JP4327524B2 - Blood pressure abnormality inspection device at load change - Google Patents

Description

  The present invention relates to an apparatus for inspecting a blood pressure abnormality during load change that becomes a blood pressure abnormality in response to a load change applied to a living body.

  Conventionally, in blood pressure management of hypertensive patients and the like, only the blood pressure value is treated as a management target, and improvement of the prognosis of the patient is not considered. This is thought to be due to the lack of information to know how much each factor affecting blood pressure affects the blood pressure in the living body. For this reason, the choice of the drug to be administered to hypertensive patients must rely on skilled experience and feeling, while improper treatment or medication can improve prognosis even if the target blood pressure is achieved. There was a problem that may not always connect. For example, high-pressure drugs have been mainly administered to patients with high blood pressure at all times. However, when high-pressure drugs are applied to a living body temporarily, blood pressure increases and cardiovascular disorders occur, It is not an effective measure to prevent accidents that cause abnormalities in certain environments.

On the other hand, as described in Patent Document 1 and Patent Document 2, a device that measures a change in blood pressure after a temporary load is applied to the patient by standing or performing a predetermined calculation. Has been proposed. According to this, since it is possible to grasp the blood pressure change generated in association with the load change due to the body position change, it is possible to evaluate the occurrence mode of the orthostatic hypertension or the orthostatic hypotension derived from the malfunction of the autonomic nerve.
Japanese Utility Model Publication No. 60-083603 Japanese Patent Laid-Open No. 05-200030

  However, since such devices are based solely on changes in blood pressure values, the changes in blood pressure are derived from peripheral resistance or stiffness changes or from changes in cardiac output. Since the cause or mechanism of the blood pressure change as to whether it is present is unknown, there has been a problem that appropriate judgment or treatment cannot always be performed.

  The present invention has been made against the background of the above circumstances, and the purpose of the present invention is to perform a load change blood pressure abnormality test that makes it possible to estimate the cause of abnormal blood pressure changes that occur due to changes in the biological load. It is to provide.

  A first means for achieving the above object is a load change blood pressure abnormality inspection device for examining a blood pressure abnormality that occurs when a biological load is changed. ) Blood pressure measuring means for measuring the blood pressure value of the living body before and after the change of the load on the living body, and (b) the pulse wave generated from the artery of the living body before and after the change of the load on the living body. (C) a blood pressure change calculating means for calculating a blood pressure change based on blood pressure values before and after a change in the load on the living body measured by the blood pressure measuring means; A waveform change calculating means for calculating a waveform change of the pulse wave before and after a change in load on the living body measured by the pulse wave measuring means; and (e) an axis indicating a blood pressure change and a waveform change. A display for displaying on the two-dimensional coordinate display surface a blood pressure change calculated by the blood pressure change calculating means and a waveform change calculated by the waveform change calculating means. Means.

  The second means for achieving the above object is a load change blood pressure abnormality inspection device for examining a blood pressure abnormality that occurs when a biological load changes, ) Blood pressure measuring means for measuring the blood pressure value of the living body before and after the change of the load on the living body, and (b) the pulse wave generated from the artery of the living body before and after the change of the load on the living body. (C) a blood pressure change calculating means for calculating a blood pressure change based on blood pressure values before and after a change in the load on the living body measured by the blood pressure measuring means; (E) calculated by the blood pressure change calculating means; and (e) a blood pressure change calculating means for calculating a waveform change of the pulse wave before and after a change in load on the living body measured by the pulse wave measuring means And a load change blood pressure abnormality risk determination means for determining the possibility of a blood pressure abnormality at the time of a load change of the living body based on the measured blood pressure change and the waveform change calculated by the waveform change calculation means. .

Third means A gist of a third invention for achieving the above object is a load change blood pressure abnormality inspection device for examining a blood pressure abnormality that occurs when a biological load changes, ) A pulse wave measuring means for measuring the pulse wave generated from the artery of the living body before and after the change of the load on the living body, and (b) before the change of the load on the living body measured by the pulse wave measuring means. And display means for displaying the pulse wave after the change in a comparable manner.
A blood pressure abnormality inspection device at the time of load change, characterized by:

  The fourth means for achieving the above object is a load change blood pressure abnormality inspection device for examining a blood pressure abnormality that occurs when a biological load changes, ) A pulse wave measuring means for measuring the pulse wave generated from the artery of the living body before and after the change of the load on the living body, and (b) before the change of the load on the living body measured by the pulse wave measuring means. And a waveform change calculating means for calculating the waveform change of the pulse wave after the change, and (c) a display for displaying the waveform change of the pulse wave before and after the change of the load on the living body calculated by the waveform change calculating means Means.

  According to the first aspect of the present invention, the blood pressure change calculated by the blood pressure change calculating means and the waveform are displayed on the two-dimensional coordinate display surface including the axis indicating the blood pressure change and the axis indicating the waveform change. Display indicating the waveform change calculated by the change calculation means is performed. Since this display shows a change in blood pressure and a change in the waveform of the pulse wave obtained from the artery, a change in cardiac output obtained from the change in waveform of the pulse wave or a change on the peripheral artery side is a change in blood pressure. Since it can be grasped at the same time, the blood pressure abnormality at the time of load change and the estimation of whether the cause is on the cardiac output side or the peripheral artery side are clarified, and appropriate judgment or treatment for the blood pressure abnormality at the time of load change becomes possible .

  Effect of the Second Invention In this way, the load change of the living body based on the blood pressure change calculated by the blood pressure change calculating means and the waveform change calculated by the waveform change calculating means by the load change blood pressure abnormality risk determining means. The possibility of abnormal blood pressure is determined. Since this determination is made based on a change in blood pressure and a waveform change of a pulse wave obtained from an artery, a change in cardiac output or a change on the peripheral artery side obtained from the change in waveform of the pulse wave is detected. Since it is taken into account at the same time as the blood pressure change, the estimation of whether the cause is on the cardiac output side or the peripheral artery side is clarified together with the blood pressure abnormality at the time of load change, and an appropriate judgment for the blood pressure abnormality at the time of load change can be obtained Appropriate treatment becomes possible.

  Advantages of the third invention In this way, since the pulse wave before and after the change of the load on the living body measured by the pulse wave measuring means is displayed by the display means in a comparable manner, the load on the living body is displayed. By comparing the shape of the pulse wave before and after the change, the change portion and the magnitude of the change can be easily grasped. If the change part is the rising part of the pulse wave, it indicates a change in the strength of the heartbeat, if the change part is a gentle decrease curve part in the latter half of the pulse wave, it indicates a change in peripheral resistance, and the change part is the center of the pulse wave If the sharpness of the part or the whole indicates the change in the stiffness of the artery, and if the change part is the amplitude of the traveling wave and the amplitude of the reflected wave in the central part of the pulse wave, it indicates the stiffness of the artery. Estimate whether the cause of abnormal blood pressure at the load change is on the cardiac output side or the peripheral artery side based on the change location and magnitude of the pulse wave shape before and after the load change Becomes clear, and appropriate judgment or treatment for blood pressure abnormality during load change becomes possible.

  Advantages of the Fourth Invention In this way, the waveform change of the pulse wave before and after the change of the load on the living body calculated by the waveform change calculation means is displayed by the display means. If the part of the waveform change is the rising part of the pulse wave, it indicates a change in the strength of the heartbeat, and if the part of the waveform change is the gentle decline curve part in the second half of the pulse wave, it indicates a change in peripheral resistance, and the waveform change If the part of the pulse wave is the central part of the pulse wave or the overall sharpness, it indicates a change in the stiffness of the artery, and if the part of the waveform change is the amplitude of the traveling wave and the amplitude of the reflected wave in the central part of the pulse wave, Based on the location of the waveform change of the pulse wave before and after the change of the load on the living body and the magnitude of the waveform change, the cause of the blood pressure abnormality at the load change is on the cardiac output side. The estimation of whether there is a peripheral artery or not is clear, and appropriate judgment or treatment for abnormal blood pressure during load change is possible.

  Hereinafter, other aspects of the invention will be described. In the first aspect of the present invention, the two-dimensional coordinate display surface includes a hypertension region under load that indicates the possibility of hypertension under load that becomes hypertension when the load on the living body is increased in relation to the waveform change, and the bioburden load. There is provided at least one on-load hypotension region that indicates the possibility of hypotension during loading, which causes hypotension when increased in relation to the waveform change. For example, the on-load hypertension region is set to a region where the blood pressure at the time of load change is changed to a predetermined abnormal increase side and the waveform change of the pulse wave indicates hardening of the peripheral artery side of the predetermined abnormality, The blood pressure at the time of load change is changed to a decreasing side, and the waveform change of the pulse wave is set in a region indicating relaxation on the peripheral side of the artery. In this way, depending on whether the display location indicating the blood pressure change and the waveform change of the pulse wave obtained from the artery is within the load high blood pressure region or the load low blood pressure region, It becomes possible to easily and easily determine hypotension during loading.

  In the second aspect of the present invention, the load change blood pressure abnormality risk determination means includes a possibility of high blood pressure during loading that causes high blood pressure when the biological load is increased, and a load that causes low blood pressure when the biological load is increased. At least one of the possible hypotension is determined based on a change in blood pressure at the time of load change and a change in waveform of a pulse wave obtained from an artery. For example, if the blood pressure during a load change changes to the increasing side and the change in the waveform of the pulse wave indicates hardening on the peripheral side of the artery, the possibility of hypertension during the load is determined, and the blood pressure during the load change decreases If the pulse waveform changes to the side and the change in the waveform of the pulse wave indicates relaxation on the peripheral side of the artery, the possibility of hypotension under load is determined. In this way, it is possible to obtain an appropriate determination with respect to abnormal blood pressure at the time of load change and to perform appropriate treatment.

  In the first and second inventions, the blood pressure change calculating means calculates a difference or a change rate of blood pressure values measured before and after the change in the biological load. Further, the waveform change calculating means calculates a difference or rate of change of the waveform characteristic value of the pulse wave measured before and after the change in the biological load. According to this configuration, the blood pressure change calculation means calculates the two-dimensional coordinate display surface including the axis indicating the difference or change rate of the blood pressure value and the axis indicating the difference or change rate of the waveform feature value. A display showing the difference or rate of change of the blood pressure value and the difference or rate of change of the waveform feature value calculated by the waveform change calculating means is performed. In addition, based on the difference or change rate of the blood pressure value calculated by the blood pressure change calculating unit and the difference or change rate of the waveform feature value calculated by the waveform change calculating unit by the blood pressure abnormality risk determining unit at the time of load change The possibility of abnormal blood pressure during load changes is determined.

  Further, the waveform characteristic value of the pulse wave includes an amplitude increase index AI indicating a ratio of a reflected wave component to a traveling wave component included in the pulse wave, a sharpness T indicating a sharpness of the pulse wave, and a rise of the pulse wave. One of the time UTs. The amplitude increase index AI is generally known as an augmentation index, and represents the ratio of the reflected wave component to the traveling wave component of the pulse wave, for example, in order to evaluate the compliance of the aorta. When the compliance of the aorta is large, the reflected wave component is small, and when the compliance is small, the reflected wave component is large. That is, since the reflected wave component of the aortic waveform increases as the aortic blood vessel becomes hard, the amplitude increase index is a waveform feature value that reflects arteriosclerosis at the pulse wave collection position. Further, as a characteristic value indicating the degree of pulse wave shape rounding, for example, a value obtained by dividing a pulse wave area by a product of a pulse wave period and a pulse wave amplitude in percentage, that is, a% MAP value is known. The sharpness T is a waveform characteristic value indicating the sharpness of the pulse wave, and is indicated by a value obtained by subtracting the% MAP value from 100, the reciprocal of the% MAP value, or the like. When the sharpness is low, the artery is soft, and when the sharpness is high, arteriosclerosis is indicated. The pulse wave rise time UT is a time from the pulse wave rise point to the pulse wave inflection point or the maximum amplitude point of the pulse wave, and is a waveform characteristic value corresponding to the strength of the heartbeat.

  The amplitude increase index is the ratio of the reflected wave component to the traveling wave component of the pulse wave, but separating the detected pulse wave (hereinafter referred to as the detected pulse wave) into the traveling wave component and the reflected wave component is not possible. Since it is difficult, the method for calculating the amplitude increase index, for example, determines the peak generation time of the traveling wave component and the peak generation time of the reflected wave component from the detected pulse wave, and the detected pulse wave at the time of the peak generation of the traveling wave component is determined. The difference between the magnitude and the magnitude of the detected pulse wave when the reflected wave component peak occurs is calculated by dividing by the pulse pressure of the detected pulse wave. The peak of the traveling wave component is assumed to be the inflection point or maximum point from the rising point to the peak of the detected pulse wave, and the peak of the reflected wave component is generated after the peak of the traveling wave component. It is said that it is the time when the first local maximum occurs.

  In the third invention, the display means displays the pulse waves before and after the change of the load on the living body measured by the pulse wave measuring means so as to overlap each other. In this way, it is possible to easily compare the shape of the pulse wave before and after the change of the load on the living body, and the change site and the magnitude of the change can be grasped more easily.

  In the fourth invention, the waveform change calculating means calculates a difference or rate of change in the waveform characteristic value of the pulse wave measured before and after the change in the biological load. In this way, the difference or change rate of the waveform feature value is displayed, so that the cause of the blood pressure abnormality at the load change is on the cardiac output side based on the content of the waveform feature value and the magnitude of the change. Or, the estimation of whether it is located on the peripheral artery side becomes clear, and appropriate determination or treatment for abnormal blood pressure during load change is possible.

  Further, the waveform feature value of the pulse wave includes an amplitude increase index AI indicating the ratio of the reflected wave component to the traveling wave component included in the pulse wave, a sharpness T indicating the sharpness of the pulse wave, and a rise of the pulse wave. One of the time UTs.

  Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings. FIG. 1 is a block diagram showing a configuration of a load change blood pressure abnormality inspection apparatus 10 to which the present invention is applied.

  In FIG. 1, the cuff 12 has a rubber bag in a cloth band bag and is wound around the upper arm portion 14 of the living body L. A pressure sensor 16 and a pressure regulating valve 18 are connected to the cuff 12 via a pipe 20, respectively. An air pump 24 is connected to the pressure regulating valve 18 via a pipe 22. The pressure regulating valve 18 regulates the pressure in the cuff 12 by regulating the high-pressure air generated by the air pump 24 and supplying it to the cuff 12 or exhausting the air in the cuff 12.

The pressure sensor 16 detects the pressure in the cuff 12 and supplies a pressure signal SP representing the pressure to the static pressure discrimination circuit 26 and the pulse wave discrimination circuit (that is, the pulse wave discrimination device) 28. Static pressure filter circuit 26 includes a low-pass filter, pressing pressure (hereinafter, this pressure cuff that pressure P _C) of the stationary pressure or cuff 12 included in the pressure signal SP to discriminate cuff pressure signal SC representing the The cuff pressure signal SC is supplied to the electronic control unit 32 via the A / D converter 30. The pulse wave discrimination circuit 28 includes a band pass filter having a signal pass band of about 1 to 30 Hz, for example, and discriminates the cuff pulse wave signal SM, which is a vibration component of the pressure signal SP, and converts the cuff pulse wave signal SM to A / This is supplied to the electronic control unit 32 via the D converter 34. The cuff pulse wave signal SM represents a brachial pulse wave because it is a pressure vibration transmitted from the brachial artery (not shown) to the cuff 12.

The electronic control unit 32 includes a CPU 36, a ROM 38, a RAM 40, and a so-called microcomputer having an I / O port (not shown). The CPU 36 uses a storage function of the RAM 40 according to a program stored in the ROM 38 in advance. However, by executing signal processing, a drive signal is output from the I / O port to control the air pump 24 and the pressure regulating valve 18. The CPU 36 controls the cuff pressure P _C by controlling the air pump 24 and the pressure regulating valve 18, and measures the blood pressure of the living body L and the waveform of the cuff pulse wave that is pressure vibration generated in the cuff 12 in synchronization with the pulse. Detection and execution. That, CPU 36 is to perform a blood pressure measurement according to the so-called oscillometric method, sequentially cuff 12 in synchronism with the pulse in the course of lowering the pressing pressure P _C of the cuff 12 which is also higher than systolic blood removal A systolic blood pressure value, a diastolic blood pressure value, and the like are measured based on a change in amplitude of a plurality of cuff pulse waves that are generated pressure vibrations. Further, the prior or after the blood pressure measurement period, and stores the collected cuff pulse wave produced in the period of holding the pressing pressure P _C of the cuff 12 in diastolic blood pressure following the pulse wave detection pressure P _H. For this reason, in this embodiment, the electronic control device 32 and the like correspond to a blood pressure measurement device 44 and a pulse wave detection device 46 in FIG.

  The CPU 36 calculates the blood pressure change before and after the load change for the living body L, calculates the waveform feature value, calculates the waveform change before and after the load change for the living body L, and also calculates the blood pressure value, the blood pressure change, the waveform, and the waveform. Changes and waveform feature values are displayed on the display 42. Then, in order to change the load applied to the living body L, the CPU 36 moves the tilt bed 48 on which the living body L is placed from one of the horizontal position and the vertical position to the other in response to the activation operation by the operator. Drive control is performed so that the posture changes. The tilt bed 48 includes a drive unit that changes the posture from one of the horizontal position and the vertical position to the other in accordance with a command from the electronic control device 32. In this embodiment, the tilt bed 48 functions as a load device for changing the load applied to the circulatory organ of the living body L. When the living body L is raised from the horizontal position to the vertical position, the load applied to the circulatory organ of the living body L is increased.

FIG. 2 is a functional block diagram for explaining a main part of the control function of the electronic control device 32 in the blood pressure abnormality test apparatus 10 during load change. In FIG. 2, the blood pressure measurement device 44 and the pulse wave detection device 46 measure the blood pressure of the living body L at least when the tilt bed 48 is in the horizontal position and when the tilt bed 48 is changed from the horizontal position to the vertical position. Each pulse wave detection is executed. Changes in blood pressure calculating unit 50, the blood pressure changes indicative of change between the blood pressure value BP ₂ which is measured when the tilt bed 48 has been varied to a measured blood pressure value BP ₁ and a vertical position when in the horizontal position For example, a blood pressure value difference ΔBP (= BP ₂ −BP ₁ ) or a blood pressure change rate R _BP (= ΔBP / BP ₁ ) is calculated. The blood pressure value BP may be any of a maximum blood pressure value, a minimum blood pressure value, and an average blood pressure value.

The amplitude increase rate calculation means 52 calculates the amplitude increase index AI of the cuff pulse wave SM detected by the pulse wave detector 46. For example, as shown in FIG. 3, on the basis of the zero crossing (zero cross) of the fourth derivative wave of the cuff-pulse-wave signal SM detected from the cuff 12 is maintained in a pulse-wave detection pressure P _H, the cuff pulse The peak point P of the traveling wave component included in the wave signal SM and its generation time t _P , the peak point R of the reflected wave component and its generation time t _R are determined, and the pulse pressure (maximum amplitude) PP is determined to reflect A difference value ΔP = (b−a) obtained by subtracting the magnitude a of the cuff pulse wave signal SM at the peak occurrence time t _P of the traveling wave component from the magnitude b of the cuff pulse wave signal SM at the peak occurrence time t _R of the wave component. Then, the amplitude increase index AI is calculated from the pulse pressure PP using the relationship shown in Formula 1. That is, the amplitude increase index AI is the ratio of the reflected wave component to the traveling wave component of the cuff pulse wave signal SM, as is apparent from Equation 1. Since the traveling wave and the reflected wave cannot be clearly separated from each other, the peak generation time point t _P of the traveling wave component is the generation point of the inflection point or the maximum point from the rising point t ₁ to the peak of the cuff pulse wave. It is assumed that the peak generation time t _R of the reflected wave component is the generation time of the first maximum point after the peak of the traveling wave component. When the compliance of the aorta is large, the reflected wave component is small, and when the compliance is small, the reflected wave component is large. That is, since the reflected wave component of the aortic waveform increases as the aortic blood vessel becomes hard, the amplitude increase index AI reflects arteriosclerosis near the pulse wave collection position, that is, near the cuff 12 mounting position.

AI = (ΔP / PP) × 100 (%) (Formula 1)

The sharpness calculation means 54 calculates the sharpness T as a waveform feature value indicating the sharpness of the cuff pulse wave SM detected by the pulse wave detection device 46. As a characteristic value indicating the degree of pulse wave shape roundness, for example, a value obtained by dividing the pulse wave area by the product of the pulse wave period and the pulse wave amplitude as a percentage, that is, the% MAP value is known. T is indicated by a value obtained by subtracting the% MAP value from 100, a reciprocal of the% MAP value, or the like. When the sharpness T is low, the artery is soft, and when the sharpness T is high, arteriosclerosis is indicated. The rise time calculation means 56 calculates the rise time UT as a waveform feature value indicating the rising state of the cuff pulse wave SM detected by the pulse wave detection device 46. For example, the rise time UT is calculated by counting the time from the pulse wave rise point t ₁ to the pulse wave inflection point or the maximum amplitude point of the pulse wave. The rise time UT of the pulse wave reflects the contractile force of the heart or the strength of the heartbeat. The amplitude increase rate calculating means 52, the sharpness calculating means 54, and the rise time calculating means 56 constitute a waveform feature value calculating means for calculating the waveform feature value of the cuff pulse wave SM detected by the pulse wave detecting device 46. is doing.

The pulse wave amplitude increase rate change means 60 changes the amplitude increase index AI ₁ calculated from the cuff pulse wave SM when the tilt bed 48 is in the horizontal position by the amplitude increase rate calculation means 52 and the tilt bed 48 changes to the vertical position. The increase ΔAI (= AI ₂ −AI ₁ ) or the increase rate R between the amplitude increase index AI ₂ calculated from the cuff pulse wave SM when the load applied to the circulatory organ of the living body L is increased. _AI (= ΔAI / AI ₁ ) is calculated. The sharpness change calculation means 62 changes the sharpness T ₁ calculated from the cuff pulse wave SM when the tilt bed 48 is in the horizontal position by the sharpness calculation means 54 and the tilt bed 48 to the vertical position, thereby changing the living body. Increase amount ΔT (= T ₂ −T ₁ ) or increase rate R _T (= ΔT /) between the sharpness T ₂ calculated from the cuff pulse wave SM when the load applied to the circulator of L is increased T ₁ ) is calculated. The rise time change calculating means 64 is configured to change the rise time UT ₁ calculated from the cuff pulse wave SM when the tilt bed 48 is in the horizontal position by the rise time calculating means 56 and the tilt bed 48 to the vertical position. Increase amount ΔUT (= UT ₂ −UT ₁ ) or increase rate R _UT (= ΔUT /) between the rise time UT ₂ calculated from the cuff pulse wave SM when the load applied to the L circulator is increased UT ₁ ) is calculated. The amplitude increase rate change calculating means 60, the sharpness change calculating means 62, and the rising time change calculating means 64 are the waveform feature value calculated from the cuff pulse wave SM when the tilt bed 48 is in the horizontal position and the tilt bed 48. Is changed to the vertical position and the change applied to the waveform feature value calculated from the cuff pulse wave SM when the load applied to the circulatory organ of the living body L is increased, that is, the amount of increase or the rate of increase is calculated. Waveform feature value change calculating means is configured.

The display means 68 includes the cuff pulse wave SM ₁ detected by the pulse wave measuring device 46 on the screen of the display 42 when the tilt bed 48 is in the horizontal position (before the load on the living body L is changed) and the tilt bed. 48 is comparably displays the cuff pulse wave SM ₂ (after the change in the load on the biological L) when given load is greatly circulatory biological L is varied to a vertical position. For example, as shown in FIG. 4, the cuff pulse wave SM ₁ and the cuff pulse wave before and after the change of the load on the circulatory organ of the living body L at the pulse wave display place 72 provided in advance on the screen of the display 42. Display SM ₂ overlaid on top of each other. In FIG. 4, the broken line indicates the cuff pulse wave SM ₁ before the change of the load on the circulatory organ of the living body L, and the display means 68 displays the blood pressure at the waveform change display place 74 provided in advance on the screen of the display 42. The blood pressure change value calculated by the change calculating means 50, for example, the blood pressure value difference ΔBP (= BP ₂ −BP ₁ ) or the blood pressure change rate R _BP (= ΔBP / BP ₁ ), and the pulse wave amplitude increase rate changing means 60 are calculated. The change value of the amplitude increase index AI, for example, the increase amount ΔAI (= AI ₂ −AI ₁ ) or the increase rate R _AI (= ΔAI / AI ₁ ), and the change of the sharpness T calculated by the sharpness change calculation means 62 A value, for example, an increase amount ΔT (= T ₂ −T ₁ ) or an increase rate R _T (= ΔT / T ₁ ), and a change value of the rise time UT calculated by the rise time change calculating means 64, for example, an increase amount ΔUT (= UT ₂ -UT ₁ Or displaying increasing rate _{R UT (= ΔUT / UT 1} ) and, respectively.

Further, the display means 68 is a two-dimensional display comprising an axis 80 indicating a blood pressure change and an axis 82 indicating a waveform change as shown in FIG. 5 in a determination area display place 76 provided in advance on the screen of the display 42. While displaying the orthogonal coordinate display surface, the blood pressure change value calculated by the blood pressure change calculating means 50, for example, the blood pressure value difference ΔBP (= BP ₂ −BP ₁ ) or the blood pressure change rate R _BP (= ΔBP / BP ₁ ), and the pulse A change value of the amplitude increase index AI calculated by the wave amplitude increase rate changing means 60, for example, an increase amount ΔAI (= AI ₂ −AI ₁ ) or an increase rate R _AI (= ΔAI / AI ₁ ), and a sharpness change calculating means 62 The change value of the calculated sharpness T, for example, the increase amount ΔT (= T ₂ −T ₁ ) or the increase rate R _T (= ΔT / T ₁ ), or the rise time UT calculated by the rise time change calculation means 64 Change value For example to display the increment ΔUT (= UT ₂ -UT ₁₎ or increase rate _{R UT (= ΔUT / UT 1} ) and a display position x showing the Invite. In FIG. 5, an example is shown in which the display position x indicates the increase amount (blood pressure value difference) ΔBP of the blood pressure value and the increase amount ΔAI of the amplitude increase index AI. On the two-dimensional orthogonal coordinate display surface, the increase amount ΔAI of the amplitude increase index AI is a region where the predetermined value, for example, +20 mmHg or more and a predetermined value, for example, −20 mmHg, and the blood pressure value difference ΔBP is a predetermined value + 10% or more, and a predetermined value, for example, − An orthostatic hypertension determination area A and an orthostatic hypotension determination area B are provided in an area of 10% or less. When the display position x is displayed in the orthostatic hypertension determination area A, the possibility of orthostatic hypertension is determined. When the display position x is displayed in the orthostatic hypotension determination area B, The likelihood of orthostatic hypotension is determined.

For example, the risk determination unit 70 may calculate a blood pressure change value calculated by the blood pressure change calculation unit 50, for example, a blood pressure value difference ΔBP (= BP ₂ −BP ₁ ) or a blood pressure change rate R based on a previously stored relationship as shown in FIG. _BP (= ΔBP / BP ₁ ) and a change value of the amplitude increase index AI calculated by the pulse wave amplitude increase rate changing means 60, for example, an increase amount ΔAI (= AI ₂ −AI ₁ ) or an increase rate R _AI (= ΔAI) / AI ₁ ), a change value of the sharpness T calculated by the sharpness change calculation means 62, for example, an increase amount ΔT (= T ₂ −T ₁ ), an increase rate R _T (= ΔT / T ₁ ), or a rise time Based on the change value of the rise time UT calculated by the change calculation means 64, for example, the increase amount ΔUT (= UT ₂ −UT ₁ ) or the increase rate R _UT (= ΔUT / UT ₁ ), the load on the circulatory organ of the living body L When it changed For example, the risk of hypertension or hypotension that occurs when the load increases, such as orthostatic hypertension or orthostatic hypotension, that is, the suspicion is determined. The display means 68 displays the determination result of the risk determination means 70 at a determination area display place 78 provided in advance on the screen of the display 42, for example, “There is a suspicion of orthostatic hypertension.” A comment indicating the judgment result such as “I suspect a symptom” is displayed.

  FIG. 6 is a flowchart for explaining a main part of the control operation of the electronic control unit 32, that is, the control operation of the CPU 36 shown in the functional block diagram of FIG.

In FIG. 6, when a measurement start operation (not shown) is performed, in step S1 (hereinafter, step is omitted), after the predetermined time has elapsed since the tilt bed 48 is set in the horizontal position, the blood pressure measurement device 44 in S2. Thus, the blood pressure BP ₁ of the living body L is measured, and the cuff pulse wave SM ₁ is detected by the pulse wave detector 46 in S3. When the blood pressure BP ₁ and the cuff pulse wave SM ₁ of the living body L on the tilt bed 48 in the horizontal state are measured in this way, the tilt bed 48 is driven from the horizontal position to the vertical position in S4, thereby tilting. The load on the circulatory organ of the living body L on the bed 48 is increased more than before. In a state in which such a load change is generated, the blood pressure BP ₂ after the load change of the living body L is measured by the blood pressure measuring device 44 in S5, and the load change of the living body L is detected by the pulse wave detecting device 46 in S6. The later cuff pulse wave SM ₂ is detected.

Then, in step S7 corresponding to the change in blood pressure calculating unit 50, measured between the blood pressure value BP ₂ when the tilt bed 48 has been varied to a measured blood pressure value BP ₁ and a vertical position when in the horizontal position For example, a blood pressure change value ΔBP (= BP ₂ −BP ₁ ) or a blood pressure change rate R _BP (= ΔBP / BP ₁ ) is calculated. In S8 corresponding to the amplitude increase rate calculation means 52, the sharpness calculation means 54, and the rise time calculation means 56, the cuff pulse wave SM detected when the tilt bed 48 is in the horizontal position by the pulse wave detection device 46. For each of the cuff pulse wave SM ₂ detected when ₁ and the tilt bed 48 are in the vertical position, the amplitude increase indexes AI ₁ and AI ₂ are calculated using the relationship shown in Equation 1, respectively, and the reciprocal of the% MAP value The sharpness T ₁ and the sharpness T ₂ are respectively calculated by calculating the time from the rising point t ₁ of the pulse wave to the inflection point of the pulse wave or the maximum amplitude point of the pulse wave, and the rising time UT ₁ and The rise time UT ₂ is calculated respectively.

Next, in S9 corresponding to the pulse wave amplitude increase rate changing means 60, the sharpness change calculating means 62, and the rising time change calculating means 64, the amplitude calculated from the cuff pulse wave SM when the tilt bed 48 is in the horizontal position. Increase between the increase index AI ₁ and the amplitude increase index AI ₂ calculated from the cuff pulse wave SM when the tilt bed 48 is changed to the vertical position and the load applied to the circulatory organ of the living body L is increased. The amount ΔAI (= AI ₂ −AI ₁ ) or the rate of increase R _AI (= ΔAI / AI ₁ ) is calculated, and the sharpness T ₁ calculated from the cuff pulse wave SM when the tilt bed 48 is in the horizontal position and its Increase amount ΔT (= T ₂ − between the sharpness T ₂ calculated from the cuff pulse wave SM when the tilt bed 48 is changed to the vertical position and the load applied to the circulatory organ of the living body L is increased. T ₁₎ some Is calculated increase rate _{R T (= ΔT / T 1} ) is provided cuff-pulse-wave SM rise time calculated from UT ₁ and the tilt bed 48 is changed to the vertical position when the tilt bed 48 is horizontal position Thus, an increase amount ΔUT (= UT ₂ −UT ₁ ) or an increase rate R _UT (=) between the rise time UT ₂ calculated from the cuff pulse wave SM when the load applied to the circulatory organ of the living body L is increased. ΔUT / UT ₁ ) is calculated.

In S10 corresponding to the risk determination means 70, the blood pressure change value calculated by the blood pressure change calculation means 50, for example, the blood pressure value difference ΔBP (= BP ₂ −BP ₁ ), for example, from the relationship stored in advance as shown in FIG. Alternatively, the blood pressure change rate R _BP (= ΔBP / BP ₁ ) and the change value of the amplitude increase index AI calculated by the pulse wave amplitude increase rate change means 60, for example, the increase amount ΔAI (= AI ₂ −AI ₁ ) or the increase rate Based on R _AI (= ΔAI / AI ₁ ), the risk of hypertension and hypotension that occurs when the load on the circulatory organ of the living body L changes, for example, when the load increases, such as orthostatic hypertension and orthostatic hypotension, Suspicion is determined.

Step S11 corresponds to the display unit 68, the screen of display 42, cuff-pulse-wave SM ₁ and its tilt bed 48 that is detected when the tilt bed 48 is a horizontal position (before the change in the load on the biological L) is As shown in FIG. 4, the cuff pulse wave SM ₂ when the load applied to the circulatory organ of the living body L is increased (after the change of the load on the living body L) is changed to the vertical position. They are displayed so as to overlap each other at a pulse wave display location 72 provided in advance on the screen. Further, at the waveform change display location 74, the blood pressure value difference ΔBP (= BP ₂ −BP ₁ ) or the blood pressure change rate R _BP (= ΔBP / BP ₁ ) and the amplitude calculated by the pulse wave amplitude increase rate changing means 60. A change value of the increase index AI, for example, an increase amount ΔAI (= AI ₂ −AI ₁ ) or an increase rate R _AI (= ΔAI / AI ₁ ), and a change value of the sharpness T calculated by the sharpness change calculation means 62, for example, an increase The amount ΔT (= T ₂ −T ₁ ) or the rate of increase R _T (= ΔT / T ₁ ) and the change value of the rise time UT calculated by the rise time change calculation means 64, for example, the increase amount ΔUT (= UT ₂ −UT ₁ ) or increase rate R _UT (= ΔUT / UT ₁ ) is displayed. Further, in a determination region display place 76 provided in advance on the screen of the display 42, a blood pressure value difference is displayed on a two-dimensional orthogonal coordinate display surface including an axis 80 indicating blood pressure change and an axis 82 indicating waveform change shown in FIG. ΔBP (= BP ₂ −BP ₁ ) or blood pressure change rate R _BP (= ΔBP / BP ₁ ) and a change value of the amplitude increase index AI calculated by the pulse wave amplitude increase rate changing means 60, for example, an increase amount ΔAI (= AI ₂₋ AI ₁ ) or an increase rate R _AI (= ΔAI / AI ₁ ) is displayed. In addition, in the determination area display place 78 provided in advance, a comment indicating the determination result of S10, for example, a determination result such as "There is a suspicion of orthostatic hypertension" or "A suspicion of orthostatic hypotension." Etc. are displayed.

  As described above, according to the present embodiment, the living body calculated by the blood pressure change calculating means 50 on the two-dimensional coordinate display surface including the axis 80 indicating the blood pressure change and the axis 82 indicating the waveform change is displayed by the display means 68. The blood pressure change before and after the load change of L and the waveform change before and after the load change of the living body L calculated by the waveform change calculation means 66 are displayed. Since this display shows the blood pressure change of the living body L and the waveform change of the pulse wave obtained from the artery, a change in cardiac output or a change on the peripheral artery side obtained from the waveform change of the pulse wave is detected. Since it can be grasped at the same time as the blood pressure change, the estimation of whether the cause is the cardiac output side or the peripheral artery side along with the blood pressure abnormality at the time of load change becomes clear, and appropriate judgment or treatment for the blood pressure abnormality at the time of load change It becomes possible.

  Further, according to the present embodiment, the load on the living body based on the blood pressure change calculated by the blood pressure change calculating means 50 and the waveform change calculated by the waveform change calculating means 66 by the blood pressure abnormality risk determining means 70 at the time of load change. Since the possibility of abnormal blood pressure at the time of change is determined, the change in cardiac output or the change in the peripheral arteries obtained from the change in the waveform of the pulse wave is considered at the same time as the blood pressure change. At the same time, the estimation of whether the cause is on the cardiac output side or the peripheral artery side is clarified, and an appropriate determination for abnormal blood pressure at the time of load change can be obtained and appropriate treatment can be performed.

  In addition, according to the present embodiment, the two-dimensional coordinate display surface has a hypertension region A during loading that indicates the possibility of hypertension during loading, which becomes hypertension when the biological load is increased, in relation to the waveform change, Since at least one of the on-load hypotension region B indicating the possibility of hypotension on load that becomes hypotension when the biological load is increased in relation to the waveform change is provided, Depending on whether or not the display location x indicating the waveform change of the pulse wave obtained from the artery is within the on-load hypertension region A or the on-load hypotension region B, the on-load hypertension or on-load hypotension is determined. It becomes possible to judge easily and easily.

  In addition, according to the present embodiment, the risk determination means 70 can reduce the on-load low blood pressure that can cause high blood pressure when the biological load is increased and low blood pressure when the biological load is increased. Since at least one of the possibility of blood pressure disease is determined based on the blood pressure change at the time of load change and the waveform change of the pulse wave obtained from the artery based on the relationship stored in advance as shown in FIG. Appropriate judgment for abnormal blood pressure is obtained, and appropriate treatment is possible.

  Further, according to the present embodiment, the display means 68 allows the waveform of the pulse wave before and after the change of the load on the living body L measured by the pulse wave measuring means 44 to be compared with each other at the display location 72 so as to be compared with each other. Therefore, by comparing the shape of the pulse wave before and after the change of the load on the living body, the change part and the magnitude of the change can be easily grasped. For example, if the change part is the rising part of the pulse wave, it indicates a change in the strength of the heartbeat, if the change part is a gentle decrease curve part in the latter half of the pulse wave, it indicates a change in peripheral resistance, and the change part is the pulse wave If the sharpness of the central part or the whole indicates the change in the stiffness of the artery, and if the change part is the amplitude of the traveling wave and the reflected wave in the central part of the pulse wave, it indicates the stiffness of the artery. Whether the cause of blood pressure abnormality at the time of load change is on the cardiac output side or on the peripheral artery side based on the change location and magnitude of the pulse wave shape before and after the change of the load on L The estimation becomes clear, and appropriate judgment or treatment for blood pressure abnormality during load change becomes possible.

  Further, according to the present embodiment, the display means 68 displays the waveform change of the pulse wave before and after the change of the load on the living body calculated by the waveform change calculation means 66, for example, the difference or change rate of the waveform feature value. Displayed at location 74. For example, if the part of the waveform change is the rising part of the pulse wave, it indicates a change in the strength of the heartbeat, and if the part of the waveform change is a gentle decline curve part in the second half of the pulse wave, it indicates a change in peripheral resistance, If the waveform change part is the central part of the pulse wave or the overall sharpness, it indicates a change in the stiffness of the artery. If the waveform change part is the amplitude of the traveling wave and the reflected wave in the central part of the pulse wave, Since it indicates the stiffness of the artery, the cause of abnormal blood pressure at the time of load change is based on the part of the waveform change of the pulse wave before and after the change of the load on the living body and the magnitude of the waveform change. This makes it possible to make an appropriate determination or treatment for abnormal blood pressure during a load change.

  As mentioned above, although embodiment of this invention was described in detail based on drawing, this invention is applied also in another aspect.

  For example, although the cuff 12 is attached to the upper arm part 14 in the above-described blood pressure abnormality inspection device 10 at the time of load change, it may be attached to other parts, for example, a thigh or an ankle. The pulse wave detection device 46 detects the cuff pulse wave SM, which is the pressure oscillation in the cuff 12, but instead, the carotid artery detects carotid artery waves by pressing the carotid artery. Using a wave sensor, a radial artery wave sensor that detects a radial artery wave by pressing the radial artery, an impedance pulse wave sensor that detects an impedance pulse wave that is an impedance change between electrodes mounted on a living body, and light For example, a photoelectric pulse wave sensor that detects a pulse wave may be used.

  In the above-described embodiment, the tilt bed 48 is used to change the load applied to the circulatory organ of the living body L. However, increasing the load on the circulatory organ of the living body L by moving the living body L up and down the stairs. Exercise load system, temperature load system that increases the load of the circulatory organ of the living body L by changing the temperature environment, nerve load system that increases the load of the circulatory organ of the living body L by causing a predetermined calculation, and medicine Thus, various load applying methods such as a drug loading method for increasing the load on the circulatory organ of the living body L are used. In the drug loading method, for example, a drug such as an antihypertensive agent, an angina pectoris drug, or an antidiabetic drug is used, and the drug is given to the living body L to change the load on the circulatory system.

  Further, the blood pressure measurement device 44 of the above-described load change blood pressure abnormality inspection device 10 performs blood pressure measurement based on the amplitude change of the cuff pulse wave SM obtained in the process of gradually decreasing the pressure of the cuff 12 by the oscillometric method. However, a blood pressure measurement device of a type that determines the blood pressure value for each beat based on the amplitude of the radial artery wave from the relationship obtained in advance may be used.

  The present invention can be modified in various ways without departing from the spirit of the present invention.

It is a block diagram which shows the structure of the blood pressure abnormality test apparatus at the time of load change which is one Example of this invention. FIG. 2 is a functional block diagram illustrating a main part of a control function of an electronic control device in the blood pressure abnormality test apparatus during load change of FIG. 1. In FIG. 2, it is explanatory drawing which calculates the amplitude increase index | exponent of cuff pulse wave SM. FIG. 3 is a diagram showing the waveform change of the cuff pulse wave SM before and after the load change of the living body L displayed by the display unit of FIG. It is a figure which shows the two-dimensional coordinate which shows the blood pressure change and waveform change which are displayed by the display means of FIG. 2 in the display of FIG. 2 is a flowchart for explaining a main part of a control operation of an electronic control device in the blood pressure abnormality test apparatus during load change of FIG. 1.

Explanation of symbols

10: Blood pressure abnormality inspection device at load change 12: Cuff 32: Electronic control device (control device)
44: Blood pressure measurement device 46: Pulse wave detection device 50: Blood pressure change calculation means 52: Amplitude increase index calculation means 54: Sharpness calculation means 56: Rise time calculation means 58: Waveform feature value calculation means 60: Waveform change calculation means 62 : Amplitude increase index change calculating means 64: Sharpness change calculating means 66: Rise time change calculating means 68: Display means 70: Blood pressure abnormality risk determining means at load change

Claims (2)

A load change blood pressure abnormality inspection device for examining a blood pressure abnormality that occurs when a biological load is changed,
Blood pressure measuring means for measuring the blood pressure value of the living body before and after the change of the load on the living body,
Pulse wave measuring means for measuring a pulse wave generated from an artery of the living body before and after a change in load on the living body,
Blood pressure change calculating means for calculating a blood pressure change based on blood pressure values before and after a change in load on the living body measured by the blood pressure measuring means;
A waveform change calculating means for calculating a waveform change of a pulse wave before and after a change in load on the living body measured by the pulse wave measuring means;
A two-dimensional coordinate display surface comprising an axis indicating a blood pressure change and an axis indicating a waveform change is provided, and a display showing the blood pressure change calculated by the blood pressure change calculation means and the waveform change calculated by the waveform change calculation means A blood pressure abnormality inspection apparatus during load change, comprising: display means for performing the display on the two-dimensional coordinate display surface.   The two-dimensional coordinate display surface includes a hypertension region under load indicating the possibility of hypertension under load that becomes hypertension when the biological load is increased in relation to the waveform change, and when the biological load is increased. 2. The on-load blood pressure abnormality inspection apparatus according to claim 1, wherein at least one of a on-load hypotension region that indicates a possibility of a hypotension on load that becomes hypotension is shown in relation to the waveform change.

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