JP2009082175A - Respiration training instrument and computer program - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a respiration training instrument that effectively improves subject's motivation for continuation of respiration training. <P>SOLUTION: The respiration training instrument measures AIs (augmentation indexes) before and after every respiration training (a start AI and a finish AI) and displays the values after every respiration training or displays the values acquired during a predetermined period together. When the start AI on a line L1 and the finish AI on a line L2 are noticed, a significant difference is found between the values from the beginning on the first week. On the other hand, a significant decrease is not easy to recognize for blood pressure values after around a week since the start of respiration training though a decrease of a certain degree is recognized after around three weeks since the start of respiration training. Values of central blood pressure may be displayed as the blood pressure values. <P>COPYRIGHT: (C)2009,JPO&INPIT

Description

  The present invention relates to a breathing exerciser and a computer program, and more particularly to a breathing exerciser and a computer program for guiding a breathing exercise pattern.

  One undesirable state of the circulatory system that leads to hypertension and arteriosclerosis is the situation where peripheral blood vessel stiffness increases the reflected wave component of blood pressure and increases the pressure load on the heart and vascular system. .

  In young people, blood vessels are rich in flexibility, but they may become hard due to contraction of blood vessels due to tension or stress. Such a change in the hardness of the blood vessel due to the contraction function of the blood vessel is hereinafter referred to as a functional change. On the other hand, in the elderly and hypertensive patients, the blood vessel wall is hardened structurally and in material. Such a change to the structural and material hardening of the blood vessel is hereinafter referred to as an organic change.

  Progression to hypertension and arteriosclerosis is considered to correspond to the transition from functional changes of the heart and blood vessels to organic changes, and the specific mechanisms are considered as follows.

  By continuously increasing pressure load on the heart and vascular system caused by functional changes in blood vessels due to tension and stress, mechanical damage accumulates in the heart and vascular system, and adaptation to pressure load As a result, the walls of the heart and blood vessels are enlarged. This is thought to lead to an organic change in which the structure and material changes, and to further increase the pressure load on the heart and vascular system.

  Respiratory training tries to guide the heart and blood vessels in the opposite direction to the increase in pressure load on the heart and vascular system caused by functional changes in the blood vessels caused by tension and stress in the mechanism of progression to arteriosclerosis. Is. Respiration training activates parasympathetic nerves and brings about physiological changes such as expansion of peripheral blood vessels, thereby reducing the pressure load on the heart and vascular system. Thus, it is considered that organic changes can be led in an improvement direction by adaptation of the heart and blood vessels.

Various techniques for examining human breathing have been disclosed.
For example, Patent Literature 1 discloses a technique for determining the degree of stress by detecting a breathing pattern of a subject. In Patent Document 1, a respiratory pattern is detected by detecting changes in the state of the subject's chest and abdomen using a piezoelectric element. Such a technique for detecting the state of the subject by the piezoelectric element is also disclosed in Patent Document 2.

Patent Documents 3 to 6 disclose a technique for measuring a physiological variable of a subject non-invasively and changing a parameter for an ideal breathing pattern in breathing training based on the measurement result. . Further, as physiological variables of the subject, Patent Literatures 7 to 8 disclose a technique for detecting the breathing pattern of the subject, and Patent Literature 9 discloses a technique for measuring blood pressure. Further, as disclosed in Non-Patent Document 1, a technique for measuring blood pressure in relation to breathing exercise as disclosed in Patent Document 9 is actually commercialized.
US Pat. No. 5,423,328 US Pat. No. 4,580,574 US Pat. No. 5,800,337 US Pat. No. 6090037 Specification International Publication No. 01/02049 Pamphlet International Publication No. 2004/014226 Pamphlet US Pat. No. 5,076,281 US Pat. No. 6,662,032 International Publication No. 2004/054429 Pamphlet Proven To Lower Blood Pressure In 7 Clinical Studies, [online], [Search February 21, 2007], Internet <http://www.resperate.com/discover/ clinical_evidence.aspx? src = cld.SubNav>

  The techniques disclosed in Patent Document 9 and Non-Patent Document 1 allow a subject to perform breathing exercise while presenting a blood pressure value that is a specific index that is considered to be related to the effect of breathing exercise. Then it is considered beneficial.

  However, it is generally considered that a period of about 3 to 4 weeks is required from the start of training in order for the subject to feel the specific effect of lowering the blood pressure value due to breathing training.

  Further, as understood from the above items, an important change required by breathing exercise is a change in pressure load on the heart and vascular system. It is the blood pressure waveform at the center (aortic origin) or the reflected wave component of the blood pressure waveform that can be directly captured.

On the other hand, it is difficult to noninvasively measure the blood pressure waveform at the aortic root.
In general, for blood pressure measurement, a non-invasive blood pressure value measured with the upper arm or the wrist is used. The blood pressure waveform measured at the periphery such as the upper arm or wrist often has the largest ejection wave, and the peak due to the reflected wave is often smaller than the ejection wave.

  On the other hand, the blood pressure waveform at the center, for example, the aortic root, often has a larger peak due to the reflected wave than the ejection wave. The reason why the peripheral blood vessels are directly affected by the dilatation is considered to be the reflected wave component of the blood pressure waveform.

  In the central blood pressure waveform, since the peak due to the reflected wave is often larger than the ejection wave, the change in the reflected wave due to breathing exercise can be directly captured as a change in blood pressure value. That is, the central blood pressure value can often be considered as a direct index indicating the effect of respiratory training.

  However, in the generally used peripheral blood pressure waveform, the ejection wave is often the largest, so it is often difficult to capture the change in the reflected wave due to breathing exercise with the blood pressure value. That is, there are many cases where the peripheral blood pressure value and the effect of respiratory training are not directly linked.

  Peripheral blood pressure values are thought to be due to a mechanism in which remodeling occurs adaptively as a result of a decrease in central blood pressure or vascular pressure. Therefore, it is considered that a period in which physiological remodeling occurs, that is, about 3 to 4 weeks as described above, is required for the peripheral blood pressure value to change significantly.

  From the above, in the conventional technique, it takes a considerable period of time to realize the effect of respiratory training based on the physiological variables of the subject measured non-invasively.

  For the subject, being able to feel the effect is an important motivation improvement factor when continuing the breathing exercise. On the other hand, if it is difficult to realize the effect, the subject may stop breathing training without waiting for the effect to be realized.

  The present invention has been conceived in view of such circumstances, and an object thereof is to provide a breathing exerciser and a computer program that can effectively improve the motivation of a subject to continue breathing training.

  A breathing exerciser according to the present invention includes a guide unit that performs processing for notifying information for guiding a breathing exercise pattern to a user, a pulse wave measurement unit that measures a pulse wave of a subject, and the pulse wave measurement unit. A pulse wave that calculates a plurality of feature amounts directly obtained from predetermined feature points of the measured pulse wave waveform and calculates an index that reflects the reflection phenomenon of the pulse wave by an operation using the calculated feature points The pulse wave feature is calculated based on the pulse wave measured before and after the execution of the process, by causing the pulse wave measurement unit to execute a pulse wave measurement before and after the execution of the process by the feature amount calculating unit and the guide unit. Control means for causing the amount calculation means to calculate the index, and presenting means for presenting the index calculated by the pulse wave feature value calculation means.

  The breathing exerciser according to the present invention further includes difference calculation means for calculating a difference between the indices based on pulse waves measured before and after execution of the processing calculated by the pulse wave feature value calculation means, It is preferable that the means further presents the difference calculated by the difference means.

  The respiratory training device of the present invention further includes storage means for storing the index based on the pulse wave measured before and after execution of the processing calculated by the pulse wave feature amount calculation means, and the control means includes: Regarding the processing by the guide means a plurality of times, it is preferable that the storage means stores the index based on the pulse wave measured before and after the execution of the processing calculated by the pulse wave feature amount calculation means.

  In the breathing exerciser according to the present invention, the control unit causes the pulse wave measurement unit to continuously measure the pulse wave of the subject, and the pulse wave measurement unit continuously measures the pulse wave. Preferably, the index corresponding to the result is calculated, and the process by the guide unit is executed when a state where the change amount of the index is within a certain amount continues for a certain period.

  In the breathing exerciser of the present invention, it is preferable that the index is AI (Augmentation Index).

  The breathing exerciser according to the present invention further includes blood pressure measurement means for measuring a blood pressure value of the subject, and the control means is connected to the blood pressure measurement means at least before or after the processing by the guide means. It is preferable to measure the blood pressure value.

  In the breathing exerciser of the present invention, it is preferable that the presenting unit presents the blood pressure value measured by the blood pressure measuring unit together with the index calculated by the pulse wave feature amount calculating unit.

  In the breathing exerciser of the present invention, the pulse wave feature amount calculating means includes means for obtaining a backward systolic component in the pulse wave detected by the pulse wave measuring means and means for obtaining the backward systolic component. It is preferable to include estimation means for calculating an estimated value of the systolic blood pressure of the central artery of the living body as the index using the obtained posterior systolic component.

  A computer program according to the present invention is a computer-readable program for causing a computer to execute a process for notifying a user of information for guiding a breathing exercise pattern to a user. A first reading step for reading the result, and a plurality of feature amounts directly obtained from predetermined feature points of the pulse wave waveform read in the first reading step are calculated, and the plurality of calculated feature points are used. A first calculation step for calculating an index that reflects the reflection phenomenon of the pulse wave by calculation, and information for guiding a breathing exercise pattern after the first reading step is notified via an information notification device. A notification step, a second reading step for reading the pulse wave of the subject after the notification step, and a predetermined waveform of the pulse wave read in the second reading step A second calculation step of calculating a plurality of feature amounts directly obtained from the feature points, and calculating an index reflecting the reflection phenomenon of the pulse wave by an operation using the calculated feature points; The step of presenting the index calculated in the step and the index calculated in the second calculation step via a device for notifying information is executed.

  According to the present invention, an indicator based on a pulse wave waveform, that is, a change in an index reflecting a change in a reflected wave component in a blood pressure waveform before and after notification of information for guiding a breathing pattern is presented to a subject. it can.

  Thereby, it is possible to provide the subject with the effect of breathing exercise based on the notification of information for guiding the breathing pattern in the form of an index that is measured in the short term.

  Therefore, according to the present invention, the subject can feel the effect of respiratory training in a shorter training period. That is, according to the present invention, the breathing exerciser can effectively improve the motivation for the subject to continue breathing training.

  Hereinafter, an embodiment of a work support apparatus of the present invention will be described with reference to the drawings. It should be noted that the same components are denoted by the same reference symbols in the respective drawings, and detailed description thereof will not be repeated.

Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings.
FIG. 1 is an external view of a breathing exerciser that is an embodiment of the breathing exerciser of the present embodiment. FIG. 2 is a diagram schematically showing the system configuration of the breathing exerciser.

  Referring to FIGS. 1 and 2, in the breathing exerciser according to the present embodiment, the pulse wave measuring device for diagnosis support includes a main body 1A, a display 1B for displaying various information to the outside, and operation keys 1D. A personal computer (PC) 1 having a central processing unit (CPU) 10, a memory 11 and an RTC (real time clock) 12, a memory card 2 detachably attached to the personal computer 1, and a cable to the personal computer 1 A numeric keypad 3, a printer 4, a sensor amplifier 5 and a sphygmomanometer 7, a sensor unit 13 connected to the sensor amplifier 5, and an arm band 8 having an air bag connected to the sphygmomanometer 7. The sensor unit 13 includes a sensor 6 and an air bag 9 that presses the sensor 6 against the living body. The CPU 10 adjusts the pressing level of the sensor 6 on the living body by the air bag 9 through the pressure control circuit 71. In the present embodiment, the sensor unit 13 functions as a pulse wave measurement unit, and the sphygmomanometer 7 functions as a blood pressure measurement unit.

  When the sensor 6 is pressed against the wrist, the pulse wave is detected via the radial artery, and the detected pulse wave signal is amplified to a predetermined level by the sensor amplifier 5, and thereafter, the A / D converter 51. It is converted into digital information and given to the CPU 10.

  The operation key 1D and the numeric keypad 3 are used to input information / instructions to the personal computer 1 by an external operation. By attaching the memory card 2 to the personal computer 1, the CPU 10 of the personal computer 1 can read and write information from and to the memory card 2.

  FIG. 3 is a view showing a modification of the appearance of the breathing exerciser of FIG. 3 shows a state in which the printer 4, the sensor amplifier 5, the numeric keypad 3, and the sphygmomanometer 7 are built in the main body 1A of the personal computer 1 of FIG.

  In the present embodiment, the respiratory training device shown in FIG. 1 (or FIG. 3) and FIG. 2 measures AI, which is circulatory system information that has measurement convenience equivalent to blood pressure measurement and is different from blood pressure information. By presenting AI before and after breathing exercise, the effect of each breathing exercise is presented to the user in a clear form. In the present embodiment, notification of information for guiding a breathing exercise pattern and presentation of AI in breathing exercise, which will be described later, are performed by display on the display 1B. The present invention is not limited, and may be sound output by further providing a speaker or the like in the breathing exerciser, or may be realized by both display and sound output.

  The above information display using the display 1B is performed by the CPU 10 executing a predetermined program stored in the memory 11 in advance. Therefore, CPU10 has the presentation part 10B for displaying such information on the indicator 1B. Further, the CPU 10 includes a guide unit 10X for presenting a breathing exercise pattern in a breathing exercise process as described later.

  Here, AI is a known index and mainly reflects the reflection intensity of the pulse wave corresponding to the arteriosclerosis of the central blood vessel (the reflection phenomenon of the pulse wave and the ease of accepting the blood flow to be delivered). The quantity is indexed. AI is said to be an effective index for early detection of cardiovascular diseases, and is known to behave differently from blood pressure. AI is calculated from the measured pulse wave. The sensor unit 13 is attached to the wrist portion with an attachment belt or the like, and the pulse wave is detected by pressing the sensor 6 against the wrist with the air bag 9 while adjusting the pressure by the pressure control circuit 71. The calculation of the AI based on the detected pulse wave is performed by the CPU 10 of the personal computer 1 executing a predetermined program stored in the memory 11 in advance. Therefore, the CPU 10 includes a pulse wave feature amount calculation unit 10A that functions as a pulse wave feature amount calculation unit.

  FIG. 4 and FIG. 5 show examples of changes over time of the measured pulse wave, respectively.

  For example, when a pulse wave as shown in FIG. 4 is measured, AI can be calculated according to the following formula (1) or formula (2).

AI = P1 / P2 (1)
AI (%) = (P1-P2) / P1 * 100 (2)
When a pulse wave as shown in FIG. 5 is measured, AI can be calculated according to the above equation (1) or the following equation (3).

AI (%) = (P2-P1) / P2 * 100 (3)
4 and 5, level P1 at time T1 indicates a peak value due to blood ejection (stimulation) waves due to the heartbeat of the heart, and level P2 at time T2 is due to reflected waves with respect to ejection waves due to heartbeats. Peak value is shown. The intensity and appearance time phase of this reflected wave change corresponding to the hardening of the blood vessel. Therefore, AI represents the ratio between the peak value of the traveling wave component and the peak value of the reflected wave component corresponding to the ejection (stimulus) wave included in the measured pulse wave waveform. As a method for determining the levels P1 and P2, a method for obtaining the pulse wave waveform by performing an operation such as differentiation on the pulse wave waveform can be applied.

  In general, the pulse wave for a young person has a relationship of level P2 <level P1, as shown in FIG.

  However, in a pulse wave for an elderly person, level P2> level P1 as shown in FIG. This is due to the fact that the high-level reflected wave is detected within a short period of time because the ejection wave cannot be sufficiently absorbed by the blood vessel wall because of hardening of the blood vessel inner wall (arteriosclerosis).

  ΔTp is related to the distance from the heart that generates the ejection wave to the reflected wave generation site and the propagation speed (acceleration) of the pulse wave. Therefore, if the level of the reflected wave generated at a site close to the heart is high, ΔTp becomes small. It is known that the pulse wave propagates quickly when the inner wall of the blood vessel is cured. Further, it is known that AI increases if ΔTp is small even if the level P2 of the reflected wave of the pulse wave is the same.

  In this way, AI calculates a plurality (levels P1, P2) of feature quantities (pulse wave amplitude level (mV)) directly obtained from the peak that is the feature point of the pulse waveform, and calculates the calculated feature quantities. It can be calculated by the following calculation.

  In the present embodiment, the above-described AI is used for explanation, but the same effect can be obtained even when ΔTp is used instead. ΔTp is also a known index like AI. ΔTp is shown in the book “Hypertension”, pp434-438 (September. 2001. Publisher: American Heart Association, Inc). ΔTp may be expressed as TR (time reflection). The TR is described in “Journal of Physiology (2000), 525.1, pP 263-270. ΔTp can be obtained directly from the position of the pulse wave rising point, which is a characteristic point of the pulse wave waveform, and the start position of the reflected wave. It is possible to calculate a plurality of feature quantities (time (msec) corresponding to the position) to be calculated and to calculate (difference) between the calculated feature quantities.

  Next, a process (breathing exercise process) executed by the CPU 10 when the user performs a breathing exercise using the breathing exerciser 1 will be described with reference to FIG. 6 which is a flowchart of the process.

  Referring to FIG. 6, in the breathing exercise process, CPU 10 first determines in step S10 whether or not the start key that is a part of operation key 1D has been pressed. If it is determined that the key has been pressed, the process proceeds to step S20. To proceed.

  In step S20, the CPU 10 waits until a predetermined time (stored in the memory 11) elapses. In addition, the specific time here is time for the user to adjust the state in order to calm down and start breathing exercise, and can be, for example, 2 to 3 minutes.

  Next, CPU10 measures AI by step S30, and advances a process to step S40. In the breathing exercise process, the user actually performs the breathing exercise (the user is informed of the information for guiding the breathing exercise pattern) during the period in which the process of step S40 described later is executed. is there. The AI measured in step S30 as described above before the execution of step S40 (that is, before the user starts breathing exercise) is hereinafter referred to as “starting AI” as appropriate.

  In step S40, the CPU 10 causes the guide unit 10X to execute a predetermined program, thereby executing a guide information notification process that is a process of notifying the user of information for guiding a breathing exercise pattern, and the process proceeds to step S50. Proceed. In the breathing exerciser 1 according to the present embodiment, in the training information notification process, for example, information indicating the timing of inspiration and the timing of expiration is displayed on the display 1B for about 15 minutes. An example of the displayed screen is shown in FIG.

  Referring to FIG. 7, in screen 400 displayed as an example of information for guiding a training pattern, the number of times of current training (number of times of training), the remaining time of current training, and the current BRS (baroreceptor reflection) : Baroreflex Sensitivity) and 14 blocks arranged in the vertical direction are displayed.

  The number of exercises will be described later with reference to FIG. 9 and Table 1. Of the 14 blocks, the upper seven of the 14 blocks are used by being highlighted when inspiration timing is indicated, and the lower seven are used for expiration timing. It is used by being highlighted when instructed.

  The BRS is calculated by “blood pressure fluctuation value (ΔBP) / heart rate fluctuation value (ΔHR)” in a time of about 2 to 3 seconds, for example. BRS is an index indicating how much the blood pressure value increases when the heart rate is changed by stimulating the autonomic nerve by deep breathing. The higher this value, the lower the baroreceptor reflection. In other words, the higher the BRS value, the better the health. In the respiratory training device of the present embodiment, BRS is not an essential display item for respiratory training. For example, it is displayed when heart rate and blood pressure are continuously measured while the training information notification process in step S40 is being executed.

  In step S50, the CPU 10 measures the AI again, and proceeds to step S60. Here, in step S50, the AI measured after the end of the training information notification process in step S40 is hereinafter referred to as “end-time AI” as appropriate.

  In step S60, the CPU 10 presents the start AI measured in step S30 and the end AI measured in step S50 by displaying them on the display 1B, and further stores these measured values in the memory 11. End the process. Here, an example of the display screen of the start time AI and the end time AI on the display 1B will be described with reference to FIG.

  Referring to FIG. 8, in screen 410 that is an example of the screen displayed on display 1 </ b> B in step S <b> 60, “the number of exercises” indicating how many breathing exercises have been completed at that time is displayed. . In the screen 410, the pre-start AI value is displayed in the display field 411, and the end-time AI is displayed in the display field 412.

  Further, the screen 410 displays 14 blocks arranged in the vertical direction. When the CPU 10 displays the start time AI and the end time AI in step S60, the CPU 10 calculates these differences and uses the difference and 14 blocks so that the state after the training is the state at the start of the training. It may indicate whether it has been improved or worsened. The upper half of the block is used to indicate that it has improved and its degree, and the lower half is used to indicate that the condition has deteriorated and its degree. The evaluation of improvement or deterioration is, for example, when a value obtained by subtracting start AI from end AI is a difference value, it is improved if it is a positive value, and deteriorated if it is a negative value. The larger the difference value, the greater the degree of improvement or deterioration. Further, instead of displaying the degree of using such 14 blocks, the CPU 10 may display the difference value between the start AI and the end AI on the screen 410 as it is.

  Table 1 schematically shows a storage mode of the start time AI and the end time AI in the memory 11.

  In Table 1, the start AI and the end AI are stored for each number of measurements. Further, the CPU 10 calculates a difference (ΔAI) between the start time AI and the end time AI of each time and stores the difference in the memory 11. Furthermore, it is preferable that the CPU 10 measures the end-time AI in step S50 and measures the blood pressure value and stores it in the memory 11 in step S60.

  In the memory 11, the number of measurements (the number of breathing exercises) for the measured values of the start AI and the end AI is treated as a large unit for one week and a detailed unit for one day. That is, the measurement result of the nth time of the m week (the nth day of the m week) is stored as a measurement value corresponding to “n times (m)”.

  As described with reference to FIG. 8, the CPU 10 displays the start time AI and the end time AI in each breathing exercise on the display 1 </ b> B at the end of each turn and also stores a plurality of breathing exercises stored in the memory 11. The start time AI and the end time AI can be displayed together. FIG. 9 shows an example of a measurement result display screen including start time AI and end time AI for three weeks.

  In FIG. 9, the AI at the start of each time is shown as a point on the line L1, and the value of the AI at the end is shown as a point on the line L2. The value of ΔAI at each time is shown as a point on L3, and the blood pressure value at the beginning of each week is shown as a point on L4.

  As can be seen from FIG. 9, when attention is paid to the start AI and the end AI, a remarkable difference is observed in these values from the first time in the first week. On the other hand, the blood pressure value can be recognized to a certain extent if a period of about 3 weeks has elapsed since the start of the breathing exercise, but it decreases significantly in about a week after the start of the breathing exercise. It is difficult to recognize. In other words, the breathing exerciser according to the present embodiment presents the start AI and the end AI (and their difference values) to the user at the end of each breathing exercise, so that the effect of each breathing exercise can be obtained. It can be said that it can be presented as information that is easy to realize.

  In the present embodiment described above, as described with reference to FIG. 6, in the breathing exercise process, the start AI is measured in step S30 and the end AI is measured in step S50. Instead, the CPU 10 measures only the pulse wave in step S30 and step S50, stores it in the memory 11, and stores each pulse stored when data presentation or the like is executed in step S60. You may calculate AI from a wave.

  In the breathing exercise process described with reference to FIG. 6, after detecting that the start button is pressed in step S10, the CPU 10 waits in step S20 before measuring the start AI in step S30. It was. Instead of waiting, the AI is continuously measured after the start button is pressed, the start AI is measured in step S30 on the condition that the value of the AI is stabilized, and the training in step S40 is performed. You may progress to an information alerting | reporting process. FIG. 10 shows a flowchart of a modified example of such breathing exercise processing.

  Referring to FIG. 10, in the modified example of the breathing exercise process, after detecting that the start button has been pressed in step S10, CPU 10 starts measuring AI in step S21, and The process proceeds to step S30 on condition that the value is stable. In addition, the process after step S30 performs the process similar to what was performed in the breathing exercise process demonstrated with reference to FIG.

  Note that AI is stabilized here, for example, the AI is calculated by measuring the pulse wave periodically (for example, every 10 seconds) after the start button is pressed, and the difference from the previous AI value. It can be assumed that the state in which the value is within the predetermined range has continued for a predetermined period (for example, 30 seconds).

  Further, in the present embodiment described above, the CPU 10 measures the blood pressure value after the training information notification process in the breathing exercise process, but before the training information notification process, for example, at the same time as the start AI or The blood pressure value may be measured between the measurement of the starting AI and the start of the training information notification process.

  Note that the breathing exerciser according to the present embodiment notifies at least information for guiding the breathing exercise pattern to the user, and before and after each breathing exercise (for example, step S30 and step in FIG. 6). It is only necessary to measure (calculate) AI and present it in S50). Therefore, the sphygmomanometer 7 can be omitted.

  Further, in the respiratory training device of the present embodiment described above, the CPU 10 reads the pulse wave measured by the pulse wave measuring means via the A / D converter 51 and calculates the AI. The personal computer 1 can also be configured such that the pulse wave measurement result is input from the outside (for example, a pulse wave measuring device) without providing the pulse wave measuring means. A configuration example of the breathing exerciser in such a case will be described with reference to FIG.

  As shown in FIG. 11, in the breathing exerciser, there is a pulse wave measuring device 50 separately from the personal computer 1, and the personal computer 1 and the pulse wave measuring device 50 are connected via an interface 1X and an interface 50X. Yes. The pulse wave measuring device 50 includes a sensor unit 13, a pressure control circuit 71, a sensor amplifier 5, and an A / D converter 51. In such a case, the CPU 10 of the personal computer 1 reads the pulse wave measurement result from the pulse wave measurement device 50 via the interface 1X as necessary, and executes AI calculation or the like.

  In this embodiment, instead of the AI value, the internal pressure of the aorta from the heart to the brain or kidney (hereinafter referred to as “central blood pressure”) may be measured (estimated) and displayed. Furthermore, it is preferable that the central blood pressure is measured (estimated) both before and after each breathing exerciser and the value of the difference between them is displayed in the same manner as the AI value.

  The central blood pressure displayed here may be measured by invasive measurement by inserting a catheter into the body of the user (subject), but may be a value estimated based on a pulse wave waveform. Below, the technical background and the actual estimation method for central blood pressure estimation based on the pulse wave waveform will be described.

[Technical background of central blood pressure estimation]
FIGS. 12A and 12B show changes in the pressure pulse wave of the peripheral artery and changes in the pressure pulse wave of the central artery measured simultaneously for the same subject. The waveforms in FIGS. 12A and 12B depend on the state of the central artery. The waveform of the central artery in FIG. 12B is measured invasively by inserting a catheter, and the pressure pulse wave of the peripheral artery in FIG. 12A oscillates the upper arm blood pressure using an electronic sphygmomanometer or the like. It was obtained by metric method. In FIG. 12A and FIG. 12B, the horizontal axis indicates the passage of time, and the vertical axis indicates the voltage level (mV) of the pressure pulse wave signal (voltage signal). This voltage level is proportional to the blood pressure. .

  The pressure pulse wave of the central artery in FIG. 12B has a large amplitude level of the reflected wave in many cases, and in the case of a person with a large amplitude level of the reflected wave, the maximum blood pressure (systolic blood pressure) of the central artery is It depends on the amplitude level of the reflected wave. FIG. 12A shows changes in the pressure pulse wave of the peripheral artery. Even if the amplitude level of the reflected wave of the pressure pulse wave of the central artery is large, the pressure pulse wave of the peripheral artery may have a large traveling wave. This is because there is a transmission characteristic in which a certain frequency (about 5 Hz) component is emphasized when the pressure pulse wave is transmitted through the blood vessel. In this case, the amplitude of the ejection wave when blood is delivered from the heart with the heartbeat is often large, and the maximum blood pressure (systolic blood pressure) of the peripheral artery is greatly influenced by the amplitude level of the ejection wave. The

  FIGS. 13A and 13B are graphs showing the results of measuring the blood pressure in the central artery before and after nitroglycerin administration by inserting a catheter into the subject's body, and the horizontal axis of the graph represents the time course. The vertical axis indicates the amplitude level of the pressure pulse wave, and the unit is indicated by pressure (mmHg). Referring to FIG. 13 (A) before administration of nitroglycerin and FIG. 13 (B) after administration of nitroglycerin, nitroglycerin acts on vascular cells to dilate blood vessels, resulting in reflection of the pressure pulse wave of the central artery. It can be seen that the wave component has been reduced because the peak of the amplitude of the pressure pulse wave has been reduced as indicated by the arrows in the figure.

  FIGS. 14A and 14B are graphs showing how reflected waves are reduced in the pressure pulse wave of the peripheral artery by administration of nitroglycerin. The horizontal axis of the graph indicates the passage of time, the vertical axis indicates the amplitude level of the pressure pulse wave, and the unit is indicated by pressure (mmHg). The pressure pulse wave of the peripheral artery shown here corresponds to the blood pressure waveform measured according to the oscillometric method using an electronic sphygmomanometer. In the waveform of the pressure pulse wave of the peripheral artery, the blood pressure is indicated at points A1 and A2 and points B1 and B2, which are the peak amplitudes of the pressure pulse wave. As shown in Patent Document 1, the reflected wave component that appears in the pressure pulse wave of the central artery appears at points a1 and a2 and points b1 and b2 in the pressure pulse wave of the peripheral artery. Therefore, it can be seen that the amplitude level of the pressure pulse wave indicating the blood pressure in the peripheral artery is not affected by the reflected wave. As shown in the figure, since the blood vessels are dilated by administering nitroglycerin, the amplitude level of the reflected wave appearing in FIG. 14 (B) is reduced compared to that of FIG. As a result, the level of the point a1 is reduced to the level of the point b1, and similarly the level of the point a2 is reduced to the level of the point b2.

  FIG. 15 is a graph showing the tendency of the amplitude level of the reflected wave in the pressure pulse wave of the peripheral artery using the actually measured value of the experimental result (hereinafter referred to as reflected wave trend) L1 and the central artery pressure (maximum value: systolic blood pressure). A central arterial pressure trend L2 indicating a tendency of change in FIG. In the graph of FIG. 15, the time is plotted on the horizontal axis, and the peak values of the central artery pressure (systolic blood pressure) and peripheral arterial pressure pulse wave (both units are (× 100 mmHg)) are plotted on the vertical axis. Yes. As described above, since the central artery pressure, that is, the systolic blood pressure of the central artery depends on the amplitude level of the reflected wave, the systolic blood pressure increases when the amplitude level of the reflected wave increases, and the systolic phase decreases when the amplitude level decreases. Blood pressure also decreases. On the other hand, in the pressure pulse wave of the peripheral artery, the influence of the reflected wave is the posterior component of systolic blood pressure (blood pressures at points A1, A2, B1, and B2 in FIGS. 14A and 14B) as shown in FIG. A) and (B) appear at points a1, a2, b1 and b2.

  Therefore, as shown in FIG. 15, the changing point of the reflected wave trend L1 appears slightly later than the changing point of the central artery pressure trend L2. In FIG. 15, the change points are shown in association with a slight time difference, and the change points appear for each beat of the heart, and the reflected wave trend L1 is shown for each heart beat. Are plotted in time series with the peak value of the reflected wave as the changing point. Thus, it can be seen from the graph of FIG. 15 that the change in the amplitude level of the reflected wave in the peripheral artery and the change in the systolic blood pressure in the central artery are almost the same. Therefore, according to this experiment, it is possible to easily grasp the time-series temporal change (trend) of systolic blood pressure in the central artery by monitoring the reflected wave trend L1 in the pressure pulse wave of the peripheral artery. Can be obtained.

[Central blood pressure estimation method (configuration of apparatus used for estimation)]
The pulse wave can be measured by using the sensor unit 13 or the like as described above. Here, the configuration of the sensor unit 101 having the same function will be described more specifically than the sensor unit 13 described above.

  FIG. 16 shows the connection relationship between the sensor unit and the fixed base. FIG. 17 shows a state where a device for detecting a pulse wave is attached to a living body.

  Referring to FIGS. 16 and 17, the pulse wave detection device is a sensor unit 101 mounted on the wrist surface for detecting a pulse wave in the radial artery of the wrist, and fixing for fixing the wrist for pulse wave detection. A stand 102 and a display unit (display unit 103 to be described later) for inputting / outputting various information related to pulse wave detection are provided. In FIG. 16, the sensor unit 101 is accommodated in the housing, and in FIG. 17, the sensor unit 101 is slid outside from the housing via the slide groove 9 (see FIG. 16) and is located on the wrist. .

  The fixed base 102 includes a fixed base unit 107, and the fixed base unit 107 is communicably connected to a display unit 103 and an external connection interface 29 of FIG. 19 described later via a USB (Universal Serial Bus) cable 4. The The fixed base unit 107 and the sensor unit 101 are connected via the communication cable 105 and the air pipe 6.

  When the pulse wave is detected, as shown in FIG. 17, the user places the sensor unit 101 on the surface of the wrist on the artery side by sliding movement while the wrist is placed at a predetermined position on the fixed base 102. The casing and the fixing base 102 are tightened through the belt 8 to stop the sensor unit 101 on the wrist from being displaced.

18A to 18E show a configuration of the sensor unit 101. FIG.
FIG. 18B shows a cross-sectional structure of the sensor unit 101 in FIG. 18A in the direction crossing the wrist when the wrist is worn. FIG. 18C is an enlarged view of a part of the broken line frame in FIG. 18B, when the cuff pressure is adjusted by the pressurization pump 115 and the negative pressure pump 116, the semiconductor pressure sensor 119 attached via a block molded by ceramic or resin is used. Move up and down freely by the amount corresponding to the pressure level. When the semiconductor pressure sensor 119 is moved downward, the semiconductor pressure sensor 119 protrudes from an opening provided in advance in the housing and is pressed against the wrist surface.

  As shown in FIGS. 18D and 18E, the arrangement direction of the plurality of sensor elements 128 of the semiconductor pressure sensor 119 is substantially perpendicular to (intersects) the artery when the sensor unit 101 is attached to the wrist. The array length is at least longer than the diameter of the artery. When each of the sensor elements 128 is pressed by the cuff pressure of the pressing cuff 118, pressure information, which is a pressure vibration wave generated from the artery and transmitted to the living body surface, is output as a voltage signal (hereinafter referred to as “pressure signal”). . For example, 40 sensor elements 128 are arranged on a measurement surface 140 having a predetermined size (5.5 mm × 8.8 mm).

  Referring to FIG. 18C, the pressure signal from sensor element 128 is sequentially sent to multiplexer 120 and amplifier 121 in PCB (Printed Circuit Board) 126 via flexible wiring 127.

  FIG. 19 shows a modification of the system configuration shown in FIG. In this figure, in place of the sensor unit 13, the sensor amplifier 5, the pressure control circuit 71, and the A / D converter 51 shown in FIG. 17, the sensor unit 1 and the fixed base unit 107 as described above are provided. . Further, FIG. 19 shows that the sensor unit 13 includes a ROM 12 that stores a program executed by the CPU 10 and a RAM 13 that functions as a work area of the CPU 10.

  The fixed base unit 107 includes a CPU 10. The memory card 2 stores data and a program for controlling operations of pulse wave detection and central blood pressure estimation. The fixed base unit 107 further includes a pressurizing pump 115, a negative pressure pump 116, a switching valve 117, and a control circuit 114 for receiving signals from the CPU 10 and transmitting the signals to the pressurizing pump 115, the negative pressure pump 116 and the switching valve 117. , A characteristic variable filter 122 that has at least two characteristic values and can be changed to any one of the characteristic values, and an A / D converter 123. The CPU 10 refers to blood pressure measurement result data input from the sphygmomanometer 7 for central blood pressure estimation.

  In FIG. 17, the detection site of the pressure pulse wave (also simply referred to as pulse wave) of the peripheral artery is the wrist and the blood pressure measurement site is the upper arm, but the measurement site is not limited to this for both the pulse wave and blood pressure. For central blood pressure, it is desirable that both measurement sites are close to each other in order to obtain higher estimation accuracy.

  The CPU 10 accesses the ROM 12, reads the program, develops it on the RAM 13, and executes it to control the entire apparatus. The CPU 10 receives an operation signal from the user from the operation key 1D, and performs control processing for the entire apparatus based on the operation signal. That is, the CPU 10 sends out a control signal based on the operation signal input from the operation key 1D. Further, the CPU 10 displays the pulse wave measurement result and the like on the display unit 125.

  The pressurizing pump 115 is a pump for pressurizing the internal pressure (hereinafter referred to as “cuff pressure”) of the pressing cuff (air bag) 118, and the negative pressure pump 116 is a pump for reducing the cuff pressure. is there. The switching valve 117 selectively connects one of the pressurizing pump 115 and the negative pressure pump 116 to the air pipe 6. The control circuit 114 controls these.

  The sensor unit 101 includes a semiconductor pressure sensor 119 including a plurality of sensor elements 128, a multiplexer 120 for selectively deriving pressure signals output from the plurality of sensor elements, and an amplifier for amplifying the pressure signals output from the multiplexer 120. 121, and a pressure cuff 118 including an air bag whose pressure is adjusted to press the semiconductor pressure sensor 119 onto the wrist.

  The semiconductor pressure sensor 119 is configured to include a plurality of sensor elements arranged at a predetermined interval in one direction on a semiconductor chip made of single crystal silicon or the like (see FIG. 18E), and is being measured by the pressure of the pressure cuff 118. It is pressed against the measurement site such as the wrist of the subject. In that state, the semiconductor pressure sensor 119 detects the pulse wave of the subject via the radial artery. The semiconductor pressure sensor 119 inputs a pressure signal output by detecting a pulse wave to the multiplexer 120 for each channel of each sensor element 128.

  The multiplexer 120 selectively outputs the pressure signal output from each sensor element 128. The pressure signal sent from the multiplexer 120 is amplified by the amplifier 121 and selectively output to the A / D converter 123 via the characteristic variable filter 122. In the present embodiment, the multiplexer 120 is dynamically controlled by the CPU 10.

  The variable characteristic filter 122 is a low-pass filter for blocking signal components of a predetermined value or more, and can change the cutoff frequency. The characteristic variable filter 122 will also be described in detail later.

  The A / D conversion unit 123 converts a pressure signal, which is an analog signal derived from the semiconductor pressure sensor 119, into digital information and gives the digital information to the CPU 10. The CPU 10 simultaneously acquires the pressure signals output from the sensor elements 128 included in the semiconductor pressure sensor 19 via the multiplexer 120 along the time axis.

  In the present embodiment, since the CPU 10, the ROM 12, and the RAM 13 are provided in the fixed base unit 107, the display unit 103 can be reduced in size.

  Although the fixed base unit 107 and the display unit 103 of the fixed base 102 are provided separately, a configuration in which both functions are built in the fixed base 102 may be adopted. In addition, although the fixed base unit 107 includes the CPU 10, these may be provided in the display unit 103. Further, it may be connected to a PC (Personal Computer) to perform various controls.

[Method for estimating central blood pressure (operation for estimation)]
The central blood pressure is estimated by using the configuration as described above. The specific central blood pressure estimation operation can be the same as that described in JP-A-2006-000176. Specifically, as described with reference to FIGS. 9, 12, and 13 in this publication, the systolic blood pressure of the central artery is estimated and used for display and the like.

More specifically, FIG. 20 (FIG. 12 of the above publication) shows the waveform of the pressure pulse wave including the reflected wave of the peripheral artery. In FIG. 20, the difference from the lowest level to the peak level of the amplitude of the pressure pulse wave is P1, and the difference from the lowest level of the amplitude of the posterior systolic component generated by the reflected wave of the pressure pulse wave to the peak level. P2, peripheral arterial pressure measured at the same time with the electronic sphygmomanometer 30, that is, systolic blood pressure is shown as P _SYS (mmHg), and diastolic blood pressure is shown as P _DIA (mmHg). At this time, the pressure P _SYS2 (mmHg) of the posterior systolic component of the peripheral artery is obtained by the following equation 1.

P _SYS2 = P2 / P1 × (P _SYS −P _DIA ) + P _DIA (Formula 1)
Once the pressure P _{SYS2 of the} posterior systolic component in the peripheral artery is obtained, the systolic blood pressure c-P _{SYS of} the central artery is then obtained according to Equation 2.

c−P _SYS = α × P _SYS2 + β (Formula 2)
Thus, by estimating and displaying the central blood pressure (central blood pressure value) considered to be a direct index indicating the effect of respiratory training, it is possible to improve the motivation of the user for respiratory training more reliably. it is conceivable that.

  The embodiment disclosed this time should be considered as illustrative in all points and not restrictive. The scope of the present invention is defined by the terms of the claims, rather than the description above, and is intended to include any modifications within the scope and meaning equivalent to the terms of the claims.

It is a figure which shows typically the external appearance of the respiratory training device of this invention. It is a figure which shows typically the system configuration | structure of the breathing exerciser of FIG. It is a figure which shows the other example of the external appearance of the breathing exerciser of FIG. It is a figure which shows an example of the change according to progress of the time of the pulse wave measured in the breathing exerciser of FIG. It is a figure which shows the other example of the change according to progress of the time of the pulse wave measured in the breathing exerciser of FIG. It is a flowchart of the breathing exercise process which CPU of FIG. 2 performs. It is a figure which shows an example of the screen displayed on the indicator of FIG. It is a figure which shows the other example of the screen displayed on the indicator of FIG. It is a figure which shows the further another example of the screen displayed on the indicator of FIG. It is a flowchart of the modification of the breathing exercise process of FIG. It is a figure which shows typically the system configuration | structure of the modification of the breathing exerciser of FIG. (A) And (B) is a figure which shows the change of the pressure pulse wave of the peripheral artery measured simultaneously about the same test subject, and the change of the pressure pulse wave of the central artery. (A) And (B) is a graph which shows the result of having inserted the catheter and measuring the central artery pressure before and after medication. (A) And (B) is a graph which shows a mode that a reflected wave is reduced in the pressure pulse wave of a peripheral artery by medication. It is a graph which shows the measurement result by the experiment of the reflected wave trend of the pressure pulse wave of a peripheral artery, and central artery pressure. It is a figure which shows the connection aspect of the sensor unit and fixed base in embodiment of this invention. It is a figure which shows the usage condition at the time of the pulse wave measurement in embodiment of this invention. (A)-(E) are figures which show the structure of the sensor unit in embodiment of this invention. It is a functional block diagram of the apparatus in embodiment of this invention. It is a figure for demonstrating the procedure of central artery pressure calculation in embodiment of this invention.

Explanation of symbols

  DESCRIPTION OF SYMBOLS 1 Breathing exerciser, 1B indicator, 1D operation key, 5 Sensor amplifier, 7 Blood pressure monitor, 10 CPU, 10A Pulse wave feature-value calculation part, 10B presentation part, 10X guide part, 11 Memory, 13,101 Sensor unit, 71 Pressure control circuit, 51 A / D converter, 102 fixing base, 107 fixing base unit.

Claims (9)

Guide means for executing a process of notifying information for guiding a user to a breathing exercise pattern;
A pulse wave measuring means for measuring the pulse wave of the subject;
A plurality of feature quantities directly obtained from predetermined feature points of the pulse wave waveform measured by the pulse wave measuring means are calculated, and the reflection phenomenon of the pulse wave is reflected by calculation using the calculated plurality of feature points. A pulse wave feature amount calculating means for calculating an index;
The pulse wave measuring unit executes pulse wave measurement before and after the execution of the process by the guide unit, and the pulse wave feature amount calculating unit calculates the index based on the pulse wave measured before and after the execution of the process. Control means for calculating
A breathing exerciser comprising: presentation means for presenting the index calculated by the pulse wave feature amount calculation means. A difference calculating means for calculating a difference between the indices based on the pulse wave measured before and after the execution of the processing calculated by the pulse wave feature amount calculating means;
The breathing exerciser according to claim 1, wherein the presenting unit further presents the difference calculated by the difference unit. Storage means for storing the index based on the pulse wave measured before and after the execution of the processing calculated by the pulse wave feature amount calculation unit;
The control unit causes the storage unit to store the index based on the pulse wave measured before and after the execution of the process calculated by the pulse wave feature amount calculation unit for the processing by the guide unit a plurality of times. The breathing exerciser according to claim 1.   The control means causes the pulse wave measurement means to continuously measure the pulse wave of the subject, and causes the index corresponding to the result of continuous pulse wave measurement by the pulse wave measurement means to be calculated, The breathing exerciser according to claim 1 or 2, wherein when the state in which the change amount of the index is within a certain amount continues for a certain period, the processing by the guide unit is executed.   The respiratory training device according to claim 1, wherein the index is AI (Augmentation Index). Blood pressure measuring means for measuring the blood pressure value of the subject,
The respiratory training device according to any one of claims 1 to 4, wherein the control means causes the blood pressure measurement means to measure a blood pressure value of a subject before or after the processing by the guide means.   The respiratory training device according to claim 6, wherein the presenting unit presents the blood pressure value measured by the blood pressure measuring unit together with the index calculated by the pulse wave feature amount calculating unit. The pulse wave feature amount calculating means includes:
Means for obtaining a backward systolic component in the pulse wave detected by the pulse wave measuring means;
The estimation means which calculates the estimated value of the systolic blood pressure of the central artery of the living body as the index using the posterior systolic component obtained by the means for obtaining the posterior systolic component. The respiratory training device according to any one of 7 above. A computer-readable program for causing a computer to execute a process of informing information that guides a user to a breathing exercise pattern.
A first reading step for reading a measurement result of a subject's pulse wave;
A plurality of feature amounts obtained directly from predetermined feature points of the pulse wave waveform read in the first reading step are calculated, and the reflection phenomenon of the pulse wave is reflected by calculation using the calculated feature points. A first calculation step for calculating an index to be performed;
A notification step of notifying information for guiding a breathing exercise pattern after the first reading step via a device for notifying the information;
A second reading step of reading the pulse wave of the subject after the notification step;
A plurality of feature amounts obtained directly from predetermined feature points of the pulse wave waveform read in the second reading step are calculated, and the reflection phenomenon of the pulse wave is reflected by calculation using the calculated feature points. A second calculating step for calculating an index to be performed;
A computer program for executing the step of presenting the index calculated in the first calculation step and the index calculated in the second calculation step via an information notification device.

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