worries that he has serious arrhythmia.
In a kind of scheme, comprised surveillance equipment 1, be integrated in or be operably connected to ICD.If it is appropriate that ICD determines heart fibrillation, then ICD will determine to convey to surveillance equipment 1.Surveillance equipment 1 is checked hemodynamic parameter (pulse, oxygen saturation, blood pressure, cardiac output) and examines indication that to remove heart fibrillation be appropriate anomalous condition or determine that it is not appropriate.If the latter, surveillance equipment 1 indication ICD does not charge.Surveillance equipment 1 also may send event information to HCP.HCP can inquiry unit gathers hemodynamic parameter and whether definite arrhythmia takes place really.If do not have arrhythmia to be detected and hemodynamic parameter is normal, do not need further to investigate.
In another kind of scheme, surveillance equipment 1 is not included among the ICD.Surveillance equipment 1 can be programmed to detect ICD and when charge.The patient can communicate to determine whether ICD charges by phone, alarmed button or other any ways described above and HCP.In another embodiment, show that in TU Trunk Unit 110 the charging incident reads for the patient.In other embodiments, other heart equipment and surveillance equipment 1 operationally carry out integrated, by bonded feature to improve their common performance.
Fig. 7 illustrates the embodiment of case control's method according to an embodiment of the invention.Originally, HCP sets up surveillance equipment 1 and is used for using with patient 102.HCP is with comprising that patient's history, surveillance equipment identifying information write (populate) data storage 210 with other information relevant with patient 102.HCP also selects therapeutic scheme to download to surveillance equipment 1.When surveillance equipment 1 is accommodated in bus stop, use adapter 85 can download therapeutic scheme.Under the help of ultrasound machine, surveillance equipment 1 is placed on the patient.In initial setting up, HCP can obtain baseline measurements and measured value can be stored as reference value in the computing equipment 20.
In step 700, surveillance equipment 1 monitored patient 102.According to therapeutic scheme F as described above or according to another therapeutic scheme, supervision can be performed.Supervision comprises that activated sensors obtains measured value, calculating parameter value, will be worth according to therapeutic scheme and do contrast with reference value and diagnosis is normal or anomalous condition.If value exceeds the scope of reference value, surveillance equipment 1 may be advanced to step 712, perhaps can begin new measurement and circulate and examine supplemental characteristic before diagnosing anomalous condition.Otherwise surveillance equipment 1 advances to step 720 and turns back to step 700 then.
In step 710, the order that surveillance equipment 1 receives from external communication device.This order can instruct surveillance equipment 1 to send parameter value according to therapeutic scheme, or upgrades therapeutic scheme or refresh routine.
In step 712, surveillance equipment activates therapeutic scheme.The frequency of (minute, hour and day), test constantly can be indicated and take which parameter of sensing, will be obtained how many data to therapeutic scheme.Therapeutic scheme by receive from step 700 or determined in response to the order that monitors therapeutic scheme.External communication device can be a computer 142.Computer 142 can comprise case control's application program 200 or can be by access to the Internet case control application program 200.Case control's application program 200 can provide and show available treatment Scheme Selection menu and can comprise the security feature that is used to protect patients ' privacy and health.External communication device also can be a communication equipment 110,120 and 132.In this step, surveillance equipment 1 activates the pick off that produces signal, and this signal is received by computing equipment 20.Computing equipment 20 is adjusted signals and is measured value with these conversion of signals, then analysis to measure value and calculating parameter value.At last, computing equipment 20 is carried out the extra instruction that therapeutic scheme provides.
In another embodiment, communication equipment does not use case control's application program directly to visit surveillance equipment 1.Communication equipment can be dialed surveillance equipment 1 and provide order by keyboard.
In step 714, surveillance equipment 1 fill order is upgraded therapeutic scheme.Renewal can comprise the reference value that change is used for determining anomalous condition, perhaps changes to be used to distinguish the seriousness of anomalous condition, the reference value of for example emergency.Other renewals comprise order or the response of change in the response profile that changes step.In this step, can increase extra therapeutic scheme.Therapeutic scheme can be updated the change that reflects status of patient, history or other factors.
In step 716, surveillance equipment 1 fill order is come refresh routine.Program can comprise module, and this module comprises the algorithm that is used to handle from the signal of pick off.Module can be updated and reflect and have the new module of improving feature.In addition, module can be updated the increase that reflects outside or extra pick off.
In step 718, surveillance equipment 1 is carried out function.Function can comprise the transmission signal of communication, carry out treatment or other specified functions in the response profile of therapeutic scheme.The response profile can be indicated the parameter that will send, and send how many data (minute, hour, day), and the frequency of test constantly.
In step 720, surveillance equipment 1 store measurement values.Value can be stored as the result of in step 712 activated therapeutic scheme or normal situation.For example, in case unusual situation is detected then step 720 can be performed, so that upgrade the caregiver basically in real time.Step 720 also can be performed at regular intervals, for example once a day, weekly, every month one inferior.Alternately or except these send, computing equipment 20 can be programmed to by making communication equipment 30 send the data of request or the information of the data that representative is asked, respond the request of the data (for example, from the health care supplier) that communication equipment 30 is received.
Although the present invention is described to have typical design, in spirit and scope of the present disclosure, the present invention can further be revised.Therefore the application plans to cover any variation, use or the adaptability revision to inventing of the rule of using it.In addition, the application plans to cover departing from from of the present disclosure of the practice that belongs to known or habitual in the technical field that the present invention relates to.
Claims (according to the modification of the 19th of treaty)
1. method that is used for the health status of monitored patient comprises:
Surveillance equipment is provided, and this surveillance equipment comprises:
Energy storage device, its exercisable energy that is stored in wherein that provides be to described surveillance equipment,
Optical pickocff is used for the relative position of sensing vascular,
Doppler sensor is used for coming sensing in the mobile fluidic speed of described vascular based on the described relative position by the described vascular that described optical pickocff sensed, and is stored in described energy in the energy storage device with preservation, and
Computing equipment, be used to operate described optical pickocff and described doppler sensor, to obtain parameter value, described computing equipment comprises one or more therapeutic schemes that are used to diagnose and respond described patient's described health status, and described optical pickocff, described doppler sensor and described computing equipment are in the enclosure packed;
Described surveillance equipment is fixed on makes on the described patient that described surveillance equipment is supported by described patient;
Calculate one or more hemodynamic parameters with described surveillance equipment;
Based on described one or more hemodynamic parameter diagnosing health situations; And
Carry out function in response to described health status.
2. the method for claim 1, wherein said hemodynamic parameter comprises in oxygen saturation, stroke volume, blood pressure and the cardiac output.
3. the method for claim 1, wherein said health status are unusual situations.
4. method as claimed in claim 3, described surveillance equipment further comprises communication equipment.
5. method as claimed in claim 4, wherein said function are to transmit alarm.
6. method as claimed in claim 4, wherein said function are the values of passing a parameter continuously.
7. the method for claim 1, wherein said function is a begin treatment.
8. the method for claim 1, wherein said surveillance equipment further comprises communication equipment, described situation is normal situation, and described function is the value of passing a parameter periodically.
9. be used to monitor the method for health status, comprise:
Surveillance equipment is provided, and described surveillance equipment comprises:
Optical pickocff is used for the relative position of sensing patient's vascular,
Energy storage device,
Doppler sensor, comprise a plurality of optionally can activated section, be used for sensing in the mobile fluidic speed of described vascular, from described a plurality of optionally can activated section selected section be activated and come the described vascular of sensing with described relative position based on described vascular, be stored in energy in the described energy storage device with preservation
Computing equipment is used to operate described optical pickocff and described doppler sensor to obtain parameter value, and described optical pickocff, described doppler sensor and described computing equipment are packaged in the shell, and
Communication equipment is connected to described computing equipment;
Send order to described surveillance equipment; And
In response to described command execution function.
10. method as claimed in claim 9, wherein, function is the parameter of calculating from group, this group comprises: oxygen saturation, stroke volume, blood pressure, heart pulse and cardiac output.
11. method as claimed in claim 9, wherein said function are to send parameter value.
12. method as claimed in claim 9, wherein, computing equipment comprises that therapeutic scheme and described function are to send parameter value according to described therapeutic scheme.
13. method as claimed in claim 12, wherein, described function is to upgrade described therapeutic scheme.
14. method as claimed in claim 9, wherein, described function is a begin treatment.
15. method as claimed in claim 13, wherein, described treatment is an electric shock.
16. method as claimed in claim 13, wherein, described treatment is administration.
17. a system that is used to monitor health status comprises:
Surveillance equipment, described surveillance equipment comprises: energy storage device, it operationally provides the energy that is stored in wherein to described surveillance equipment; The optical pickocff of relative position that is used for sensing patient's vascular; Come sensing fluid mobile speed in vascular to be stored in the doppler sensor of the described energy in the energy storage device with preservation based on described relative position by the described vascular of described optical pickocff institute sensing, be used to operate the computing equipment that described optical pickocff and described doppler sensor obtain parameter value, described optical pickocff and described doppler sensor and described computing equipment are in the enclosure packed;
The patient monitoring application program is used for sending data and the parameter value that is used to receive from surveillance equipment to surveillance equipment; And
Data storage is used for the stored parameter value.
18. system as claimed in claim 17, wherein, described parameter value comprises: one or more oxygen saturations, stroke volume, blood pressure and cardiac output.
19. system as claimed in claim 17, wherein, described parameter value comprises heart pulse.
Claims (19)
1. method that is used to monitor health status comprises:
Surveillance equipment is provided, and this surveillance equipment comprises:
Optical pickocff is used for the relative position of sensing vascular,
Doppler sensor is used for the mobile fluidic speed of the described vascular of sensing, and
Computing equipment, be used to operate described optical pickocff and described doppler sensor, to obtain parameter value, described computing equipment comprises one or more therapeutic schemes that are used to diagnose and respond health status, and described optical pickocff, described doppler sensor and described computing equipment are in the enclosure packed;
Calculate one or more hemodynamic parameters with described surveillance equipment;
Based on described one or more hemodynamic parameter diagnosing health situations; And
Carry out function in response to described health status.
2. the method for claim 1, wherein said hemodynamic parameter comprises in oxygen saturation, stroke volume, blood pressure and the cardiac output.
3. the method for claim 1, wherein said health status are unusual situations.
4. method as claimed in claim 3, wherein said surveillance equipment further comprises communication equipment.
5. method as claimed in claim 4, wherein said function are to transmit alarm.
6. method as claimed in claim 4, wherein said function are the values of passing a parameter continuously.
7. the method for claim 1, wherein said function is a begin treatment.
8. the method for claim 1, wherein said surveillance equipment further comprises communication equipment, described situation is normal situation, and described functional cycle the value of passing a parameter.
9. be used to monitor the method for health status, comprise:
Surveillance equipment is provided, and this surveillance equipment comprises:
Optical pickocff is used for the relative position of sensing vascular,
Doppler sensor is used for sensing in the mobile fluidic speed of described vascular,
Computing equipment is used to operate described optical pickocff and described doppler sensor to obtain parameter value, and described optical pickocff, described doppler sensor and described computing equipment are packaged in the shell, and
Communication equipment is connected to described computing equipment; And
Send order to described surveillance equipment; And
In response to described command execution function.
10. method as claimed in claim 9, wherein, function is the parameter of calculating from group, described group comprises: oxygen saturation, stroke volume, blood pressure, heart pulse and cardiac output.
11. method as claimed in claim 9, wherein, described function is to send parameter value.
12. method as claimed in claim 9, wherein, computing equipment comprises that therapeutic scheme and described function are to send parameter value according to described therapeutic scheme.
13. method as claimed in claim 12, wherein, described function is to upgrade described therapeutic scheme.
14. method as claimed in claim 9, wherein, described function is a begin treatment.
15. method as claimed in claim 13, wherein, described treatment is an electric shock.
16. method as claimed in claim 13, wherein, described treatment is administration.
17. a system that is used to monitor health status comprises:
Surveillance equipment, described surveillance equipment comprises: the optical pickocff that is used for the relative position of sensing vascular, be used for the doppler sensor of sensing fluid in the mobile speed of vascular, be used to operate the computing equipment that described optical pickocff and described doppler sensor obtain parameter value, described optical pickocff and described doppler sensor and described computing equipment are in the enclosure packed;
The patient monitoring application program is used for sending data and being used to receive parameter value from surveillance equipment to described surveillance equipment; And
Data storage is used for the stored parameter value.
18. system as claimed in claim 17, wherein, described parameter value comprises: one or more in oxygen saturation, stroke volume, blood pressure and the cardiac output.
19. system as claimed in claim 17, wherein, described parameter value comprises heart pulse.
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