The present application claims priority from Japanese Patent Application No. 2014-155481 filed on Jul. 30, 2014, the entire content of which is incorporated herein by reference.
The presently disclosed subject matter relates to a biological information measuring apparatus and a biological information measuring method for measuring a blood pressure.
An intra-aortic balloon pumping (IABP) is a circulation assisting apparatus which is widely used for a left ventricle. In an IABP, a balloon catheter is placed in the thoracic descending aorta of a subject, and the balloon is inflated and deflated in synchronization with the pulsation of the heart to pressure-assist the heart to increase oxygen supply to the cardiac muscle and to reduce oxygen consumption by the cardiac muscle.
For example, JP2007-503883A discloses an apparatus having a function of optimally setting the treatment timing of an IABP.
In some cases, during use of an IABP, invasive blood pressure is measured by using a biological information monitor. A biological information monitor measures the maximum, minimum, and average values of the blood pressure for each cardiac cycle, and displays the values on a biological information monitor. However, the blood pressure values displayed on the monitor during use of the IABP are most likely balloon-assisted blood pressure values.
When evaluating effects of the IABP treatment or deciding whether to wean from the IABP, it is important to know the blood pressure originating from the heart of the subject (in other words, the blood pressure value not assisted by the IABP). However, as described above, the biological information monitor may display balloon-assisted blood pressure values. Therefore, doctors or the like may not be able to correctly evaluate effects of the IABP treatment or decide whether to wean from the IABP. Moreover, doctors or the like may not be able to correctly determine the degree of assistance by the IABP. That is, doctors or the like may not be able to obtain accurate blood pressure values during use of the IABP.
Illustrative aspects of the present invention provide a biological information measuring apparatus and a biological information measuring method according to which blood pressure values of a subject can be obtained accurately even during use of an IABP.
According to an illustrative aspect of the present invention, a biological information measuring apparatus includes a pulsation information detecting unit configured to detect heartbeat information relating to a heartbeat of a subject, a blood pressure waveform measuring unit configured to measure a blood pressure waveform of the subject in an invasive manner, and a calculating unit configured to detect a cardiac cycle from the heartbeat information and to calculate, based on a detection of a maximal blood pressure value of the blood pressure waveform in the cardiac cycle, at least one of a systolic pressure of the subject, an end-diastolic pressure of the subject, an augmentation pressure of an IABP, a systolic pressure assisted by the IABP and an end-diastolic pressure assisted by the IABP.
According to another illustrative aspect of the present invention, a biological information measuring method includes detecting heartbeat information relating to a heartbeat of a subject, measuring a blood pressure waveform of the subject in an invasive manner, detecting a cardiac cycle of a heart from the heartbeat information, and calculating at least one of a systolic pressure of the subject, an end-diastolic pressure of the subject, an augmentation pressure of an IABP, a systolic pressure assisted by the IABP, and an end-diastolic pressure assisted by the IABP, based on a detection of a maximal blood pressure value of the blood pressure waveform in the cardiac cycle.
According to another illustrative aspect of the present invention, a non-transitory computer readable medium stores a program that, when executed by a computer, causes the computer to execute a method including receiving heartbeat information relating to a heartbeat of a subject, and a blood pressure waveform of the subject measured in an invasive manner, detecting a cardiac cycle of a heart from the heartbeat information, and calculating at least one of a systolic pressure of the subject, an end-diastolic pressure of the subject, an augmentation pressure of an IABP, a systolic pressure assisted by the IABP, and an end-diastolic pressure assisted by the IABP, based on a detection of a maximal blood pressure value of the blood pressure waveform in the cardiac cycle.
According to another illustrative aspect of the present invention, a program causes the computer to execute a method including receiving heartbeat information relating to a heartbeat of a subject, and a blood pressure waveform of the subject measured in an invasive manner, detecting a cardiac cycle of a heart from the heartbeat information, and calculating at least one of a systolic pressure of the subject, an end-diastolic pressure of the subject, an augmentation pressure of an IABP, a systolic pressure assisted by the IABP, and an end-diastolic pressure assisted by the IABP, based on a detection of a maximal blood pressure value of the blood pressure waveform in the cardiac cycle.
Hereinafter, an exemplary embodiment of the present invention will be described with reference to the drawings.
The electrocardiogram measuring unit 11 has, for example, electrocardiogram electrodes and an amplifying circuit. The electrocardiogram electrodes are attached to the chest and the like of the subject. The electrocardiogram measuring unit 11 acquires an ECG (Electrocardiogram) based on electrocardiogram signals obtained from the electrocardiogram electrodes, and supplies the acquired ECG to the heartbeat blood pressure calculating unit 13.
The blood pressure waveform measuring unit 12 invasively measures the blood pressure waveform of the subject. The blood pressure waveform measuring unit 12 includes, for example, a blood pressure transducer, an amplifying circuit, a catheter, various tubes and a three-way cock. The user such as a doctor adjusts the zero point of the blood pressure value before start of the measurement of the blood pressure.
When the arterial blood pressure is to be measured, the doctor or the like inserts a catheter (arterial needle) into the radial artery of the subject. In the case where the venous blood pressure is measured, a Swan-Ganz catheter may be used. In the blood pressure waveform measuring unit 12, the blood pressure transducer converts the blood pressure to a blood pressure signal, and a blood pressure waveform which is obtained from the blood pressure signal is supplied to the heartbeat blood pressure calculating unit 13 and the output unit 14. The process of measuring the blood pressure waveform may be performed by the blood pressure waveform measuring unit 12, in a similar manner as a usual invasive blood pressure measurement process (see, e.g., Sakurai and Watanabe, “M E Hayawakari Q&A 3-Ketsuatsukei, Shinpakushutsuryokei, Ketsuryukei”, NANKODO, pp. 33-92).
The ECG and the blood pressure waveform are input to the heartbeat blood pressure calculating unit 13. The heartbeat blood pressure calculating unit 13 calculates values of the blood pressure which is not assisted by the IABP (values of the blood pressure due to the heartbeat of the subject) in addition to values of the blood pressure assisted by a balloon. The method of calculation will be described in detail.
The heartbeat blood pressure calculating unit 13 analyzes the ECG to detect a QRS wave. The heartbeat blood pressure calculating unit 13 detects above-described peak points in the predetermined time period from the QRS wave. The heartbeat blood pressure calculating unit 13 treats the interval of the detected peak points as a cardiac cycle.
The heartbeat blood pressure calculating unit 13 detects a maximal value of the blood pressure in each detected cardiac cycle. A maximal value is a peak point where the blood pressure transitions from ascent to descent. Except in cases of arrhythmia, dicrotic wave, and the like, in the case of a cardiac cycle in which balloon assist is not performed, one maximal value appears in one cardiac cycle. In the case of a cardiac cycle in which balloon assist is performed, two maximal values appear in one cardiac cycle. The heartbeat blood pressure calculating unit 13 does not treat peak points (so-called noises or dicrotic wave) where ascent and descent of the blood pressure value are repeated in a short time period (predetermined time period), as a maximal value. The heartbeat blood pressure calculating unit 13 may perform a filtering process as preprocessing in order to eliminate the influence of noises and the like. The heartbeat blood pressure calculating unit 13 estimates the IABP assist ratio in accordance with situation of detection of a maximal value (the detection number of a maximal value in one cardiac cycle). With respect to the blood pressure waveform of
In the case where the mode of the IABP is presumed to be 1:n (n being two or more), the heartbeat blood pressure calculating unit 13 detects the first maximal value in one cardiac cycle where two maximal values appear, as the subject's own systolic pressure (see
The method of calculating the blood pressure value in the case where the IABP assist ratio is 1:1 will be described with reference to
Furthermore, the heartbeat blood pressure calculating unit 13 may further calculate the time period between the unassisted systolic pressure and the augmentation pressure. In this case, the heartbeat blood pressure calculating unit 13 determines whether the difference between the calculated time period (time period between the unassisted systolic pressure and the augmentation pressure) and a predetermined time period is within a given range or not. The predetermined time period is a preferable time period (when high effects of treatment are achieved) from the unassisted systolic pressure in the IABP treatment to the augmentation pressure. If the difference is not within the given range, therefore, the heartbeat blood pressure calculating unit 13 determines that the treatment timing of the IABP (operation timing of the balloon) is not adequate. In the case where the biological information measuring apparatus 1 measures also the arterial pressure (ART), the heartbeat blood pressure calculating unit 13 may perform a comparison with waveform of the ART, and determine whether the operation timing of the IABP is adequate or not.
A user of the biological information measuring apparatus 1 (e.g., a doctor) may input mode information explicitly indicating whether the IABP is being used or not. The user may input the mode information by operating an input unit (not shown) of the biological information measuring apparatus 1. The input unit may be, for example, a button or a touch display provided on a housing of the biological information measuring apparatus 1. The mode information may contain information of the assist ratio. In the case where a ratio of 1:3 is input as the assist ratio, when the heartbeat blood pressure calculating unit 13 detects two maximal values in certain one cardiac cycle, for example, the unit is controlled so as to detect only one maximal value in subsequent two cardiac cycles. As described above, the assist ratio is explicitly known, and therefore the heartbeat blood pressure calculating unit 13 can more adequately calculate pressure values. In the case where the assist ratio is explicitly input, the heartbeat blood pressure calculating unit 13 may calculate pressure values by using the assist ratio. When the assist ratio is designated as 1:1, for example, the heartbeat blood pressure calculating unit 13 may determine the minimum blood pressure value of each cardiac cycle, as the assisted end-diastolic pressure.
Depending on the characteristics of the subject, influences of noise, and the like, the blood pressure value may repeatedly perform fine ascent and descent operations. Therefore, the heartbeat blood pressure calculating unit 13 is controlled so as not to treat a peak value (point where the blood pressure transitions from ascent to descent) which may be caused by fine ascent and descent operations, as a maximal value. Even in the case where the IABP is used, it is adequate that the unit is controlled while assuming that three or more maximal values do not appear in one cardiac cycle. In other words, when the heartbeat blood pressure calculating unit 13 detects three or more maximal values in one cardiac cycle, the accuracy of detecting pressure values is lowered. Therefore, the heartbeat blood pressure calculating unit 13 detects only an adequate peak value as a maximal value.
The output unit 14 outputs the blood pressure waveform and the blood pressure values calculated by the heartbeat blood pressure calculating unit 13. The output unit 14 displays the blood pressure waveform acquired by the blood pressure waveform measuring unit 12, in the form of a time-series graph, and also the pressure values calculated by the heartbeat blood pressure calculating unit 13. Hereinafter, examples of the output of the output unit 14 will be described.
In a first example, the output unit 14 displays the systolic pressure and end-diastolic pressure which are designated by the user, as numerical values on a display screen. Here, the designation means whether the values are blood pressure values of the subject, or those of the blood pressure assisted by the balloon.
A second example will be described with reference to
A third example will be described with reference to
The output unit 14 may display also the time period from the systolic pressure of the subject to the augmentation pressure. As described above, when the time period is inadequate (too short or too long), it is possible to determine that the treatment timing of the IABP (operation timing of the balloon) is not adequate. If the heartbeat blood pressure calculating unit 13 determines that the treatment timing of the IABP (operation timing of the balloon) is not adequate, the output unit 14 may output a display or sound attracting the user's attention. This enables the doctor or the like to change the setting of the IABP so as to perform proper treatment.
Next, effects of the biological information measuring apparatus 1 according to the exemplary embodiment will be described. During the balloon operation of the IABP, two maximal blood pressure values exist in one cardiac cycle. When the balloon of the IABP is not operated, one maximal value of the blood pressure exists in one cardiac cycle. As described above, the biological information measuring apparatus 1 calculates a cardiac cycle, and, in accordance with the detection of the maximal blood pressure value in one cardiac cycle, further calculates the systolic pressure of the subject, the augmentation pressure (blood pressure assisted by the IABP), and the end-diastolic pressure of the subject. When referring the end-diastolic pressure of the subject which is displayed distinctly from the augmentation pressure, the doctor or the like can easily determine effects of the IABP treatment or weaning from the IABP.
Usually, the balloon of an IABP is inflated and deflated in synchronization with the blood pressure (blood pressure waveform) or an ECG. In the R wave of an ECG, moreover, the voltage is largely changed. Based on the timing of detecting the QRS wave of the ECG, the heartbeat blood pressure calculating unit 13 can accurately calculate the blood pressure values of the subject (the systolic pressure and the end-diastolic pressure), and values of blood pressures assisted by the IABP (the systolic pressure and the end-diastolic pressure).
The output unit 14 displays the calculated systolic pressure and end-diastolic pressure of the subject, together with the blood pressure waveform on the display screen (
Preferably, the heartbeat blood pressure calculating unit 13 calculates the blood pressure values by using the mode information (information indicating whether the IABP is used or not, and the assist ratio) which is explicitly designated. By having the assist ratio in advance, the heartbeat blood pressure calculating unit 13 can determine timings when two maximal values appear in one cardiac cycle. Therefore, the likelihood of erroneous detection by the heartbeat blood pressure calculating unit 13 can be remarkably reduced.
While the present invention has been described with reference to certain exemplary embodiments thereof, the scope of the present invention is not limited to the exemplary embodiments described above, and it will be understood by those skilled in the art that various changes and modifications may be made therein without departing from the scope of the present invention as defined by the appended claims.
In the above-described example, a cardiac cycle is calculated by using the ECG. The invention is not limited to this. The ECG is used for obtaining information (heartbeat information) relating to the pulsation (heartbeat) of the heart. Therefore, a configuration other than the electrocardiogram measuring unit 11 may be employed in so far as it can obtain heartbeat information relating to the heartbeat of the subject. For example, the pulse wave may be detected by using an SpO2, and the cardiac cycle may be estimated from the pulse wave to perform the process described above. That is, the biological information measuring apparatus 1 has a pulsation information detecting unit configured to obtain heartbeat information of the subject (an ECG in the example of
In a related art, the measurement of blood pressure values during use of an IABP has not been deeply studied. Accordingly, the biological information measuring apparatus 1 is advantageous even it is configured to calculate only at least one of the systolic pressure and end-diastolic pressure of the subject in the manner described above. That is, the biological information measuring apparatus 1 may be configured to calculate and to output a necessary blood pressure value in accordance with designation (e.g., designation using a button) by the doctor or the like. In other words, the biological information measuring apparatus 1 may be configured to calculate at least one of the systolic pressure of the subject, the end-diastolic pressure of the subject, the augmentation pressure of the IABP, the systolic pressure assisted by the IABP, and the end-diastolic pressure assisted by the IABP. For example, the biological information measuring apparatus 1 may be configured to detect only the second maximal value in one cardiac cycle to detect only the augmentation pressure.
The processes in the heartbeat blood pressure calculating unit 13 and the output unit 14 may be implemented by computer programs which operate in the biological information measuring apparatus 1. That is, the biological information measuring apparatus 1 includes also a configuration which has a usual computer, such as a central processing unit (CPU) and a memory device.
The programs may be stored in a non-transitory computer readable medium of any one of various types, and then supplied to the computer. The non-transitory computer readable medium includes tangible storage media of various types. Examples of the non-transitory computer readable medium are a magnetic recording medium (e.g., a flexible disk, a magnetic tape, and a hard disk drive), a magneto-optical recording medium (e.g., a magneto-optical disk), a CD-read only memory (CD-ROM), a CD-R, a CD-R/W, a semiconductor memory (e.g., a mask ROM, a programmable ROM (PROM), an erasable PROM (EPROM), a flash ROM, and a random access memory (RAM)). Alternatively, the programs may be supplied to the computer by means of a transitory computer readable medium of any one of various types. Examples of the transitory computer readable medium are an electrical signal, an optical signal, and an electromagnetic wave. The transitory computer readable medium can supply the programs to the computer through a wired communication path such as a metal wire or an optical fiber, or a wireless communication path.
Number | Date | Country | Kind |
---|---|---|---|
2014-155481 | Jul 2014 | JP | national |
Number | Name | Date | Kind |
---|---|---|---|
5169379 | Freed | Dec 1992 | A |
5365933 | Elghazzawi | Nov 1994 | A |
5392780 | Ogino | Feb 1995 | A |
6082105 | Miyata | Jul 2000 | A |
6290641 | Nigroni | Sep 2001 | B1 |
6679829 | Nigroni | Jan 2004 | B2 |
20010034469 | Nigroni | Oct 2001 | A1 |
20050148812 | Nigroni et al. | Jul 2005 | A1 |
Number | Date | Country |
---|---|---|
3-030774 | Feb 1991 | JP |
3-202069 | Sep 1991 | JP |
5-161612 | Jun 1993 | JP |
10-127587 | May 1998 | JP |
2007503883 | Mar 2007 | JP |
2012-213474 | Nov 2012 | JP |
Entry |
---|
El-Ghazzawi, et al.; “An Algorithm to Extract Blood-Pressure Waveform Features During Intra-Aortic Balloon Pump Assist”, Anesthesia Technology, Nov. 1989, 2 pages total. |
Search Report dated Dec. 4, 2015, issued by the European Patent Office in counterpart European Application No. 15176563.3. |
Communication dated Feb. 28, 2017, issued by the Japanese Patent Office in counterpart Japanese application No. 2014-155481. |
Office Action dated Sep. 27, 2017 by the Japanese Patent Office in counterpart Japanese Patent Application No. 2014-155481. |
Number | Date | Country | |
---|---|---|---|
20160029903 A1 | Feb 2016 | US |