JP6027767B2 - Automatic blood pressure measurement device. - Google Patents

Description

  The present invention relates to an automatic blood pressure measuring device having a compression band wound around a compression site in order to detect a pulse wave generated from an artery in the compression site that is a part of a living body such as an arm or an ankle. It is about.

  Cardiovascular information such as the blood pressure value of a living body detects a pulse wave generated from an artery of a living body in synchronization with the pulsation as a pressure vibration in a compression band wound around a pressed portion of the living body, and the pulse It is measured based on the compression pressure of the compression band when a preset change state of the wave magnitude is reached. Such indirect blood pressure measurement is known as an oscillometric method or a cuff vibration method and is widely adopted. In such an oscillometric method, the magnitude of the pulse wave generated in the cuff increases and decreases with the continuous change of the compression pressure in the compression band, and the blood pressure is measured by an auscultation method from the envelope indicated by the amplitude value. The blood pressure value is statistically determined by comparison with the value. For example, this is the blood pressure measuring device shown in Patent Literature 1 and Patent Literature 2.

  However, in such a blood pressure measurement method, the compression pressure applied to the artery from the compression band has a large pressure difference between the center and the end of the compression band in the cuff width direction (longitudinal direction of the blood vessel). For example, since there is a pressure difference of several tens of mmHg, the compression of the artery is not uniform, and the pressure vibration generated in the compression band in response to the pulsation of the artery is the center of the compression band. This is the result of compression of the artery in the compression state in which a compression pressure difference is formed between the end and the end, and the pressure vibration generated in the compression band in response to the pulsation of the artery It is inevitable that it is unclear in principle due to its dependence on flexibility. For this reason, in practical use, a measurement algorithm for correcting the measurement value so as to reduce the average error with the measurement value by the auscultation method has been created.

Japanese Patent Application Laid-Open No. 06-031567 Japanese Patent Application Laid-Open No. 07-236617

  However, the blood pressure measurement value by the auscultation method used for correcting the blood pressure measurement value by the oscillometric method is determined based on the occurrence and disappearance of the Korotkoff sound generated from the artery on the downstream side of the compression band. The generation of Korotkoff sounds is caused by blood flow and pulse wave propagation. The width of the compression band that affects blood flow and pulse wave propagation in the artery and the part of the living body around which the compression band is wound The actual situation is that the blood pressure measurement value is influenced by the thickness. If the width of the compression band is too small, the compression pressure is not applied sufficiently to the artery, resulting in a short cuff effect that the blood pressure is measured high. If the width of the compression band is too large, compression A large cuff effect occurs in which the attenuation during pulse wave propagation under the belt is large and the blood pressure value is measured low. The American Heart Association (AHA) has developed blood pressure measurements when the width of the compression band is not appropriate for the arm thickness in order to correct for the effects of the short and large cuff effects described above. The correction value is announced, and it is recommended to correct the correction value of the maximum blood pressure value and the correction value of the minimum blood pressure value with different values. Since the blood pressure measurement by the auscultation method is determined based on the generation and disappearance of Korotkoff sound generated from the artery on the downstream side of the compression band, the large cuff effect is easily influenced by the attenuation of the pulse wave, and the blood pressure is sufficiently high. Measurement accuracy was not obtained. At the same time, the blood pressure measurement value obtained by the oscillometric method, which has created a measurement algorithm so as to eliminate the error between the blood pressure measurement value obtained by the auscultation method, has not obtained sufficiently high blood pressure measurement accuracy.

  An object of the present invention is to provide an automatic blood pressure measurement device that can reduce the influence of the width dimension of the compression band and obtain an accurate blood pressure measurement value.

  The present inventor conducted various studies on the effects of the compression band and the compression pressure on the arterial pressure and the pressure pulse wave against the background described above. First, for example, the upper arm measurement model, the brachial artery model, and the brachial blood flow pulse wave propagation model to be subjected to pulse wave measurement shown in FIGS. 14A, 14B, and 14C are shown in FIG. The pressure pulse wave data shown was considered correspondingly. In general, in a cuff pressure-free physiological state where there is no compression from the compression band, it is known that the arterial pressure of the upper arm is a combination of a traveling wave incident from the heart side and a reflected wave from the peripheral side . Further, regarding the blood flow in the artery, as seen in the blood flow pulse wave of FIG. 15 (b), it is the sum of the pulsating flow pushed out during the systole and the steady flow of the whole pulse wave period. In the cuff pressure-free physiological state, the flow rate is low in the diastole, the viscosity can be regarded as a steady flow of Poiseuille that does not affect the speed, and in the systole the vascular compliance is small, so the vasomotion can be ignored, Blood flow can be expressed by the Navier-Stokes equation of motion.

  In order to solve the above-mentioned problem, the present inventor considers that a compression band having a triple cuff structure in which the air chamber is divided into three parts is necessary, and FIGS. 14 (a), (b) and (c) ) Shows the compression band. The blood flow and the propagation of the pulse wave are divided into three types: the systolic and diastolic phases of the heart, the compression pressure of the compression zone is higher than the maximum blood pressure value SBP, between the highest blood pressure value SBP and the lowest blood pressure value DBP, and lower than the lowest blood pressure value DBP. It is necessary to consider separately from the compression pressure region.

  Consider the case where the compression pressure in the compression band is greater than or equal to the maximum blood pressure value SBP. Since the artery is closed at the site under the compression band, it is considered that a reflected wave having an inverted phase from the closed site is generated upstream of the compression band. At the downstream side of the compression zone, the arterial pressure that is attenuated by the outflow of the steady flow from the peripheral side remains. In this state, it can be regarded as a Poiseuille steady flow in which the fluid flows in the circular pipe due to the pressure gradient. The pulse wave waveform in the systole has a thin peak waveform due to the negative effect of the phase-inverted reflected wave.

Next, a case where the compression pressure is between the maximum blood pressure value SBP and the minimum blood pressure value DBP will be considered. The artery under the compression zone becomes an applanation in the second half of the pulse cycle, and the pressure pulse wave propagates as an independent wave, so the systolic part, which is the first half of the pulse wave, is an isolated wave that is not affected by the previous pulse wave. The diastolic part of the pulse wave has no inertial term. The pulse wave is divided into a static pressure Pms that is a steady pressure and a dynamic pressure Pmd that is a pulsation pressure. The energy of the static pressure Pms portion of the pulse wave depends on the amount of fluid, and the dynamic pressure Pmd portion depends on the kinetic energy (1/2) ρv ² . The pulse wave propagates due to the retention of blood vessels due to the extension of the artery due to vascular compliance and the inertia of the blood, but since the pulse wave propagating under the compression zone is a solitary wave, the kinetic energy is lost in the diastolic part The energy of the static pressure part is mainly over the entire period of the pulse wave. Under this compression pressure, the blood flow is steady during the diastole of the pulmonary pressure pulse wave in the Pd region, which is the pressure in the downstream artery of the compression zone, and the pressure is attenuated depending on the amount of blood flowing away from the arterial system. To do. When the pressure decay is small compared to the constant pressure exhaust in the compression zone for blood pressure measurement, the bottom pressure gradient of the plethysmographic pulse wave is It is small and the bottom pressure of the open pulse is observed higher than the compression pressure. As can be observed in the broken line portion of FIG. 15A, the bottom pressure of the pressure pulse wave in the Pd region is attenuated in parallel with the cuff pressure under this compression pressure, so that the pressure is limited to the compression pressure. Yes. This is apparent from the fact that the peak value of the pressure pulse wave varies according to the fluctuation of the systolic blood pressure, but the pressure pulse wave has a small variation due to the bottom pressure being limited as described above. At the end of diastole, blood is pushed out by pressure.

  Consider the pulsating part at the end of systole. Under the pressure in the compression zone, the steady flow and the pressure pulse wave are the same, the contribution of the inertial part of the blood is attenuated, and the pressure pulse wave propagates at the blood flow velocity. As can be seen from the attenuation of the pulse wave in FIG. 15A, the pulse wave under this compression zone is attenuated by its propagation. The cause is large energy loss due to vasomotion and energy loss due to viscous resistance. It is thought that reflection of the pressure pulse wave occurs from time to time rather than the head of the solitary wave, but there is no blood that is the medium of the pressure pulse wave when there is no blood flow in the solitary wave state, and the lower limit of the pressure pulse wave Is limited by pressure. Moreover, the waveform of the volume pulse wave observed is limited to the static pressure portion of the existing blood flow. If the effective width of the cuff is 8 cm and the blood flow velocity is 30 cm / sec, the pulse wave propagation time PWT is 260 msec, and when the time width of the observed pulse wave is less than this, the compression zone There is a state (time zone) in which both ends of the artery are closed at the same time, the dynamic pressure component of the pressure pulse wave disappears, and the obtained volume pulse wave follows the change in blood flow. In this state, in part d downstream of the compression band in FIG. 14 (c), it flows in a circular pipe and can be regarded as a steady flow of Poiseuille. Since the impedance of the part d on the downstream side of the compression band is lower than that of the part c below the compression band, the reflected wave c1 from the downstream end of the compression band toward the upstream side is considered to be small. Consider the reflected wave c2 in which the reflected wave d1 from the branch part of the pressure pulse wave propagated to the part d appears under the compression band. When the pressure potential due to the difference between the blood flow flowing into the d portion and the blood flow flowing out from the d portion to the peripheral portion increases and exceeds the pressure under the compression band, the reflected wave c2 falls under the compression band. appear. At a higher compression pressure at which the reflected wave c2 appears, the time width of the pulse wave is the time width of the pulse wave struck during the systole, but when the reflected wave c2 appears, the time width rapidly expands. The blood vessel closes at the end of diastole, but the pulse wave does not become isolated within the width of the compression zone. The reflected wave also has an attenuation of the pulse wave. When viewed comprehensively, the attenuation rate in the traveling direction of the pulse wave decreases with the observation of the reflected wave c2. This can be said to be a region where dynamic pressure appears in the pressure pulse wave. The attenuation of the pressure pulse wave is assumed to be the same as the observed attenuation of the volume pulse wave in the upstream, middle and downstream areas. Thereafter, the fluid is expressed by the Navier-Stokes equation of motion in the portion d downstream of the compression zone. As described above, the bottom pressure in the portion d is caused by the difference between the inflowing blood flow and the outflowing blood flow, that is, depending on the magnitude of the peripheral blood vessel resistance, the blood pressure rises and shifts slightly higher than the compression pressure. doing.

  The blood pressure determined in a state where the reflected wave c2 is not generated is the maximum blood pressure value SBP for the traveling wave. However, since the reflected wave c2 is considerably smaller than the magnitude of the reflected wave when there is no compression due to the compression band, it is considered that the influence on the maximum blood pressure value SBP is not so great. In the auscultation method, the K sound waveform is observed when the pressure pulse wave reaches the downstream end of the compression band, and at this time, the I sound is detected to determine the systolic blood pressure. When the reflected wave c2 is generated, the signal detected by the microphone is synchronized with the reflected wave c2. Further, since the pulse wave attenuates, the systolic blood pressure determined by the auscultation method in the absence of the reflected wave c2 is determined to be lower than the progressive wave of the pressure pulse wave on the upstream side of the compression band by the amount of attenuation of the pulse wave. Is done.

  As for the pressure pulse wave in the Pd region, the reflected wave d2 is observed when the pulse wave grows after the maximum blood pressure. The reflected wave d2 is generated until the compression pressure reaches the minimum blood pressure because the impedance of the artery under the compression band is higher than the impedance of the artery on the downstream side of the compression band and impedance mismatch occurs. . If the reflection point starts with the descending leg of the pressure pulse wave, the peak pressure of the pressure pulse wave is not different from the peak pressure when there is no compression pressure, but if it starts with the ascending leg, the peak pressure of the pressure pulse wave is compressed The peak pressure may be exceeded when there is no pressure. The reflected wave d1 in the Pd region becomes energy loss with the reflected wave d2 at the downstream end of the compression band, but when the pressure exceeds the compression pressure, it propagates under the compression band and becomes a reflected wave c2 component in the Pd region. One component of the pulse wave. In a state where the compression pressure of the compression band is about 10 mmHg higher than the diastolic blood pressure, that is, in a state where Pt = 0, a continuous pulse wave is observed with the artery opened, and at a compression pressure lower than this, the blood flow is It becomes a steady flow and is expressed by the Navier-Stokes equation of motion. The blood vessel wall has a large blood vessel compliance and is described by an equation of motion of an elastic tube. There are two possible causes for the constant opening of the blood vessel under the compression zone at a pressure higher than the diastolic blood pressure. As a first factor, in order to close the blood vessel, the blood flow under the compression zone must be eliminated. For example, when the effective length (width) of the compression zone is 4 cm and the blood flow velocity is 30 cm / sec, compression is performed. It is considered that a time of 130 msec for pulsing from the lower belt region is necessary, and if the time during which the arterial pressure is lower than the compression pressure is shorter than this, fluid remains and a continuous pulse wave is formed. . As a second factor, when the peripheral vascular resistance depending on the amount of blood flowing from the peripheral in the diastole is high, the arterial pressure in the Pd region becomes higher than the compression pressure because the pressure attenuation in the diastole is small, It is thought that the blood vessels of the The blood flow in this region has the characteristics of a thin elastic tube having a high viscous resistance and a slow pulse wave velocity compared to inertia. The pressure pulse wave has a large blood vessel wall motion, and the pulse wave continues to attenuate.

  Next, at the pressure when the compression pressure is equivalent to the minimum blood pressure value DBP, the disappearance point of the K sound in the auscultation method and the reflected wave d2 of the pressure pulse wave in the blood pressure method in the Pd region in the downstream region of the compression zone disappear. And are consistent. This is considered to be a state in which the impedance of the arterial vasculature in the Pd region and the Pb region is matched and the reflected wave d2 disappears. Therefore, a pressure with a similar shape (high cross-correlation) in which the pulse wave attenuation in the Pd region is no longer observed, and a pressure with the same pulse wave propagation velocity in the Pd region and the Pb region (in agreement with the propagation characteristics of micro vibrations) Pressure), the pressure at which the bottom fluctuation of the observed pulse wave is no longer limited by the compression pressure in the compression band is determined as the minimum blood pressure. Therefore, by determining the minimum blood pressure with this algorithm, it is not necessary to correct the large cuff effect, and this pressure determination is considered to be a good match between the open method and the non-invasive method.

In the compression band of the triple cuff structure, the present inventor determines the transmission rate between the upstream expansion bag, the intermediate expansion bag, and the downstream expansion bag that are adjacent to each other with the change in the compression pressure of the compression band. Asked. That is, when a certain pressure pulse is applied to the upstream inflation bag, a pulse wave generated in the intermediate inflation bag and the downstream inflation bag in response thereto is detected, and the transmission rate to the intermediate inflation bag (dB: intermediate inflation) Pulse wave generated in the bag / constant pressure pulse applied to the upstream inflation bag) and transmission rate to the downstream inflation bag (dB: pulse wave generated in the downstream inflation bag / constant applied to the upstream inflation bag) Pressure pulse). As shown in FIG. 16, the pressure pulse wave is transmitted at a substantially constant transmission rate regardless of the frequency, and as shown in FIG. 17, the upstream inflation bag (cuff 1) to the intermediate inflation bag (cuff 2). This shows that crosstalk (interference wave) ΔV ₁₂ is generated and crosstalk (interference wave) ΔV ₂₃ from the intermediate expansion bag (cuff 2) to the downstream expansion bag (cuff 3) is generated.

  FIG. 15A shows the following phenomenon. (I) Pressure pulse generated in the upstream inflation bag at the beginning when arterial blood is blocked by the upstream inflation bag as the compression pressure of the compression band of the triple cuff structure decreases from a value higher than the maximum blood pressure value The waves are relatively large, and only the crosstalk is generated in the intermediate expansion bag and the downstream expansion bag. (Ii) Gradually, when the blood in the artery advances under the intermediate inflation bag, the pressure pulse wave generated in the intermediate inflation bag increases, and the downstream inflation bag is still in a state of only crosstalk. (Iii) Next, when the blood in the artery advances under the downstream inflation bag, the pressure pulse wave generated in the downstream inflation bag increases. In the compression cuff having a triple cuff structure, in the compression pressure in which the blood vessel is in an applanation state due to the compression band wound around the living body at the time of measuring blood pressure, From the waveform of the rise time of the pulse wave corresponding to the time for the pulse wave to propagate between the expansion bags from the intermediate expansion bag to the downstream expansion bag, the interference rate of the pulse waves of the mutual expansion bags is obtained. When the transmission rate obtained by applying the above-mentioned constant pressure pulse exceeds a preset value, the cuff is insufficiently compressed and the blood vessel is in a state of short cuff effect that does not become an applanation state. It is shown that.

  And (iv) When the pressure pulse wave is observed, negative reflection occurs at the head of the pressure pulse wave under the compression zone, so that the pressure pulse wave generated in each inflatable bag decreases rapidly from its peak and peaks. It has a pulse shape with a narrow time width. Due to the superposition of the traveling wave and the positive reflected wave generated from the downstream artery of the compression band, an amplitude difference is generated in the pulse wave generated in the upstream inflation bag, the intermediate inflation bag, and the downstream inflation bag, but the reflection is reflected. Since the wave propagates from the downstream region to the upstream region, the increment of the peak of the pulse wave generated in the downstream expansion bag is relatively large.

  Therefore, the maximum blood pressure value SBP of the living body can be determined based on the compression pressure at the time when the pulse wave generated in the downstream inflation bag rises. The maximum blood pressure value SBP of the living body can be determined based on the compression pressure at the time of the rise of the pulse wave generated in the intermediate expansion bag. Since the pulse wave includes crosstalk, it is desirable to use the pulse wave after removing the influence of the crosstalk. In addition, it is desirable to determine with reference to the propagation time under the compression band. The present invention has been made based on such findings.

That is, the present invention includes (a) a pair of upstream inflatable bag and downstream inflatable bag made of a flexible sheet material positioned at a predetermined interval in the direction of the artery in the compressed part of the living body, A compression belt having an intermediate inflatable bag disposed adjacently between the pair of upstream inflatable bags and the downstream inflatable bag and having an air chamber independent of the pair of upstream inflatable bags and downstream inflatable bags An automatic blood pressure measurement device that measures a blood pressure value of the living body based on a pulse wave generated from an artery in a compressed portion of the living body around which the compression band is wound, and (b) the upstream side adjacent to each other In the process of applying a uniform pressure distribution from the expansion bag, the intermediate expansion bag, and the downstream expansion bag to the artery in the compressed portion of the living body, and changing the compression pressure, the upstream expansion bag, Pulse waves generated in the expansion bag and downstream expansion bag , To determine the systolic blood pressure value of the subject based on the compression pressure against the object to be compression sites at the rise determination of the pulse waves generated intermediate expansion bag or downstream inflation bladder, (c) the intermediate expansion bag or downstream From the pulse wave generated in the expansion bag, an interference rate representing the pressure fluctuation propagated from the expansion bag adjacent to the upstream side of the intermediate expansion bag or the downstream side expansion bag is obtained, and the interference rate is within a preset value. In some cases, the blood pressure is determined by determining that the cuff size is appropriate .

According to the automatic blood pressure measurement device of the present invention, the intermediate inflation bag or the downstream side of the pulse waves generated in the upstream inflation bag, the intermediate inflation bag, and the downstream inflation bag provided adjacent to each other in the compression band. The maximum blood pressure value of the living body is determined based on the compression pressure value for the compressed portion at the time of determining the rise of the pulse wave generated in the expansion bag. Since the upstream expansion bag, the intermediate expansion bag, and the downstream expansion bag, which are independent air chambers provided adjacent to each other in the compression band, are compressed to the pressed portion, the center and the end of the compression band The compression pressure difference between the compression belt and the upstream expansion bag, the intermediate expansion bag, and the downstream expansion bag made of independent air chambers is highly flexible in the width direction of the compression belt. Since the influence on the blood flow and the propagation state of the pulse wave due to the compression state is reduced, the influence of the width of the compression band can be greatly reduced, and an accurate maximum blood pressure value can be obtained . Further, an interference rate representing a pressure fluctuation propagated from an expansion bag adjacent to the upstream side of the intermediate expansion bag or the downstream expansion bag is obtained from a pulse wave generated in the intermediate expansion bag or the downstream expansion bag, and this interference is obtained. By determining that the cuff size is appropriate when the rate is within a preset value and performing blood pressure determination, an accurate blood pressure value can be obtained in which the influence of the width of the compression band is greatly reduced .

  Here, preferably, the rising determination is determined based on a pulse wave generated in the intermediate expansion bag or the downstream expansion bag exceeding a predetermined rising determination value. In this way, by setting the rising judgment value in advance so as to obtain a highly accurate systolic blood pressure value, the influence of the width of the compression band can be greatly reduced, and an accurate systolic blood pressure value can be obtained.

  Preferably, the pulse wave generated in the intermediate inflatable bag or the downstream inflatable bag is obtained in advance representing a pressure fluctuation transmitted from an inflatable bag adjacent to the upstream side of the intermediate inflatable bag or the downstream inflatable bag. Based on the crosstalk value, the crosstalk is corrected so as to be removed. In this way, since a pulse wave with less influence of crosstalk from the expansion bag adjacent to the upstream side of the intermediate expansion bag or the downstream expansion bag is obtained, the influence due to the width dimension of the compression band is greatly reduced. A more accurate systolic blood pressure value can be obtained.

  Further, preferably, the maximum blood pressure value is a cuff pressure corresponding to a rise determination of a pulse wave generated in the intermediate expansion bag and a cuff pressure corresponding to a rise determination of a pulse wave generated in the downstream expansion bag. Of these, the larger cuff pressure is determined. In this way, a more accurate systolic blood pressure value can be obtained in which the influence of the width of the compression band is greatly reduced.

  Preferably, the difference between the magnitude of the pulse wave generated in the intermediate expansion bag and the magnitude of the pulse wave generated in the downstream expansion bag is determined to be equal to or less than a preset coincidence determination value. A minimum blood pressure value of the living body is determined based on a compression pressure value corresponding to the pressed part. In this way, it is determined that the impedance immediately below the compression band and the impedance on the downstream side of the compression band are matched with respect to the blood flow in the artery, and in such a state, the pulse wave velocity immediately below the compression band and The pressure at the time when the bottom pressure (lower peak pressure) of the pressure pulse wave observed by the direct method is no longer restricted by the compression pressure due to the compression band is equal to the pulse wave velocity on the downstream side of the compression band. Therefore, a highly accurate minimum blood pressure value is obtained.

  Preferably, the pulse waves generated in the intermediate inflation bag and the downstream inflation bag, which are used when determining the minimum blood pressure value, are adjacent to the upstream side of the intermediate inflation bag and the downstream inflation bag, respectively. Are corrected based on cross-talk values determined in advance representing pressure fluctuations propagated from. In this way, since the pulse wave from which crosstalk has been removed is used, a more accurate minimum blood pressure value can be obtained.

1 shows an automatic blood pressure measurement device according to an embodiment of the present invention, which includes an upper arm compression band that is wound around an upper arm that is a compressed portion of a living body. It is the figure which notched a part which shows the outer peripheral surface of the compression belt | band | zone of FIG. It is a top view which shows the upstream expansion bag, the intermediate | middle expansion bag, and the downstream expansion bag which were provided in the compression belt | band | zone of FIG. It is sectional drawing which cut | disconnects and shows the upstream expansion bag of FIG. 3, an intermediate | middle expansion bag, and a downstream expansion bag in the width direction. It is a functional block diagram for demonstrating the principal part of the control function with which the electronic control apparatus of FIG. 1 was equipped. FIG. 6 is a diagram illustrating pulse wave signals from the plurality of expansion bags generated when the pressure values of the plurality of expansion bags are gradually reduced by the cuff pressure control unit of FIG. a) shows the waveform before crosstalk correction, and (b) shows the waveform after crosstalk removal correction. FIG. 6 is a diagram illustrating pulse wave signals from the plurality of expansion bags generated when the pressure values of the plurality of expansion bags are gradually reduced by the cuff pressure control unit of FIG. 5 when the pressure is 134 mmHg; a) shows the waveform before crosstalk correction, and (b) shows the waveform after crosstalk removal correction. FIG. 6 is a diagram illustrating pulse wave signals from the plurality of inflation bags generated in a process in which the compression pressure values of the plurality of inflation bags are gradually reduced by the cuff pressure control unit of FIG. 5, and the compression pressure value is 113 mmHg. It is a certain time. FIG. 6 is a diagram showing pulse wave signals from the plurality of inflation bags generated in a process in which the compression pressure values of the plurality of inflation bags are gradually reduced by the cuff pressure control unit of FIG. 5, and the compression pressure value is 73 mmHg. It is a certain time. It is a time chart explaining the control action of the cuff pressure control part contained in the electronic controller of FIG. It is a figure which respectively shows the waveform of the pulse wave before correction | amendment which removes crosstalk, the waveform of the pulse wave after correction | amendment, and the crosstalk waveform removed by correction | amendment. It is one side of the flowchart explaining the principal part of control action of the electronic controller of FIG. 5 shows an envelope (envelope) connecting the amplitude values of pulse wave signals from the plurality of inflation bags extracted in the process of gradually decreasing the pressure values of the plurality of inflation bags by the cuff pressure control means of FIG. FIG. It is a figure explaining the pulse wave transmission in the artery in the upper arm of a living body, (a) is the upper arm model of the living body to which the compression band is attached, (b) is the arterial model in the upper arm, (c) is the upper arm The pulse wave propagation models in are shown respectively. (A) When the compression pressure from the compression band attached to the upper arm of the living body is changed, the compression pressure obtained from the intermediate expansion bag of the compression band, the pulse wave extracted from the compression pressure, the artery in the upper arm It is a time chart which shows in parallel the pressure pulse wave obtained by the direct method from the compression zone downstream site | part. (B) is an example of the ultrasonic blood flow waveform of the brachial artery. It is a figure which shows the frequency characteristic of the transmission rate of the crosstalk from the upstream expansion bag which is an independent air chamber provided in the compression band to the intermediate expansion bag adjacent to it. It is a figure which shows the interference of the pulse wave from the upstream expansion bag which is an independent air chamber provided in the compression zone to the intermediate expansion bag adjacent to it.

  Hereinafter, an embodiment of the present invention will be described in detail with reference to the drawings. In the following embodiments, the drawings are appropriately simplified or modified, and the dimensional ratios, shapes, and the like of the respective parts are not necessarily drawn accurately.

  FIG. 1 shows an automatic blood pressure measurement apparatus 14 according to an example of the present invention, which includes a compression band 12 for an upper arm that is wound around a pressed part that is a part of a living body, for example, the upper arm 10 that is one of the limbs of the living body. ing. This automatic blood pressure measurement device 14 is a compression generated in response to a change in the volume of the artery 16 in the process of decreasing the compression pressure of the compression band 12 that has been increased to a value sufficient to stop the artery 16 in the upper arm 10. Pulse waves (see FIGS. 6 to 9 described later) that are pressure oscillations in the band 12 are sequentially extracted, and the systolic blood pressure value SBP and the diastolic blood pressure DBP of the living body are measured based on changes in the pulse waves. is there.

  FIG. 2 is a partially cutaway view showing the outer peripheral surface of the compression band 12. As shown in FIG. 2, the compression band 12 includes a belt-shaped outer bag 20 made of a synthetic resin fiber outer circumferential side nonwoven fabric 20 a and a inner circumferential side nonwoven fabric (not shown) whose back surfaces are laminated with a synthetic resin such as PVC. An upstream inflatable bag 22, an intermediate inflatable bag 24 and a downstream that are sequentially housed in the width direction in the belt-like outer bag 20 and are made of a flexible sheet such as a soft polyvinyl chloride sheet and can independently press the upper arm 10. A raised pile (not shown) attached to the end of the inner peripheral nonwoven fabric is detachably attached to a hook and loop fastener 28 attached to the end of the outer peripheral side nonwoven fabric 20a. 10 is detachably mounted. When attached to the upper arm 10, the downstream inflation bag 26 is positioned on the downstream side of the artery 16 in the upper arm 10 with respect to the upstream inflation bag 22 and the intermediate inflation bag 24. Further, the intermediate expansion bag 24 is positioned upstream of the downstream expansion bag 26, and the upstream expansion bag 22 is positioned upstream of the downstream expansion bag 26 and the intermediate expansion bag 24. The upstream inflatable bag 22, the intermediate inflatable bag 24, and the downstream inflatable bag 26 have independent air chambers that are connected in the width direction and press the upper arm 10 respectively, and have pipe connecting connectors 32, 34, and 36, respectively. It is provided on the outer peripheral surface side. The pipe connecting connectors 32, 34 and 36 are exposed to the outer peripheral surface of the compression band 12 through the outer peripheral side nonwoven fabric 20a.

  FIG. 3 is a plan view showing the upstream expansion bag 22, the intermediate expansion bag 24, and the downstream expansion bag 26 provided in the compression band 12, and FIG. 4 is a cross-sectional view taken along the width direction, that is, the arrow a direction in FIG. FIG. The upstream inflation bag 22, the intermediate inflation bag 24, and the downstream inflation bag 26 are for detecting pulse waves that are pressure oscillations generated in response to the volume change of the artery 16 compressed by them, respectively. It has a longitudinal shape. The upstream expansion bag 22 and the downstream expansion bag 26 are arranged adjacent to both sides of the intermediate expansion bag 24. Further, the intermediate expansion bag 24 is disposed at the center in the width direction of the compression band 12 while being sandwiched between the upstream expansion bag 22 and the downstream expansion bag 26. In the state where the compression band 12 is wound around the upper arm 10, the upstream expansion bag 22 and the downstream expansion bag 26 are positioned at a predetermined interval in the longitudinal direction of the upper arm 10, and the intermediate expansion bag 24 is arranged between the upstream expansion bag 22 and the downstream expansion bag 26 so as to be continuous in the longitudinal direction of the upper arm 10. As shown in FIG. 4, the distance L12 between the center of the upstream expansion bag 22 and the center of the intermediate expansion bag 24 and the distance L23 between the center of the intermediate expansion bag 24 and the center of the downstream expansion bag 26 are at least 30 mm. The distance L13 between the center of the upstream expansion bag 22 and the center of the downstream expansion bag 26 is set to at least 6 cm. The propagation speed of the pulse wave when the blood vessel is in the applanation state is equivalent to the blood flow speed, and the blood flow speed in the compression band 12 is about 30 mm / 100 msec from the experimental value of about 30 cm / sec. The interference rate can be measured at a rise time of 100 msec.

  The intermediate inflatable bag 24 has side edges of a so-called gusset structure on both sides. That is, at both ends in the longitudinal direction of the upper arm 10 of the intermediate inflatable bag 24, a pair of folding grooves 24f and 24f made of a flexible sheet folded in a direction approaching each other so as to become closer to each other are respectively provided. Is formed. The adjacent end portions 22a and 26a of the upstream expansion bag 22 and the downstream expansion bag 26 adjacent to the intermediate expansion bag 24 are inserted into the pair of folding grooves 24f and 24f. ing. Thereby, both ends 24a and 24b of the intermediate expansion bag 24, the adjacent end 22a of the upstream expansion bag 22, and the adjacent end 26a of the downstream expansion bag 26 are overlapped with each other, that is, an overlap structure. Therefore, when the upstream expansion bag 22, the intermediate expansion bag 24, and the downstream expansion bag 26 press the upper arm 10 with equal pressure, a relatively uniform pressure distribution is obtained even in the vicinity of the boundary between them.

  The upstream inflatable bag 22 and the downstream inflatable bag 26 also have side edges of a so-called gusset structure at the end portions 22 b and 26 b opposite to the intermediate inflatable bag 24. That is, the end portions 22b and 26b on the opposite side of the intermediate expansion bag 24 of the upstream expansion bag 22 and the downstream expansion bag 26 are flexibly folded in a direction approaching each other so as to become deeper as they approach each other. Folding grooves 22f and 26f made of a conductive sheet are respectively formed. The sheets constituting the folding grooves 22f and 26f are opposite to each other via connection sheets 38 and 40 having through holes arranged in the upstream expansion bag 22 and the downstream expansion bag 26 so as not to protrude in the width direction. It is connected to the side portion, that is, the portion on the intermediate expansion bag 24 side. As a result, the compression pressure on the artery 16 of the upper arm 10 can be obtained at the end portions 22b and 26b of the upstream expansion bag 22 and the downstream expansion bag 26 in the same manner as the other portions. The compression width is equivalent to the width dimension. The width direction of the compression band 12 is about 12 cm, and since the three upstream expansion bags 22, the intermediate expansion bag 24, and the downstream expansion bag 26 are arranged in the width direction, each is substantially about 4 cm. It must be the width dimension. In order to generate a sufficient compression function even with such a narrow width dimension, both end portions 24a and 24b of the intermediate expansion bag 24 and adjacent end portions 22a and 26a of the upstream expansion bag 22 and the downstream expansion bag 26 are used. And end portions 22b and 26b of the upstream side expansion bag 22 and the downstream side expansion bag 26 opposite to the intermediate expansion bag 24 are side edges of a so-called gusset structure. Has been.

  Between the end portions 22a and 26a of the upstream expansion bag 22 and the downstream expansion bag 26 on the intermediate expansion bag 24 side, and the inner wall surfaces of the pair of folding grooves 24f and 24f into which they are inserted, that is, the opposite groove side surfaces In each, a longitudinal shielding member 42 having rigidity anisotropy in which the bending rigidity in the width direction of the compression band 12 is higher than the bending rigidity in the longitudinal direction of the compression band 12 is interposed. The shielding member 42 has the same length as the upstream expansion bag 22 and the downstream expansion bag 26 or the intermediate expansion bag 24. In the present embodiment, as shown in FIGS. 3 and 4, the outer peripheral side gap and the downstream side expansion of the gap between the end 22a of the upstream side expansion bag 22 and the folding groove 24f into which it is inserted. Longitudinal shielding members 42 are respectively interposed in gaps on the outer peripheral side of the gap between the end portion 26a of the bag 26 and the folding groove 24f into which the bag 26 is inserted. May also be interposed. Since the outer circumferential side gap has a larger shielding effect than the inner circumferential side gap, it is sufficient to be provided at least in the outer circumferential side gap.

  The shielding member 42 includes a plurality of resin-made flexible hollow tubes 44 parallel to the longitudinal direction of the upper arm 10, that is, the width direction of the compression band 12, and the circumferential direction of the upper arm 10, that is, the compression band 12. The flexible hollow tubes 44 are connected to each other directly by molding or bonding, or indirectly through another member such as a flexible sheet such as an adhesive tape. Is configured. The shielding member 42 is latched by a plurality of latching sheets 46 provided at a plurality of positions on the outer peripheral side of the end portions 22a and 26a of the upstream inflation bag 22 and the downstream inflation bag 26 on the intermediate inflation bag 24 side. Yes.

  Returning to FIG. 1, in the automatic blood pressure measurement device 14, an air pump 50, a quick exhaust valve 52, and an exhaust control valve 54 are connected to a main pipe 56. From the main pipe 56, a first branch pipe 58 connected to the upstream expansion bag 22, a second branch pipe 62 connected to the intermediate expansion bag 24, and a third branch pipe 64 connected to the downstream expansion bag 26. Are branched. The first branch pipe 58 includes a first on-off valve E1 in series for directly opening and closing between the air pump 50 and the upstream expansion bag 22. The main pipe 56 includes a second opening / closing valve E2 in series for directly opening / closing the air pump 50, the quick exhaust valve 52 and the exhaust control valve 54, and the branch pipes. The third branch pipe 64 includes a third on-off valve E3 in series for directly opening and closing the space between the air pump 50 and the downstream expansion bag 26. A first pressure sensor T1 for detecting the pressure value in the upstream expansion bag 22 is connected to the first branch pipe 58, and a second pressure sensor T2 for detecting the pressure value in the intermediate expansion bag 24 is provided. A third pressure sensor T 3 connected to the second branch pipe 62 and detecting the pressure value in the downstream expansion bag 26 is connected to the third branch pipe 64.

  From the first pressure sensor T1, the second pressure sensor T2, and the third pressure sensor T3 to the electronic control unit 70, an output signal indicating the pressure value in the upstream expansion bag 22, that is, the compression pressure value PC1 of the upstream expansion bag 22. An output signal indicating the pressure value in the intermediate expansion bag 24, that is, the compression pressure value PC2 of the intermediate expansion bag 24, and an output signal indicating the pressure value in the downstream expansion bag 26, that is, the compression pressure value PC3 of the downstream expansion bag 26, respectively. Supplied. The electronic control unit 70 is a so-called microcomputer including a CPU 72, a RAM 74, a ROM 76, an I / O port (not shown), and the like. In the electronic control unit 70, the CPU 72 processes input signals in accordance with a program stored in the ROM 76 in advance using the storage function of the RAM 74, and the electric air pump 50, the quick exhaust valve 52, the exhaust control valve 54, By controlling the first on-off valve E1, the second on-off valve E2, and the third on-off valve E3, respectively, they are generated in response to changes in the volume of the artery 16 of the upper arm 10 pressed against the expansion bags 22, 24, and 26, respectively. Pulse wave signals SM1, SM2, and SM3 (for example, see FIGS. 6 (a), 7 (a), 8, and 9 described later) indicating pulse waves that are pressure vibrations in the expansion bags 22, 24, and 26, respectively. Collect. Further, the electronic control unit 70 calculates the maximum blood pressure value SBP and the minimum blood pressure value DBP of the living body based on the pulse wave signals SM1, SM2, and SM3, and causes the display device 78 to display the measurement value that is the calculation result. . In addition to the output signals from the first pressure sensor T1, the second pressure sensor T2, and the third pressure sensor T3, the electronic control device 70 is supplied with an output signal from the blood pressure value measurement starting unit 80. The blood pressure value measurement activation unit 80 outputs a command signal for starting blood pressure measurement in response to a manual activation operation or every preset blood pressure measurement cycle.

  FIG. 5 is a functional block diagram for explaining the main part of the control function provided in the electronic control unit 70. In FIG. 5, the cuff pressure control unit 82, when the blood pressure measurement start command signal is supplied from the blood pressure value measurement starting unit 80, for example, as shown in the time chart of FIG. 10, 54, and the air pump 50 is started in a state in which the first on-off valve E1, the second on-off valve E2, and the third on-off valve E3 are opened, thereby the upstream expansion bag 22, the intermediate expansion bag 24, and the downstream expansion bag. The pressure pressure value PC applied to the artery 16 of the upper arm 10 by 26 is rapidly increased to a pressure increase target pressure value PCM (for example, 180 mmHg) set in advance sufficiently higher than the maximum blood pressure value SBP in the artery 16. For example, the pressure of each expansion bag is increased until the compression pressure value PC2 of the intermediate expansion bag 24 becomes equal to or higher than the pressure increase target pressure value PCM. Subsequently, the cuff pressure control unit 82 uses the exhaust control valve 54 to set the compression pressure values PC of the upstream expansion bag 22, the intermediate expansion bag 24, and the downstream expansion bag 26 that have been increased in pressure at a preset speed. Decrease the pressure gradually at the same time. At this time, the cuff pressure control unit 82 sets the compression pressure value PC of the upstream expansion bag 22, the intermediate expansion bag 24, and the downstream expansion bag 26 for each predetermined speed reduction (for example, within a range of 3 to 10 mmHg). Hold for a predetermined time. Then, the cuff pressure control unit 82 determines that the compression pressure value PC2 of the intermediate inflation bag 24 is lower than the measurement end pressure value PCE (for example, 30 mmHg) set in advance to a value sufficiently lower than the minimum blood pressure value DBP in the artery 16. When the pressure becomes smaller, the quick exhaust valve 52 is used to exhaust the pressure in the upstream expansion bag 22, the intermediate expansion bag 24, and the downstream expansion bag 26 to atmospheric pressure.

  The pulse wave collection unit 84 performs the first pressure sensor T1, in the process in which the cuff pressure control means 82 gradually decreases the pressure values PC of the upstream expansion bag 22, the intermediate expansion bag 24, and the downstream expansion bag 26, respectively. Based on output signals from the second pressure sensor T2 and the third pressure sensor T3, a pulse wave signal SM1 indicating a pulse wave that is a pressure fluctuation in the upstream expansion bag 22, the intermediate expansion bag 24, and the downstream expansion bag 26. , SM2 and SM3 are sequentially collected and stored in the RAM 74. FIGS. 6A, 7A, 8, and 9 are diagrams illustrating a pulse wave signal SM that is a cuff volume pulse wave PVR generated in the above process. These pulse wave signals SM1, SM2, and SM3 shown in FIGS. 6A, 7A, 8, and 9 are obtained when the compression pressure value PC of the compression band 12 is 153 mmHg, 134 mmHg, 113 mmHg, and 73 mmHg. , A pulse wave signal SM1 (broken line) indicating a pulse wave M1 from the upstream expansion bag 22 obtained by discriminating the output signal from the first pressure sensor T1 by low-pass filter processing or band-pass filter processing; The pulse wave signal SM2 (solid line) indicating the pulse wave M2 from the intermediate expansion bag 24 obtained by discriminating the output signal from the pressure sensor T2 by low-pass filter processing or band-pass filter processing, and the third pressure sensor Downstream expansion obtained by discriminating the output signal from T3 by low-pass filtering or band-pass filtering Pulse wave signal indicating the pulse wave M3 from 26 SM3 is (dashed line). Then, the pulse wave collection unit 84 uses the pulse wave signals SM1, SM2, and SM3 obtained above together with the cuff pressure signal PK2 indicating the compression pressure value PC2 of the intermediate inflating bag 24 when they are generated, for a predetermined value in the RAM 74. Store in the storage area.

The crosstalk calculating unit 86 generates the rising pressures of the pulse waves of the pulse wave signals SM1, SM2, and SM3 detected from the upstream inflation bag 22, the intermediate inflation bag 24, and the downstream inflation bag 26, respectively, with a compression pressure equal to or higher than the average blood pressure value. from the amplitude, the interference ratio r ₀ of the interference factor r _{0 (12)} and the downstream inflation bladder 26 of the intermediate expansion bag 24 ₍₁₃₎ is measured sequentially calculates the crosstalk for each pressing pressure of a predetermined interval. In the compression band 12 wound around the upper arm 10, the intermediate inflation bag 24 not only receives the pulse wave from the artery 16 directly below it, but also affects the influence of the pressure fluctuation of the upstream inflation bag 22 adjacent to the upstream side, that is, interference. As a result, the pulse wave signal SM2 representing the pulse wave including them is detected. In addition, the downstream inflation bag 26 not only receives a pulse wave from the artery 16 immediately below it but also is affected by the pressure fluctuation of the intermediate inflation bag 24 adjacent to the upstream side thereof, and therefore, the pulse representing the pulse wave including them. A wave signal SM3 is detected. Therefore, in order to correct the pulse wave represented by the pulse wave signal SM2 and obtain a pulse wave before being subjected to interference, the pulse wave passes through the upstream inflation bag from the following equation (1) in which the interference rate r ₀ is stored in advance. It is calculated based on the amplitudes ΔP ₁ and ΔP ₂ of the pulse wave measured at the rise time of the pulse wave within the propagation time. In the formula (1), as shown in FIG. 17, when the upstream inflatable bag is generalized as the cuff 1 and the inflatable bag adjacent to the downstream side is generalized as the cuff 2, from the center of the cuff 1 obtained in advance. The volume and pressure of the cuff 1 and cuff 2 before the elapse of the pulse wave propagation time t ₁₂ in the artery to the center of the cuff 2 are V ₁ , P _1, V ₂ , and P _2, and the cuff 1 due to pulsation of the artery The volume change and the pressure change of the cuff 2 are denoted by ΔV ₁ , ΔP ₁ and ΔV ₂ , ΔP ₂ . Of the volume change, the crosstalk from the cuff 1 to 2 is ΔV _{12, and the} increment due to _the pulse wave propagation is ΔV _{pp, 1} and ΔV _{pp, 2} . It is assumed that fluctuation due to the pulse wave of the cuff internal pressure is small in isothermal change, pressure change and volume change.

The first term on the right side of equation (1) is the increment by which the pulse wave has propagated to the brachial artery region immediately below cuff 2, and the second term on the right side is the increment due to crosstalk from cuff 1 to cuff 2. During the time when the head of the pulse wave is propagating through the region of cuff 1, ΔV _{pp, 2} = 0 in the first term on the right side of equation (1), and ΔP2 / ΔP1 is only for the crosstalk as shown in equation (2). It becomes constant at. The ratio ΔP2 / ΔP1 in this constant region is determined as the interference rate r ₀ .

When the above time region in which the interference rate r ₀ is constant is narrower than the preset time, the interference rate r ₀ becomes large due to the influence of the pulse wave of the first term on the right side of the equation (1) traveling directly under the cuff 2. It is determined that the cuff is in a short cuff effect with insufficient pressure.

The pulse wave correcting unit 88 stores the pulse wave represented by the pulse wave signal SM2 detected from the intermediate expansion bag 24 and the pulse wave represented by the pulse wave signal SM3 detected from the downstream expansion bag 26 by the following formula ( 3), and correction based on the interference ratio r _{0 (13)} of the interference ratio r _{0 (12)} and the downstream inflation bladder 26 of the intermediate expansion bag 24 calculated in the crosstalk computing unit 86, the pulse after correction The wave is stored in the RAM 74. In equation (3), the pulse wave before correction detected from the predetermined cuff 2 is detected from PVRc2 (t), the pulse wave after correction is detected from PVRc (t), and the cuff 1 adjacent to the upstream side of the predetermined cuff 2 The obtained pulse wave is generalized as PVRc1 (t). FIG. 11 shows the detected pulse wave before correction with PVRc1 (t) as a one-dot chain line, and the corrected pulse wave separated therefrom with PVRc2 (t) as a solid line and contribution from the upstream cuff ( PVRc3 (t) is indicated by a broken line. FIGS. 6B and 7B show the corrected pulse wave in the systole, and FIG. 13 shows the contraction formed using the maximum amplitude of the corrected pulse wave PVRc2 (t). The intermediate envelope Em, the downstream envelope Ed, and the upstream envelope Ep near the period are indicated by broken lines.

  The pulse wave propagation time PWT calculation unit 90 calculates the time difference between the rising point of the pulse wave signal SM1 detected from the upstream expansion bag 22 and the rising point of the pulse wave signal SM2 detected from the intermediate expansion bag 24, that is, the pulse wave propagation time. The time difference between the rising point of the pulse wave signal SM2 detected from t12 and the intermediate expansion bag 24 and the rising point of the pulse wave signal SM3 detected from the downstream expansion bag 26, that is, the pulse wave propagation time t23 is calculated.

  The blood pressure value determining unit 92 applies each of the upstream inflatable bags 22, the intermediate inflatable bag 24, and the downstream inflatable bag 26 to the living body and applies a constant pressure to the living body and gradually decreases the pressure. Of the pulse wave signals SM1, SM2, and SM3 detected from the intermediate expansion bag 24 and the downstream expansion bag 26, the pulse wave represented by the pulse wave signal SM2 detected from the intermediate expansion bag 24, and the pulse wave correction unit 88. The rise of the pulse wave corrected by the pulse wave correction unit 88, which is the pulse wave represented by the compression pressure value PC2 at the time of the pulse wave rise determination corrected by the pulse wave signal SM3 detected from the downstream expansion bag 26 Based on the compression pressure value PC3 at the time of determination, a maximal blood pressure value determining unit 94 that determines the maximal blood pressure value SBP of the living body and displays it on the display device 78 is provided. The systolic blood pressure value determining unit 94 determines, for example, the higher pressure value PC of the compression pressure value PC2 and the compression pressure value PC3 as the maximum blood pressure value SBP of the living body. The rise determination is performed, for example, when the pulse wave after correction of the pulse wave signal SM2 exceeds the rising determination value J2 stored in advance and when the pulse wave after correction of the pulse wave signal SM3 is corrected. This determination is made when the rising determination value J3 stored in advance is exceeded. The pulse wave represented by the pulse wave signal SM2 detected from the intermediate expansion bag 24 and corrected by the pulse wave correction unit 88, and the pulse wave represented by the pulse wave signal SM3 detected from the downstream expansion bag 26 The pulse waves corrected by the pulse wave correction unit 88 are both of the same magnitude because the crosstalk has been removed. Therefore, the rising determination value J2 and the rising determination value J3 are Although the values are similar or approximate to each other, values obtained experimentally in advance are used to absorb a difference in detection sensitivity characteristics derived from the detection position.

  In addition, the blood pressure value determination unit 92 includes an intermediate pulse wave signal SM1, SM2, and SM3 detected from the upstream inflating bag 22, the intermediate inflating bag 24, and the downstream inflating bag 26 in the process of gradually decreasing the pressure of the compression band 12. The pulse wave represented by the pulse wave signal SM2 detected from the expansion bag 24 and corrected by the pulse wave correction unit 88 and the pulse wave represented by the pulse wave signal SM3 detected from the downstream expansion bag 26 And a minimum blood pressure value determining unit 96 that determines the minimum blood pressure value DBP of the living body based on the fact that there is no attenuation between the pulse wave corrected by the pulse wave correcting unit 88. This diastolic blood pressure value determining unit 96 determines the difference ΔA between the magnitude A24 of the pulse wave generated in the intermediate inflation bag 24 and the magnitude A26 of the pulse wave generated in the downstream inflation bag 26 during the slow pressure reduction process of the compression band 12. However, the compression pressure value PC when determined to be equal to or less than the pre-stored coincidence determination value JA is determined as the diastolic blood pressure value DBP of the living body.

The cuff size effect determination unit 98 compresses the cuff because the applanation of the blood vessel is insufficient if the interference rate r ₀ calculated by the crosstalk calculation unit 86 is not less than a predetermined value, for example, 0.8. If the short cuff effect is insufficient, the display device 78 displays a message to that effect, or stops displaying the blood pressure measurement value. Further, the pulse wave propagation time t12 from the upstream expansion bag 22 to the intermediate expansion bag 24 calculated by the pulse wave propagation time PWT calculation unit 90, the pulse wave propagation time t23 from the intermediate expansion bag 24 to the downstream expansion bag 26, Alternatively, based on the pulse wave propagation time t13 from the upstream inflatable bag 22 to the downstream inflatable bag 26, it is determined whether the measurement value becomes low due to the large cuff effect and the measurement accuracy of the blood pressure value cannot be obtained. To do. The cuff size effect determination unit 98 determines, for example, whether or not the pulse wave propagation time t13 is equal to or greater than a previously stored determination value jt. If the determination is affirmative, the blood pressure value measurement value decreases due to the large cuff effect. In this state, a message to that effect is displayed on the display device 78 or the display of the blood pressure measurement value is stopped.

  FIG. 12 is a flowchart for explaining a main part of the control operation of the electronic control unit 70. When a power switch (not shown) is turned on, the initial state shown at time t0 in FIG. In this state, the first on-off valve E1, the second on-off valve E2, the third on-off valve E3, and the quick exhaust valve 52 are normally open, so that they are in an open state (non-operating state), and the exhaust control valve 54 is normally closed. Since it is a valve, it is in a closed state (non-operating state), and the air pump 50 is in a non-operating state.

  Next, when a startup operation device (not shown) is operated and the measurement operation of the automatic blood pressure measurement device 14 is started, first, the steps of FIG. 12 corresponding to the cuff pressure control unit 82 (hereinafter, “step” is omitted). In S1, the compression pressure value of the compression band 12 is increased. Specifically, as shown in FIG. 10, while the quick exhaust valve 52 is closed, the air pump 50 is activated and compressed air pumped from the air pump 50 is used in the main pipe 56 and in it. The pressures in the upstream expansion bag 22, the intermediate expansion bag 24, and the downstream expansion bag 26 communicated with each other are rapidly increased. Then, compression of the upper arm 10 by the compression band 12 is started.

  Subsequent to S1, in S2 corresponding to the cuff pressure control unit 82, based on the cuff pressure signal PK2 indicating the compression pressure value PC2 of the intermediate inflatable bag 24, the compression pressure value PC2 is higher than the maximum blood pressure value of the living body. It is determined whether or not a pressure increase target pressure value PCM (for example, 180 mmHg) set in advance so as to be higher. At a time point before time t1 in FIG. 10, the determination in S2 is negative and S1 and subsequent steps in FIG. 12 are repeatedly executed. However, when the time t1 in FIG. 10 is reached, the determination in S2 is affirmed.

  If the determination in S2 is affirmative as described above, the operation of the air pump 50 is stopped in S3 corresponding to the cuff pressure control unit 82. Then, the pressure values PC1, PC2 and PC3 of the boosted upstream side expansion bag 22, intermediate expansion bag 24 and downstream side expansion bag 26 are simultaneously reduced at a gradual step-down rate set in advance to 3 to 5 mmHg / sec, for example. Thus, the exhaust control valve 54 is actuated to start slow exhaust. At this time, the exhaust control valve 54 is controlled so that the pressure reduction amount of the compression pressure value PC of the upstream expansion bag 22, the intermediate expansion bag 24, and the downstream expansion bag 26 becomes a predetermined amount within a range of 5 to 10 mmHg, The first on-off valve E1, the second on-off valve E2, and the third on-off valve E3 are operated so that the compression pressure value PC is held for a predetermined time for each predetermined amount of deceleration pressure reduction. In order to hold the compression pressure value PC, the first on-off valve E1, the second on-off valve E2, and the third on-off valve E3 are closed. A time t3 in FIG. 10 is a start time of the slow exhaust, and a time t3 to a time t4 is a time during which the compression pressure value PC is held for a predetermined time.

  After S3, in S4 corresponding to the pulse wave sampling unit 84, the first pressure sensor T1, the second pressure sensor T2, and the third pressure sensor are held while the compression pressure values PC1, PC2, and PC3 are held for a predetermined time, respectively. Low-pass filter processing or band-pass filter processing for discriminating signals in the wavelength band of several Hz to several tens Hz with respect to the output signal from T3, respectively, thereby the pulse wave components from the expansion bags 22, 24 and 26 are obtained. The pulse pressure signals SM1, SM2, and SM3 shown are extracted, and the compression pressure value of the intermediate expansion bag 24 from which the AC component has been removed by performing low-pass filter processing on the output signal from the second pressure sensor T2 A cuff pressure signal PK2 indicating PC2 is extracted, and is associated with each other and sequentially stored in the RAM 74 together with the pulse wave generation time. FIGS. 6A, 7A, 8, and 9 are diagrams illustrating pulse wave signals SM1, SM2, and SM3 extracted and stored.

  In S4, the pressure amplitudes of the pulse wave signals SM1, SM2, and SM3 and the pulse wave signals SM1, SM2, and SM3 are based on the cuff pressure signal PK2 at that time, for example, as shown in FIG. An envelope that connects the amplitude values of various pulse wave signals is created and stored, and displayed on the display device 78 as necessary. In the envelope of FIG. 13, the value between each measurement point is obtained by curve interpolation, for example. In FIG. 13, the upstream envelope Ep created using the pulse wave signal SM1 from the upstream inflation bag 22, the intermediate envelope Em created using the pulse wave signal SM2 from the intermediate inflation bag 24, and the downstream inflation bag. The downstream envelope Ed created using the pulse wave signal SM3 from No. 26 is indicated by a solid line, and the corrected envelope in which the stroke around the systole is corrected is indicated by a broken line.

Next, in S5 corresponding to the crosstalk calculating unit 86, pulse wave signals SM2 and SM3 detected from the intermediate expansion bag 24 and the downstream expansion bag 26, respectively, when a constant pressure pulse is applied to the upstream expansion bag 22. from pressure amplitude interference ratio r ₀ of the interference factor r _{0 (12)} and the downstream inflation bladder 26 of the intermediate expansion bag 24 is crosstalk value ₍₁₃₎ is sequentially calculated for each compression pressure. That is, in order to correct the pulse wave represented by the pulse wave signal SM2 to obtain a pulse wave before receiving interference, the interference rate r ₀ is calculated based on ΔP1 and ΔP2 from the previously stored equation (1). .

  Next, in S6 corresponding to the cuff pressure control unit 82, the compression pressure value PC2 is held based on the cuff pressure signal PK2 indicating the compression pressure value PC2 of the intermediate expansion bag 24 while the compression pressure value PC is held for a predetermined time. It is determined whether or not value PC is equal to or less than a preset measurement end pressure value PCE (for example, 30 mmHg). At a time point before time t11 in FIG. 10, the determination in S5 is negative, and S3 and subsequent steps in FIG. 12 are repeatedly executed. However, the determination in S5 is affirmed at time t11 in FIG.

  If the determination in S6 is affirmative as described above, in S7 corresponding to the cuff pressure control unit 82, the pressures in the upstream inflation bag 22, the intermediate inflation bag 24, and the downstream inflation bag 26 are each discharged to atmospheric pressure. The quick exhaust valve 52 is actuated so as to be pressurized. This state is shown after time t11 in FIG.

Next, in S8 corresponding to the pulse wave correction unit 88, the pulse wave represented by the pulse wave signal SM2 detected from the intermediate expansion bag 24 and the pulse wave signal SM3 detected from the downstream expansion bag 26 stored in the RAM 74 are stored. The interference rate r ₀ (12) of the intermediate expansion bag 24 calculated in S5 corresponding to the crosstalk calculation unit 86 and the interference of the downstream expansion bag 26 from the equation (3) stored in advance. Correction is made based on the rate r ₀ (13), and the corrected pulse wave is stored in the RAM 74.

Next, in S9 corresponding to the pulse wave propagation time PWT calculation unit 90, the rising point of the pulse wave signal SM1 detected from the upstream expansion bag 22 and the rising point of the pulse wave signal SM2 detected from the intermediate expansion bag 24 Between the rising point of the pulse wave signal SM2 detected from the intermediate expansion bag 24 and the rising point of the pulse wave signal SM3 detected from the downstream expansion bag 26, that is, the pulse wave propagation time t23. Are calculated respectively.

  Next, in S10 corresponding to the systolic blood pressure value determining unit 94, a process of applying a uniform compression pressure to the living body from the upstream expansion bag 22, the intermediate expansion bag 24 and the downstream expansion bag 26 and gradually decreasing the compression pressure. The pulse wave represented by the pulse wave signal SM2 detected from the intermediate expansion bag 24 among the pulse wave signals SM1, SM2, and SM3 detected from the upstream expansion bag 22, the intermediate expansion bag 24, and the downstream expansion bag 26. The pulse wave is expressed by the compression pressure value PC2 at the time of the pulse wave rising determination corrected by the pulse wave correction unit 88 or the pulse wave signal SM3 detected from the downstream expansion bag 26, and by the pulse wave correction unit 88. Based on the corrected pressure value PC3 at the time of the rising judgment of the pulse wave, the living body's systolic blood pressure value SBP is calculated. For example, the higher pressure value PC of the pressure value PC2 and the pressure value PC3 is determined as the maximum blood pressure value SBP of the living body.

  Next, in S11 corresponding to the minimum blood pressure value determining unit 96, pulse wave signals SM1 and SM2 detected from the upstream inflation bag 22, the intermediate inflation bag 24, and the downstream inflation bag 26 in the slow pressure reduction process of the compression band 12 are performed. And SM3, the pulse wave represented by the pulse wave signal SM2 detected from the intermediate expansion bag 24 and corrected by the pulse wave correction unit 88, and the pulse wave signal SM3 detected from the downstream expansion bag 26 The minimum blood pressure value DBP of the living body is calculated based on the fact that there is no attenuation between the pulse wave represented by and the pulse wave corrected by the pulse wave correction unit 88. For example, when it is determined that the difference ΔA between the magnitude A24 of the pulse wave generated in the intermediate expansion bag 24 and the magnitude A26 of the pulse wave generated in the downstream side expansion bag 26 is equal to or less than the coincidence determination value JA stored in advance. Is determined as the minimum blood pressure value DBP of the living body.

Next, in S12 corresponding to the cuff size effect determination unit 98, the interference rate r ₀ (12) and the interference rate r ₀ (13) calculated in S5 corresponding to the crosstalk calculation unit 86 are preset to about 0.8. If it is equal to or greater than the specified value, the applanation of the blood vessel is insufficient, and therefore the occurrence of a short cuff effect with insufficient cuff compression is determined. If the determination is affirmed, a message to that effect is output or the display of the blood pressure measurement value is stopped. Further, the pulse wave propagation time t12 from the upstream expansion bag 22 to the intermediate expansion bag 24 calculated by S9 corresponding to the pulse wave propagation time PWT calculation unit 90, and the pulse wave from the intermediate expansion bag 24 to the downstream expansion bag 26 Based on the propagation time t23 or the pulse wave propagation time t13 from the upstream inflatable bag 22 to the downstream inflatable bag 26, is the measurement value low due to the large cuff effect, and the blood pressure value measurement accuracy cannot be obtained? It is determined whether or not. For example, it is determined whether or not the pulse wave propagation time t13 is greater than or equal to a preliminarily stored determination value jt. If the determination is affirmative, the blood pressure value measurement value has been reduced due to the large cuff effect, and display A message to that effect is displayed on the device 78, or the display of the blood pressure measurement value is stopped. Next, in S13, the systolic blood pressure value SBP and the diastolic blood pressure value DBP calculated in S10 and S11 are displayed on the blood pressure display device 78.

  As described above, according to the automatic blood pressure measurement device 14 of the present embodiment, the pulses generated in the upstream inflation bag 22, the intermediate inflation bag 24, and the downstream inflation bag 26 provided adjacent to each other in the compression band 12. Among the waves, the maximum blood pressure value SBP of the living body is determined based on the compression pressure value PC for the upper arm (compressed portion) 10 of the living body at the time of rising judgment of the pulse wave generated in the intermediate inflation bag 24 or the downstream inflation bag 26. Is done. Since the upstream expansion bag 22, the intermediate expansion bag 24, and the downstream expansion bag 26, which are independent air chambers provided adjacent to each other of the compression band 12, are compressed to the upper arm 10, the central portion of the compression band 12 And the upstream expansion bag 22, the intermediate expansion bag 24 and the downstream expansion bag 26, which are independent air chambers, are flexible in the width direction of the compression band 12. Since the influence of the compression state of the compression band 12 on the blood flow and the propagation state of the pulse wave is reduced, the influence of the width dimension of the compression band 12 can be greatly reduced, and an accurate maximum blood pressure value SBP can be obtained. can get.

  Further, according to the automatic blood pressure measurement device 14 of the present embodiment, the rising determination is that the pulse wave generated in the intermediate expansion bag 24 or the downstream expansion bag 26 exceeds a predetermined rising determination value J2 or J3. Therefore, it is possible to greatly reduce the influence of the width dimension of the compression band 12 by setting the rising determination value J2 or J3 in advance so as to obtain a highly accurate systolic blood pressure measurement value SBP. An accurate systolic blood pressure value SBP is obtained.

  Further, according to the automatic blood pressure measurement device 14 of the present embodiment, the pulse wave generated in the intermediate inflation bag 24 or the downstream inflation bag 26 is inflated adjacent to the upstream side of the intermediate inflation bag 24 or the downstream inflation bag 26. Since the crosstalk is corrected based on a preliminarily obtained crosstalk value representing the pressure fluctuation propagated from the upstream side of the intermediate expansion bag 24 or the downstream side expansion bag 26, Since a pulse wave with little influence of crosstalk from the adjacent inflatable bag can be obtained, a more accurate systolic blood pressure value SBP can be obtained in which the influence of the width dimension of the compression band 12 is greatly reduced.

  Further, according to the automatic blood pressure measurement device 14 of the present embodiment, the maximum blood pressure value SBP is determined based on the cuff pressure corresponding to the rise of the pulse wave generated in the intermediate expansion bag 24 and the pulse wave generated in the downstream expansion bag 26. Is determined based on the larger cuff pressure of the corresponding cuff pressure at the time of rising determination, so that a more accurate systolic blood pressure value SBP that greatly reduces the influence of the width dimension of the compression band 12 is obtained. can get.

  Further, according to the automatic blood pressure measurement device 14 of the present embodiment, the difference between the magnitude of the pulse wave generated in the intermediate inflatable bag 24 and the magnitude of the pulse wave generated in the downstream side inflatable bag 26 is set as a predetermined coincidence determination. Since the minimum blood pressure value DBP of the living body is determined based on the compression pressure value corresponding to the upper arm (compressed site) 10 when it is determined that the value JA or less, the blood pressure in the artery 16 is directly below the compression band 12. In this state, the pulse wave propagation velocity immediately below the compression belt 12 and the pulse wave propagation velocity in the downstream region of the compression belt 12 are equivalent to each other. Since the compression pressure when the bottom pressure (lower peak pressure) of the pressure pulse wave observed by the direct method is no longer limited by the compression pressure by the compression band is determined as the minimum blood pressure value DBP, the highly accurate minimum blood pressure value BP is obtained.

  Further, according to the automatic blood pressure measurement device 14 of the present embodiment, the pulse waves generated in the intermediate expansion bag 24 and the downstream expansion bag 26 used when determining the minimum blood pressure value DBP are the intermediate expansion bag 24 and The pulse wave from which the crosstalk has been removed is corrected based on the crosstalk value obtained in advance representing the pressure fluctuation transmitted from the expansion bag adjacent to the upstream side of the downstream side expansion bag 26. Is used, a more accurate minimum blood pressure DBP can be obtained.

  As mentioned above, although one Example of this invention was described in detail with reference to drawings, this invention is not limited to this Example, It can implement in another aspect.

  For example, in the systolic blood pressure determination unit 94 of the above-described embodiment, the systolic blood pressure value SBP is calculated based on the cuff pressure corresponding to the rise of the pulse wave generated in the intermediate expansion bag 24 and the pulse wave generated in the downstream expansion bag 26. Although it was determined based on the larger one of the cuff pressures corresponding to the rising determination time, the rising of the pulse wave generated in one of the intermediate expansion bag 24 and the downstream expansion bag 26 from the beginning. Based on this, the systolic blood pressure value SBP may be determined.

Further, S5 corresponding to the crosstalk calculating unit 86 of the above-described embodiment is the pulse wave signal SM1 detected from the upstream inflation bag 22, the intermediate inflation bag 24, and the downstream inflation bag 26 in the automatic blood pressure measurement routine. from pressure amplitude of SM2 and SM3, interference ratio _r 0 of the intermediate expansion bag 24 (12) and interference ratio _r 0 of the downstream inflation bladder 26 (13), had been successively calculated for each pressing pressure of a predetermined distance A constant value may be used regardless of the compression pressure.

  Further, the above-described pressure increase target pressure value PCM and measurement end pressure value PCE do not necessarily have to be set in advance. For example, based on the previously measured systolic blood pressure value SBP and the diastolic blood pressure value DBP input by the operator after the power switch of the automatic blood pressure measuring device 14 is turned on, the input systolic blood pressure value SBP has a predetermined value (for example, 30 mmHg). ) May be set to the pressure increase target pressure value PCM, and the measurement end pressure value PCE may be set to a value obtained by subtracting a predetermined value (for example, 30 mmHg) from the input minimum blood pressure value DBP. Alternatively, during the rapid pressure increase by the cuff pressure control means 82 (between the times t1 and t2 in FIG. 10), for example, the pulse wave signal SM2 from the intermediate expansion bag 24 is extracted to create an envelope, and well known based on the envelope. The maximal blood pressure value SBP and the diastolic blood pressure value DBP of the living body are predicted according to the oscillometric algorithm, and the boost target pressure value PCM is a value obtained by adding a predetermined value (for example, 20 mmHg) to the predicted maximal blood pressure value SBP. The measurement end pressure value PCE may be set to a value obtained by subtracting a predetermined value (for example, 20 mmHg) from the predicted minimum blood pressure value DBP.

  Further, during the gradual pressure reduction process by the cuff pressure control means 82, while the compression pressure value PC of the upstream expansion bag 22, the intermediate expansion bag 24 and the downstream expansion bag 26 is held for a predetermined time, the upstream expansion bag 22, A plurality of pulse wave signals SM1, SM2, and SM3 from the intermediate expansion bag 24 and the downstream expansion bag 26 are sampled, and the systolic blood pressure value SBP and the diastolic blood pressure value DBP are based on the average value of the pulse wave signals SM corresponding to the multiple impulses. May be determined. In this case, a more accurate blood pressure value can be obtained.

  Further, at the time of blood pressure measurement, it is not always necessary to step down the compression pressure value PC stepwise at a preset slow speed reduction rate after the pressure is raised to the pressure increase target pressure value PCM. That is, the compression pressure value PC may be continuously reduced. Alternatively, the deceleration pressure reduction may be performed only in the vicinity of the blood pressure value measurement, and the measurement time may be shortened by rapid pressure reduction in the other sections.

  In the above-described embodiment, the blood pressure value is determined while the pressure in the compression band 12 is decreased. However, the present invention is not limited to this, and the process in which the pressure in the compression band 12 is increased. The pressurization measurement for determining the blood pressure value may be performed. In such a pressure increase measurement, the above-described systolic blood pressure value determination algorithm and diastolic blood pressure value determination algorithm can be used, and similar effects can be obtained.

  Moreover, the expansion bag with which the compression belt 12 is provided is not limited to three, and may be four or more.

  It should be noted that the above description is merely an embodiment, and other examples are not illustrated. However, the present invention is implemented in variously modified and improved modes based on the knowledge of those skilled in the art without departing from the gist of the present invention. Can do.

10: Upper arm (stressed part of living body)
12: compression band 14: automatic blood pressure measurement device 16: artery 22: upstream inflation bag 24: intermediate inflation bag 26: downstream inflation bag DBP: minimum blood pressure value PWT: pulse wave propagation time SBP: maximum blood pressure values SM1, SM2, SM3: Pulse wave signal (pulse wave)

Claims (6)

A pair of upstream inflation bags and downstream inflation bags made of a flexible sheet material positioned at a predetermined interval in the direction of the artery of the compressed portion of the living body, and the pair of upstream inflation bags and downstream inflation The living body having a compression band disposed adjacent to and between the pair of bags, and having an intermediate expansion bag having an air chamber independent of the pair of upstream and downstream expansion bags, An automatic blood pressure measuring device for measuring a blood pressure value of the living body based on a pulse wave generated from an artery in the compressed part of
In the process of changing the compression pressure by applying a compression pressure from the adjacent upstream inflation bag, the intermediate inflation bag, and the downstream inflation bag to the artery in the compressed portion of the living body with an even pressure distribution, Of the pulse waves generated in the upstream expansion bag, the intermediate expansion bag, and the downstream expansion bag, the compression pressure value for the compressed portion corresponding to the rise determination of the pulse wave generated in the intermediate expansion bag or the downstream expansion bag Based on the maximum blood pressure value of the living body based on,
From the pulse wave generated in the intermediate expansion bag or the downstream expansion bag, an interference rate representing a pressure fluctuation propagated from the expansion bag adjacent to the upstream side of the intermediate expansion bag or the downstream expansion bag is obtained. An automatic blood pressure measurement device that performs blood pressure determination by determining that the cuff size is appropriate when it is within a preset value .   The automatic blood pressure measurement device according to claim 1, wherein the rising determination is determined based on a pulse wave generated in the intermediate expansion bag or the downstream expansion bag exceeding a predetermined rising determination value. The pulse wave generated in the intermediate inflatable bag or the downstream inflatable bag is based on a crosstalk value obtained in advance representing a pressure fluctuation transmitted from the inflatable bag adjacent to the upstream side of the intermediate inflatable bag or the downstream inflatable bag. The automatic blood pressure measurement device according to claim 1 or 2 , which has been corrected. The maximum blood pressure value is the greater of the cuff pressure corresponding to the rise determination of the pulse wave generated in the intermediate expansion bag and the cuff pressure corresponding to the rise determination of the pulse wave generated in the downstream expansion bag. The automatic blood pressure measuring device according to any one of claims 1 to 3 , wherein the automatic blood pressure measuring device is determined based on a cuff pressure. Based on the difference between the magnitude of the pulse wave generated in the intermediate inflatable bag and the magnitude of the pulse wave generated in the downstream inflatable bag being equal to or less than a preset coincidence determination value, the minimum blood pressure value of the living body is determined. The automatic blood pressure measuring device according to any one of claims 1 to 4 , wherein the automatic blood pressure measuring device is determined. The pulse waves generated in the intermediate expansion bag and the downstream expansion bag have crosstalk values determined in advance representing pressure fluctuations propagated from the expansion bags adjacent to the upstream side of the intermediate expansion bag and the downstream expansion bag, respectively. 6. The automatic blood pressure measuring device according to claim 5 , wherein each is corrected based on each.

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