WO2010029032A1

WO2010029032A1 - Measurement device and measurement method

Info

Publication number: WO2010029032A1
Application number: PCT/EP2009/061520
Authority: WO
Inventors: Dick Scholten; Franz Laermer
Original assignee: Robert Bosch Gmbh
Priority date: 2008-09-15
Filing date: 2009-09-07
Publication date: 2010-03-18
Also published as: DE102008042115A1

Abstract

The invention relates to a measurement device (1) comprising measurement means (3) for determining the pulse wave transit time and/or pulse wave velocity and/or pulse wave shape and comprising fastening means (2) for fastening the measurement device (1) to the human body (14). According to the invention, control means (8) are adapted to control the measurement means (3) in such a way that a long-term profile of the pulse wave transit time and/or of the pulse wave velocity and/or of the pulse wave shape can be determined therewith. The invention further relates to a measurement method.

Description

description

title

Measuring device and measuring method

State of the art

The invention relates to a measuring device according to the preamble of claim 1 and to a measuring method according to the preamble of claim 10.

The standard therapy for patients with heart failure and chronic hypertension is the treatment with antihypertensive drugs. The right dosage and the right combination of prescribed medications must be evaluated individually for each case. The most important basis for the evaluation is a daily blood pressure measurement performed by the patient. Medication evaluation based on daily individual measurements is problematic because blood pressure is not constant throughout the day and is influenced by many factors such as body position, activity, the body's post-daytime rhythm, stress, metabolic activity and food.

It is also problematic that the metabolization as well as the effect of drugs is dependent on the interaction with other drugs or foods. In addition, there is often a lack of involvement of the patient in the medication, for example, because the medication is forgotten, the medication is taken at the wrong time or in the wrong dosage. The evaluation can be improved by a long-term blood pressure measurement, in which the blood pressure is measured approximately every 20 minutes with an automatic, body-worn measuring device over 24 hours. However, wearing this measuring device is a significant burden on the patient and is therefore usually performed only once a quarter. By means of the long-term blood pressure measuring device the blood pressure course can be recorded after taking a medicine. In doing so, the above-mentioned problems which occur during daily individual measurements must also be taken into account in part.

DE 10 2005 003 678 A1 describes a device for long-term blood pressure measurement.

To analyze the morphology of the vessel wall of blood vessels, it is known to measure the pulse wave transit time, ie the time it takes a pulse wave (tube wave) to cover a defined distance. The pulse duration gives information about the degree of calcification of the blood vessels. To determine the pulse wave transit time, the patient must go to a doctor's office where the measurement is performed with a stationary meter.

The previously described in the literature systems for detecting the pulse wave transit time or the pulse shape are limited in addition to the previously described application either to applications for estimating the level of blood pressure, for monitoring recovery phases, for determining the respiratory effort or for determining a massive blood loss. It is also known to use a pulse wave transit time measurement as a before and after measurement in a provocation test with drugs. (see P. Elter, "Methods and Systems for non-invasive, continuous and stress-free blood pressure measurement ", Dissertation, ITIV-Karlsruhe, 2001, RP Schmidt et al.," Pulse Transit Time to appraisal of clinical applications ", Thorax, 1999, 54, pp. 452-458, R. Ochiai , "Detection of Cardiovascular Instability by Pulse Wave Transit Time", Anesthesiology, 91, No 3A, 1999, p 549; CS Hayward et al., "Assessment of Endothelial Function Using Perpheral Waveform Analysis", JACC, 40, p. No. 3, 2002, pp. 521-528).

DISCLOSURE OF THE INVENTION Technical Problem

The invention has for its object to provide a measuring device, based on their measurement results waiving a blood pressure measurement, reliable statements about the effectiveness and / or the duration of action and / or the dosage of at least one drug and / or on the medik kameineinnahmeverhalten a Patients can be made. Furthermore, the object is to propose a corresponding measuring method.

Technical solution

This object is achieved with regard to the measuring device having the features of claim 1 and with regard to the measuring method having the features of claim 10. Advantageous developments of the invention are specified in the subclaims. All combinations of at least two features disclosed in the description, the claims and / or the figures fall within the scope of the invention. In order to avoid repetition, features disclosed in accordance with the device should also be described as being in accordance with the method. be considered and be claimable. Likewise, according to the method disclosed features should be considered as device disclosed and claimed claimable.

The invention has recognized that the most important class of antihypertensive drugs, especially ACE inhibitors and AT2 receptor blockers, affect the vascular tension of blood vessels. Based on this finding, the further realization is that the measurement of the vascular tension is a very specific parameter for the effect of this class of drugs, as the blood pressure. Since the vascular tension, like the blood pressure, depends on various factors, such as the body position, the activity, the daytime post-rhythm of the body, stress, the metabolic activity and the ingested food, the invention proposes a measuring device designed as a long-term measuring device with which the pulse wave transit time and / or the pulse wave velocity and / or the pulse waveform can / can be measured over a relatively long period, preferably over 24 hours, very particularly preferably regularly. In other words, the measuring device designed according to the concept of the invention is designed to detect a long-term profile of the, preferably arterial, pulse wave transit time and / or the, preferably arterial, pulse wave velocity and / or the, preferably arterial, pulse waveform and thus the vascular tension, in particular the effect of Monitor blood vessel-relaxing medications and / or patient involvement. In contrast to backpressure-based blood pressure measurements, the burden of wearing a measuring device constructed according to the concept of the invention is low. The measurement results thus determined over a long period of time make it possible to make a statement about the vascular tension (tension). tion and / or relaxation) of the blood vessel wall, which in turn allows a conclusion on the effectiveness of at least one drug, or a combination of drugs. Furthermore, based on the measurement results statements about the duration of action of at least one drug and / or on the type of dosage of at least one drug possible. Also, the medication intake behavior of a patient can be made by a corresponding evaluation of the pulse wave transit time and / or the pulse wave velocity and / or the pulse waveform. It is very particularly preferred if the control means of the measuring device control the measuring means in such a way that these measurements carry out at least one of the aforementioned parameters continuously or at certain, preferably regular, intervals. It is very particularly preferred if measurements can be carried out at intervals of 15 to 30 minutes, preferably at intervals of 20 minutes, in order to obtain a good overview of the vessel voltage over a relatively long period of time.

In a development of the invention, it is advantageously provided that the control means control the measuring means in such a way that they have a duration of at least 2 hours, in particular of at least 4 hours, preferably of at least 6 hours, preferably of at least 8, very particularly preferably at least 12 hours, more preferably at least 24 hours more, in particular a variety of, perform measurements. It is particularly preferred if the measurements are carried out at regular time intervals, more preferably about every 20 minutes. The measuring apparatus and / or the measuring method can also be designed in such a way that measurements are carried out exclusively during sleep, in order to prevent the patient from being burdened by wearing the measuring apparatus. direction during the day. It is essential that measurements are carried out over a longer period of time, in particular at regular intervals.

In a development of the invention, it is advantageously provided that the measurement results determined by the measuring means are stored in a memory. Most preferably, the memory is externally readable, for example by establishing a cable connection between a personal computer and the measuring device and / or by removing a storage medium. Additionally or alternatively, the measured measurement results can be transmitted to a receiver by radio, for example via mobile radio, etc. In this case, a first embodiment can be implemented in which all measurement results are transmitted at the end of the measurements at once or an alternative second embodiment in which each measurement result is transmitted individually or groups of measurement results, in particular to an evaluation center.

Particularly preferred is an embodiment of the measuring device in which this means for measuring the pulse rate has. As will be explained later, the pulse rate can be used to check the plausibility of the measurement results. Thus, in an optional evaluation of the measurement results by the measuring device, measurement results can be disregarded or weighted differently, which are measured at a time at which a conspicuous, for example, very high pulse rate is measured which is at an exception, for example a sudden stress or a sudden indicates physical effort. In a development of the invention, it is advantageously provided that the measuring device evaluates the recorded measurement results with the aid of integral analysis means. In particular, the analysis means may be designed such that they perform an evaluation of the vessel wall tension, in particular of a patient's arterial blood vessels, on the basis of the measurement results. Preferably, the analysis means are designed such that on the basis of the measurement results and / or on the basis of the measurement results determined vessel wall tension an evaluation of the effectiveness of at least one drug or group of drugs and / or the duration of action of at least one drug and / or a group of drugs and / or the dosage of a drug or a group of drugs. In addition or as an alternative, the analysis means can be designed in such a way that, on the basis of the abovementioned parameters, it evaluates the medication intake behavior of the patient, that is to say his involvement in the intake of the medication. Advantageously, the control means and the analysis means are realized by a common electronics.

As already indicated above, the analysis means can additionally be designed in such a way that the optionally measured pulse frequency is used to plausibilize the measurement results, in particular in such a way that measurement results which were measured at a time at which a conspicuous pulse frequency was measured are not evaluated or more or less taken into account in the evaluation.

In a development of the invention, it is advantageously provided that the measuring means and / or the analysis means, the may be part of common logic means that determine the pulse wave velocity by a signal analysis of the detected pulse shape. In most people, the pulse shape is in the form of a double pulse, which results from the reflection of the pulse in the arterial vasculature. The vascular tension has a significant influence on the time interval of the amplitudes of a double pulse. By determining the distance between the double pulse maxima, it is possible to deduce the pulse wave velocity and thus the vessel wall voltage when the distance traveled by the reflected pulse wave is known. Additionally or alternatively, it is possible to determine the pulse wave velocity based on a pulse-wave propagation time measurement.

Particularly convenient for the patient is an embodiment of the measuring device in which measuring means determine the pulse wave velocity and / or the pulse waveform on the basis of a transmission or reflection measurement. For this purpose, preferably a body part, for example a finger of a patient, is illuminated with the aid of an infrared-emitting LED. In the transmission method, the optical transmission is measured by means of a photodiode, which changes due to a volume expansion due to a pulse wave propagation.

Instead of a transmission measurement, a reflection measurement can also be carried out. In principle, it is possible to determine the abovementioned parameters by measuring methods based on a wide variety of measurement principles. The invention also leads to a method for determining a long-term profile of the pulse wave transit time and / or the pulse wave velocity and / or the pulse waveform, in particular with the aim of determining the vessel wall tension of preferably arterial blood vessels; this in turn with the aim of analyzing the efficacy and / or the duration of action and / or the dosage of at least one drug and / or to evaluate the drug intake behavior of a patient.

It is very particularly preferred if the pulse frequency is used for plausibility of measurement results.

It is very particularly preferred if the pulse wave velocity is determined on the basis of a signal analysis of a detected double pulse shape. For this purpose, the relative position of two amplitudes of the double pulse can be determined by a signal analysis processor. Immediately from knowledge of the relative amplitude position, a statement about the vessel wall tension can be made.

It is particularly preferred if the measuring device is fixed to a finger and / or a hand and / or on an arm joint and / or on an earlobe and / or toe of a patient and / or if the measurement of the pulse wave transit time and / or the pulse wave velocity and / or the pulse waveform is performed at one of these locations. It is also conceivable to select other body locations for positioning and / or performing the measurement. The invention also leads to the use of a previously described device for evaluating the vessel wall tension and / or the efficacy of at least one drug and / or the duration of at least one drug and / or drug intake behavior of a patient and / or the dosage of at least one drug.

Brief description of the drawings

Further advantages, features and details of the invention will become apparent from the following description of preferred embodiments and from the drawings. These show in:

1 is a schematic diagram of a measuring device,

Fig. 2: a schematic diagram illustrating the measuring principle of the double pulse measurement.

Embodiments of the invention

In the figures, like elements and elements having the same function are denoted by the same reference numerals.

FIG. 1 shows a measuring device 1 for measuring the pulse wave velocity and the pulse waveform of human pulse waves (tube waves). The measuring device 1 comprises only schematically indicated fastening means 2 for fixing the measuring device 1 to the human body. Furthermore, the measuring device comprises measuring means 3. The measuring means 3 in turn comprise an LED light source 4 for emitting infrared radiation 5 as well an IR intensity sensor 6 for detecting the transmission of the infrared radiation 5 by a human finger 7. The transmission decreases when a pulse wave (tube wave) through a blood vessel (in particular an artery) between the LED light sensor 4 and the sensor 6 through running. The measuring means 3 are associated with control means 8, which cause a measurement of the pulse wave velocity and the pulse waveform every 20 minutes over a period of 24 hours. The measurement result is passed via a signal-conducting connection to analysis means 9, which analyze the measurement results with respect to the vessel wall tension of the patient's blood vessels and the effectiveness of at least one drug and the duration of action of at least one drug and the dosage of at least one drug and the drug intake behavior of the patient , The result of this analysis and the actual measurement results are stored in a memory 10. Furthermore, the measurement results and the analysis result are visualized on a screen 11. Via a plug contact 12 in a housing 13 of the measuring device 1, the measurement results and the analysis results from the memory 10 can be retrieved.

One way to determine the Pulswellengeschwindig- speed will be explained with reference to the illustration of FIG. 2. A human body 14 with a schematically indicated heart 15 can be recognized. However, a heartbeat sends out a pulse wave through an arterial blood vessel 16 in the direction of the finger 7. For example, with a measuring device 1 shown in FIG. 1, a first pulse wave amplitude 17 can be detected. Due to the heartbeat of the heart 15, however, the pulse wave is not emitted exclusively in the direction of finger 7, but also in the Abdominal cavity into it. There it meets an arterial branch 18 (reflection point) at which it is reflected and only then propagates in the direction of finger 7. There, a second (double), smaller pulse wave amplitude 19 is detected with the aid of a measuring device. With the aid of a signal analysis processor, the time interval t between the pulse amplitudes 17, 19 and thus, knowing the distance traveled by the pulse waves, the pulse wave velocity can be determined.

Claims

claims

1. Measuring device with measuring means (3) for determining the pulse wave transit time and / or the pulse wave velocity and / or the pulse waveform and with fastening means (2) for fixing the measuring device (1) to the human body (14),

characterized,

in that the control means (8) are designed to control the measuring means (3) in such a way that a long-term profile of the pulse wave transit time and / or the pulse wave velocity and / or the pulse waveform is detectable with these.

2. Measuring device according to claim 1, characterized in that the control means (8) the measuring means (3) are designed such that these in a period of at least 2 hours, in particular of at least 4 hours, preferably of at least 6 hours, preferably from perform at least 8 hours, more preferably at least 12 hours, more preferably at least 24 hours, several measurements.

3. Measuring device according to one of the preceding claims, characterized in that a, in particular externally readable memory (10) is provided for storing the measurement results.

4. Measuring device according to one of claims 2 or 3, characterized in that radio means are provided for transmitting the measurement results to a receiver.

5. Measuring device according to one of the preceding claims, characterized in that means are provided for measuring the pulse rate.

6. Measuring device according to one of the preceding claims, characterized in that analysis means (9) are provided on the basis of the measurement results, an assessment of the vessel wall tension and / or the effectiveness of at least one drug and / or the duration of action of at least one medication and / or the drug intake behavior of a patient and / or on the dosage of at least one drug performing are designed.

7. Measuring device according to claim 6, characterized in that the analysis means (9) are designed to take into account the pulse frequency for plausibility of the measurement results.

8. Measuring device according to one of the preceding claims, characterized the pulse wave velocity can be determined on the basis of a signal analysis of a measured double pulse shape and / or on the basis of the pulse wave transit time.

9. Measuring device according to one of the preceding claims, characterized in that the measuring means (3) are formed measuring on the basis of a transmission or reflection measurement and / or based on a based on an electrical, optical, magnetic, thermal, acoustic and / or electromagnetic principle measuring method are formed measuring.

10. measuring method for determining the pulse wave transit time and / or the pulse wave velocity and / or the pulse wave shape,

characterized,

that a long-term profile of the pulse wave transit time and / or the pulse wave velocity and / or the pulse waveform is created.

11. Measuring method according to claim 10, characterized in that on the basis of the measurement results, an evaluation of the vessel wall tension and / or the effectiveness of at least one drug and / or the duration of action of at least one drug and / or the medication intake behavior of a patient and / or the dosage at least one drug is performed.

12. Measuring method according to claim 11, characterized in that the pulse frequency is measured and taken into account for the plausibility of the measurement results.

13. Measuring method according to one of claims 10 to 12, characterized in that the pulse wave velocity on the basis of a signal analysis of a measured double pulse shape and / or based on the pulse travel time are determined.

14. Measuring method according to one of claims 10 to 13, characterized in that the measurement is performed on a finger (7) and / or on a hand and / or on an arm joint and / or on an earlobe and / or on a toe and / or a measuring device (1) for performing the measurements is determined at at least one of these body locations.

15. Use of a device according to one of claims 1 to 9 for evaluating the vessel wall tension and / or the effectiveness of at least one drug and / or the duration of action of at least one drug and / or the drug intake behavior of a patient and / or the dosage of at least one drug.