U.S. patent number 3,905,354 [Application Number 05/443,442] was granted by the patent office on 1975-09-16 for blood pressure measuring system.
This patent grant is currently assigned to Medical Monitors, Inc.. Invention is credited to Abraham Lichowsky.
United States Patent |
3,905,354 |
Lichowsky |
September 16, 1975 |
Blood pressure measuring system
Abstract
The blood pressure measuring system includes the generation of
output signals by correlation of pressure pulses detected in a
fluid system used to close off the blood flow, with acoustic pulses
detected downstream near the blood flow close-off point in a
patient's arm or other portion of his body. Correlating the
pressure pulses with the acoustic pulses and generating output
signals only when there is a coincidence between the pressure and
acoustic pulses minimizes the effect of spurious signals and
artifacts to the end that a more accurate systolic and diastolic
blood pressure reading may be provided. In this respect, the
systolic pressure is indicated at the point in time that the output
signals start and the diastolic pressure is indicated at the point
in time that the output signals terminate.
Inventors: |
Lichowsky; Abraham (Los
Angeles, CA) |
Assignee: |
Medical Monitors, Inc. (Los
Angeles, CA)
|
Family
ID: |
23760820 |
Appl.
No.: |
05/443,442 |
Filed: |
February 19, 1974 |
Current U.S.
Class: |
600/494 |
Current CPC
Class: |
A61B
5/02141 (20130101); A61B 7/045 (20130101); A61B
5/02208 (20130101); A61B 5/7239 (20130101) |
Current International
Class: |
A61B
5/022 (20060101); A61B 7/00 (20060101); A61B
7/04 (20060101); A61B 005/02 () |
Field of
Search: |
;128/2.5A,2.5C,2.5G,2.5M,2.5P,2.5Z |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
Primary Examiner: Howell; Kyle L.
Attorney, Agent or Firm: Pastoriza; Ralph B.
Claims
What is claimed is:
1. A method of automatically measuring a patient's systolic and
diastolic blood pressure comprising the steps of:
a. applying pressure to close off blood flow to a portion of the
patient;
b. detecting pressure pulses corresponding to the patient's
heartbeat;
c. decreasing the applied pressure gradually;
d. generating quantized pressure signals in response to said
pressure pulses to provide individually defined pressure signals of
uniform amplitude;
e. detecting acoustic pulses in said portion of the patient as the
applied pressure is being decreased;
f. generating quantized signals in response to said acoustic pulses
to provide individually defined acoustic signals of uniform
amplitude;
g. correlating said pressure signals and acoustic signals to
provide an output signal only when a pressure signal occurs
simultaneously with an acoustic signal; and,
h. utilizing said output signals to provide indications of pressure
being applied at the start and termination of the output signals,
whereby the patient's systolic and diastolic blood pressures are
respectively measured.
2. The method of claim 1, in which said pressure is applied at a
given rate over a given range and thence held for a given time
interval and thence again applied at said given rate over a second
given range and held for said given time interval, the application
and holding being repeated until there is an absence of said output
signals detected during any two successive time intervals, said
step of decreasing the applied pressure gradually then being
initiated.
3. A system for automatically measuring the systolic and diastolic
blood pressures of a patient, comprising, in combination:
a. means for applying pressure to close off blood flow to a portion
of the patient's circulatory system;
b. means responsive to the patient's heartbeat to detect pressure
pulses in substantial synchronism with said heatbeat;
c. means connected to said means for applying pressure for
gradually decreasing the applied pressure;
d. pressure transducer means connected to said means for gradually
decreasing the applied pressure to provide an analog pressure
signal of the pressure;
e. means responsive to pulses in the downstream side of the
close-off pressure point in the patient's circulatory system to
detect acoustic pulses;
f. filtering and threshold detecting means for respectively
filtering and detecting said pressure and acoustic pulses and
respectively providing quantized individually defined electrical
pressure and acoustic signals;
g. coincidence circuit means receiving said pressure and acoustic
signals and providing an output signal only upon coincidence of a
pressure signal and an acoustic signal; and
h. measuring means connected to receive the output signals and
responsive to said analog pressure signal to provide indications of
the pressure detected by said pressure transducer means at the
start and termination of said output signals, whereby the systolic
and diastolic blood pressures are automatically measured.
4. A system according to claim 3, in which said means for applying
pressure includes a flexible fluid chamber arranged to surround
said portion of the patient and having an inlet fluid line and
associated inlet control valve, said means for gradually decreasing
the applied pressure including an outlet fluid line from said
chamber and associated outlet control valve, said means responsive
to the patient's heartbeat to detect pressure pulses including a
differentiating circuit receiving said analog pressure signal and
providing said pressure pulses in response to pressure fluctuations
in said analog pressure signal; an analog-to-digital converter
responsive to said analog pressure signal to generate digital coded
signals indicative of the pressure, said coded signals being
applied to and stored in said measuring means; and a logic control
circuit connected to said inlet and outlet control valves and
connected to receive said coded signals and said output signals
whereby automatic proportional opening and closing of the valves is
controlled by the coded and output signals in accord with a
programmed application of pressure and gradual decreasing of
pressure to be provided in said fluid chamber.
5. A system according to claim 4, in which said means responsive to
pulses downstream of the close-off pressure point includes an
acoustical conduit with one end in physical contact with said
portion of the patient and its other end terminating in a
microphone for receiving sound in said conduit and converting the
sound into said acoustic pulses, there being provided insulation
material around said microphone to shield it from ambient noise and
vibration.
6. A system according to claim 4, in which said measuring means
includes means providing a visual digital display of the systolic
and diastolic blood pressures.
7. A system according to claim 4, in which said measuring means
includes means for automatically recording said systolic and
diastolic blood pressures.
Description
This invention relates to blood pressure measuring systems and more
particularly to an improved system for automatically indicating
and/or recording a patient's systolic and diastolic blood pressures
by the use of pneumatic and electronic components so that it is no
longer necessary for a doctor or nurse to conduct the various steps
involved in determining such pressures.
BACKGROUND OF THE INVENTION
The systolic blood pressure of a patient or person is a measure of
the peak or maximum pressure in the patient's circulatory system
whereas the diastolic blood pressure is a measure of the average
pressure of blood flowing through the circulatory system. The
conventional and normal procedure for determining these pressures
involves a doctor or nurse closing off a portion of the patient's
circulatory system, such as at the patient's arm to block flow of
blood to the lower portion of the arm. A fluid pressure chamber
normally operated by air is wrapped about the upper portion of the
patient's arm and pressure is applied until the blood flow is cut
off. By the use of a stethoscope positioned downstream of the
close-off point, the doctor can determine when sufficient pressure
has been applied to close off the blood flow, there being an
absence of acoustic pulses resulting from blood pressure and flow
pulses detected in the stethoscope.
After the close-off has been achieved, the doctor or nurse will
gradually release the pressure and carefully listen with the
stethoscope for the start of blood flow to the lower portion of the
arm. At the instant a first acoustic pulse is detected in the
stethoscope, a reading of a suitable manometer or other pressure
indicating device connected to the fluid chamber is taken, thereby
indicating the systolic blood pressure. The pressure is gradually
decreased further until such time as there is an absence of
pronounced acoustic pulses detected by the doctor listening in the
stethoscope and at this point, another pressure reading is taken,
which serves to indicate the diastolic blood pressure.
The acoustic pulses, called Korotkoff sounds in the medical
profession, are divided into five phases based on changes in the
characteristics of the sounds as cuff pressure is decreased. Phase
IV is a muffled sound relative to the first three phases. Phase V
is silent. There is some disagreement on whether the end of Phase
III or Phase IV more accurately represents the true diastolic
pressure.
While it is a widespread practice for technicians and nurses to
take a patient's blood pressure in accord with the foregoing
procedure, very few persons even among professionals are really
skilled at determining accurately the systolic and diastolic
pressure without taking internal taps. One of the major problems is
the introduction of extraneous signals (artifacts) by movement or
activity of the patient and incidental interactions between the
instrument components, such as the stethoscope and the patient, his
clothing, and so forth. Extraneous room noises also interfere with
a proper detection of changes in blood flow. A properly trained
physician or nurse can, after much experience, conduct fairly
accurate blood pressure measurements. In this respect, the doctor's
sensitivity to proper acoustic pulses and improper or erroneous
signals becomes developed to the point that he can exclude most
spurious signals in making his measurement.
Since there are relatively few persons really capable of taking
accurate blood pressure measurements, several systems have been
proposed for mechanizing the process to the end that the subjective
factors introduced when an untrained person attempts to take the
pressure can be eliminated. However, such mechanized systems for
automatically indicating or recording the systolic and diastolic
pressures are also subject to false triggering by spurious signals
and it has been found that a trained doctor or nurse can still best
provide the most accurate measurements. Nevertheless, it would
still be desirable if there were some means for accurately
determining a patient's blood pressure in a thoroughly automatic
manner. Such an automatic system would enable large numbers of
patients to have their blood pressures taken with consistent
results. Moreover, the necessity of trained specialists for
carrying out the procedure could be avoided.
BRIEF DESCRIPTION OF THE PRESENT INVENTION
With the foregoing considerations in mind, the present invention
contemplates a system for automatically measuring a patient's
systolic and diastolic blood pressure wherein most extraneous
noises and spurious signals are eliminated all to the end that
great accuracy is achieved in a fully automatic manner.
Briefly, the system involves applying pressure to close off blood
flow to a portion of the patient. The applied pressure is then
decreased gradually and then pressure pulses are detected
corresponding to the patient's heartbeat and blood flow pulses in
the closed off portion. Also acoustic pulses are detected in a
portion of the patient downstream of the blood flow as the applied
pressure is being decreased. Electrical signals in turn are
generated corresponding to the detected pressure and acoustic
pulses. These signals are then quantized and correlated to provide
an output signal only when a pressure signal occurs simultaneously
with an acoustic signal. Spurious signals or extraneous pulses are
thus substantially eliminated, since most disturbances causing
pressure fluctuations do not produce significant acoustic output
while acoustic interference does not produce significant pressure
transients. On the other hand, heartbeats within the appropriate
cuff pressure range produce pressure and sound in essential time
synchronism.
The output signals resulting from coincidence of the pressure and
acoustic signals are then utilized to display or record
automatically a pressure reading at points in time corresponding to
the start and termination of the output signals.
BRIEF DESCRIPTION OF THE DRAWINGS
A better understanding of the system of this invention will be had
by now referring to the accompanying drawings in which:
FIG. 1 is a block diagram of the automatic blood pressure measuring
system of this invention wherein the blood pressure is being taken
from a patient's arm; and,
FIG. 2 illustrates a pressure analog signal plot and pulse diagrams
indicating conditions at correspondingly lettered points in the
block diagram of FIG. 1, useful in explaining the operation of the
system.
DETAILED DESCRIPTION OF THE INVENTION
Referring first to FIG. 1, there is shown a patient 10 together
with means for applying pressure to a portion of his body, such as
his left arm 11, as by means of a flexible fluid chamber 12. The
chamber 12 may constitute a wrap-around flat tubular arrangement
which can be secured so that increasing the fluid pressure within
the chamber applies pressure to the arm 11.
Towards the foregoing end, there is provided an inlet tube 13
including an inlet control valve 14 in turn receiving fluid under
pressure from a source 15. The valve 14 is of the proportional type
so that the rate of pressure build up or application to the fluid
chamber 12 can be controlled by the degree of opening of the valve
14.
Means for gradually decreasing the pressure in the fluid chamber 12
includes an outlet tube 16 having an outlet valve 17. The outlet
valve 17 is also of the proportional type so that the rate of
bleeding off of fluid pressure from the chamber can be controlled.
A pressure transducer 18 in the tube 13 serves to convert the
actual pressure changes occurring in the fluid chamber 12 to an
electrical analog signal.
In the particular embodiment illustrated, a means for generating
pressure pulses corresponding to the patient's heartbeat takes the
form of a differentiating circuit 19 connected to receive the
analog signal from the pressure transducer 18. As will become
clearer as the description proceeds, the differentiating circuit 19
detects pressure fluctuations in the analog signal to provide
essentially a series of electrical pressure pulses which are then
passed through a filter and threshold detector network 20 to
provide quantized electrical pressure signals. As shown, these
electrical pressure signals are passed into one side of a
coincidence circuit 21.
Means responsive to pulses in the downstream side of the close-off
pressure point in the patient's arm 11 are provided to generate
acoustic pulses. This means in the embodiment illustrated takes the
form of an acoustical conduit 22 with one end 23 in physical
contact with the patient's arm and its other end terminating in a
microphone 24, preferably mounted in sound insulation and vibration
isolating material 25 to shield the microphone from ambient noise
and perturbations. Acoustic pulses from the microphone are passed
through a filter and threshold detector network 26 to provide
quantized output electrical acoustic signals which are then passed
through the other side of the coincidence circuit 21.
The coincidence circuit 21 will provide an output signal only when
signals simultaneously occur at its first and second inputs. These
output signals are passed to a measuring means 27 which may include
a digital display and/or recording means.
Referring again to the output of the pressure transducer 18, it
will be noted that the analog pressure signal is also passed to an
analog-to-digital converter 28 which essentially converts the
pressure values into digital coded signals. These coded signals are
passed along a first line 29 into the measuring means 27, the
measuring means being triggered to display or record the specific
pressure coded signal fed thereto at the start of output signals
received therein and at the termination of such output signals.
Thus, the coded signals are stored and updated during each output
signal. After termination of the output signal the first and last
stored coded signals are displayed.
The same coded signals are also passed along a line 30 to a logic
control circuit 31 connected to control the action of the inlet and
outlet valves 14 and 17 through summing junctions as shown. It will
also be noted that the output signals from the coincidence circuit
21 are also passed to the logic control circuit 31 by way of line
32 and that differentiated signals from circuit 19 are passed to
the summing junctions. The proportional operation of the valves 14
and 17 are thus responsive to pressure rates of change feedback
signals from the differentiating circuit 19.
In the upper graph of FIG. 2, there is illustrated at 33 the analog
pressure signal appearing at the point A at the output of the
pressure transducer 18. This plot represents the changes in
pressure in millimeters of mercury occurring in the fluid chamber
12 of FIG. 1 as a function of time in seconds. It will be noted
that the pressure is applied at a given rate over a given range
which rate is fairly rapid; for example, 50 millimeters per second.
After a given pressure range has been covered, the pressure is held
for a given time interval or dwell period such as indicated at 34.
The given rate of application is then again applied over a second
given range, for example, 20 millimeters of mercury and then again
held for the given time interval, the application and holding of
the pressure being repeated as indicated. The respective steps or
dwell periods might, for example, be one second in duration. At one
of the dwell periods, the inlet valve 14 of FIG. 1 is automatically
closed and the outlet valve 17 opened very slightly to permit a
gradual decrease in the pressure as indicated by the curve 33. It
will be noted that there are slight pressure fluctuations in the
overall analog pressure signal 33. These fluctuations,
corresponding to the heartbeats of the patient, are accentuated in
the range between the systolic and diastolic pressures.
As described in conjunction with FIG. 1, these pressure
fluctuations in the analog pressure curve are utilized to generate
pressure pulses. These pressure pulses are shown in diagram B at 35
and correspond to the signals appearing at the lettered point B
from the differentiating circuit 19.
Diagram C shows the pressure pulses after they have passed through
the filter and threshold network 20 wherein it will be noted that
they are essentially quantized to provide sharp individual pressure
signals 36 of uniform amplitude.
Pulse diagram D in FIG. 2 illustrates the detected acoustic pulses
some of which are shown at 37 from the microphone 24 of FIG. 1
which pulses are passed into the filter and threshold network 26.
It will be noted that various extraneous noise signals and
variations accompany the acoustic pulses and it is in the proper
detection of the acoustic pulses resulting from a resumption of
blood flow that is most important in providing accurate blood
pressure measurements. As mentioned, the spurious signals which
appear between the pulses have not been properly discriminated
against in automatic apparatus heretofore proposed for making blood
pressure measurements.
Diagram E shows the result of filtering and quantizing the acoustic
pulses to provide uniform acoustic signals as at 38.
Pulse diagram F in FIG. 2 illustrates some of the output signals at
39 from the coincidence circuit 21. These output signals only occur
upon time coincidence of the pressure signals 36 and the acoustic
signals 38 and because of this correlation, it will be immediately
evident that a substantial proportion of the extraneous unwanted
signals are eliminated.
In the various plots A to F of FIG. 2, the abscissa time scales in
seconds are identical. It will be noted that by projecting in time
the start of the output signals 39 in diagram F up to the analog
pressure curve 33, and thence over to the ordinate axis there will
be provieed an indication of the systolic blood pressure. This
blood pressure corresponds to the start of blood flow which is
indicated by the acoustic pulses 37 in diagram D. When full normal
flow is achieved as a result of the continued decrease in the
pressure, these acoustic pulses 37 will no longer be evident and
thus the output signals 39 will terminate. This projected point
onto the analog pressure curve and thence over to the ordinate
pressure axis will indicate the diastolic blood pressure.
During the rapid pressure build up at the initial portion of the
analog pressure curve 33 as shown in diagram A, it will be noted
that slight pressure fluctuations will occur both during the build
up period and the dwell period, such as indicated at 40, thereby
assuring generation of the pressure pulses 35 in diagram B over the
entire pressure range of interest. Further, it will be evident that
until the pressure build up passes the systolic pressure point,
there will be detected acoustic pulses by the microphone 24 of FIG.
1, as indicated at 41 in diagram D. Accordingly, coincidence of
these acoustic pulses with the initial pressure pulses will give
rise to output signals 42 from the coincidence circuit during the
application of pressure.
The significance of the foregoing signals will be understood when
considering the overall operation of the system which will now be
described.
OPERATION
Referring to FIG. 1, the fluid chamber 12 is initially applied to a
portion of the patient's body such as his arm. Further, the small
cup 23 at the end of the acoustical conduit 22 may be attached to
the chamber so that it is secured to the lower portion of the
patient's upper arm in a position to detect acoustic pulses therein
as a consequence of constricted blood flow.
The logic control circuit 31 for the inlet and outlet valves 14 and
17 is programmed and controlled by the fedback signals on the lines
30 and 32 and the differentiated signals from the circuit 19. Thus,
upon starting a cycle of the equipment, the logic control 31 will
open the inlet valve 14 to apply pressure fairly rapidly from the
pressure source 15 to the fluid chamber 12.
Referring to diagram A of FIG. 2, the build up of pressure in the
fluid chamber is shown by the analog pressure curve 33 wherein the
build up rate is indicated at fifty millimeters per second. The
programmed pressure control in the logic circuit 31 is such as to
cause the valve 14 to close when 120 millimeters of mercury
pressure is reached, so that the pressure is held for a dwell
period of, for example, one second as indicated by the step 34. If
any blood is still flowing to the lower portion of the patient's
arm, acoustic pulses such as indicated at 41 in diagram D will be
detected and output pulses 42 will be fed back into the logic
control 31 through line 32 signalling that the pressure build up
program is to be continued. The valve 14 will then be opened until
the pressure increases, for example, 20 more millimeters of mercury
to 140 at which point the valve will be closed for a second dwell
period.
At the second dwell period, it will be noted that the pressure is
above the represented systolic pressure and therefore flow has been
blocked off and there will be no acoustic pulses corresponding to
41 in diagram D detected. Thus the output signals 42 will
terminate. The pressure program in the logic control 31 is such as
to effect one further pressure increase as a safety measure to make
sure that blood flow is completely blocked. Thus, the pressure will
increase in steps until two successive dwell periods have passed at
which no acoustic pulses such as indicated at 41 are detected.
In the example of FIG. 2, this pressure is 160 millimeters of
mercury but in the event that pressure pulses were detected during
the dwell period at one-forty or one-sixty, the build up would
continue as indicated by the dotted lines.
After the build up has been completed which in the example chosen
is 160 millimeters of mercury, the inlet valve 14 is closed and the
outlet valve 17 of FIG. 1 is opened slightly to permit a gradual
decrease in pressure. This decrease may be at the rate, for
example, of 2 millimeters per second.
During this decrease period, the small pressure fluctuations in the
analog pressure curve 33 caused by the heartbeat are accentuated
and generate the pressure pulses 35.
The gradually decreasing pressure will continue until a point is
reached at which blood flow will start to the lower extremity of
the arm. As mentioned, this pressure corresponds to the systolic
blood pressure and in the example of FIG. 2 occurs at about 138
millimeters of mercury. The resumption of flow is marked by
accentuation of pressure pulses as indicated at 33' giving rise to
pressure signals as shown at 36'. Resumption of flow is also marked
by the detection of the acoustic pulses 37 as shown in diagram D.
An output electrical signal from the coincidence circuit will only
occur when the acoustic pulses are in time synchronism with the
pressure pulses 35 as correlated by coincidence of the pressure and
acoustic signals 36 and 38. Thus, as also mentioned heretofore,
spurious, extraneous acoustic pulses are substantially eliminated.
The start of the output signals 39 triggers the measuring means 27
in FIG. 1 to record the systolic pressure as provided by the coded
signals on line 29. This pressure could as well be visually
displayed.
Termination of the output pulses 39 as will occur when the
diastolic pressure is reached also triggers the measuring means 27
to record and/or display the corresponding diastolic pressure as
provided by the coded signals and stored during the last output
pulse.
It will thus be evident that the start and termination of the
output signals from the coincidence circuit 21 define the indirect
systolic and diastolic pressure points of the patient in the same
manner that a doctor determines such pressures by taking readings
when he listens for the initiation and termination of the acoustic
pulses. However, in view of the provision of the correlation
technique as described, accurate and consistent results can be
achieved.
It should be understood that in the event the raw signal-to-noise
ratio is relatively low, further correlation techniques can be
employed by utilizing more than the two individual channels. For
example, it should be understood that the provision of the pressure
pulses by differentiating the slight pressure fluctuations in the
analog pressure curve 33 constitutes only one means of obtaining
such correlation signals. Other techniques could be used such as
arterial displacement, light transmission modulation at extremeties
of the body, electrical potential fluctuation at the skin, and so
forth.
The essence of the present invention resides in providing at least
two independent signals corresponding, first, to the patient's
heartbeat in the form of pressure signals, and second, to acoustic
signals caused by constricted blood flow in the downstream portion
of the circulatory system which is closed off. Time correlation of
these signals then provides accurate output signals which are
relatively clear of extraneous pressure pulses or spurious signals.
The start and termination of the generated output signals are then
utilized to trigger the proper display of the systolic and
diastolic pressures or as mentioned automatically record such
pressures.
From the foregoing description, it will thus be evident that the
present invention has provided a vastly improved blood pressure
measuring system wherein accurate and consistent measurements can
be achieved without the necessity of skilled personnel.
* * * * *