Device for measuring blood pressure.

p0001The invention relates to a blood pressure measuring device of time, in particular for the automatic measurement of blood pressure over a longer period, in which the measured values ​​obtained in each case are stored in a memory.

p0002Ambulatory blood pressure monitors that allow monitoring and recording of the blood pressure values ​​of patients over extended periods of time, especially over 24 hours, are used in practice for some time. The blood pressure measurement is usually carried out at constant time intervals, for example every fifteen minutes. A drawback of such blood pressure monitors is that the often repeated interruption of the blood circulation, in particular by pressurizing a cuff to the patient is very uncomfortable in the long run.

p0003In a blood pressure measuring device known from DE-38 07 672 A1 of the blood pressure is determined indirectly via the continuously measured pulse transit time. However, this is not a true replacement for a direct measurement of blood pressure, since the pulse transit time is not only dependent on the blood pressure. It is therefore also necessary to measure blood pressure in demand for a clearly verifiable measurement using a cuff immediately because such cuffs are also calibrated.

p0004The invention has for its object to provide a blood pressure measuring device of the aforementioned type, with which can be determined by means of a cuff performed blood pressure measurements, and thus at a lower load on the patient during a long-term monitoring in total to be determined blood pressure values ​​at a lower number of immediate, for example. Furthermore, to be improved by combination of parameters and time-synchronous evaluation and presentation of measurement values ​​the significance of test results, especially taking into account existing correlations between Blutdruckmeßwerten and further measured values ​​or Meßwertkombinationen.

p0005The major part of this problem is solved by the invention in that the blood pressure measuring device comprises a long-term ECG measurement device and an evaluation and control circuit via which a respective immediate blood pressure measurement as a function of which is triggered if the means of the Holter ECG-measuring device determined parameters predetermined values ​​or may not have.

p0006An advantage of this blood pressure measuring device is that the respective blood pressure measurements are always performed under defined, predetermined body states for which they are needed for later diagnosis. In particular, critical body conditions are suitable, in which certain limit values ​​of parameters determined by means of the Holter device are out of range. This also highlights the fact is taken that the blood pressure not only on the age and constitution of the individual patient depends, but also of their mental and physical condition. Blood pressure measurements at such body states that are associated with a later diagnosis performed not of interest are not carried out, so that the patient is generally much relieved.

p0007Preferably also determined by means of the long term ECG measurement device parameter values ​​can be stored in a memory so that these parameters can be retrieved together with the associated blood pressure values ​​again and for subsequent diagnosis, the required mapping for the values ​​is added to each other.

p0008Advantageously, the blood pressure measurement is done at several different, predeterminable values ​​of the determined by means of the long term ECG measurement device parameters or at several different, fixable from the start states of the body of the patient.

p0009Another very crucial discharge of the patient from unnecessary blood pressure measurements is advantageously achieved in that the evaluation and control circuit includes repetition recognition to detect multiply occurring during the measurement period parameter values ​​and is designed such that the repeated occurrence of specific parameter values ​​under remains a renewed blood pressure measurement. It can be determined that the suppression of a blood pressure measurement takes place only when certain parameters or parameter combinations have repeatedly rendered virtually identical blood pressure readings, so that a high level of security for this is that caused by the suppression of Blutdruckmeßvorgängen no reduction in the overall validity of measurements have , The suppression itself unnecessarily repeated blood pressure measurements also increases the clarity of recoverable images and facilitates accordingly the diagnosis.

p0010The corresponding sensors having Holter-measuring device is designed in a particularly advantageous manner for the determination of such parameters as, in the form of the QRS complex, QRS intervals, heart rate, the number of premature beats, the ST changes, the Arrhytmieüberwachung the pulse on a limb, in particular the earlobe, the pulse wave Velocity, he d body temperature, respiratory rate, arterial sounds and / or pCO₂ changes present.

p0011The so-called QRS complex corresponds to the excitation propagation in both ventricles. For determining the pulse transit time (PWL) the duration of the caused by each heartbeat pulse wave is measured, for example, using either the time difference between the R wave of the electrocardiogram and the arrival of the pulse at a peripheral artery measures or the time difference between two different far-distal pulses detected by mechanical or optical pickup.

p0012For each diagnosis, it is expedient if the results of the blood pressure or ECG measurement on a visual display represented and / or downloaded via an output unit are.

p0013The usable in particular in connection with a blood pressure measuring device of the type mentioned invention Holter device advantageously comprises an evaluation circuit which predeterminable in appearance, a respective blood pressure measurement-requiring values ​​of the parameters determined provides an appropriate control signal for the sphygmomanometer and / or acoustic or optical signal transmitter controls. If a corresponding signal perceived, for example, it can then the patient or a present doctor place the cuff and making the required blood pressure measurement.

p0014When blood pressure meter used in this case only one a respective blood pressure measurement inducing trigger circuit is optionally provided, which is the control signal of the Holter device acted upon.

p0015The invention is explained below with reference to the single FIGURE.

p0016This shows a schematic representation of a blood pressure measuring device 10 for automatically measuring blood pressure over a longer period.

p0017This blood pressure measuring device 10 includes an evaluation nd control circuit 16 with associated memories 12 and 20 for the obtained measured values. The detected in the course of monitoring blood pressure readings are stored in memory 12th

p0018The blood pressure measuring device 10 also includes the necessary for immediate blood pressure measurement device part 22 with an automatic actuation of a cuff 26 serving pump 24 a Holter-measuring device 14, which is the memory 20 assigned to receive particular herzfreguenzspezifischen parameters 18th

p0019The mentioned parameters 18 are determined by a number of sensors 34, which are, for example, may include the following can be placed electrodes on the body of the patient.

p0020The Holter-14 is designed for the determination of different, already explained in the individual parameters. Basically, both the measurement of individual as well as a certain combination of parameters is possible, the device is preferably designed such that certain parameters or combinations of parameters can be fixed and depends on patient selected by the physician. In principle, however, also the device physician using parameter combinations even pretend and select dates.

p0021The required for the automatic blood pressure measurement device part 22 including the automatic operation of the cuff 26 serving pump 24, together with the long term ECG measurement device 14 and the evaluation and control circuit 16 including associated memory 12, 20 combined to form a system 28 which as portable, mountable on the patient system is formed. A respective blood pressure measurement including a corresponding actuation of the sleeve 26 by the pump 24 occurs as a function of whether the parameters determined by means of long-term ECG measurement device 14 having 18 predetermined values ​​or not. For example, there is a pressure measurement when these parameter values ​​exceed certain thresholds or fall or be within certain ranges.

p0022The blood pressure measurement is carried out at a plurality of different, presettable Parameterwertern, ie with different defined states of the body.

p0023Further, the evaluation and control electronics 16 comprises a repetition identification, over which is detectable when repeatedly occur during the measuring period values ​​certain parameters or combinations of parameter values. In this case, the electronics provide for corresponding comparison of a plurality of such constellations in dependence on the comparison result, that in this particular constellation under remains a further blood pressure measurement, and it can be assumed that a further measurement would only further provide the already known value.

p0024The results from the blood pressure and ECG measurements are displayed on a visual display 30th Alternatively or additionally it can be provided for retrieval of this data also an output unit. It can also be present in particular an input unit for input of the presettable parameter specifications.

p0025In the present case, the long-term ECG device provides for triggering the measurement of blood pressure via a line 44 a control signal to the device portion 22 for automatically performing the blood pressure measurement. As shown in the drawing, this control signal is generated in this specific case by the evaluation and control circuit sixteenth Basically, it is also conceivable to provide the ECG device with an evaluation circuit, which upon the occurrence of predeterminable, blood pressure check-requiring parameter values ​​triggers an acoustic or optical signal transmitter 32nd

p0026can particularly favorably in the present invention the use of the temporal course of the respiratory rate and the flow noise in arteries affect as parameters, in particular in combination with other aforementioned parameters.

p0027The consideration of the breathing frequency may provide essential clues in apnea treatment in connection with the measurement of blood pressure for the doctor, and the evaluation of the flow noise in arteries provides insights into the vascular condition so that in turn sizes are obtained, which in conjunction with the blood pressure measurement for both diagnosis as well as for the determination and formation of a current blood pressure profile representative signal are of importance.

p0028Because of zeitsynchonen detecting a plurality of measured quantities to the doctor can be provided a valuable diagnostic tool available through the corresponding representation, but this time synchronous capture of several measured values ​​also makes it possible to equip the device with a strong ability to learn, because different by comparison of the course parameter values, for example via a calibrated cuff performed blood pressure measurements is a high correlation between these time-spaced blood pressure measurements and the curve of a measured signal or any weighted combination of several measurement signals can be created, so that then practically continuously the blood pressure values ​​read from the corresponding representation of this waveform and the others can be compared synchronously recorded measurement values.

p0029It is advantageous, furthermore, to take into account the current state of the patient in that the parameters used to form a corresponding blood pressure profile signal are changed automatically when the patient is, for example, in a resting phase, an active phase or an exciting phase. In this way, it is again not only possible to improve the validity of time-synchronous measurement representations for the doctor, but also the accuracy of a formed continuous measurement signal, which represents the blood pressure to increase so that virtually always a match with time-spaced blood pressure individual measurements by means calibrated cuff is obtained.