JP6747779B2 - Heart catheter inspection apparatus and method of operating heart catheter inspection apparatus - Google Patents

Description

The present invention relates to a heart catheter inspection apparatus for measuring blood pressure in each part of a heart (hereinafter referred to as a site) to diagnose a heart disease, and a method for operating the heart catheter inspection apparatus .

BACKGROUND ART Conventionally, there is a cardiac catheter inspection device that diagnoses a heart disease by measuring the blood pressure in each site by inserting a catheter to each site of the heart and analyzing the measurement result.

In this type of cardiac catheter inspection apparatus, the ability of the heart to function as a pump, heart valve diseases (for example, stenosis and regurgitation), etc. are diagnosed based on the blood pressure in each site. For example, when the pressure in the left ventricle is extremely higher than the pressure in the aorta, it can be determined that the aortic valve is stenotic. Further, as one method for diagnosing a heart valve disease, there is a method for obtaining a valve opening area. The valve area can be obtained by measuring the blood pressure in two sites that sandwich the valve and based on the pressure difference.

As a first method for measuring blood pressure in two sites with a valve sandwiched between them, there is a method of simultaneously measuring blood pressure in two sites using two catheters. The second method is a method called extraction analysis. In the pull-out analysis, the catheter introduced into the blood vessel from the thigh or the like and inserted to the site on the distal side of the heart is pulled in the pull-out direction, and in the process, the blood pressure in the adjacent sites is sequentially measured across the valve. Has become. Withdrawal analysis has the advantage that blood pressure at multiple sites can be measured at approximately the same time with a single catheter. By the way, in the medical field, generally, in the process of inserting (that is, pushing) the catheter into the site on the distal side, when measuring the blood pressure in the adjacent sites with the valve in between, it is also called pull-out analysis. Has been. Therefore, in the present application, the pull-out analysis has a meaning including the case where the intra-site blood pressure is sequentially measured during the process of pushing the catheter.

The cardiac catheter test apparatus analyzes using the blood pressure in each site thus measured. This analysis is performed on the blood pressure waveform in each site using analysis parameters (may be called evaluation parameters) according to each site. An outline of this analysis parameter and diagnosis using the analysis parameter is described in, for example, Patent Document 1 and Non-Patent Document 1.

US Patent Application Publication No. 2007/073170

"Starting cardiac catheterization," Medical View Co., Ltd., October 1, 2013, 1st edition, 1st edition

By the way, in the diagnostic method as described above, since the analysis parameter used for each site is different, when performing the extraction analysis, the timing at which the pressure sensor moves between adjacent sites across the valve (hereinafter referred to as the extraction timing). Must be set in the device.

Generally, a doctor pulls out a catheter, and a technician sets the timing of pulling out the catheter. Alternatively, the withdrawal timing is set in advance. The technician instructs the doctor when to withdraw the catheter, and the doctor withdraws the catheter when instructed. Alternatively, the doctor instructs the technician about the withdrawal timing, and the technician inputs the withdrawal timing into the device by, for example, pressing a button on the device when the instruction is given.

An example of setting the pull-out timing will be described. The following example is an example in which the extraction timing is preset. The cardiac catheterization examination apparatus had a blood pressure waveform recording period of 10 seconds, was set to record the pulmonary artery pressure in the first 5 seconds, and recorded the right ventricle pressure in the latter 5 seconds, that is, 5 seconds from the start of recording. It is assumed that the withdrawal timing has been set after 2 seconds. In this case, the technician instructs the doctor to withdraw the catheter when 5 seconds have elapsed from the start of recording. However, if the extraction timing of the doctor shifts, for example, a situation may occur in which the pulmonary artery pressure is recorded in the first half 7 seconds and the right ventricle pressure is recorded in the latter half 3 seconds.

In this case, the analysis unit of the cardiac catheter inspection apparatus performs the analysis assuming that the pulmonary artery pressure recorded during 5 to 7 seconds after the start of recording is also the right ventricular pressure. Specifically, despite the pulmonary arterial pressure, the analysis may be performed using the analysis parameter for the right ventricle pressure, and as a result, a correct analysis result may not be obtained.

In actuality, in order to avoid such inconvenience, the recorded pressure waveform is displayed on the display, and the technician visually finds a change in the displayed blood pressure waveform shape, thereby performing operations such as resetting the extraction point. Is being done.

However, performing such an operation naturally requires a lot of work.

The present invention has been made in consideration of the above points, and a cardiac catheter inspection device capable of recognizing a correct extraction timing without trouble, and a heart for discriminating a heart site measuring a blood pressure waveform. A method for operating a catheter inspection device is provided.

One aspect of the cardiac catheter inspection apparatus of the present invention is
A cardiac catheter test device for analyzing blood pressure waveforms measured at each site in the process of extracting a catheter from a site in the heart,
From the measured blood pressure waveform, an analysis unit that obtains a plurality of analysis parameters,
From the plurality of analysis parameters obtained by the analysis unit, to configure an analysis parameter group by extracting the type of analysis parameters according to the site, based on the content of each analysis parameter included in this analysis parameter group, A site determination unit that determines from which site the blood pressure waveform is obtained,
It is equipped with.

One aspect of the method for operating the cardiac catheter inspection apparatus of the present invention is:
A method for operating a cardiac catheter inspection device having an analysis unit and a site determination unit,
In the analysis unit, from the blood pressure waveform measured in the heart, an analysis step of obtaining a plurality of analysis parameters,
In the site determination unit, from the plurality of analysis parameters obtained in the analysis step, an analysis parameter group is formed by extracting analysis parameters of a type according to the site, and each analysis parameter included in the analysis parameter group Based on the content, a site determination step of determining from which site the blood pressure waveform was obtained,
including.

According to the present invention, by providing the site determination unit that determines which site the blood pressure waveform was measured at, it is possible to recognize the correct extraction timing without manually setting the switching timing of the site, Using the analysis parameter group corresponding to each site, it becomes possible to correctly perform heart analysis.

The figure which shows schematic structure of the cardiac catheter inspection apparatus of embodiment. Diagram showing the state of blood pressure waveforms measured in the right and left ventricles Diagram showing blood pressure waveforms measured in the aorta and pulmonary artery The figure which shows the appearance of the blood pressure waveform measured in the right atrium and the left atrium. Diagram showing each site of the heart and the state of the catheter inserted into the heart Diagram for explaining when the catheter is pulled out from the pulmonary artery to the right ventricle Diagram for explaining when the catheter is pulled out from the right ventricle to the right atrium Diagram for explaining when the catheter is pulled out from the left ventricle to the aorta

Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings.

FIG. 1 is a diagram showing a schematic configuration of a cardiac catheter inspection device 100 according to the present embodiment. As shown in FIG. 1, the catheter 110 of the cardiac catheter inspection apparatus 100 is inserted from the femoral artery of the subject 200 into the aorta of the subject 200 and then into the heart 210. The inside of the catheter 110 is filled with physiological saline or the like, and the pressure at the tip of the catheter 110 is measured by a pressure sensor provided in the measuring unit 111. Thereby, the blood pressure in the heart 210 is measured. By adjusting the insertion amount of the catheter 110 by the doctor, the site where the pressure measurement point (the tip of the catheter 110) is located in the heart 210 is changed.

The measurement unit 111 subjects the blood pressure waveform measured by the pressure sensor to predetermined signal processing such as analog-digital conversion and amplification. The measurement unit 111 outputs the processed blood pressure waveform to the analysis unit 112.

To the analysis unit 112, the electrocardiographic waveform from the electrocardiograph 120 is input in addition to the blood pressure waveform from the measurement unit 111. The analysis unit 112 obtains a plurality of analysis parameters from the blood pressure waveform. The plurality of analysis parameters calculated by the analysis unit 112 include SP (Systoric Pressure), BDP (Begin Diastolic Pressure), EDP (End Diastolic Pressure), and DP (Diastolic Pressure). Phase pressure), MEAN (Mean Pressure), a wave (Atrial Wave), and v wave (Ventricular Wave). The analysis unit 112 obtains the plurality of analysis parameters by detecting a relative position of the blood pressure waveform with respect to the electrocardiographic waveform and a characteristic point such as an inflection point of the blood pressure waveform. Since the method of obtaining the plurality of analysis parameters is a known technique, the description thereof will be omitted.

Here, since the blood pressure waveform changes from site to site, at the time of heart diagnosis, diagnosis is performed using analysis parameters unique to each site.

Specifically, SP, BDP, and EDP are used as analysis parameters for blood pressure waveforms measured in the right ventricle and the left ventricle. In the following description, the SP, BDP and EDP analysis parameters will be referred to as a first analysis parameter group.

For blood pressure waveforms measured in the aorta and pulmonary artery, SP, DP, and MEAN are used as analysis parameters. In the following description, the SP, DP and MEAN analysis parameters will be referred to as a second analysis parameter group.

For blood pressure waveforms measured in the right atrium, the left atrium, and veins, a-wave, v-wave, and MEAN are used as analysis parameters. In the following description, the a-wave, v-wave, and MEAN analysis parameters will be referred to as a third analysis parameter group.

The site determination unit 113 determines at which site in the heart 210 the input blood pressure waveform is the signal measured. The site determination unit 113 configures an analysis parameter group by extracting analysis parameters of a type according to the site from the plurality of analysis parameters obtained by the analysis unit 112, and each analysis parameter included in this analysis parameter group. The site from which the blood pressure waveform is obtained is determined based on the contents of.

The display 114 displays the site that is the determination result by the site determination unit 113 and the first, second or third analysis parameter group corresponding to the site. Specifically, when the site determination unit 113 obtains a determination result that the blood pressure waveform measurement location is the right ventricle or the left ventricle, the display 114 displays the first analysis parameter group. In addition, when the site determination unit 113 obtains a determination result that the measurement position of the blood pressure waveform is the aorta or the pulmonary artery, the display 114 displays the second analysis parameter group. When the site determination unit 113 obtains a determination result that the blood pressure waveform measurement location is the right atrium, the left atrium, or the vein, the display 114 displays the third analysis parameter group.

Next, the site determination processing performed by the site determination unit 113 will be described in detail.

The site determination unit 113 examines which analysis parameter group of the first, second and third analysis parameter groups the blood pressure waveform measured by the catheter 110 is most suitable to determine the blood pressure. It is designed to determine the site where the waveform was measured.

This process will be specifically described.

First, each analysis parameter will be briefly described with reference to FIGS. 2, 3, and 4. FIG. 2 shows blood pressure waveforms measured in the right ventricle and the left ventricle. FIG. 3 shows blood pressure waveforms measured in the aorta and the pulmonary artery. Incidentally, SP is the systolic blood pressure within one beat (from one R wave to the next R wave). FIG. 4 shows blood pressure waveforms measured in the right atrium and the left atrium. The values of SP, BDP, EDP, DP, and MEAN that are analysis parameters can be obtained based on the R wave in the electrocardiographic waveform, and the presence and value of the presence of the a wave and the v wave can be obtained. ..

The normal values of SP, BDP, and EDP measured in the right ventricle are as follows.
SP: 15-35 mmHg
BDP: 0 to 8 mmHg.........Pattern 1
EDP: 1 to 6 mmHg

The normal values of SP, BDP and EDP measured in the left ventricle are as follows.
SP: 100-140 mmHg
BDP: 3 to 12 mmHg ......Pattern 2
EDP: 6 to 12 mmHg

The normal values of SP, DP, and Mean measured in the aorta are as follows.
SP: 100-140 mmHg
DP: 60 to 90 mmHg.........Pattern 3
Mean: 70-105 mmHg

The normal values of SP, DP, and Mean measured in the pulmonary artery are as follows.
SP: 15-25 mmHg
DP: 6 to 12 mmHg.........Pattern 4
Mean: 9-18 mmHg

The normal values of a-wave, v-wave, and Mean measured in the right atrium are as follows.
a wave: present (not present in patients with atrial fibrillation)
v wave: exists... Pattern 5
Mean: 2-8 mmHg

The normal values of a-wave, v-wave, and Mean measured in the left atrium are as follows.
a wave: present (not present in patients with atrial fibrillation)
v wave: exists.........Pattern 6
Mean: 3 to 8 mmHg

The site determination unit 113 determines which site the blood pressure waveform is measured by checking which of the above-mentioned patterns 1 to 6 the analysis parameter belongs to. For example, when the analysis parameter belongs to pattern 1, it is determined that the blood pressure waveform is the blood pressure waveform measured in the right ventricle, and when it belongs to pattern 6, the blood pressure waveform is measured in the left atrium. It is determined that the blood pressure waveform has been changed.

However, the values of the above patterns 1 to 6 are normal values and may deviate from the normal values when there is a heart disease. Therefore, the similarity of each of the patterns 1 to 6 of the analysis parameter may be calculated by the score, and the site of the pattern with the highest score may be determined as the site where the blood pressure waveform is measured. For example, if the value is within the normal value range, the score is 2 points. If not, the total value is calculated for each pattern, and the pattern with the largest total value is examined.

For example, when the blood pressure waveform is 110 mmHg for SP, 15 mmHg for BDP, 7 mmHg for EDP, 15 mmHg for DP, 40 mmHg for Mean, and there is no a wave or v wave, the pattern 1 Is the largest among the patterns 1 to 6 with the score=2+1+2=5, and it is determined that the blood pressure waveform is measured in the left ventricle.

Next, the operation of this embodiment will be described.

FIG. 5 shows each site of the heart 210 and a state of the catheter 110 inserted in the heart 210. As described above, the measuring unit 111 measures the blood pressure at the tip of the catheter 110. When the catheter 110 is inserted from the inferior vena cava (IVC) side, it is inserted to the pulmonary artery (PA) via the right atrium (RA), the tricuspid valve, the right ventricle (RV), and the pulmonary valve in this order. .. Then, the blood pressure in the pulmonary artery (PA), the right ventricle (RV), and the right atrium (RA) is measured in this order by being pulled out by the doctor. On the other hand, when the catheter 110 is inserted from the aorta (AO) side, the catheter 110 is inserted to the left ventricle (LV) via the aorta (AO) and the aortic valve in order. Then, the blood pressure in the left ventricle (LV) and the aorta is measured in this order by being pulled out by the doctor. By the way, since it is difficult to enter a catheter from the left ventricle (LV) to the left atrium (LA), the blood pressure in the left atrium (LA) is usually measured by inflating the balloon from the pulmonary artery (PA) side and measuring the pulmonary wedge pressure. It is performed by a special method such as (PCW).

As shown in FIG. 6A, when the catheter 110 is withdrawn from the pulmonary artery to the right ventricle, a blood pressure waveform as shown in FIG. 6B is measured. The blood pressure waveform of the period t1 in FIG. 6B is the blood pressure waveform measured in the pulmonary artery, and the blood pressure waveform of the period t2 is the blood pressure waveform measured in the right ventricle. In the determination by the site determination unit 113, the score of the pattern 4 should be the maximum during the period t1, and the score of the pattern 1 should be the maximum during the period t2. The site determination unit 113 determines that the blood pressure waveform in the period t1 is measured in the pulmonary artery, the blood pressure waveform in the period t2 is measured in the right ventricle, and the switching timing (the period t1 and the period). The switching timing of t2) is detected and output to the display 114.

As shown in FIG. 7A, when the catheter 110 is withdrawn from the right ventricle to the right atrium, a blood pressure waveform as shown in FIG. 7B is measured. The blood pressure waveform in period t1 in FIG. 7B is the blood pressure waveform measured in the right ventricle, and the blood pressure waveform in period t2 is the blood pressure waveform measured in the right atrium. In the determination by the site determination unit 113, the score of pattern 1 should be the maximum during the period t1, and the score of pattern 5 should be the maximum during the period t2. The site determination unit 113 determines that the blood pressure waveform of the period t1 is measured in the right ventricle, that the blood pressure waveform of the period t2 is measured in the right atrium, and the switching timing thereof (the period t1 and The switching timing of the period t2) is detected and output to the display 114.

When the catheter 110 is withdrawn from the left ventricle to the aorta as shown in FIG. 8A, a blood pressure waveform as shown in FIG. 8B is measured. The blood pressure waveform of period t1 in FIG. 8B is the blood pressure waveform measured in the left ventricle, and the blood pressure waveform of period t2 is the blood pressure waveform measured in the aorta. In the determination by the site determination unit 113, the score of pattern 2 should be the maximum during the period t1, and the score of pattern 3 should be the maximum during the period t2. The site determination unit 113 determines that the blood pressure waveform in the period t1 is measured in the left ventricle, the blood pressure waveform in the period t2 is measured in the aorta, and the switching timing (the period t1 and the period). The switching timing of t2) is detected and output to the display 114.

As a result, the doctor can correctly diagnose the heart by using the analysis parameter group corresponding to each site without manually setting the site switching timing.

As described above, according to the present embodiment, the analysis parameter group (patterns 1 to 6) is created by extracting the analysis parameters of the type according to the site from the plurality of analysis parameters obtained by the analysis unit 112. By providing the site determination unit 113 configured to determine from which site the blood pressure waveform is obtained based on the content of each analysis parameter included in this analysis parameter group, it is possible to save labor as in the conventional case. It is possible to realize the cardiac catheter inspection device 100 that can recognize the withdrawal timing without putting it on. As a result, the heart can be correctly diagnosed by using the analysis parameter group corresponding to each site without manually setting the site switching timing.

In addition, in the above-mentioned embodiment, the case where the site which is the determination result by the site determination unit 113 and the analysis parameter group suitable for diagnosing the site are displayed on the display 114 is not limited to this. The determination result of the determination unit 113 may be output by voice to notify the site currently being measured.

Further, in the above-described embodiment, the case where the present invention is applied to the extraction analysis has been described, but the present invention can also be used as a site determination method for determining the site of the heart measuring the blood pressure waveform. In this case, an analysis step of obtaining a plurality of analysis parameters from the blood pressure waveform measured in the heart and an analysis parameter of a type according to the site are analyzed from the plurality of analysis parameters obtained in the analysis step. A site determination step of configuring a parameter group and determining from which site the blood pressure waveform is obtained based on the content of each analysis parameter included in this analysis parameter group, do it.

The above-described embodiments are merely examples of specific embodiments for carrying out the present invention, and the technical scope of the present invention should not be limitedly interpreted by these. That is, the present invention can be implemented in various forms without departing from the gist or the main features thereof.

INDUSTRIAL APPLICABILITY The present invention is suitable for, for example, a cardiac catheter inspection apparatus that analyzes a blood pressure waveform measured at each site in the process of withdrawing a catheter from a site in the heart.

100 cardiac catheter inspection device 110 catheter 111 measuring unit 112 analyzing unit 113 site determining unit 114 display 120 electrocardiograph 200 subject 210 heart

Claims (2)

A cardiac catheter test apparatus for analyzing a blood pressure waveform measured at each site in the process of extracting a catheter from a site in the heart,
From the measured blood pressure waveform, SP (systolic pressure), BDP (initial diastolic pressure), EDP (end diastolic pressure), DP (diastolic pressure), MEAN (mean pressure), a wave ( An analysis unit for obtaining atrial wave) and v wave (ventricular wave),
From the plurality of analysis parameters obtained by the analysis unit, to configure an analysis parameter group by extracting the type of analysis parameters according to the site, based on the content of each analysis parameter included in this analysis parameter group, Determine from which site the blood pressure waveform was obtained,
And,
SP (systolic pressure), BDP (initial diastolic pressure) and EDP (end diastolic pressure) are used as the analysis parameter group for the right ventricle and the left ventricle,
SP (systolic pressure), DP (diastolic pressure) and MEAN (mean pressure) are used as the analysis parameter group for the aorta and pulmonary artery,
And/or a wave (atrial wave), v wave (ventricular wave) and MEAN (mean pressure) are used as the analysis parameter group for the right atrium and the left atrium,
With reference to the normal value of the analysis parameter group for each site, based on the similarity between the reference value and the analysis parameter group configured, to determine from which site the blood pressure waveform was obtained, Site judgment section,
A display unit that displays a site that is the determination result by the site determination unit and an analysis parameter group corresponding to the site,
A cardiac catheter inspection apparatus comprising: A method for operating a cardiac catheter inspection device having an analysis unit and a site determination unit,
In the analysis unit, from the blood pressure waveform measured in the heart, SP (systolic pressure), BDP (initial diastolic pressure), EDP (end diastolic pressure), DP (diastolic pressure), MEAN (as a plurality of analysis parameters). An analysis step for obtaining an average pressure), an a wave (atrial wave) and a v wave (ventricular wave),
From the plurality of analysis parameters obtained by the analysis unit, to configure an analysis parameter group by extracting the type of analysis parameters according to the site, based on the content of each analysis parameter contained in this analysis parameter group, Determine from which site the blood pressure waveform was obtained,
And,
SP (systolic pressure), BDP (initial diastolic pressure) and EDP (end diastolic pressure) are used as the analysis parameter group for the right ventricle and the left ventricle,
SP (systolic pressure), DP (diastolic pressure) and MEAN (mean pressure) are used as the analysis parameter group for the aorta and pulmonary artery,
And/or a wave (atrial wave), v wave (ventricular wave) and MEAN (mean pressure) are used as the analysis parameter group for the right atrium and the left atrium,
With reference to the normal value of the analysis parameter group for each site, based on the similarity between the reference value and the analysis parameter group configured, to determine from which site the blood pressure waveform was obtained, Site determination step,
A display step of displaying a site that is the determination result in the site determination step and an analysis parameter group corresponding to the site;
A method for operating a cardiac catheter inspection apparatus including:

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