WO2012077666A1 - 血圧情報測定装置および該装置での動脈硬化度の指標の算出方法 - Google Patents
血圧情報測定装置および該装置での動脈硬化度の指標の算出方法 Download PDFInfo
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- WO2012077666A1 WO2012077666A1 PCT/JP2011/078155 JP2011078155W WO2012077666A1 WO 2012077666 A1 WO2012077666 A1 WO 2012077666A1 JP 2011078155 W JP2011078155 W JP 2011078155W WO 2012077666 A1 WO2012077666 A1 WO 2012077666A1
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- blood pressure
- reflected wave
- pressure waveform
- wave
- arteriosclerosis
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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
- A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
- A61B5/021—Measuring pressure in heart or blood vessels
- A61B5/02108—Measuring pressure in heart or blood vessels from analysis of pulse wave characteristics
- A61B5/02125—Measuring pressure in heart or blood vessels from analysis of pulse wave characteristics of pulse wave propagation time
-
- 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
- A61B5/0225—Measuring pressure in heart or blood vessels by applying pressure to close blood vessels, e.g. against the skin; Ophthalmodynamometers the pressure being controlled by electric signals, e.g. derived from Korotkoff sounds
Definitions
- the present invention relates to a blood pressure information measuring apparatus and a method for calculating an index of arteriosclerosis in the apparatus, and in particular, a blood pressure information measuring apparatus for measuring blood pressure information effective for determination of arteriosclerosis and the degree of arteriosclerosis in the apparatus.
- the present invention relates to an index calculation method.
- PWV pulse wave velocity
- cuffs are worn at least at two or more locations such as the upper arm and lower limb, and the pulse wave is measured at the same time, so the pulse wave is measured by the difference in the appearance time of each pulse wave (ejection wave, reflected wave). It can be calculated from the length of the artery between two points wearing a cuff or the like. This time difference is used as Tr (Traveling time to reflected wave) which is another index of arteriosclerosis.
- Patent Document 1 Japanese Patent Application Laid-Open No. 2004-113593
- Patent Document 1 Japanese Patent Application Laid-Open No. 2004-113593
- An evaluation device is disclosed. Using this device, the heart side pulse wave can be measured while compressing the peripheral side. Thereby, the ejection wave ejected from the heart is separated from the reflected wave from the iliac bifurcation and each part in the artery. Then, the arteriosclerosis degree is determined by calculating the time difference between the peak of the traveling wave component and the reflected wave component and the intensity ratio.
- Patent Document 2 Japanese translations of PCT publication No. 2009-517140 (hereinafter referred to as Patent Document 2) describes a method of separating ejection waves and reflected waves using estimated values of the blood pressure waveform and blood flow waveform of the aorta. Disclosure. 16 (A) and 16 (B) are diagrams for explaining the method of Patent Document 2, and are blood pressures that are a composite wave of the ejection wave and the reflected wave shown in FIG. 16 (A). As shown in FIG. 16B, the ejection wave (traveling wave in the figure) and the reflected wave are separated from the waveform.
- the blood pressure waveform of the aorta is measured in the pressure waveform estimated by the transfer function method from the blood pressure waveform measured in the peripheral arteries (radial artery, brachial artery, etc.) of the upper body, or in the carotid artery.
- a blood pressure waveform is used as an approximate value.
- the above transfer function method is disclosed in US Pat. No. 5,265,011.
- the blood flow waveform is shown in the following non-patent document 1 (BE Westerhof et al. Quantification of wave reflection in the human aorta from pressure alone: a proof of principal. Hypertension 2006; 48; 595-601).
- a triangular waveform having a base from the rise to the notch of the blood pressure waveform and a peak of the cardiac contraction peak is used.
- the cross-correlation between the ejected wave and the reflected wave separated in this way is calculated, and the time when the correlation is highest is detected as the appearance time difference between the ejected wave and the reflected wave.
- the appearance time difference between the two waveforms can be accurately detected by the cross-correlation, but when the waveform shapes are different, the error in detecting the appearance time difference is detected. Becomes larger.
- the blood pressure waveform is deformed while the ejection wave from the heart propagates through the aorta.
- the manner of deformation varies depending on the condition of the subject, such as the degree of progression of arteriosclerosis. For this reason, the appearance time difference between the ejection wave and the reflected wave may not be accurately detected due to the cross-correlation.
- FIG. 17 shows Tr calculated from the pulse wave propagation time between two points measured by a conventional PWV measuring device and Tr obtained from the carotid blood pressure waveform actually measured for about 200 subjects. It is a figure which shows the relationship with PWV Tr).
- the PWV Tr value calculated from the pulse wave velocity between two points of the heart and femoral artery measured using the PWV measuring device and the propagation distance between the two points can be measured using a noninvasive measuring device.
- the Tr value is considered to be the most accurate Tr value so far.
- the Tr value obtained from the blood pressure waveform of the carotid artery is obtained by detecting the time difference between the ejection wave and the reflected wave separated using the blood pressure waveform and the triangular blood flow waveform by the above-described cross-correlation method. It was obtained. From the results of FIG. 17, it was found that the Tr value obtained from the blood pressure waveform of the carotid artery was calculated to be longer than the Tr value obtained using the PWV measurement device in many subjects. This result is considered to indicate that there is clearly an error in the time difference between the ejection wave and the reflected wave detected from the carotid artery pulse waveform by the cross-correlation method.
- a predetermined ratio for example, 10% or 20%
- the time when the threshold value is reached is reflected.
- a method for estimating the rising point of a wave is known.
- 18A and 18B illustrate a method of estimating the rising point of the reflected wave using a threshold value. After separating the ejected wave and the reflected wave from the measured blood pressure waveform of the measured person using the cross-correlation method (FIG. 18A), the maximum amplitude of the reflected wave is made equal to the maximum amplitude of the ejected wave. It expands in the amplitude direction until it becomes (FIG. 18B).
- the threshold is set to 20%
- the axial coordinates are estimated as the rising point of the reflected wave
- Tr is estimated and calculated as the time difference between the rising point of the ejection wave and the rising point of the reflected wave (FIG. 18B).
- the shape of the blood pressure waveform is not similar to each other and is large as described above, even if the threshold ratio is used as described above, the appearance time difference between the ejection wave and the reflected wave is not accurately detected. There is a case.
- the present invention has been made in view of such problems, and accurately calculates an index effective for determining the degree of arteriosclerosis by accurately detecting the time difference between the ejection wave and the reflected wave from the blood pressure waveform. It is an object of the present invention to provide a blood pressure information measuring device that can perform and a method for calculating an index of arteriosclerosis in the device.
- the blood pressure information measurement device is a blood pressure information measurement device that calculates an index of the degree of arteriosclerosis of a subject as blood pressure information, and is attached to a measurement site of the subject.
- An air bag an adjusting means for adjusting the internal pressure of the air bag, a blood pressure waveform for one beat from a pressure waveform based on the change in the internal pressure of the air bag, and a component of the ejection wave in the blood pressure waveform
- an arithmetic unit for performing processing for calculating an index of the degree of arteriosclerosis of the subject by specifying the component of the reflected wave.
- the arithmetic device includes a process for setting a threshold value based on an index that represents a characteristic of the shape of the blood pressure waveform according to the current time when the reflected wave appears in the blood pressure waveform, and the amplitude of the reflected wave is greater than the maximum amplitude of the reflected wave. Executes processing to specify the time point of the amplitude obtained from the threshold value as the rising point of the reflected wave, and to calculate the index of arteriosclerosis based on the rising point of the ejection wave and the rising point of the reflected wave To do.
- the index representing the shape characteristic of the blood pressure waveform represents the degree of arteriosclerosis of the subject
- the threshold value is a ratio to the maximum amplitude of the blood pressure waveform
- the set threshold value is the degree of arteriosclerosis of the subject.
- the threshold value on the side where the progression is smaller is smaller than the threshold value on the side where the degree of arteriosclerosis is not advanced.
- the index representing the shape characteristic of the blood pressure waveform is an AI (Augmentation Index) value that is a ratio between the amplitude of the ejection wave and the amplitude of the reflected wave in the blood pressure waveform, and a provisional Tr value obtained from a differential curve of the blood pressure waveform. , And the age of the subject.
- AI Application Index
- the blood pressure information measurement device further includes a compression means for compressing the distal side of the measurement site, and the calculation device is based on a change in the internal pressure of the air bag in a state where the distal side of the measurement site is compressed and driven. Then, a process for calculating an index of arteriosclerosis as the blood pressure information of the subject is performed.
- the measurement site is a subject's neck
- the arithmetic unit obtains a carotid artery waveform as a blood pressure waveform.
- a method for calculating an index of arteriosclerosis is a method for calculating an index of arteriosclerosis of a subject as blood pressure information, and a detected air bag attached to a measurement site of the subject
- the step of identifying the blood pressure waveform for one beat from the pressure waveform based on the internal pressure change and receiving the input of the internal pressure change, and the index representing the shape characteristic of the blood pressure waveform according to the current position of the reflected wave in the blood pressure waveform Setting a threshold based on the reflected wave, identifying the time when the amplitude of the reflected wave is an amplitude obtained from the maximum amplitude of the reflected wave and the threshold value as a rising point of the reflected wave,
- a step of calculating an index of the degree of arteriosclerosis based on the rising point of the outgoing wave and the rising point of the reflected wave is executed.
- the present invention it is possible to accurately detect the difference in appearance time between the ejection wave and the reflected wave from the blood pressure waveform, thereby accurately calculating an index effective for determining the degree of arteriosclerosis.
- Tr as one of the indices for determining the degree of arteriosclerosis is the time between the appearance time of the ejection wave and the appearance time of the reflected wave that the traveling wave reflects from the bifurcation of the iliac artery and returns Expressed in intervals.
- PWV calculated from the pulse wave propagation time between two points measured with a PWV measuring device, It is known that there is a correlation with Tr estimated from the arterial pulse waveform.
- threshold values are determined from ejected waves and reflected waves separated using a blood pressure waveform measured in the carotid artery and a triangular blood flow waveform. It is a figure which shows the relationship between Tr (henceforth estimation Tr) calculated
- the threshold when the threshold is set to 10% of the amplitude of the reflected wave, the difference between PWV Tr and estimated Tr is small for subjects with short Tr, but PWV Tr and estimated Tr are long for subjects with long Tr. The difference becomes larger.
- the threshold value when the threshold value is set to 30% of the amplitude of the reflected wave, the difference between PWV Tr and estimated Tr is long for a subject with a long Tr, as opposed to when the threshold value is 10%. Although it is small, the difference between PWV Tr and estimated Tr increases as Tr decreases.
- the threshold value when the threshold value is 20% of the amplitude of the reflected wave, it is an intermediate result.
- FIGS. 4 (A) and 4 (B) are diagrams showing specific examples of blood pressure waveforms measured in the carotid artery of a subject with a short Tr and a subject with a long Tr, respectively.
- the maximum amplitude of each pulse wave is set to “1”, and the ratio of the amplitude to the maximum amplitude over time is shown.
- 5 (A) and 5 (B) for each blood pressure waveform in FIGS. 4 (A) and 4 (B), the ejection wave (solid line) and the reflected wave (dashed line) are separated using the cross-correlation method.
- FIG. 6 (A) and 6 (B) expand the reflected wave waveforms of FIGS. 5 (A) and 5 (B) in the amplitude direction until the maximum amplitude is the same as the maximum amplitude of the ejection wave.
- the ratio of the amplitude of the reflected wave to the amplitude of the ejected wave is larger in the subject with a short Tr.
- the slope from the appearance of the separated reflected wave to the peak is the steepest at the time of appearance for the subject with a short Tr (FIG. 6A), and gradually decreases as the peak is approached.
- the slope immediately after the appearance is steep, but thereafter the slope up to about 20% is gentle, and then the slope becomes steep again.
- a subject with a short Tr estimates a point close to the appearance of the reflected wave as a rising point, and a subject with a long Tr reflects It is considered appropriate to estimate the rising point at a point slightly after the appearance of the wave.
- Tr is an index of the degree of arteriosclerosis, and it indicates that the arteriosclerosis progresses as the subject with a shorter Tr and the arteriosclerosis does not progress with a longer Tr.
- Tr is short, that is, when the reflected wave appears early in the blood pressure waveform, the magnitude of the reflected wave in the blood pressure waveform increases, and when Tr is long, that is, when the reflected wave appears slowly in the blood pressure waveform, The size becomes smaller.
- the inventors of the present invention can reflect a subject with various degrees of arterial stiffness by using a threshold value for determining the rising point of the reflected wave according to the degree of arterial stiffness of the subject.
- a threshold value for determining the rising point of the reflected wave according to the degree of arterial stiffness of the subject.
- the rising point of the wave can be estimated more accurately.
- the degree of arterial sclerosis of the subject for example, the magnitude of the reflected wave appearing in the blood pressure waveform can be used, and a different threshold is set as a threshold for determining the rising point of the reflected wave accordingly. Can be used.
- the ratio (AI (Augmentation Index) value) between the amplitude of the ejection wave and the amplitude of the reflected wave obtained from the blood pressure waveform can be used.
- a value representing the magnitude of the reflected wave appearing in the blood pressure waveform a value ⁇ obtained from the following formulas (1) to (3) is determined in accordance with the AI value calculated from the measured blood pressure waveform. Is used as a threshold value ⁇ .
- the coefficient a and coefficient b in the following equation (2) are based on the relationship between the AI value measured for a large number of subjects in advance and the rising point of the reflected wave, and as the AI value decreases, ⁇ approaches ⁇ 2 and the AI value increases. This is an experimental value determined so that ⁇ approaches ⁇ 1.
- FIG. 7 is a diagram showing the relationship between the AI value and the threshold value ⁇ obtained from the equations (1) to (3).
- the value ⁇ 1 is used as the threshold value ⁇
- the second value whose AI value is smaller than AI1.
- the threshold value is smaller than AI2
- the value ⁇ 2 larger than the value ⁇ 1 is used as the threshold value ⁇ .
- the AI value is set as the threshold value ⁇ . The smaller the value is, the closer to ⁇ 2, and the larger the AI value, the closer to ⁇ 1 is used. Therefore, when the AI value is large (the amplitude of the reflected wave is large), the threshold value ⁇ is set small.
- the threshold value ⁇ is set large. Will be.
- a more accurate estimated Tr value is calculated by variably setting the threshold value according to the Al value of the blood pressure waveform measured from the subject.
- FIG. 8 is a diagram illustrating a specific example of the external appearance of a blood pressure information measurement device (hereinafter abbreviated as a measurement device) 1 according to the embodiment.
- the measuring device 1 includes a base 2 connected by an air tube 10 and an arm band 9 attached to the upper arm that is a measurement site.
- a display unit 4 that displays various information including measurement results and an operation unit 3 that is operated to give various instructions to the measuring apparatus 1 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 armband 9 includes an air bag as a fluid bag for compressing a 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 compared to the air capacity of the air bag 13A.
- 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 blood pressure waveform (pulse waveform), a heart rate, and the like.
- FIG. 10 is a block diagram showing a specific example of the configuration of the measuring apparatus 1.
- measuring apparatus 1 includes an air system 20A connected to air bag 13A through air tube 10, an air system 20B connected to air bag 13B through air tube 10, and a CPU ( Central Processing Unit) 40.
- 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 connected to the drive circuit 26A, and the drive circuit 26A is further connected to the CPU 40.
- the air pump 21A is driven by a drive circuit 26A that has received a command from the CPU 40, and pressurizes the air bag 13A by sending compressed gas into the air bag 13A.
- the air valve 22A is connected to the drive circuit 27A, and the drive circuit 27A is further connected to the CPU 40.
- the air valve 22B is connected to the drive circuit 27B, and the drive circuit 27B is further connected to the CPU 40.
- the open / close states of the air valves 22A and 22B are controlled by drive circuits 27A and 27B, respectively, which have received a command from the CPU 40.
- the air valves 22A and 22B maintain or depressurize the pressure in the air bags 13A and 13B, respectively. Thereby, the pressure in air bag 13A, 13B is controlled.
- the pressure sensor 23A is connected to the amplifier 28A, the amplifier 28A is further connected to the A / D converter 29A, and the A / D converter 29A is further connected to the CPU 40.
- the pressure sensor 23B is connected to the amplifier 28B, the amplifier 28B is further connected to the A / D converter 29B, and the A / D converter 29B is further connected to the CPU 40.
- the pressure sensors 23A and 23B detect pressures in the air bags 13A and 13B, respectively, and output signals corresponding to the detected values to the amplifiers 28A and 28B. The output signals are amplified by the amplifiers 28A and 28B, digitized by the A / D converters 29A and 29B, and then input to the CPU 40.
- the air tube from the air bag 13A and the air tube from the air bag 13B are connected by a 2-port valve 51.
- the 2-port valve 51 is connected to the drive circuit 53, and the drive circuit 53 is further connected to the CPU 40.
- the 2-port valve 51 has a valve on the air bag 13A side and a valve on the air bag 13B side, and these valves open and close by being driven by a drive circuit 53 that receives a command from the CPU 40.
- the memory 41 stores a program executed by the CPU 40.
- the CPU 40 reads out and executes a program from the memory 41 based on a command input to the operation unit 3 provided on the base 2 of the measuring apparatus, and outputs a control signal according to the execution. Further, the CPU 40 outputs the measurement result to the display unit 4 and the memory 41.
- the memory 41 stores information about the measurer including at least the age as required. And CPU40 reads the information regarding the said measurer with the execution of a program as needed, and uses it for a calculation.
- CPU 40 receives an input of a pressure signal from pressure sensor 23B as a function for calculating Tr (estimated Tr) as an index for determining the degree of arteriosclerosis according to the principle described above.
- the specifying unit 404 obtains a blood pressure waveform for one beat from the input blood pressure waveform, and specifies the rising point, that is, the start point of the blood pressure waveform for one beat as the rising point of the ejection wave. Further, the specifying unit 404 specifies the rising point of the reflected wave in the blood pressure waveform using the threshold value ⁇ .
- FIG. 11 is a flowchart showing the operation of the measuring apparatus 1.
- the operation shown in FIG. 11 is started when the measurer presses the switch 32.
- This operation is realized by the CPU 40 reading a program stored in the memory 41 and controlling each unit shown in FIG.
- movement with the measuring apparatus 1 is demonstrated using FIG.
- FIG. 13A shows the time change of the pressure P1 in the air bag 13B
- FIG. 13B shows the time change of the pressure P2 in the air bag 13A.
- S3 to S17 attached to the time axis in FIGS. 13A and 13B coincide with the operations of the measurement operation in the measurement apparatus 1 described later.
- each unit is initialized in CPU 40 in 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.
- the blood pressure in step S3 is measured by an oscillometric method that is performed with a normal sphygmomanometer.
- the CPU 40 When the blood pressure measurement in step S3 is completed, the CPU 40 outputs a control signal to the drive circuit 53 in step S5 to open both the air bag 13A side valve and the air bag 13B side valve of the 2-port valve 51. . As a result, the air bag 13A and the air bag 13B communicate with each other, a part of the air in the air bag 13A moves to the air bag 13B, and the air bag 13B is pressurized.
- the pressure P2 in the air bladder 13A increases to a pressure higher than the maximum blood pressure value from the start of pressurization in step S3 until the blood pressure measurement is completed. Thereafter, when the valve of the 2-port valve 51 is opened in step S5, part of the air in the air bag 13A moves to the air bag 13B, and the pressure P2 decreases. At the same time, as shown in FIG. 13A, the pressure P1 in the air bladder 13B rapidly increases. When the pressure P1 and the pressure P2 coincide, that is, when the internal pressures of the air bags 13A and 13B change, the movement of air from the air bag 13A to the air bag 13B ends.
- step S7 the CPU 40 outputs a control signal to the drive circuit 53 at this time, and closes both valves of the 2-port valve 51 opened in step S5.
- FIGS. 13A and 13B it is shown that the pressure P1 and the pressure P2 match at the time of step S7.
- the pressure P2 in step S5 is not significant, and the pressure P1 at the time of step S7.
- the pressure P2 is higher than the maximum blood pressure value.
- step S9 the CPU 40 outputs a control signal to the drive circuit 27B and adjusts the pressure P1 in the air bag 13B to a pressure suitable for measuring a pulse wave.
- the decompression adjustment amount here is preferably about 5.5 mmHg / sec, for example.
- the pressure suitable for measuring the pulse wave is preferably about 50 to 150 mmH.
- the CPU 40 performs an operation for extracting a feature point from the blood pressure waveform every time a blood pressure waveform for one beat based on the pressure signal from the pressure sensor 23B is input in step S11. Do.
- FIG. 12 is a flowchart showing the operation for extracting feature points in step S11.
- CPU 40 receives a pressure signal from pressure sensor 23B and specifies a blood pressure waveform for one beat.
- the CPU 40 specifies the start point of the blood pressure waveform for one beat as the rising point of the ejection wave.
- step S103 the CPU 40 specifies the maximum amplitude of the ejection wave of the blood pressure waveform for one beat and the maximum amplitude of the reflected wave, and calculates the AI value by calculating the ratio thereof.
- the CPU 40 calculates the threshold value ⁇ used for specifying the rising point of the reflected wave from the maximum amplitude of the blood pressure waveform for one beat from the above-described equations (1) to (1) to (AI) obtained from the AI value obtained from the blood pressure waveform. 3) is stored in advance.
- the threshold value ⁇ is calculated by substituting the AI value calculated in step S103 into the equation.
- step S107 the CPU 40 identifies the point in time of reaching the amplitude obtained by multiplying the maximum amplitude of the reflected wave by the threshold value ⁇ in the blood pressure waveform identified in step S101 as the rising point of the reflected wave. Store as feature points.
- the measurement operation in step S11 is performed by repeating the input of the blood pressure waveform a predetermined number of times (for example, for 10 beats). Meanwhile, the pressure P1 in the air bladder 13B is maintained at a pressure suitable for measuring a pulse wave as shown in FIG. 13A, and the pressure P2 in the air bladder 13A is maintained in FIG. As shown, the pressure is maintained higher than the maximum blood pressure value. Thereby, the peripheral blood-feeding state of the measurement site is maintained.
- step S15 CPU 40 determines the average value of the repeatedly input values and the specified drive. Tr (estimated Tr) as an index of the degree of arteriosclerosis is calculated using the rising point of the outgoing wave.
- step S17 the CPU 40 outputs a control signal to the drive circuits 27A and 27B to open the air valves 22A and 22B, thereby releasing the pressure in the air bags 13A and 13B to atmospheric pressure.
- the pressures P1 and P2 rapidly decrease to atmospheric pressure in the section of step S17.
- the calculated systolic blood pressure value (SYS), diastolic blood pressure value (DIA), arteriosclerosis index, and measurement results such as the measured pulse wave are displayed on the display unit 4 provided on the base 2. Applied and displayed.
- FIG. 14 is a diagram showing the relationship between Tr (estimated Tr) calculated by the measuring apparatus 1 and PWV Tr calculated from the pulse wave propagation time between two points measured by a conventional PWV measuring apparatus.
- the estimated Tr calculated by the measuring apparatus 1 is an ejection wave and a reflected wave separated using a blood pressure waveform and a triangular blood flow waveform measured in the carotid artery using a conventional method. From the relationship between the estimated Tr and the PWV Tr calculated by detecting the time difference with the cross-correlation method (FIG. 17), it can be seen that it is closer to the PWV Tr. That is, it can be seen that the estimated Tr calculated by the measuring apparatus 1 is smaller in difference from the PWV Tr than in FIG.
- the device 1 of the present invention can calculate the calculated Tr (estimated Tr). It is clear that the error can be made smaller than the conventional method of calculating the pulse wave Tr, and the degree of arteriosclerosis can be determined with high accuracy.
- the AI value is used as a value representing the magnitude of the reflected wave appearing in the blood pressure waveform as the degree of arterial stiffness of the subject.
- a value calculated by differentiating the blood pressure waveform is also referred to as “temporary Tr value”.
- the provisional Tr value calculated by differentiating the blood pressure waveform is a reflected wave such as a point corresponding to the maximum point of the second derivative curve of the blood pressure waveform or a point corresponding to the falling zero cross point of the fourth derivative curve of the blood pressure waveform.
- the value calculated as the rising point of can be used.
- the CPU 40 of the measuring apparatus 1 replaces the above-described equations (1) to (3) with equations (1 ′) to (3 ′).
- ⁇ ⁇ 1 (differentiation Tr ⁇ Tr_2)
- ⁇ temporary Tr ⁇ a ′ + b ′ (Tr — 2 ⁇ differential Tr ⁇ Tr — 1) Equation (2 ′)
- ⁇ ⁇ 2 (Tr_1 ⁇ differentiation Tr) Equation (3 ′).
- FIG. 15 is a diagram showing the relationship between the provisional Tr value and the threshold value ⁇ obtained from the equations (1 ') to (3').
- the temporary Tr value when the temporary Tr value is larger than the first threshold value Tr1, the value ⁇ 2 is used as the threshold value ⁇ , and the second threshold value is smaller than Tr1.
- the threshold value is smaller than Tr2, the value ⁇ 1 smaller than the value ⁇ 2 is used as the threshold value ⁇ .
- the Tr value is set as the threshold value ⁇ . The smaller the value, the closer to ⁇ 1, and the larger the temporary Tr value, the closer to ⁇ 2.
- the threshold value ⁇ is set large when the temporary Tr value is large, and the threshold value ⁇ is set small when the temporary Tr value is small. become.
- the estimated Tr value is calculated using the threshold value variably set according to the temporary Tr value.
- Other configurations of the second embodiment are basically the same as those in the first embodiment.
- Embodiments of the present invention are not limited to the embodiments described above, for example, based on the fact that arteriosclerosis generally progresses as the age increases and arteriosclerosis does not progress as the age decreases.
- the age of the subject may be used as the degree.
- the age of the subject is used as the degree of hardening of the subject's arteries, there is a relationship that the AI value is smaller as the subject's age is higher, so the CPU 40 of the measuring apparatus 1 is similar to the above formulas (1) to (3). , And stores a formula using the age of the subject as a parameter.
- the relationship between the age of the subject and the threshold value ⁇ obtained from the same formula as the formulas (1) to (3) is similar to the AI value, compared to Ag1 in which the age of the subject is the first threshold value.
- the value ⁇ 1 is used as the threshold value ⁇
- the value ⁇ 2 larger than the value ⁇ 1 is used as the threshold value ⁇ .
- the threshold ⁇ is closer to ⁇ 2 as the age is lower, and the value closer to ⁇ 1 as the age is higher.
- 1 measuring device 2 substrate, 3 operation unit, 4 display unit, 9 armband, 10 air tube, 13A, 13B air bag, 20A, 20B air system, 21A air pump, 22A, 22B air valve, 23A, 23B pressure sensor, 26A 27A, 27B, 53 drive circuit, 28A, 28B amplifier, 29A, 29B converter, 31, 32 switch, 40 CPU, 41 memory, 51 2-port valve, 100 upper arm, 401 input unit, 402 AI calculation unit, 403 Threshold calculation unit, 404 identification unit, 405 Tr calculation unit.
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Abstract
Description
図1、図2、図3は、それぞれ、図17と同じ被験者について、頚動脈において測定された血圧波形と三角形状の血流波形とを用いて分離した駆出波と反射波からしきい値を用いて推定して求めたTr(以下推定Trという)と、従来のPWV測定装置で測定した2点間の脈波伝播時間から算出したTr(以下PWV Trという)との関係を示す図である。
α=AI×a+b (AI_2≦AI≦AI_1) …式(2)、
α=α1 (AI_1<AI) …式(3)。
図10を参照して、測定装置1は、空気袋13Aにエアチューブ10を介して接続されるエア系20A、および空気袋13Bにエアチューブ10を介して接続されるエア系20Bと、CPU(Central Processing Unit)40とを含む。エア系20Aは、エアポンプ21Aと、エアバルブ22Aと、圧力センサ23Aとを含む。エア系20Bは、エアバルブ22Bと、圧力センサ23Bとを含む。
実施態様1では、被験者の動脈の硬化度合いとして血圧波形に現れる反射波の大きさを表わす値としてAI値を用いているが、AI値に替えて、血圧波形を微分して算出される値(以降、この値を「仮Tr値」と称する)を用いて推定することも可能である。
α=α1 (微分Tr<Tr_2) …式(1’)、
α=仮Tr×a’+b’ (Tr_2≦微分Tr≦Tr_1) …式(2’)、
α=α2 (Tr_1<微分Tr) …式(3’)。
Claims (6)
- 血圧情報として被験者の動脈硬化度の指標を算出する血圧情報測定装置(1)であって、
空気袋を内包し、被験者の測定部位に巻き付けるためのカフ(9)と、
前記空気袋の内圧を調整するための空気袋内圧調整手段(20A,20B)と、
前記空気袋への空気注入及び/又はそこからの空気排出の過程で前記空気袋の内圧の変化を検出するための圧力センサ(23A,23B)と、
前記圧力センサが検出した前記空気袋の内圧変化に基づいた圧力波形から一拍分の血圧波形を得て、当該血圧波形のうちの駆出波の成分と反射波の成分とを分離し特定して前記被験者の動脈硬化度の指標を算出する処理を行なうための演算装置(40)とを備え、
前記演算装置は、
前記血圧波形における前記反射波の出現時点に応じた前記血圧波形の形状の特徴を表わす指標に基づいてしきい値を設定するしきい値設定処理部(403)と、
前記反射波の振幅が、反射波の最大振幅と前記しきい値とから得られる振幅となる時点を、前記反射波の立ち上がり点として推定する立ち上がり点推定処理部(404)と、を備え、
前記反射波の推定された立ち上がり点に基づいて前記駆出波と前記反射波の出現時間差を算出して、前記動脈硬化度の指標を算出する処理とを実行する、血圧情報測定装置。 - 前記血圧波形の形状の特徴を表わす指標は前記被験者の動脈硬化の度合いを表わし、
前記しきい値は、前記血圧波形の最大振幅に対する割合であり、前記設定される前記しきい値は、前記被験者の動脈硬化の度合いが進んでいる側のしきい値の方が、動脈硬化の度合いが進んでいない側のしきい値よりも小さい、請求項1に記載の血圧情報測定装置。 - 前記血圧波形の形状の特徴を表わす指標は、前記血圧波形における前記駆出波の振幅と前記反射波の振幅との比率であるAI(Augmentation Index)値、前記血圧波形の微分曲線から得られる特徴点に対応した前記血圧波形の位置に基づいて算出される値、および前記被験者の年齢のうちのいずれかである、請求項1または2に記載の血圧情報測定装置。
- 前記測定部位の末梢側を圧迫するための圧迫手段をさらに備え、
前記演算装置は、前記測定部位の末梢側が圧迫されて駆血された状態での前記空気袋の内圧変化に基づいて前記被験者の血圧情報として動脈硬化度の指標を算出する処理を行なう、請求項1~3のいずれかに記載の血圧情報測定装置。 - 前記測定部位は前記被験者の頚であって、前記演算装置は、前記血圧波形として頚動脈波形を得る、請求項1~4のいずれかに記載の血圧情報測定装置。
- 血圧情報として被験者の動脈硬化度の指標を算出する方法であって、
検出された、被験者の測定部位に装着された空気袋の内圧変化の入力を受け付けて、前記内圧変化に基づいた圧力波形から一拍分の血圧波形を取得するステップと、
取得した当該血圧波形のうちの駆出波の成分と反射波の成分とを分離し特定して前記被験者の動脈硬化度の指標を算出するステップとを備え、
前記算出するステップは、
前記血圧波形における前記反射波の出現時点に応じた前記血圧波形の形状の特徴を表わす指標に基づいてしきい値を設定するステップと、
前記反射波の振幅が、反射波の最大振幅と前記しきい値とから得られる振幅となる時点を、前記反射波の立ち上がり点として推定するステップと、
前記反射波の推定された立ち上がり点に基づいて前記駆出波と前記反射波の出現時間差を算出するステップとを含む、動脈硬化度の指標の算出方法。
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