FR3055204A1 - DIAGNOSTIC ASSISTING METHOD FOR DETECTING ARTERIAL PRESSURE ANOMALY - Google Patents

Abstract

The invention relates to a diagnostic aid method for detecting an abnormality of arterial pressure in an individual, in which, during a gradual release of an initial constriction of a member of the individual who has locally blocked any circulation arterial recirculation for a measurement of an instantaneous throttling pressure, characterized in that at least two measurements (31 to 34) are carried out, namely a first measurement. (31) to a first limb on the left side of the individual and a second measurement (32) to a second limb on the right side of the individual, comparing the at least two measures (31 to 34) by calculating (42) a ratio between a first magnitude function of at least one of said two measurements (31, 33) and representative of the left side of the individual and a second magnitude function of at least one of said two measurements (32, 34) and on the right side of the individual to obtain a ratio of systolic arterial pressures between the left and right sides of the individual.

Description

055 204

58039 ® FRENCH REPUBLIC

NATIONAL INSTITUTE OF INDUSTRIAL PROPERTY © Publication number:

(to be used only for reproduction orders) (© National registration number

COURBEVOIE © Int Cl ⁸ : A 61 B 5/025 (2017.01)

PATENT INVENTION APPLICATION

A1

©) Date of filing: 30.08.16. © Applicant (s): LENORMAND GUILLAUME— FR. (© Priority: @ Inventor (s): LENORMAND GUILLAUME and POI- GNANT ANTOINE. (47) Date of public availability of the request: 02.03.18 Bulletin 18/09. ©) List of documents cited in the report preliminary research: Refer to end of present booklet (© References to other national documents ® Holder (s): LENORMAND GUILLAUME. related: ©) Extension request (s): © Agent (s): HIRSCH & PARTNERS.

Pty DIAGNOSTIC ASSISTANCE METHOD FOR DETECTING AN ARTERIAL PRESSURE ANOMALY.

FR 3 055 204 - A1 (m / f The invention relates to a diagnostic aid method for detecting an abnormality in blood pressure in an individual, method in which, during a progressive relaxation of an initial constriction of a member of the individual having locally blocked all arterial circulation, an instant of start of arterial recirculation is detected in order to then carry out a measurement of an instantaneous throttling pressure, a process characterized by the fact that at least two measurements are taken ( 31 to 34), namely a first measurement (31) to a first member on the left side of the individual and a second measurement (32) to a second member on the right side of the individual, said at least two measurements are compared (31 to 34) by calculating (42) a ratio between a first quantity function of at least one of said two measurements (31, 33) and representative of the left side of the individual and a second quantity function of at least one of said two measures (32, 34) and representative of the right side of the individual in order to obtain a ratio of systolic arterial pressures between the left side and the right side of the individual.

l

DIAGNOSTIC ASSISTANCE METHOD FOR DETECTING A

BLOOD PRESSURE FAULT

Field of the invention

The present invention relates generally to a diagnostic aid method for detecting an abnormality in blood pressure in an individual. It finds particular application in the determination of the state of the arteries of an individual as well as in the automated determination of abnormal heart rhythms.

The present invention also relates to equipment for implementing a diagnostic aid method for detecting an abnormality in blood pressure in an individual.

State of the art

Conventionally, the blood pressure of an individual is measured by compressing a member by an inflatable cuff forming a tourniquet completely blocking the arterial circulation downstream of the artery thus crushed. This cuff is gradually deflated to measure its pressure, by a manometer, when the blood begins to pass locally, that is to say that the pressure of the artery manages to overcome the external crushing pressure exerted by the tourniquet. It is therefore a question of systolic pressure, that is to say the pressure peak produced by the contraction of the left ventricle of the heart, which aims to irrigate the whole body.

The sound of blood passing with local turbulence is detected by a microphone placed locally on the limb.

We keep listening to note the pressure for which all passing noise disappears, that is to say that the local blood flow is then free of any turbulence, which indicates that the artery has completely resumed its natural section.

This type of measurement makes it possible to enlighten the practitioner on for example the elasticity of the arteries, since an artery, tied up at a certain distance from the heart, will more easily accept an excess of blood volume if it can dilate, thus suffocating the systolic pressure peak. On the contrary, a rigid artery does not have this dampening effect of overpressure and transmits almost completely the thrust from the heart to the area of the withers, through which the blood thus under high pressure will be able to more easily squirt downstream. In this case, the recirculation, after total blocking and gradual relaxation, occurs more quickly since the recirculation pressure is relatively high.

The above measures can also detect an artery with a somewhat narrowed section, in particular obliterating arteriopathy. These measures are advantageous, on the one hand, at a great distance from the heart, at the ankles, for which the pressure drop across the entire length of the artery considered is likely to be very high, and on the other hand , in emergency, in case of chest pain for the differential diagnosis of a myocardial infarction or to contribute to the diagnosis of an aortic dissection.

However, such measurements are relatively tedious to perform and dependent on the operator responsible for carrying out the measurements, so that, in general, the practitioner performs only a measurement of the pressure of an arm and does not systematically palpate the pulse at the level of the four limbs. In this context, he therefore only imperfectly perceives the general state of the individual, that is to say that a preventive or curative treatment which would be useful risks not being prescribed.

Object of the invention

In this context, the problem posed here is to propose a diagnostic assistance method tending to reduce the acuity of such a problem and to allow detection. Another problem is to allow the detection of rhythmic and / or biological anomalies.

To this end, the invention relates first of all to a diagnostic aid method for detecting an abnormality of blood pressure in an individual, method in which, during a progressive relaxation of an initial constriction of a limb the individual having locally blocked all arterial circulation, an instant of start of arterial recirculation is detected in order to then carry out a measurement of an instantaneous throttling pressure, a process characterized by the fact that at least two measurements are carried out, namely a first measurement to a first member on the left side of the individual and a second measurement to a second member on the right side of the individual, said at least two measurements are compared by calculating a ratio between a first quantity function of at least one of said two measurements and representative of the left side of the individual and a second quantity depending on at least one of said two measurements and representative ve on the right side of the individual to obtain a systolic blood pressure report between the left side and the right side of the individual.

According to one embodiment of the invention:

- the first member on the left side of the individual is the left arm and the second member on the right side of the individual is the right arm,

- during the calculation step, the first quantity representative of the left side of the individual is defined by the first measurement and the second quantity representative of the right side of the individual is defined by said second measurement in order to obtain a ratio systolic arterial pressures between the left and right arms.

When the difference between the systolic pressures of the left arm and the right arm exceeds a certain threshold, this difference being able to be deduced from the ratio of arterial pressures between the left arm and the right arm, this can mean that an anomaly of the aorta is present. In some cases, aortic dissection representing a medical emergency is possible.

According to another embodiment of the invention, the first member on the left side of the individual is the left arm and the second member on the right side of the individual is the right arm, the method comprising the following steps:

at least four measurements are made, namely the first measurement on the left arm, the second measurement on the right arm, a third measurement on a left leg and a fourth measurement on a right leg, the said at least four measurements are compared (31, 32 , 33, 34) by calculating, during the calculation step, the first quantity representative of the left side of the individual defined by a first ratio between the first measurement and the third measurement in order to obtain a first systolic pressure index between the left leg and the left arm, the second quantity representative of the right side of the individual defined by a second ratio between the second measurement and the fourth measurement in order to obtain a second systolic pressure index between the right leg and the arm right, so to calculate said ratio of systolic arterial pressures between the left side and the right side of the individual.

If the difference between the first and second systolic pressure index exceeds a certain threshold, it may mean that an abnormality of the aorta is present, in particular an aortic dissection representing a medical emergency is possible. In addition, the calculation of the first and second systolic pressure index improves the interpretation of the measurement relating to the leg. The systolic pressure index can represent the result of dividing the leg pressure by that of the arm, or vice versa.

Advantageously, a sequence of several elementary cycles (between three and seven) is carried out comprising, each for a member which is particular to it, the constriction and the corresponding relaxation, the respective pressure measurement is memorized each time, and then re-read pressure measurements to calculate said ratio of systolic arterial pressures between the left side and the right side of the individual. The advantage of controlling such a sequential operation of various cuffs or equivalent pressure measurement resides in the fact that, at any one time, only one limb is compressed, so that the compression of one cannot distort the measurements of the other. In other words, blood from the heart still reaches the arteries over their entire length, except for the downstream section of the one being measured.

In one embodiment of the invention, a sequence is carried out comprising the constriction and the corresponding relaxation of at least two members simultaneously, and subsequently the simultaneous measurements of said at least two members to calculate said ratio of systolic arterial pressures between the left side and the right side of the individual.

According to another embodiment of the invention, a sequence is carried out comprising the constriction and the corresponding relaxation of the left arm, the right arm, the right leg and the left leg simultaneously, and subsequently the simultaneous measurements to calculate the says ratio of systolic arterial pressures between the left side and the right side of the individual.

Preferably, several measurements will be made for each of the members in order to make an average of the measurements noted for each of the members. The sequence is repeated each time a predetermined time interval elapses, preferably the sequence defining a time interval of 5 minutes and being repeated 3 to 7 times.

In one embodiment of the invention, an alert message is communicated when the first systolic pressure index and / or the second systolic pressure index has a value less than 0.9 or greater than 1.3.

In another embodiment, the method comprises the following steps:

- a pulse measurement is carried out on the individual, data relating to Korotkov noise acquired during the pulse measurement are extracted, said data relating to Korotkov noise is recorded, said recorded data relating to Korotkov noise is compared with a predetermined database comprising data representative of rhythms of sinus heartbeats or rhythms of heartbeats having arrhythmia, in order to communicate an alert message if the rhythm of heartbeats has arrhythmia.

In one embodiment, during the step of comparing the recorded data relating to Korotkov noises with the predetermined database:

processing the recorded Korotkov noise data to determine a plurality of time intervals, each of the time intervals being measured between two peaks of amplitude characteristic of a heartbeat, comparing the plurality of time intervals to to determine whether the successive time intervals are substantially equal, or, the recorded data relating to Korotkov noise is processed to determine a first curve profile to be compared, said first curve profile to be compared is compared with a second profile of recorded curve in the predetermined and representative database of sinus heartbeats, an algorithm calculating the difference between successive key measurement points of said first curve profile and corresponding successive reference points of said second curve profile, the algorithm adding the sum of the squares of said differences in order to d end a score representative of the similarity between said first cam profile and said second curved profile.

In one embodiment of the invention, when the first systolic pressure index and / or the second systolic pressure index has a value less than 0.9 or greater than 1.3, the method further comprises a step of performing a measurement of pulse oximetry on the individual.

In one embodiment of the invention, an alert message is communicated when the ratio of systolic arterial pressures between the left arm and the right arm has a value less than 0.9 or greater than 1.3.

Also targeted is equipment for diagnostic assistance for detecting an anomaly in blood pressure in an individual, comprising a central unit connected to measurement means by interface means arranged for, during a gradual relaxation of a initial throttling of a member of the individual having locally blocked all arterial circulation, detecting an instant of start of arterial recirculation and then carrying out a measurement of an instantaneous throttling pressure, said interface means being further arranged to receive as input and supply to the central unit a plurality of at least two arterial pressure signals from the measuring means comprising a first pressure signal and a second pressure signal, the central unit comprising connected calculation means downstream of the interface means and arranged to calculate a ratio between a first quantity function of at least u n of said blood pressure signals and representative of the left side of the individual and a second quantity function of at least one of said blood pressure signals and representative of the right side of the individual, in order to allow the calculation of a ratio of systolic arterial pressures between the left side and the right side of the individual.

In one embodiment, of the invention, the first quantity is defined by the first pressure signal and the second quantity is defined by said second pressure signal, said calculation means being arranged in order to obtain a blood pressure ratio systolic between the first pressure signal and the second pressure signal.

In another embodiment of the invention, the interface means are arranged, in addition, to receive as input and supply to the central unit, a third pressure signal and a fourth pressure signal, said calculation means being arranged to calculate:

the first representative quantity defined by a first ratio between the first pressure signal and the third pressure signal, the second representative quantity defined by a second ratio between the second pressure signal and the fourth pressure signal.

Description of the drawings

The invention will be better understood on reading the description which follows and on examining the figures which accompany it. These figures are given only by way of illustration but in no way limit the invention:

- Figure 1 illustrates a block diagram of the equipment according to a first embodiment,

- Figure 2 illustrates a functional block diagram of the equipment according to a second embodiment.

detailed description

In FIGS. 1 and 2, equipment is illustrated implementing a diagnostic assistance method for detecting an anomaly in blood pressure in an individual during a progressive relaxation of an initial strangulation of a member of the individual. having locally blocked all arterial circulation. The method consists first of all in detecting an instant of the start of arterial recirculation in order to then measure an instantaneous throttling pressure. At least two measurements are made, namely a first measurement 31, 33 to a first member on the left side of the individual and a second measurement 32, 34 to a second member on the right side of the individual, the said at least are compared two measurements 31.32, and a ratio 42 is calculated between a first quantity representative of the left side of the individual 31.33 and a second quantity representative of the right side of the individual 32.34 in order to obtain a pressure ratio systolic arteries between the left side and the right side of the individual.

In the exemplary embodiment illustrated in FIG. 1, the first member on the left side of the individual is the left arm and the second member on the right side of the individual is the right arm. During the calculation step 42, the first quantity representative of the left side of the individual is defined by the first measurement 31 and the second quantity representative of the right side of the individual is defined by said second measurement 32 in order to obtain a ratio of systolic arterial depression between the left and right arms.

The equipment shown in FIG. 1 comprises a central unit 10 connected to interface circuits 20 arranged to receive as input and provide the central unit 10 with two measurements 31, 32 associated with two blood pressure signals 31, 32, the central unit 10 comprising calculation circuits 42, connected downstream of the interface circuits 20, the calculation circuits being arranged to calculate a ratio between a first quantity representative of the first blood pressure signal 31 and a second quantity representative of the second blood pressure signal 32. In the example illustrated in FIG. 1, the first quantity (representative of the left side of the individual) is defined by the first pressure signal 31 and the second quantity (representative of the right side of the individual) is defined by the second pressure signal 32. The calculation circuits 42 thus make it possible to calculate a ratio of arterial pressures s ystolic between the left side and the right side of the individual. In particular, the equipment shown in FIG. 1 makes it possible to obtain a ratio of systolic arterial pressures between the left arm and the right arm.

In the exemplary embodiment illustrated in FIG. 2, the first member on the left side of the individual is the left arm and the second member on the right side of the individual is the right arm. According to this exemplary embodiment, in addition to the first measurement 31 carried out on the left arm and the second measurement 32 carried out on the right arm, a third measurement 33 is carried out on a left leg and a fourth measurement and a fourth measurement 34 is carried out at a straight leg. During the calculation step 42, the first quantity representative of the left side of the individual is defined by a first relationship between the first measurement 31 and the third measurement 33 in order to obtain a first systolic pressure index between the left leg and the left arm and the second quantity representative of the right side of the individual is defined by a second relationship between the second measurement 32 and the fourth measurement 34 in order to obtain a second index of systolic pressure between the right leg and the right arm . The calculation of the ratio between the first report (also called first systolic pressure index) and the second report (also called second systolic pressure index) thus makes it possible to calculate said ratio of systolic arterial pressures between the left side and the right side of the 'individual.

In another example of embodiment of the equipment shown in FIG. 2, the equipment comprises a central unit 10 connected to interface circuits 20 arranged to receive as input, and supply to the central unit 10, a plurality of '' at least four measurements 31, 32, 33, 34 associated with four blood pressure signals 31, 32, 33 34, the central unit 10 comprising calculation circuits 42, connected downstream of the interface circuits 20, the circuits of calculation being arranged for:

calculating a first ratio between the first blood pressure signal 31 and the third blood pressure signal 33 in order to obtain a first systolic pressure index between the left leg and the left arm, which first report defining a first quantity representative of the left side of the individual,

calculating a second ratio between the second arterial pressure signal 32 and the fourth arterial pressure signal 34 in order to obtain a second systolic pressure index between the right leg and the right arm, which second ratio defining a second quantity representative of the side right of the individual,

- calculate said ratio of systolic arterial pressures between the left side and the right side of the individual via the calculation of the ratio between the first systolic pressure index and second systolic pressure index.

The equipment illustrated in FIG. 2 is connected to at least one cuff 9 for taking the voltage. Alternatively, the equipment can be connected to two or four armbands 9 in order to take the tension of two or four respective members of an individual, only one of the armbands being shown in FIG. 2. The armbands 9 can be only analog, or include digital circuits to thus constitute auto-tensiometers digitizing the measurements and perform digital calculations on the pressures measured. Depending on the number of blood pressure cuffs 9 connected to the equipment, the diagnostic assistance process can be adapted to take into account the measures necessary to assist in the diagnosis and possibly detect an anomaly in blood pressure.

When a single cuff 9 is connected to the equipment, a sequence is carried out comprising, each for a member which is particular to it, the constriction and the corresponding relaxation, the respective pressure measurement is memorized each time, and then re-reads the pressure measurements 31,

32, 33, 34 to calculate the said ratio of systolic arterial pressures between the left side and the right side of the individual. So, when one wishes to take the measurements of the two arms and two legs, it is necessary to take the tension from each of these members sequentially.

When at least two cuffs 9 are connected to the equipment, in particular the equipment shown in FIG. 1, a sequence is carried out comprising the constriction and the corresponding relaxation of at least two members simultaneously, and subsequently the simultaneous measurements 31, 32,

33, 34 of said at least two members to calculate said ratio of systolic arterial pressures between the left side and the right side of the individual.

When four cuffs 9 are connected to the equipment shown in FIG. 2, a sequence is carried out comprising the constriction and the corresponding relaxation of the left arm, the right arm, the right leg and the left leg simultaneously, and subsequently the simultaneous measurements 31, 32, 33, 34 to calculate the said ratio of systolic arterial pressures between the left side and the right side of the individual. When it is desired to take the measurements of both arms and both legs, it is then possible to take the tension on each of these members simultaneously, which reduces the time spent taking the measurement.

The means used to store the pressure measurements are detailed below in the description.

Advantageously, the sequence is repeated each time a predetermined time interval elapses, preferably the sequence defining a time interval of 5 minutes and being repeated from 3 to 7 times. The multiplicity of taking these measurements advantageously improves the reliability of these measurements.

Such an armband 9 comprises an inflatable envelope 1 in the form of a band carrying, at two respective ends, two mutual fastening elements, such as at least one hook and one eyelet or two Velcro bands, in order to constitute a collar, of length fixed once placed, surrounding the limb considered. A first type of cuff 9 can be configured to take the tension at the level of the arms, a second type of cuff can be configured to take the tension at the level of the foot via an envelope configured to adapt to the specific anatomy of the foot and aimed at compressing the pedal artery, and a third type of cuff is configured to take the tension in the arms or in the legs. Preferably, when there is a plurality of armbands 9, these have the ability to associate and synchronize.

A pump 2 makes it possible to inflate an internal volume of the envelope 1 beyond a pressure blocking any arterial circulation and a pressure detector, that is to say a pressure gauge 3, connected to the internal volume of the envelope 1, provides an instantaneous pressure value. A regulator 4, of progressive setting in the vent, introduces a controlled leakage of the air of the internal volume, so as to gradually reduce the pressure to the atmospheric pressure value. The regulator 4 can be a passive element, insofar as the leakage which it induces is limited with respect to the air supply from the pump 2, or else the regulator 4 can comprise an actuator controlling an opening valve a passage from venting to a limited section. A microphone 5 is carried by a so-called internal face of the envelope 1, that is to say turned towards the inside of the sheath that constitutes the cuff 9, and therefore pressed against the skin of the individual.

The reference 7 designates an optional central autotensiometer unit, comprising a calculation block 71, here a microprocessor, a memory 72 of instructions for controlling the calculation block 71, and circuits 76 for connection to a data transmission network. 100.

At first, the central unit 7 will not be used to explain the operation of the equipment.

The central unit 10 comprises a time base 11 supplying clock signals at various frequencies desired for the various functional blocks.

The interface circuits 20 comprise, in this example, a pressure signal input multiplexer 21 with four input channels respectively connected at the output of the four pressure gauges 3 so as to receive the respective instantaneous pressure signals therefrom, here in the form analog. A sequencer 60, with an activation button 61, controls the multiplexer 21, for successively examining each of the pressures of the various pressure gauges 3. The multiplexer 21 is connected at the output to an analog / digital converter circuit 22 whose digital pressure values thus obtained are directed, by the sequencer 60, to a particular memory among four memories 31, 32, 33 and 34 belonging to memory circuits 30, respectively reserved, in this order, for measuring the pressure of the left arm, the right arm, the left leg and the right leg. In one embodiment, the multiplexer 21 is arranged to receive respective signals from the individual's geolocation, blood circulation, body temperature, pulse or oximetry, each of these signals being from sensors.

In this exemplary embodiment, the calculation circuits 42 are connected in reading to the arm pressure memories 31 and 32 and to the leg pressure memories 33 and 34. A first calculation consists in dividing the pressure value of the leg memory left 33 by the pressure value of the left arm memory 31 so as to obtain a first index of systolic pressure between the left leg and the left arm.

In this embodiment, it is also planned to perform a calculation of the same kind for the right side, that is to say taking into account the pressure value of the right leg memory 34 and the pressure value of the right arm memory 32 to thereby obtain a second systolic pressure pressure index between the right leg and the right arm. A multiplexer 41, controlled by the sequencer 60, is thus connected at the input to the four outputs of the arm pressure memories 31, 32 and of the leg pressure 33 and 34, and connected at the output to a value input of the calculation circuits 42 .

A display 50 successively receives two numbers representing the values of the systolic pressure indices above and a number representing the ratio of systolic arterial pressures between the left side and the right side corresponding to a result of the division between the first systolic pressure index and the second systolic pressure index. The display can for example display them in sequence. The display 50 can also, in a manner not shown here, be connected to the outputs of the memories 31, 32, 33, 34 so as to also display the respective values automatically and sequentially in addition to the three reports above. The display can be digital but it can also be, or include, an analog display, for example of the kind with a bar of light-emitting diodes or of elementary blocks of liquid crystals, LCD, display in which a more or less large number of successive blocks to present a segment whose length varies as the magnitude of the displayed value.

Circuits for exchanging measurement signals, other than the above pressure signals, or for controlling signals between the equipment and the various cuffs 9, will now be described.

The interface circuits 20 comprise a multiplexer 23 for inputting sound signals, controlled by the sequencer 60 and comprising four input channels respectively connected at the output of the respective microphones 5. An analog / digital converter 24, connected to the output of the multiplexer 23, supplies digital signals corresponding to sound analysis circuits 25, arranged to compare the signal of each microphone 5 with a minimum threshold and for, in case of exceeding the threshold , send a current pressure storage command to a demultiplexer 64 of the sequencer circuits 60, which directs it to the desired memory 31 to 34. There is thus performed a storage of an instantaneous value of the pressure signal associated with the noise picked up and this command is itself stored in order to subsequently cause the activation of the calculation circuits 42 on the basis of said stored pressure value. For this storage purpose, the instantaneous, that is to say current, value of the pressure of the pressure gauge 3 considered is applied to the input of the corresponding memory 31 to 34.

The above pressure storage command is transmitted by the sound analysis circuits 25 to the sequencer circuits 60, which consequently transmit a memorization clock pulse (arrows) to that of the memories 31 to 34 which is concerned.

As a variant, and in a dual manner, instead of preventing the memorization of a series of decreasing pressure values greater, therefore without interest, than the limiting throttling pressure, provision may be made on the contrary for temporarily memorizing them. one after the other, each new value overwriting the previous one in memory, and stopping such an update of the memory 31 to 34 considered when the arterial recirculation is detected by the sound analysis circuits 25. The sequencer circuits 60 therefore cyclically transmit such clock pulses during the initial phase corresponding to the range of excessive pressures, comprised between a maximum initial pressure, blocking of arterial circulation, and the limit pressure, of recirculation. The above stop is effected by cessation of sending of the storage clock pulses controlling the memories 31 to 34.

The sound analysis circuits 25 are here arranged to perform a spectral, that is to say frequency, analysis of the microphone signals 5 and to compare a result with a model in order to deduce therefrom a mutual difference and the compare to a minimum threshold to decide if a noise picked up represents a so-called arterial recirculation. This frequency analysis here relates to an analysis by discrete Fourier transform, cyclically providing, at successive time intervals, a spectrum representing amplitudes of various frequency components. The spectrum, updated at each time interval, is compared to a so-called spectrum model in order, according to a difference representing their mutual difference with respect to each frequency line, to decide whether an arterial circulation is perceived.

In one embodiment, the sound analysis circuits are further arranged to analyze cardiac arrhythmias during blood pressure measurements so as to signal the operator a cardiac iythmic anomaly by analyzing the collected sound samples. by means of the microphone 5 carried by the cuff 9. First of all, a pulse measurement is carried out on the individual, then data relating to Korotkov noises acquired during the measurement of the pulse are extracted in order to record them. Finally, said recorded data relating to Korotkov noise is compared with a predetermined database comprising data representative of rhythms of sinus heart beat or of heart beat rhythms having arrhythmia, which database being contained in the analysis circuits. audible 25. An alert message is then communicated if the rhythm of the heartbeat has an arrhythmia. In one embodiment, the step of comparing the recorded data relating to Korotkov noise with the predetermined database comprises processing the recorded data relating to Korotkov noise to determine a plurality of time intervals, each of the intervals of time being measured between two peaks of amplitude characteristic of a heartbeat and comparing the plurality of time intervals to determine if the successive time intervals are substantially equal. In another embodiment, the step of comparing the recorded data relating to Korotkov noise with the predetermined database comprises processing the recorded data relating to Korotkov noise to determine a first curve profile to be compared, comparing said first curve profile to be compared with a second curve profile recorded in the predetermined database and representative of sinus heart beats. An algorithm then calculates the difference between successive key measurement points of said first curve profile and corresponding successive reference points of said second curve profile, the algorithm adding the sum of the squares of said differences in order to determine a score representative of the similarity. between said first curve profile and said second curve profile.

The various envelopes 1 are inflated by the respective pumps 2 under the control of the sequencer circuits 60. To this end, the sequencer circuits 60 comprise a shift register 62 series / parallel with eight binary stages, of which in the state at rest, a value input is polarized at a binary level, here the value bit 1, representing a pump activation command 2. The bit 1 above comes, in this example, from the output of the eighth stage, the other seven stages, from rank 1 to 7, containing the opposite value, 0. It is therefore a logical ring in which the 1 can rotate. The four stages of odd rank are connected at the output to the respective four pumps 2, to activate and deactivate them, one after the other, by the bitl.

To control the inflation of a first of the envelopes 1, the sequencer 60 emits a clock pulse shifting by one position the content of the register 62, so that the 1 of the eighth stage, pushed by the 0 of the seventh stage which replaces, passes, looping back into the first stage, which is connected to an activation input of one of the pumps 2, through the interface circuits 20. The instantaneous pressure of the envelope 1 considered is then monitored , at the output of the converter 22, by monitoring circuits 63 belonging to the sequencing circuits 60, and is compared with a maximum pressure threshold, that is to say the inflation pressure setpoint. When the maximum threshold is crossed upwards, the monitoring circuits 63 command the emission of a second advance pulse from the register 62, so that the 1 of its first stage, passing through the second stage, is replaced by the 0 at the exit of the eighth floor. The pump 2 considered therefore stops. If the regulator 4 is of the active type, an opening command is sent to it via a link (not shown) of the interface circuits

20.

The initial pressure being thus established, the pressure measurement cycle of the cuff 9 considered continues with the expansion phase thus initiated, with the monitoring of the instantaneous pressure exposed above. When the arterial recirculation limit pressure is detected and stored, a second same cycle is started by sending a third clock pulse, which passes the activation 1 into the third stage of register 62. The cycle described above above is repeated as follows, but for another of the four pumps 2.

In the interface circuits 20, the reference 26 designates circuits for connection with the data transmission network 100, here the Internet network.

The equipment can thus also exchange interface signals, of the types described above, with armbands 9 or remote self-blood pressure monitors provided with Internet interface circuits, such as the connection or connection circuits 26 or 76.

The central unit 10 is further arranged to concurrently process several said pluralities of at least four, in this example, blood pressure signals, for several individuals respectively. The interface circuits 20 shown are therefore duplicated correspondingly or, preferably, the capacity of the functional blocks is increased. It is the same for the functional blocks of the central unit 10.

The network link circuits 26 comprise, according to the OSI classification, circuits for physical interface with the Internet 100, level 1, circuits for managing the format and flow of information messages exchanged with the Internet, level 2, and service message exchange management circuits for establishing and breaking Internet connections, level 3. Communication is thus established with remote equipment comprising, for example, self-blood pressure monitors equipped with similar interface circuits. that the network link circuits 26. The particular application considered here, that is to say the remote measurement of the arterial pressures and possibly the management of pumps 2 or equivalent actuators and associated circulation sensors 5, can then be executed by means of application software housed in a memory of the central unit 10. As mentioned above, the application software performs the cyclic scanning of the measurements remote, or even local, blood pressure monitors and transmits to them any remote controls for pumps 2 and sound sensors 5 and others. The calculated pressure measurements and reports can also be transmitted from the central unit 10, via the Internet network 100, to a remote equipment for processing the results, for example a hospital or even a centralized maintenance server for medical monitoring files for individuals, or even a mobile phone with the capacity to perform the various calculations. Advantageously, circuits of the mobile telephone are used to provide functions corresponding to said measurements, such as for example the calculation of cardiovascular risk score, the detection of arterial circulation by a microphone fitted to the telephone or the remote processing of signals from the equipment. which are aggregated in the phone within an application.

Advantageously, the central unit 10 or the remote equipment for processing the results may also include an alert module configured to communicate an alert message when the calculated pressure reports are below or above predetermined thresholds. According to one embodiment, an alert message is communicated when the first systolic pressure index and / or the second systolic pressure index has a value less than 0.9 or more than 1.3. According to another embodiment, an alert message is communicated when the ratio of systolic arterial pressures between the left arm and the right arm has a value less than 0.9 or greater than 1.3. These alert messages can, for example, be of a visual nature and be displayed via the display 50 or be of an audible nature to be heard by the operator. Alternatively, when the first systolic pressure index and / or the second systolic pressure index has a value less than 0.9 or greater than 1.3, it is further provided to perform a pulse oximetry measurement on the individual.

The data coming from the central unit 10 and in particular from the calculation circuits 20 can interface a secure database hosted by the data transmission network 100 so as to allow people with access codes to access the database which contains in particular the measurements and the various calculations. In addition, depending on the values of the various reports and indexes, alert messages can be communicated directly to the emergency services in the event of abnormal data relating to reports of systolic blood pressure between the left and right side or to the measurements. pulse on the individual. These alert messages communicated to the emergency services may also be accompanied by data relating to the location of the individual on whom the measurements were carried out.

Each plurality of four armbands 9 or auto-tensiometers is associated with an identifier making it possible to find in memory 30 the current values which are specific to it. Likewise, the sequencer circuits 60 then operate in time sharing between the various pluralities, that is to say between the various individuals. Specifically, for simultaneous operation of the active phases of pressurization and subsequent measurement of several of the cuffs 9 or self-blood pressure monitors, the central unit 10 operates by performing, in an interlaced manner, the concurrent tasks in time slices respectively and successively allocated, one by one, to these tasks. Each time slot can be provided to process the entire task considered and then release the central unit 10 for a task from another set of cuffs 9. It is then an asynchronous operation.

Preferably, however, each task which requires the availability of the central unit 10 is only allocated a time slot of fixed duration, for example limited to a few milliseconds. If the task is not completed within this period, which is the case for monitoring the appearance of arterial recirculation, a time delay commands that the context of this task be stored in memory just before the end of the time slot to be resumed when this task again obtains access to the central unit 10, after tasks linked to other sets of cuffs 9 have also been treated. In addition to the pressure measurements, this cyclic storage also concerns the sequencer circuits 60, which can thus, for each set of cuffs 9, be reconfigured in their previous state. The reallocation of the time slots can be carried out according to a cycle of predetermined period, that is to say that each set of cuffs 9 has a particular time slot in a time frame. As a variant, each active set of armbands 9, or of self-tensiometers, emits and maintains a request state at the input of the central unit 10, so that the time frame is then dynamically reduced to only the slices useful time, to avoid downtime.

The connection circuits 26 are provided for concurrently processing several connections, here therefore of the Internet type, with several connection circuits 76 of remote blood pressure monitors (9), that is to say exchanging data packets with several pieces of equipment remote interface devices each having a specific IP address. Given the propagation time in the Internet, much greater than the duration of a time slot above, the circuits of the links 26 operate asynchronously with respect to these slots, that is to say that they include memories, not shown, of internal interface with the central unit 10, for receiving data to be transmitted, this transmission can thus occur at any time, and therefore in particular outside the time slot considered.

The operation of the central unit 7 will now be explained in more detail.

The central unit 7 has the function of managing the organs 2 to 5 of the cuff 9, which is then a self-blood pressure monitor. To this end, the link 26 and connection 76 circuits are connected by the network 100, which, as a variant, may be a local network.

The memories 72 and 73 respectively contain instructions for determining blood pressure measurement values and instructions for detecting arterial circulation, to constitute, with the calculation block 71, circuits for determining blood pressure measurement values, exploiting the quantities sensed by the pressure gauge 3, and arterial circulation detection determination circuits, exploiting the magnitudes sensed by the microphone 5. Two respective outputs of these circuits are connected to the connection circuits 76, to transmit the measurements, then digitized, to the central unit 10. As a variant, the sound analysis function of the circuits 25 is ensured by the calculation block 71, so that the decision to recognize traffic noise is made locally, therefore without the need to transmit the corresponding sound signals.

The memory 72 is further connected at the input to the connection circuits 76 to receive said instructions through the network connection circuits 76, coming from the central unit 10 or from a commissioning server.

The central unit 7 is also here intended to be remote-controlled, by reception, through the connection circuits 76, of commands, issued by the central unit 10, to launch at least three elementary cycles corresponding respectively to said measurements pressure.

The connection circuits 76 are here integrated into a telephone set which, in this example, is of portable type and intended for a radiotelephony, cellular or constellation of satellites network. The rest of the central unit 7 could be external to the station and connected to it by an input / output port. However, here, the entire central unit 7 is integrated into the station. In particular, the calculation block 71 is arranged to operate in time sharing between telephone link management tasks 10 and tasks linked to the operation of the equipment, specifically of the cuff 9.

As a variant, the various circuits of the central unit 10 necessary for the calculation of said ratio can be integrated into the portable station above, which thus represents such complete equipment. The network link 26 and network connection 76 circuits are merged into a single assembly making it possible to receive remote controls for triggering measurements and / or to send the calculated report to a monitoring center. Such an embodiment can also be in the form of a watch bracelet, the bracelet being inflatable to ensure the function of the envelope 1.

In all embodiments, it can also be provided that the central unit 10 measures the heart rate, whether during the decompression of the envelope 1 or without pressure, possibly applied to the chest. The measurements are transmitted to operating means, in the same way as for the results from the pressure measurements.

Claims (15)

1. A diagnostic aid method for detecting an abnormality of arterial pressure in an individual, method in which, during a progressive relaxation of an initial constriction of a member of the individual having locally blocked all arterial circulation, detects an instant of start of arterial recirculation to then carry out a measurement of an instantaneous throttling pressure, process characterized in that at least two measurements (31 to 34) are carried out, namely a first measurement (31) to a first member on the left side of the individual and a second measurement (32) to a second member on the right side of the individual, said at least two measurements (31 to 34) are compared by calculating (42) a ratio between a first quantity function of at least one of said two measurements (31, 33) and representative of the left side of the individual and a second quantity function of at least one of said two measurements (32, 34) and represented sentative on the right side of the individual to obtain a systolic blood pressure ratio between the left and right side of the individual. 2. Method according to claim 1, in which: - the first member on the left side of the individual is the left arm and the second member on the right side of the individual is the right arm, during the calculation step (42), the first quantity representative of the left side of the individual is defined by the first measurement (31) and the second quantity representative of the right side of the individual is defined by said second measurement (32) in order to obtain a ratio of systolic arterial pressures between the left arm and the arm law. 3. Method according to claim 1, in which the first member on the left side of the individual is the left arm and the second member on the right side of the individual is the right arm, and in which: at least four measurements are made, namely the first measurement (31) on the left arm, the second measurement (32) on the right arm, a third measurement (33) on a left leg and a fourth measurement on a right leg (34) , - comparing said at least four measurements (31, 32, 33, 34) by calculating, during the calculation step (42), the first quantity representative of the left side of the individual defined by a first relationship between the first measure (31) and the third measure (33) in order to obtain a first systolic pressure index between the left leg and the left arm, the second quantity representative of the right side of the individual defined by a second ratio between the second measure (32) and the fourth measurement (34) in order to obtain a second systolic pressure index between the right leg and the right arm, thereby calculating said systolic arterial pressure ratio between the left side and the right side of the individual . 4. Method according to any one of the preceding claims, in which a sequence is carried out comprising, each for a member which is particular to it, the constriction and the corresponding relaxation, the respective pressure measurement is memorized each time, and then we re-read the pressure measurements (31, 32, 33, 34) to calculate the said ratio of systolic arterial pressures between the left side and the right side of the individual. 5. Method according to any one of claims 1 to 3, in which a sequence is carried out comprising the constriction and the corresponding relaxation of at least two members simultaneously, and subsequently the simultaneous measurements (31,32,33, 34) said at least two members for calculating said ratio of systolic arterial pressures between the left side and the right side of the individual. 6. Method according to claim 3, in which a sequence is carried out comprising the constriction and the corresponding relaxation of the left arm, the right arm, the right leg and the left leg simultaneously, and subsequently the simultaneous measurements (31, 32 , 33, 34) to calculate the said ratio of systolic arterial pressures between the left side and the right side of the individual. 7. Method according to any one of claims 4 to 6, in which the sequence is repeated each time a predetermined time interval elapses, preferably the sequence defining a time interval of 5 minutes and being repeated by 3 to 7 times. 8. The method of claim 3 or any of claims 4 to 7 when dependent on claim 3, wherein an alert message is communicated when the first systolic pressure index and / or the second systolic pressure index has a value less than 0.9 or greater than 1.3. 9. Method according to any one of the preceding claims, in which: - a pulse measurement is carried out on the individual, data relating to Korotkov noise acquired during the pulse measurement are extracted, said data relating to Korotkov noise is recorded, said recorded data relating to Korotkov noise is compared with a predetermined database comprising data representative of rhythms of sinus heartbeats or rhythms of heartbeats having arrhythmia, in order to communicate an alert message if the rhythm of heartbeats has arrhythmia. 10. The method of claim 9, wherein, during the step of comparing the recorded data relating to Korotkov noise with the predetermined database: processing the recorded Korotkov noise data to determine a plurality of time intervals, each of the time intervals being measured between two peaks of amplitude characteristic of a heartbeat, comparing the plurality of time intervals to to determine whether the successive time intervals are substantially equal, or, the recorded data relating to Korotkov noise is processed to determine a first curve profile to be compared, said first curve profile to be compared is compared with a second profile of recorded curve in the predetermined and representative database of sinus heartbeats, an algorithm calculating the difference between successive key measurement points of said first curve profile and corresponding successive reference points of said second curve profile, the algorithm adding the sum of the squares of said differences in order to d end a score representative of the similarity between said first cam profile and said second curved profile. 11. Method according to any one of claims 8 to 10, in which, if the first systolic pressure index and / or the second systolic pressure index has a value less than 0.9 or greater than 1.3, a measurement of pulse oximetry on the individual. 12. The method of claim 2 or any one of claims 4 or 5 when dependent on claim 2, wherein an alert message is communicated when the systolic blood pressure ratio between the left arm and the right arm has a value less than 0.9 or greater than 1.3. 13. Equipment for diagnostic assistance for detecting an anomaly in blood pressure in an individual, comprising a central unit (10) connected to measurement means (9) by interface means (20) arranged for, during '' a progressive relaxation of an initial constriction of a member of the individual having locally blocked all arterial circulation, detecting an instant of start of arterial recirculation and then carrying out a measurement of an instantaneous constriction pressure, said means interface (20) being further arranged to receive as input and supply to the central unit (10) a plurality of at least two blood pressure signals (31 to 34) from the measuring means (9) comprising a first pressure signal (31) and a second pressure signal (32), the central unit (10) comprising calculation means (42) connected downstream from the interface means (20) and arranged to calculate a ratio between a first quantity function of at least one of said blood pressure signals (31,33) and representative of the left side of the individual and a second quantity function of at least one of said blood pressure signals (32,34) and representative of the right side of the individual, to allow calculation of a systolic blood pressure ratio between the left side and the right side of the individual. 14. Equipment according to claim 13, in which the first quantity is defined by the first pressure signal (31) and the second quantity is defined by said second pressure signal (32), said calculation means being arranged in order to obtain a ratio of systolic arterial pressures between the first pressure signal (31) and the second pressure signal (32). 15. Equipment according to any one of claims 13 and 14, wherein the interface means (20) are arranged, in addition, to receive as input and provide the central unit (10), a third pressure signal (33) and a fourth pressure signal (34), said calculation means (42) being arranged to calculate: the first representative quantity defined by a first relationship between the first pressure signal (31) and the third pressure signal 5 press (33), - The second representative quantity defined by a second relationship between the second pressure signal (32) and the fourth pressure signal (34). 1/2