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BACKGROUND OF THE INVENTION
1. Field of the Invention
The present invention generally relates to a pulse wave detecting apparatus.
2. Problem Solved by the Invention
There has been proposed a pulse wave detecting apparatus for detecting a pulse wave produced from an arterial vessel of a subject. The apparatus includes a pulse wave sensor having a press surface, and a plurality of pressure sensing elements
provided in the press surface such that the elements are arranged in one or more arrays. The press surface is adapted to be pressed against the arterial vessel via a body surface of the subject such that the array or arrays extend(s) in a direction
intersecting the arterial vessel. Each of the pressure sensing elements senses the pulse wave transmitted thereto from the arterial vessel and generates a pulse wave signal representative of the sensed pulse wave. The pulse wave detecting apparatus
utilizes the pulse wave signal supplied from an optimum pressure sensing element selected out of the pressure sensing elements. This apparatus is disclosed in U.S. patent application Ser. No. 508,609 filed on Apr. 13, 1990 the assignee of which is
the assignee of the present application.
If it is identified in the above indicated apparatus that an abnormal pulse wave signal is supplied from the optimum pressure sensing element, it is required that the optimum element be updated, namely, changed to another element that supplies a
normal pulse wave signal. However, provided that a new optimum element be selected based on the pulse wave signals supplied from the pressure sensing elements after the abnormality of the signal from the optimum element is identified, a comparatively
long time would be needed until the new optimum element is selected.
SUMMARY OF THE INVENTION
It is therefore an object of the present invention to provide a pulse wave detecting apparatus which, upon identification of the abnormality of a pulse wave signal supplied from an optimum pressure sensing element, instantly selects a new optimum
element in place of the element supplying the abnormal signal.
The above object has been achieved by the present invention, which provides a pulse wave detecting apparatus comprising (a) sensing means for sensing a pulse wave produced from an arterial vessel of a subject, the sensing means including a press
surface, and a plurality of pressure sensing elements provided in the press surface such that the pressure sensing elements are arranged in at least one array, the press surface being adapted to be pressed against the arterial vessel via a body surface
of the subject such that the at least one array extends in a direction intersecting the arterial vessel, each of the pressure sensing elements sensing the pulse wave transmitted thereto from the arterial vessel and generating a pulse wave signal
representative of the sensed pulse wave, (b) storing means for concurrently storing the pulse wave signals generated by the pressure sensing elements, (c) selecting means for selecting, as an optimum pressure sensing element, one of the pressure sensing
elements such that an amplitude of the pulse wave signal from the selected one element is the greatest of the amplitudes of the pulse wave signals stored in the storing means, (d) judging means for judging whether or not the pulse wave signal from the
selected one pressure sensing element is abnormal, and (e) changing means for, if an affirmative judgement is provided by the judging means, changing the optimum pressure sensing element from the selected one pressure sensing element to another of the
pressure sensing elements such that an amplitude of the pulse wave signal from the selected another element is the greatest of the amplitudes of the pulse wave signals which are stored in the storing means concurrently with the abnormal pulse wave
signal.
In the pulse wave detecting apparatus constructed as described above, the storing means concurrently stores the pulse wave signals supplied from the plurality of pressure sensing elements, and the judging means judges whether or not the pulse
wave signal from the optimum pressure sensing element is abnormal. If the judging means judges that the pulse wave signal from the optimum element is abnormal, the changing means changes the optimum element from the element supplying the abnormal
signal, to another of the elements such that an amplitude of the signal from the selected another element is the greatest of the amplitudes of the signals which are stored in the storing means concurrently with the abnormal signal. Hence, the present
apparatus instantly replaces the optimum element by a new one.
According to a feature of the present invention, the judging means judges that the pulse wave signal supplied from the optimum pressure sensing element is abnormal, if an amplitude of the pulse wave signal is smaller than a predetermined value.
According to another feature of the present invention, the plurality of pressure sensing elements are grouped into a plurality of element groups, the changing means comprising means for calculating a value by summing up amplitudes of the pulse
wave signals supplied from the pressure sensing elements belonging to each of the element groups which signals are stored in the storing means concurrently with the abnormal pulse wave signal, means for selecting one of the element groups such that the
summed-up value obtained with respect to the selected one element group is the greatest of all the summed-up values obtained with respect to said element groups, and means for determining an amplitude of each of the pulse wave signals from the pressure
sensing elements belonging to the selected one element group.
According to yet another embodiment of the present invention, the changing means changes the optimum pressure sensing element from the selected another element to yet another element, if the judging means judges that the pulse wave signal
supplied from the selected another element is abnormal.
According to a further feature of the present invention, the apparatus further comprises means for pressing the sensing means against the arterial vessel via the body surface while varying the pressing force, and holding the pressing force at an
optimum level, and means for judging whether the pressing force is being varied, or is held at the optimum level.
According to another feature of the present invention, the apparatus further comprises sampling means for periodically determining a magnitude of the pulse wave signal supplied from the each of the pressure sensing elements, determining means for
determining a lower peak and a following upper peak of the pulse wave signal, based on variation of the magnitudes determined by the sampling means, calculating means for calculating a value, SLOPE, by subtracting, from each of the magnitudes determined
by the sampling means, a magnitude of the pulse wave signal determined by the sampling means by a predetermined number of periods to the each of the magnitudes, checking means for judging whether or not the sensing means is located at an appropriate
position on the body surface, the checking means judging that the sensing means is located at the appropriate position, if a value, upc, is smaller than a value, dwc, the value upc being defined as the number of positive or zero SLOPEs out of the values
SLOPE obtained by the calculating means between commencement of the lower peak determination of the determining means, and the following upper peak, the lower peak determination being commenced if negative SLOPEs are obtained by the calculating means
over a predetermined number of successive cycles of the periodic magnitude sampling of the determining means, the value dwc being defined as the number of the remaining, negative SLOPEs out of the values SLOPE, and displacing means for, if said sensing
means is judged not to be located at the appropriate position, displacing the sensing means to the appropriate position at which the selecting means selects, as the optimum pressure sensing element, one element located generally in the middle of the at
least one array of the pressure sensing elements. In a preferred embodiment according to this feature, the plurality of pressure sensing elements are grouped into a plurality of element groups, the sampling means calculating, with respect to each of the
element groups, a value by summing up the magnitudes determined thereby, the calculating means calculating the value SLOPE by subtracting, from each of the summed-up values obtained by the sampling means, a summed-up value obtained by the sampling means
prior by the predetermined number of periods to the each of the summed-up values, the checking means providing a negative judgement if, with respect to at least one of the element groups, the sensing means is judged not to be located at the appropriate
position. In the event that the sensing means is located at an inappropriate position such as a position directly above a bone or a tendon, the phase of the pulse wave signal from the probe means is reversed and is not suitable to utilize. In this
event, therefore, the sensing means is displaced so as to obtain a pulse wave signal whose phase is not reversed.
BRIEF DESCRIPTION OF THE DRAWINGS
The above and optional objects, features and advantages of the present invention will be better understood by reading the following detailed description of the presently preferred embodiment of the invention when considered in conjunction with
the accompanying drawings in which:
FIG. 1 is a diagrammatic view of the blood pressure monitoring system having an arterial pulse wave detecting apparatus which embodies the present invention;
FIG. 2 is an illustrative view of a partially cut away pulse wave detector probe of the monitoring system of FIG. 1, the detector probe being set on a wrist of a subject;
FIG. 3 is a bottom view of the detector probe of FIG. 2;
FIGS. 4(a) and 4(b) shows a flow chart according to which the monitoring system of FIG. 1 is operated;
FIG. 5 shows a flow chart representing the lower peak determine routine of FIG. 4(a);
FIG. 6 shows a flow chart representing the upper peak determine routine of 4(a);
FIG. 7 shows a flow chart representing the proper upper peak determine routine of FIG. 4(a); and
FIG. 8 shows an example of the arterial pulse wave obtained by summing up the signals supplied from the pressure sensing elements belonging to each of the element groups of the detector probe of FIG. 2.
DETAILED DESCRIPTION OF THE
PREFERRED EMBODIMENT
Referring first to FIG. 1, there is shown a blood pressure monitoring system for monitoring blood pressure of a subject by using an arterial pulse wave detecting apparatus which embodies the present invention. Reference numeral 10 designates an
inflatable cuff formed of rubber. The cuff 10 is wound around, for example, an upper arm 12 of a subject so as to occlude an underlying arterial vessel. The cuff 10 is connected via piping 20 to a first pressure sensor 14, a first selector valve 16,
and an electric pump 18. The electric pump 18 supplies the cuff 10 with a pressurized fluid, for example, pressurized air so as to increase a pressure in the cuff 10 (hereinafter, referred to as the "cuff pressure"). The first pressure sensor 14 senses
the cuff pressure, and generates a cuff pressure signal SK representative of the sensed cuff pressure, to a central processing unit (CPU) 24 via a first analog to digital (A/D) converter 22.
The CPU 24 is coupled via data bus to a read only memory (ROM) 26, a random access memory (RAM) 28, and an output interface 30. The CPU 24 processes signals according to program stored in the ROM 26, while utilizing the temporary-storage
function of the RAM 28. In particular, the CPU 24 controls the electric pump 18 and the first selector valve 16 via drive circuits (not shown), respectively, so as to regulate the cuff pressure. In addition, the CPU 24 determines systolic and diastolic
blood pressure of the subject by the so-called "oscillometric method" in which the cuff pressure is slowly decreased and the blood pressure values are determined based on variation in the amplitudes of cuff pressure fluctuations sensed in the process of
slow cuff pressure decrease.
Referring next to FIGS. 2 and 3, there is shown a pulse wave detector probe 33 which is set on a wrist 32. The detector probe 33 includes a cylindrical housing 34 having an open end and a closed end or bottom wall. The detector probe 33 is
detachably worn around the wrist 32 with the help of a fastener band 38 such that the open end thereof contacts a surface 36 of the wrist 32. The detector probe 33 further includes a pulse wave sensor 42 supported by the housing 34 via a diaphragm 40 in
the interior of the housing 34. The pulse wave sensor 42 is movable relative to the housing 34 in such a manner that the sensor 42 is advanceable out of the open end of the housing 34. The housing 34 and the diaphragm 40 cooperate with each other to
provide a pressure chamber 44. The pressure chamber 44 is supplied with pressurized fluid from the electric pump 18 via a second selector valve 46, so that the pulse wave sensor 42 is pressed against the wrist surface 36 with a pressing force
corresponding to a pressure P in the pressure chamber 44 (hereinafter, referred to as the "chamber pressure P"). The second selector valve 46 is selectively placed in a first or PRESSURE-INCREASE position in which the valve 46 permits the pressurized
fluid to be supplied to the pressure chamber 44 so as to increase chamber pressure P, a second or PRESSURE-MAINTAIN position in which the valve 46 maintains chamber pressure P, and a third or PRESSURE-DECREASE position in which the valve 46 permits the
fluid in the pressure chamber 44 to be discharged so as to decrease chamber pressure P. Between the second selector valve 46 and the pressure chamber 44 is provided a second pressure sensor 47 which senses chamber pressure P and generates a chamber
pressure signal SP representative of the sensed chamber pressure to the CPU 24 via a second A/D converter 49.
A pair of generally arcuate rubber bags 48, 50 are provided between an inner wall of the housing 34 in the vicinity of the open end thereof, and the pulse wave sensor 42, such that the rubber bags 48, 50 are aligned with the secured ends of the
fastener band 38, respectively. The rubber bags 48, 50 are fixed to both the housing 34 and the pulse wave sensor 32. The rubber bags 48, 50 are supplied with pressurized fluid from the electric pump 18 via a third selector valve 52. The third
selector valve 52 is selectively placed in a first position in which the valve 52 permits the pressurized fluid to be supplied to one 48 of the rubber bags, and a second position in which the valve 52 permits the pressurized fluid to be supplied to the
other rubber bag 50, so that the pulse wave sensor 32 is movable in a direction generally perpendicular to an underlying radial artery 54.
The pulse wave sensor 42 includes a semiconductor chip 56 formed of, for example, monocrystalline silicon. The chip 56 has a press surface 58 adapted to be pressed against the radial artery 54 via the wrist surface 36. A plurality of pressure
sensing elements 60, for example, pressure sensing diodes are formed in the press surface 58 such that the elements 60 are arranged in two arrays 60A in an alternate manner. With the detector probe 33 set on the wrist 32, the element arrays 60A each
extend generally perpendicular to the radial artery 54. Each of the elements 60 senses an arterial pulse wave, namely, oscillatory pressure wave that is produced from the radial artery 54 and transmitted to the wrist surface 36 in synchronous
relationship with heartbeats of the subject, and generates a pulse wave signal SM representative of the sensed pulse wave to the CPU 24 via a third A/D converter 62. The arterial pulse wave consists of successive pulses each of which corresponds to a
heartbeat.
The pressure sensing elements 60 are provided at regular intervals of distance as viewed in the direction of the arrays 60A thereof. The regular interval is sufficiently small so that a plurality of elements 60 can be located directly above the
radial artery 54. A distance between the opposite end elements of the arrays 60A is much greater than a maximum lumen of the radial artery 54 that is assumed when the artery 54 is pressed under the pulse wave sensor 42. As shown in FIG. 3, the pressure
sensing elements 60 are grouped into a first, a second and a third group G1, G2, G3 in the order of description as viewed in the direction of the arrays 60A thereof. All the element groups G1-G3 include the same number of elements 60.
According to the program stored in the ROM 26, the CPU 24 controls the second selector valve 46 via a drive circuit (not shown) so as to regulate chamber pressure P. Based on pulse wave signals SM supplied from the pressure sensing elements 60
when chamber pressure P is held at a predetermined value, the CPU 24 selects as an optimum pressure sensing element 60* one pressure sensing element 60a such that an amplitude of pulse wave signal SM* from optimum element 60*, namely, selected one
element 60a is the greatest of all the amplitudes of the pulse wave signals. Further, while increasing chamber pressure P, the CPU 24 determines, based on pulse wave signal SM* from optimum element 60*, an optimum chamber pressure P* corresponding to an
optimum pressing force for most suitably pressing the pulse wave sensor 42 against the radial artery 54. In addition, the CPU 24 determines a relationship between blood pressure and pulse wave (hereinafter, referred to as the "BP-PW relationship"),
based on the blood pressure values measured by using the cuff 10 and pulse wave signal SM* supplied from optimum pressure sensing element 60*. The CPU 24 periodically determines a systolic and a diastolic pressure value according to the BP-PW
relationship based on magnitudes of the upper and lower peaks of each of the heartbeat synchronous pulses represented by pulse wave signal SM*, and commands a display 64 to successively indicate the blood pressure values determined (this process will be
referred to as the "blood pressure monitoring").
In the meantime, according to the program stored in the ROM 26, the CPU 24 commands the RAM 28 to concurrently store pulse wave signals SM supplied from all the pressure sensing elements 60, in corresponding memory areas of the RAM 28 each of
which is capable of storing pulse wave signal data corresponding to a predetermined number of heartbeats. While chamber pressure P is increased for determining optimum chamber pressure P*, or during the blood pressure monitoring, the CPU 24 checks if
pulse wave signal SM* from optimum pressure sensing element 60* or selected one element 60a is abnormal or not. If the result of the checking is affirmative, the CPU 24 selects another pressure sensing element such that an amplitude of pulse wave signal
SM from the selected another element is the greatest of the amplitudes of pulse wave signals SM which are stored in the RAM 28 concurrently with the abnormal pulse wave signal, and the CPU 24 changes optimum element 60* from the element 60a to the
selected another element.
Referring next to FIGS. 4(a) and 4(b), there is shown a flow chart representing the program according to which is operated the blood pressure monitoring system constructed as described above.
First, the cuff 10 is wound around the upper arm 12 of a subject and the detector probe 33 is set on the wrist 32 of the subject. When electric power is applied to the present system through operation of a power switch (not shown),
initialization is carried out on the system so that all the flags and counters that will be described hereinafter are reset to zero. The control of the CPU 24 begins with Step S1 in which a systolic and a diastolic blood pressure (mmHg) of the subject
are determined by the previously-described oscillometric method in which the cuff 10 is used. Step S1 is followed by Step S2 in which chamber pressure P (i.e., pressure in the pressure chamber 44) is increased to a predetermined value, for determining
an amplitude of pulse wave signal SM supplied from each of the pressure sensing elements 60 with chamber pressure P held at the predetermined value. In Step 2, one pressure sensing element 60a is selected as an optimum pressure sensing element 60* which
provides pulse wave signal SM* whose amplitude is the greatest of all the amplitudes of pulse wave signals SM from the pressure sensing elements 60 of the element groups G1-G3.
The groups G1, G2 and G3 each comprises, for example, a left-hand, a middle, and a right-hand group of sensing elements 60, extending substantially perpendicular to the radial artery.
Step S2 is followed by Step S3 in which it is judged whether or not optimum pressure sensing element 60*, namely, selected one element 60a is one located generally in the middle of the element arrays 60A. If the judgement in Step S3 is
affirmative (YES), the control proceeds with Step S5. On the other hand, if the judgement is negative (NO), the control proceeds with Step S4 in which according to a predetermined algorithm the CPU 24 operates for discharging the fluid in the pressure
chamber 44, and moving the pulse wave sensor 42 in a direction generally perpendicular to the radial artery 54 so that an element located generally in the middle of the element arrays 60A is selected as optimum element 60*. Subsequently the control goes
back to Step S2.
In Step S5, the fluid in the pressure chamber 44 is discharged. Subsequently the pressure chamber 44 is supplied with the pressurized fluid from the electric pump 18 so that chamber pressure P is increased at a suitable rate. Step S5 is
followed by Step S6 in which flag F1 is placed in the position, F=1, indicating that chamber pressure P is being increased. Step S6 is followed by Step S7 in which, while chamber pressure P is being increased, pulse wave signals SM supplied from all the
pressure sensing elements 60 are concurrently stored in the corresponding memory areas in the RAM 28. In other words, the magnitude of pulse wave signal SM from each element 60 periodically is determined, and data of the determined magnitudes are
timewise stored in the corresponding memory area of the RAM 28 (this process will be referred to as the "periodic data sampling"). The period is, for example, 5 ms (milliseconds). Step S7 is followed by Step S8 in which, with respect to each of the
element groups G1-G3, the magnitudes sampled in Step S7 at a current cycle with respect to the pressure sensing elements 60 belonging to each element group G1-G3, are summed up. The summed-up value is stored in the RAM 28. The summed-up values
collected over cycles provide a summed-up pulse wave as shown in FIG. 8. In Step S8, in addition, with respect to each element group G1-G3 a value, DIFF, is calculated by subtracting a summed-up value obtained at the preceding cycle (i.e., 5 ms before)
from the summed-up value obtained at the current cycle and a value, SLOPE, is calculated by subtracting, from the summed-up value obtained at the current cycle, a summed-up value obtained at a cycle prior by a predetermined number of periods or cycles
(e.g., 8 cycles) to the current cycle (i.e., 40 ms before).
Step S8 is followed by Step S9 in which it is judged whether or not flag F2 is in the position, F2=1, indicating that with respect to at least one of the element groups G1-G3 a lower peak has been determined on the summed-up pulse wave obtained
in Step S7 with respect thereto. As described above, the summed-up pulse wave consists of the summed-up values obtained with respect to the pressure sensing elements 60 belonging to each element group G1-G3. If the judgement in Step S9 is negative,
namely, if with respect to every element group G1-G3 no lower peak has been determined on the summed-up pulse wave thereof, the control goes to Step S10 in which it is judged whether or not at least one of the element groups G1-G3, or the summed-up pulse
wave thereof, has come to a situation allowing commencement of a lower peak determination. Step S10 and other steps, SA1 (FIG. 5), SB1, SB5-SB10 (FIG. 6) and SC1, SC2 (FIG. 7), that will be described hereinafter are effected in such a manner that, if in
each step an affirmative judgement is provided with respect to at least one of the element groups G1-G3, the control proceeds with the corresponding following step in which a judgement is made with respect to each of the at least one element group. In
Step S10, an affirmative judgement is provided, for example, if negative SLOPEs have been obtained in Step S8 over eight or more successive cycles. If the judgement in Step S10 is negative, the control returns to Step S7 and the following steps. On the
other hand, if the judgement in Step S10 is affirmative, the control goes to Step S11, that is, the lower peak determine routine. The present monitoring system is adapted such that, once the judgement in Step S10 is turned affirmative, affirmative
judgements are provided over cycles until a lower peak is determined on the summed-up pulse wave of the at least one element group G1-G3
The lower peak determine routine of Step S10 is represented by a flow chart shown in FIG. 5. The control begins with Step SA1 in which it is judged whether or not a positive DIFF has been obtained in Step S8 at a current cycle. If the judgement
in Step SA1 is negative, the control goes back to Step S7 and the following steps. On the other hand, if the judgement is affirmative, the control proceeds with Step SA2 in which it is judged whether or not counter C1 has counted none, namely, the
content thereof is zero. Counter C1 counts the number of successive affirmative judgements provided in Step SA1 over successive cycles. If the judgement in Step SA2 is affirmative, namely, if the affirmative judgement provided in Step SA1 at the
current cycle is the first one, the control goes to Step SA3 in which the summed-up value obtained in Step S8 at the preceding cycle is determined as a lower peak value. Step SA3 is followed by Step SA4 in which one is added to the content of counter
C1, and subsequently in Step S5 it is judged whether or not counter C1 has counted five, for example, namely, whether or not five or more successive affirmative judgements have been provided in Step SA1 over successive cycles.
If the judgement in Step SA5 is negative, the control goes back to Step S7 and the following steps. On the other hand, if the judgement is affirmative, the control goes to Step SA6 in which the lower peak determined in Step SA3 provisionally is
adopted. Step SA6 is followed by Step SA7 in which is determined a value, minSLOPE, that is an absolute value of the smallest value of the negative SLOPEs obtained with respect to a portion of the summed-up pulse wave between the commencement of the
present, lower peak determination (indicated at b in FIG. 8), and the provisionally adopted lower peak. Step S7 is followed by Step SA8 in which counter C1 is reset to zero. Once counter C1 begins to count, then the judgement in Step SA2 is found
negative and the control skips Step SA3 and goes to Step SA4. The lower peak determine routine of Step S11 is followed by Step S12 in which flag F2 is placed in the position F2=1, and the control goes back to Step S7 and the following steps.
If flag F1 is in the position F2=1, the judgement in Step S9 is found affirmative, and the control proceeds with Step S13 in which it is judged whether or not flag F3 is in the position, F3=1, indicating that with respect to at least one of the
element groups G1-G3 an upper peak has provisionally been determined on the summed-up pulse wave obtained with respect thereto. If the judgement in Step S13 is negative, namely, if with respect to every element group G1-G3 no provisional upper peak has
been determined, the control goes to Step S14, that is, the provisional upper peak determine routine.
The provisional upper peak determine routine is represented by a flow chart shown in FIG. 6. Initially, in Step SB1 it is judged whether or not a negative DIFF has been obtained in Step S8 at a current cycle. If the judgement in Step SB1 is
negative, the control goes back to Step S7 and the following steps. On the other hand, if the judgement is affirmative, the control goes to Step SB2 in which the summed-up value obtained in Step S8 at the preceding cycle provisionally is determined as
an upper peak value, maxV.
SB2 is followed by Step SB3 in which is obtained a value, maxSLOPE, that is the greatest value of the positive SLOPEs obtained with respect to a portion of the summed-up pulse wave between the provisionally adopted lower peak and the provisional
upper peak (indicated at d in FIG. 8). Step SB3 is followed by Step SB4 in which values, t, ts, dst, are determined on the summed-up pulse wave. Value t is defined as a period of time between the commencement of the periodic data sampling (indicated at
d in FIG. 18), and the sampling time of the provisional upper peak. Value ts is defined as a period of time between the commencement of the lower peak determination and the sampling time of the provisional upper peak. Value dst is defined as a period
of time between the sampling time of the provisionally adopted lower peak and the sampling time of the provisional upper peak. Values t, ts, dst are indicated in FIG. 8.
Step SB4 is followed by Step SB5 in which it is judged whether or not value t obtained in Step SB4 at the current cycle is greater than a parameter, twind. Parameter twind is defined by the following expression: twind=4/5.times.ts.sub.-1, where
ts.sub.-1 is a value ts which has been determined with respect to the preceding, proper upper peak determined in Step S15 that will be described hereinafter. The initial value, zero, is predetermined for parameter twind. If the judgement in Step SB5 is
affirmative the control goes to Step SB6, while if the judgement is negative the control goes to Step SB7. In Step SB6 it is judged whether or not value maxSLOPE determined in Step SB2 at the current cycle is greater than a value, 1/2.times.mth, while
in Step SB7 it is judged whether or not the value maxSLOPE is greater than a value, mth. Parameter mth is defined by the following expression: mth=7/10.times.maxSLOPE.sub.-1, where maxSLOPE.sub.-1 is a value maxSLOPE which has been determined with
respect to the preceding proper upper peak. The initial value, zero, is predetermined for parameter mth. If the judgement in Step SB6 or Step SB7 is affirmative, the control goes to Step SB8 in which it is judged whether or not value maxSLOPE
determined in Step SB3 at the current cycle is greater than a value minSLOPE determined in Step SA7 with respect to the provisionally adopted lower peak preceding the present, provisional upper peak. If the judgement in Step SB8 is affirmative, the
control goes to Step SB9 in which it is judged whether or not value dst obtained in Step SB4 at the current cycle is greater than a predetermined time, for example, 30 ms and smaller than a parameter, mds. Parameter mds is defined by the following
expression: mds=1/2.times.ts.sub.-1, and falls within the range of 500 to 200 ms. The initial value, 500 ms, is predetermined for parameter mds. If the judgement in Step SB9 is affirmative, the control goes to Step SB10 in which it is judged whether or
not value ts obtained in Step SB4 at the current cycle is greater than a predetermined value, for example, 200 ms and simultaneously value dst obtained in Step SB4 at the current cycle is smaller than a half of the value ts. If affirmative judgements
are provided in Step SB6 or SB7 and Steps SB8, SB9, SB10, the control goes to Step SB11 in which flag F3 is placed in the position F3=1 indicating that a provisional upper peak has been determined on the summed-up pulse wave obtained with respect to at
least one of the element groups G1-G3. Subsequently the control goes back to Step S7 and the following steps. If flag F3 is in the position F3=1, the judgement in Step S13 is found affirmative, and the control goes to Step S15, that is, the proper
upper peak determine routine.
If a negative judgement is provided in any of Steps SB6-SB10, it means that the provisional upper peak determined in Step SB2 at the current cycle is a secondary upper peak, not a proper upper peak, and that the provisionally adopted lower peak
preceding the provisional upper peak is a notch, not a proper lower peak. Each pulse of the arterial pulse wave normally has proper (or primary) upper and lower peaks and in addition a secondary upper peak and a secondary lower peak or notch. The
proper upper peak corresponds to the systole (or compression) of the heart, while the proper lower peak corresponds to the diastole (expansion). In this case, the control goes to Step SB12 in which flag F2 is placed in the position, F2=0, indicating a
lower peak has not been determined yet. Subsequently the control goes back to Step S7 and the following steps so as to determine another lower peak.
The proper upper peak determine routine is represented by a flow chart shown in FIG. 7. Initially, the control begins with Step SC1 in which it is judged whether or not a negative or zero DIFF has been obtained in Step S8 at a current cycle. If
the judgement in Step SC1 is affirmative, the control goes to Step SC2 in which a summed-up value, newV, obtained in Step S8 at a current cycle is smaller than value maxV of the provisional upper peak determined in Step S14. If the judgement in Step SC2
is affirmative, the control goes to Step S3 in which counter C3 counts one. Counter C3 counts the number of successive cycles at which affirmative judgements are provided in both Steps SC1 and SC2. Step SC3 is followed by Step SC4 in which it is judged
whether or not counter C3 has counted five. If the judgement in Step SC4 is negative, the control goes back to Step S7 and the following steps. If the judgement in either of Steps SC1 and SC2 is negative, the control goes to Step SC5 in which flag F3
is placed in the position, F3=0, indicating that a provisional upper peak has not been determined yet, and counter C3 is reset to zero. Subsequently the control goes back to Step S7 and the following steps so as to determine another provisional upper
peak.
If the judgement in Step SC4 is affirmative, the control goes to Step SC6 in which it is judged whether or not, with respect to every element group G1-G3 a value, upc, is smaller than a value, dwc. Value upc is defined as the number of positive
or zero SLOPEs out of the SLOPEs obtained between the commencement of the lower peak determination, and a current cycle (indicated at e in FIG. 8), while value dwc is defined as the number of the remaining, negative SLOPEs out of the same SLOPEs. If the
judgement in Step SC6 is affirmative, it means that with respect to every element group G1-G3 the phase of the summed-up pulse wave obtained with respect thereto is normal, or not reversed, as shown in FIG. 8. In this case, the control goes to Step SC7
in which the provisional upper peak is determined as a proper upper peak of a pulse of the arterial pulse wave. In addition, the affirmative judgement in Step SC6 means that the provisionally adopted lower peak preceding the provisional upper peak is a
proper lower peak of the arterial pulse wave. Step SC7 is followed by Step SC8 in which counter C3 is reset to zero, and subsequently in Step SC9 values twind, mth, mds are determined with respect to the present proper upper peak. These values are
utilized for determining proper upper and lower peaks of a subsequent pulse of the arterial pulse wave. Step SC9 is followed by Step S16 of FIG. 4(b).
On the other hand, if the judgement in Step SC6 is negative, the control goes to Step SC10 in which it is judged whether or not with respect to every element group G1-G3 the number upc is greater than the number dwc. If the judgement in Step
SC10 is negative, it means that with respect to at least one of the element groups G1-G3 the phase of the summed-up pulse wave thereof is normal. In this case, the control goes to Step SC11 in which values twind, mth, mds are determined based on the
normal summed-up pulse wave. If the judgement in Step SC11 is affirmative, it means that with respect to every element group G1-G3 the phase of the summed-up pulse wave is reversed. The phase-reversed pulse wave would be generally symmetrical with the
non-reversed pulse wave, with respect to a line parallel to the axis of time of FIG. 8. The phase-reversed pulse wave is not suitable to use for determining proper upper and lower peaks of the arterial pulse wave. In this case, therefore, the control
goes to Step SC12 in which parameters twind, mth, mds are initialized to the initial values zero, zero, 500 ms, respectively. A comparatively large displacement of the pulse wave sensor 42 relative to the radial artery 54 as viewed in a direction
generally perpendicular to the artery 54 due to, for example, physical motion of the subject, may cause the pressure sensing elements 60 to be moved to a location directly above a radius or tendon (not shown), possibly resulting in producing a
phase-reversed pulse wave. Step SC12 is followed by Step SC13 in which flags F2 and F3 are placed in the positions F2=0 and F3=0, respectively, and subsequently the control returns to Step S4 to re-locate the pulse wave sensor 42 so that a pressure
sensing element generally located in the middle of the element arrays 60A is selected as optimum element 60*.
The proper upper peak determine routine of Step S15 is followed by Step S16 in which an upper and a lower peak of pulse wave signal SM* from optimum pressure sensing element 60* are determined based on the sampling times of the proper lower and
upper peaks determined in Step S15, and an amplitude of pulse wave signal SM* is determined from magnitudes of the upper and lower peaks. The upper and lower peak magnitudes and the amplitude are stored in the RAM 28. In the case where chamber pressure
P is being increased for determining optimum chamber pressure P*, chamber pressure values (P) represented by pressure signal SP at the sampling times of the upper and lower peak are also stored in the RAM 28.
Step S16 is followed by Step S17 in which it is judged whether or not pulse wave signal SM* from optimum pressure sensing element 60* or selected one element 60a is abnormal. An affirmative judgement is provided, for example, if the amplitude
determined in Step S16 is smaller than a value which is predetermined based on an amplitude estimated at optimum chamber pressure P*. If the judgement in Step S17 is negative, the control goes to Step S18 in which it is judged whether or not flag F1 is
in the position F1=1, namely, whether or not chamber pressure P is being increased. If the judgement in Step S18 is affirmative, the control goes to Step S19 in which it is judged whether or not chamber pressure P has exceeded a predetermined value Pa.
If the judgement in Step S19 is negative, the control goes to Step S20 in which flags F2 and F3 are placed in the positions F2=0 and F3=0, respectively, and subsequently the control goes to Step S7 and the following steps. If the judgement in Step S19
is affirmative, namely, if chamber pressure P has exceeded value Pa, the control goes to Step S21 in which an optimum chamber pressure P* corresponding to an optimum pressing force for most suitably pressing the pulse wave sensor 42 against the radial
artery 54, is determined based on, for example, variations in magnitude of lower peak and amplitude of pulse wave signal SM* from optimum element 60* which variations are detected while chamber pressure P is being increased. In addition, in Step S21
chamber pressure P is maintained at optimum pressure value P* determined.
Step S21 is followed by Step S22 in which a BP-PW relationship is determined based on the systolic and diastolic pressure values determined in Step S1 by using the cuff 10, and magnitudes of the upper and lower peaks of pulse wave signal SM* from
optimum pressure sensing element 60* which peaks are sampled when chamber pressure P is equal to optimum pressure value P*. Step S22 is followed by Steps S23 and S20 in which flags F1, F2, F3 are placed in the positions F1=0, F2=0, F3=0, respectively.
Subsequently, the control goes back to Step S7 and the following steps. Since a negative judgement is provided in Step S18, the control goes to Step S24 in which a systolic and a diastolic pressure value are determined according to the BP-PW
relationship determined in Step S22 based on the upper and lower peaks magnitudes determined in Step S16 at a current cycle on pulse wave signal SM* from optimum pressure sensing element 60*, and the display 64 indicates the blood pressure values
determined. Step S24 is followed by Step S20, and subsequently the control goes back to Step S7 and the following steps. By repeating Steps S7-S18, Step S24 and S20, systolic and diastolic pressure values periodically are determined and display | | |
