JPS63216537A - Apparatus for measuring heart rate output quantity - Google Patents

Abstract

(57) [Summary] This bulletin contains application data before electronic filing, so abstract data is not recorded.

Description

DETAILED DESCRIPTION OF THE INVENTION [Industrial Field of Application] The present invention relates to a cardiac output measuring device used when performing a cardiac function test.

[Prior Art] Conventionally, an indicator dilution method has been used to measure cardiac output by right heart catheterization for cardiac function testing. This indicator dilution method includes a thermodilution method that calculates cardiac output from heat diffusion, a dye dilution method that calculates cardiac output from changes in illuminance due to dye diffusion, and a method that calculates cardiac output from changes in resistance due to electrolyte diffusion. There are electrolyte dilution methods to determine the amount. This thermodilution method will be explained.

In right heart catheterization, as shown in Fig. 16, a catheter 4 is introduced from the jugular vein, femoral vein, contralateral vein, etc., passes through the superior vena cava or vena cava, the right atrium, and the right ventricle, and its tip reaches the pulmonary artery. It is placed so that it is located inside. The catheter 25 is arranged such that the discharge port 26 is located in the right atrium and the thermistor 1 is located in the pulmonary artery. When a liquid with a temperature higher or lower than the blood temperature is injected into the right atrium from the discharge port 26, the liquid is diffused and diluted in the right atrium and right ventricle. The temperature of this diluted liquid is determined by a thermistor 27 located in the pulmonary artery.
The Stewart
Cardiac output is calculated using the following equation (1) using the Hamilton method.

S I-CI・(Tb-Tt)・■.

CO=-
... (1) Sb-Cb-geΔTbdt where, CO: cardiac output, Sl: specific gravity of injected liquid C5: specific heat of injected liquid, vl: amount of injected liquid T1: temperature of injected liquid, Tb: blood temperature S,: specific gravity of blood, Cb
: Specific heat of blood S': ΔTbdt・area of thermodilution curve.

[Problems to be solved by the invention] ■: In the thermodilution method described above, as can be seen from the formula for calculating cardiac output, the amount of injected liquid and its temperature greatly affect the accuracy of the calculated value. Affect. Incidentally, normally, the liquid temperature T is accurately measured with a thermistor, etc., and then the catheter 26 is brimmed to inject the indicator liquid into the blood vessel. This may result in cooling or heating, which may cause errors in measurement values. Therefore, in the past, the amount of liquid remaining inside the catheter was calculated based on the inner diameter of the catheter (French size).
Based on the amount of injected fluid, etc., a correction constant is determined based on Edwards' formula, and this correction constant is applied to the calculation of cardiac output.
The scolding of the residual liquid mentioned above was reduced.

However, the correction constant obtained from Edwards' formula is just a list of numerical values and has no meaning to the measurer, so calculation errors when calculating the correction constant,
Furthermore, human errors occur when inputting the determined correction constants into the measuring device. This error is not limited to thermodilution methods, but is a problem that occurs in indicator dilution in general, since indicator dilution methods use catheters.

■: Now, as you can see from Figure 17, if the operation of injecting the indicator liquid and the start of the integral calculation are not performed at the specified timing, the integral calculation will be performed after the blood temperature has decreased, etc. This may cause calculation errors. However, in the past, the measurer relied on intuition to instruct the measuring device to start measurement, that is, to start integration, after injecting the liquid, so there was always the possibility of a measurement error occurring. This error factor is not limited to the thermodilution method, but is also a general problem of indicator dilution.

■: In measuring cardiac output based on the thermodilution method described above,
The temperature of the injected indicator liquid is measured, usually by immersing it in an ice or wetting solution that is maintained at a predetermined temperature.

Therefore, if an experienced measurer or absolutely accurate measurement of cardiac output is not required, the above solution temperature may be considered as the indicated liquid temperature TI.

d) On the other hand, in the method of measuring cardiac output using the thermodilution method or indicator dilution method described above, cardiac output is measured intermittently every time the indicator liquid is injected, so it is not possible to measure the cardiac output continuously. It cannot be used to measure cardiac output. Further, if measurements are to be made frequently, the total amount of liquid to be injected increases, which increases the burden on the subject, and at the same time increases the risk of infection due to the liquid injection operation, which is not preferable.

In order to eliminate the disadvantages associated with cardiac output measurement according to the conventional indicator dilution method, in particular the thermodilution method, which allows only one-shot measurement, the applicant of the present invention filed Japanese Patent Application No. 24
In No. 4586 (Japanese Unexamined Patent Publication No. 125329/1983), a completely new cardiac output measuring device was proposed that enabled continuous cardiac output measurement. This continuously measurable cardiac output measuring device allows continuous recording.

■Secondly, the above-mentioned patent application No. 59-244586 is based on the measurement of cardiac output and blood flow velocity by a single thermodilution method.
The gist of this study is to find the relationship between cardiac output and blood flow velocity, and then calculate cardiac output from this relationship and blood flow velocity. That is,
There is a fixed relationship between cardiac output and blood flow velocity, so unless you are looking for an absolute cardiac output value, you can simply find the blood flow velocity value and calculate the relative change in cardiac output. It becomes possible to know.

Therefore, the present invention was proposed in order to eliminate the drawbacks of the above-mentioned conventional examples.The purpose of the present invention is to manually set data close to the data of the actual indicated liquid and calculate the cardiac output based on the thermodilution method. The purpose of the present invention is to propose an easy-to-operate measuring device for measuring cardiac output.

[Means and operations for solving the problems] The configuration of the present invention for achieving the above-mentioned problems includes: an indicator liquid data detection unit that outputs data related to an indicator liquid before being injected into a blood vessel; blood data detection means for detecting and outputting blood data diluted by the indicator liquid injected into the blood;
an integrating means for integrating the difference value between the blood data at each time and predetermined reference blood data; a manual means for setting arbitrary data and inputting it as a data value of the indicator liquid; The present invention is characterized by comprising cardiac output calculation means for calculating cardiac output based on the data input as data and the integral value.

[Margin below] [Examples] Examples according to the present invention will be described in detail below with reference to the accompanying drawings.

<External Appearance of Example Device> FIGS. 1A to 1C are plan views of a continuous measurement and recording device for cardiac output to which the present invention is applied.

A front view and a back view are shown. FIG. 2A shows the appearance of the catheter connected to this measuring device, FIG. 2B shows a cross-sectional view of the distal end of the catheter along the longitudinal direction, and FIG. 2C shows a cross-sectional view of the opening of the catheter. .

The principle of this measuring device is to measure the initial cardiac output CO based on an indicator dilution method such as the thermodilution method, electrolyte dilution method, dye dilution method, etc., and the blood flow velocity V when this cardiac output is measured. Then, a parameter S that connects this blood flow velocity V to the cardiac output CO is determined. After determining this parameter, the cardiac output Cot at any time can be determined from this blood flow velocity V1 and the parameter S by simply measuring the blood flow velocity Vl at any time.

The measuring method for determining the initial cardiac output Co may be any of the indicator dilution methods described above, but the embodiments shown in FIG. 1A and subsequent figures are particularly based on the thermodilution method.

The external appearance of the measuring device 100 shown in FIGS. 1A to 1C will be explained. FIG. 1A is a top view of apparatus 100. 50
is a well-known plotter. This plotter 50 outputs measurement results and the like. 52 and 53 are switches for specifying the output mode on the plotter 50 when measuring the initial cardiac output value co by the thermodilution method. The switch 52 is
Specifies to output Co as a numerical value (Fig. 5). The switch 53 specifies that changes in blood temperature T, etc. be output as a curve (FIG. 4). switch 57.5
8 is the paper feed speed of the plotter 5o (20 mm/hour and 10 m
m/min).

Reference numeral 54 indicates a switch for outputting the 12-hour progress of COI, etc., on the plotter 50 (Fig. 8); 55 indicates outputting the COI, etc. data stored in the memory for the past 30 minutes on the plotter 50 (Fig. 8); 6 and 7). 80 is a memo switch, and when this switch is pressed, the recording paper is fed 6 cm. Reference numeral 56 is a switch for instructing to output changes in COI, T b * vl, etc. on recording paper in real time (FIGS. 6 and 7).

Switches 59.60 (Fig. 1A), 61.62 (1st
Figure B) etc. are switches for manually setting desired data when inputting the data into the device 100, and the setting values are sequentially determined by the catheter diameter (unit:
french), of the indicated liquid? Volume per person (1st position: ml), body surface area (unit: m2), initial CAL value (unit: L/min)
It is.

64 is a switch that sets the mode of the measuring device to continuous mode, and at the same time, when the mode is set to continuous mode, this switch/
Indicator 64 lights up.

Reference numeral 65 denotes a single (intermittent) mode switch/indicator, which is mainly used when changing from continuous mode to single mode when it is desired to set the parameter S again. Lights up when in intermittent mode (SINGLE mode). Display 68 is a four-digit LED that digitally displays cardiac output. Switches 66 and 67 change the temperature displayed on the three-digit LED display 69 to blood temperature Tt,
or the temperature TI of the indicator liquid.

The ENTRY switch/indicator 70 indicates that the initial cardiac output value CO has been measured by the thermodilution method, and the CO
2 as data! (ENTRY) Displays that it is now possible to do the following. If this switch 70 is pressed while this ENTRY indicator 70 is lit, that Co will be registered as data. In this registration, in order to obtain the parameter S, the initial cardiac output value CO is measured several times using the thermodilution method, and the measurer judges and registers the data that is likely to be reliable. This is because the average value of the registered data is set as co.

The 5TART switch/indicator 72 indicates that preparation for measuring the initial cardiac output value CO by thermodilution is complete, and when this switch is pressed at that point, integration based on the Stuart-Hamilton equation is started.

The display 71 is a bar graph, and mainly displays the value of blood temperature T in real time.

73 and 74 are the connector 15 of the catheter 4 (FIG. 2A) which has a built-in blood temperature sensor, and the connector 16 of the temperature probe 12 (FIG. 2A) for measuring the temperature of the injected fluid, respectively.
It is a connector for connecting.

Switch 75 in FIG. 1C is a rotary switch that manually sets the temperature of the injectate. 76 is an R3232C interface connector for communicating with other external measuring devices, and 78 is a connector for communicating with other external measuring devices (or from the device) such as blood temperature Tb, blood flow velocity V1, cardiac output CO1, etc. A terminal 77 for outputting an analog signal is a connector for connecting a power cable.

(Functions of the measuring device) The features of the embodiment device shown in FIGS. 1A to 1C and 2A to 2C are as follows: ■: To correct the influence of the indicator liquid remaining in the catheter. Instead of having to calculate the correction constants based on the conventional Edwards formula, the measurer creates a table of correction constants in advance and uses the table as data to access when injecting the indicated liquid. This measuring device is provided with a switch 59 for manually setting the inner diameter size (unit: French) of the catheter used for the test, and a switch 60 for setting and inputting the amount of liquid to be injected (unit: 2 m1).

■: After injecting the indicator liquid into the blood vessel, the change in blood temperature T is automatically recognized without the need for the operator's intervention.
Integration based on the above Stewart-Hamilton equation (1) is started.

■: Temperature probe 1 to measure the temperature of the indicator liquid.
2 is used, but when the connector 16 of this probe 12 is not connected to the measuring device 100, this disconnection is detected and the value set on the switch 75 (Fig. 1C) on the back of the device is used to indicate the liquid temperature. Enter as TI.

■-Once, measure CO by thermodilution method and set parameter S.
After determining , Co, blood temperature Tb, blood flow velocity vl, etc. are continuously stored in the memory and output on recording paper as necessary. The output mode is (i): Not measured
CO1, etc. are output on the recording paper of the plotter 50 in substantially real time (FIGS. 6 and 7). This is done by pressing the "Continuous Record" switch 56.

(ii): C for the past 30 minutes stored in memory
Data such as OI is reproduced and output (Fig. 6).

Figure 7). This is done by pressing switch 55.

(iii): The past 12 hours of data such as COI are compressed and reproduced and output on the plotter 50 (FIG. 8). this is,
This is convenient when measuring data on a patient who requires rest and noiselessness because the plotter does not make any print noise.

(2): The parameter S is manually set via the switch 62, and co+ can be continuously determined from this S and the blood flow velocity v1. This is useful when you want to know the relative changes in COl.

(2): With the bar graph display 71, changes in blood temperature Tb can be visually confirmed when determining the initial cardiac output value CO using the thermodilution method. In particular, this bar graph can not only display the temperature change by changing it every moment, but also can display the blood temperature baseline (reference temperature value Tba) and maximum temperature T bmax fixed.

(2) This device has a built-in battery (148 in Figure 9) to protect stored data from failures such as power outages. When the output voltage of this battery 148 decreases, the LED 78 is blinked to call attention to it.

■Two-piece measurement device 100 other than the COI
Analog output circuits (142, 151) are provided for outputting the signals from the terminal 78 as analog signals.

[Phase]: For an external measuring device other than the wood measuring device 100,
The number of circuits (144) that output col, etc. as digital signals using the 3232 interface is reduced.

Structure of Catheter> FIG. 2A shows a catheter incorporating a thermistor for measuring blood temperature Tb for the thermodilution method, a thermistor for measuring blood flow velocity V, and the like. In the same figure,
Catheter 4 is configured to have 4 lumens.

This catheter 4 has a pressure detection port 18 provided at its tip.
, a balloon 17 made of a flexible elastic body attached a few mm back from the tip so as to cover the entire tip of the catheter tube, and a balloon for injecting or releasing air to expand and deflate the balloon 17. Balloon side hole 25 provided on the side of the inner tube and 10 to 2 holes from the tip
A thermistor 1 provided at a position of 0 mm, a thermistor 2 provided further 10 to 15 mm from there to the base side,
Furthermore, it has a discharge port 3 provided at a position spaced apart from the thermistors 1 and 2 in a range of 8.5 to 38 cm, and spaced apart from the tip in a range of 12 to 40 cm. The thermistor 1 is used to measure the thermal equilibrium temperature for measuring the blood flow velocity v (vt). Thermistor 2 measures the diluted blood temperature T necessary to measure the initial cardiac output CO by the thermodilution method.

used to measure The discharge port 3 is for discharging an indicator liquid.

The catheter 4 shown in Fig. 2A is connected to a vein, femoral vein, or contravening vein, and is used in the pulmonary artery via the femoral vein or vena cava, the right atrium, and the right ventricle; therefore, the direction of blood flow is Considering that it is from the catheter proximal end side to the distal end side, the thermistor 2 is connected to the discharge port 3.
It is provided on the distal side (that is, on the downstream side of blood flow) when viewed from above. On the other hand, in the case of a catheter that is conduited from a peripheral artery and used in the aorta, the thermistor 2 is placed on the proximal end side of the catheter when viewed from the discharge port 3 because the blood flow direction is opposite. .

FIG. 2B shows a sectional view of the main part of the catheter 4.

In the figure, the pressure detection port 18, the balloon side hole 25, the thermistor 1.2, and the discharge port 3 communicate with the four lumens, respectively. These four lumens are a pulmonary artery pressure lumen 19 that transmits the pressure of the pulmonary artery, a balloon lumen 20 that is an air passage that expands and deflates the balloon 17,
These are a thermistor lumen 21 that accommodates the thermistor 1.degree. 2 and their lead wires, and an injection lumen 23 that passes an indicator liquid for dilution. Furthermore, these four lumens are independent, and a second lumen is provided at the rear end of the catheter.
As shown in the figure, it is connected to a pulmonary pulse pressure measuring tube 8, a balloon tube 6, a thermistor tube 12, and an indicator liquid injection tube 10. Each tube 8,6.
10 is equipped with a connector 7.9.11 at its rear end.

The thermistor tube 12 is connected to a connector 15, through which lead wires 22, 24 connected to the thermistors 1 and 2, respectively, are passed.

Furthermore, the catheter of the embodiment shown in FIGS. 2A to 2C will be described in detail. FIG. 2B is an enlarged sectional view of the thermistor 1, thermistor 2, and the balloon 17, and FIG.
'It is a line cross-sectional view. The four-lumen structure of this catheter described above has a balloon lumen 20 as shown in Fig. 2C.
, pulmonary artery pressure lumen 19, and injection lumen 23 (second
(Fig. C) and the thermistor lumen 21. The balloon lumen 20 has a balloon side hole 25 and communicates with the balloon tube 6. The pulmonary artery pressure lumen 19 is
It has a pressure detection port 18 and communicates with the pulmonary artery pressure measurement tube 8 . The injection lumen 23 extends from the tip of the catheter to
It has a discharge port 3 at a position of 40 cm and communicates with an indicator liquid injection tube 10 on the base side. Further, the thermistor lumen 21 has side holes 26 and 27 in which the thermistors 1 and 2 are installed, respectively, at a position 1 to 2 cmwff from the tip and further 1 to 1° and 5 cm 1 l from there to the base side. It also incorporates thermistor lead wires 22, 24 from the thermistor 1.2, and communicates with the thermistor tube 13 on the base side.

In addition, if the thermistor 1 is a self-heating type thermistor,
It is more preferable to locate it on the downstream side of the thermistor 2 with respect to the blood flow direction. That is, when measuring cardiac output with the catheter 4, it is necessary to accurately measure the temperature of the blood flow diluted by the thermistor 2, and the thermistor 2 is made less susceptible to the influence of the thermistor 1, which is a self-heating type. It's for a reason.

The characteristics of the thermistor 1 used in the catheter of the example are B
25-45 = 3500, R(37) = 1000Ω, and its magnitude is 1.18'XQ.

4=X0.15t (unit: Lllm). The characteristics of thermistor 2 are Bzs-4s = 3980 K, R
(37) = 40Ω, its size is 0.50' x □.

16""Xo, 15t. Thermistor 1 is 0°01
It is preferable to generate a calorific value of ~50 Joules; a higher calorific value may raise the blood temperature or even damage the blood vessel wall if it comes in contact with it, whereas a lower calorific value may cause detection. Due to reasons such as decreased sensitivity,
I don't like either of them.

(Operating procedure for the measuring device) To better understand this measuring device, please refer to Figure 3A and 3.
The operating procedure from the operator's perspective will be explained using Figure B.

First, inject in step S1? IE? FA degree probe 1
2 to the measuring device main body 100. In step S2,
The temperature probe 12 is immersed in the injection indicator liquid in a water-cooled container (in this example, provided within the measuring device 100). This liquid may be physiological saline or the like. Step S3
After brimming the catheter 4 in Step S4
Insert it until it reaches the pulmonary artery. The catheter 4 is inserted from a vein in the upper or lower limb and placed in the pulmonary artery. Next, in step S5, the connectors of the catheter shown in FIG. 2A are connected to the main body of the device. When these connectors are connected to the device, first, the vascular placement position of the catheter 4 is determined.
Pressure detection port 18, tube 8. This is confirmed based on the blood pressure value and pressure waveform detected from the arterial pressure that has passed through the connector 9. After the catheter is indwelled, the pulmonary artery pressure is measured, and the balloon 17 is inflated to occlude the pulmonary artery to determine the pulmonary artery wedge pressure. In this way, the catheter 4 is left in place.

Next, in step S6, predetermined values are set using the switches 59-61. The switch 62 is set when measuring the relative Cot (described later), and is not necessary when measuring the initial cardiac output value CO by the thermodilution method described now. do not have.

In step S7, the measuring device is powered on. Step S
While confirming that there is no abnormal display (indicating a device failure) in Step 8, wait for the SIN0LE indicator 65 to light up in Step S9. When the indicator 65 lights up, the BLOOD indicator 66 lights up, and the display 6
9 displays the blood temperature T, ゛ in the pulmonary artery. If you want to know the temperature of the injection liquid at this point, use INJECTAT.
When the E switch 67 is pressed, the display on the display 69 becomes the injection liquid temperature TI. The TI display will automatically return to the BLOOD display after 30 seconds have passed, and the display 69 will automatically return to the BLOOD display.
Tb is displayed again.

The reason for automatically returning to the Tb display in this way is
This is because Tb is more meaningful as information to the operator. On the other hand, the bar graph display 71 at this point should be displaying the base line of the blood temperature Tb.

Furthermore, in step SIO, the 5TART indicator 72
Wait until it lights up. When this indicator lights up, it means that preparations are ready to start measuring the initial cardiac output value Co by the thermodilution method.

In step 311, the mode of information to be output to the plotter 50 is selected using the switch 52 or 53, if necessary. In step 512, the cock 11 is opened to inject the liquid into the blood vessel.

After liquid injection, the measuring device automatically reads the change in Tb and determines the optimal time to start integration. If the operator presses the 5TART switch 72 before detecting this optimal point,
Integration of Tb starts from the moment the button is pressed. switch 7
If 2 is not pressed, T from the point determined by the device itself
b Integrate the data. The CO measurement calculation using this thermodilution method usually completes in a few seconds, but changes during that time are stored in a predetermined memory (RAM 132 in FIG. 9) and displayed on the display 69 and bar graph display 71. be done. Furthermore,
If the switch 53 has been pressed, changes in blood temperature T, as shown in FIG. 4, are output to the plotter 50. These displays allow the operator to confirm that the device' is operating normally. In FIG. 4, the blood temperature Tb is becoming negative upward. Note that the date, time, etc. will also be output on this graph for the convenience of the measurer.

The output example shown in FIG. 4 is an output speed of 300 II 1 mZ.

When the measurement of Co by thermodilution is completed, the value is displayed digitally on the display 68, and if the switch 52 is pressed, the measurement result is outputted by the plotter 50 as shown in FIG. . In addition to the date and time, FIG. (=V+
), cardiac index CI (=CO/BSA), infusion temperature IT
(-TI), and **ENT to indicate that it has been registered.
Displays such as RY** are also recorded. The completion of the co measurement can be confirmed by lighting the ENTRY indicator 70 (step 515).

If the measurer determines that the obtained data such as CO is reliable, he/she will be able to register this data by e-mail.
NTRY switch 70 is pressed (step 517). After a while, the 5TART indicator 72 lights up again. This completes the measurement of the initial cardiac output co by the thermodilution method.

If it is desired to obtain more accurate Co, repeat the operations from step S11 described above to obtain a plurality of measurement data. For each measurement, the ENTRY switch 70 is pressed and registered, and the initial cardiac output value CO value is determined from the registered plural CO values. Note that the first 1.2 measurement data are unreliable, so it would be better not to register them.

Once sufficiently reliable Co data has been obtained in the manner described above, it is time to start continuous COI measurements. This is the C0NT I NUOUS switch 64 at the end.
This can be done by simply pressing . When this switch 64 is pressed, C
0NTINtJOUS indicator 64 lights up,
The entire measuring device is in continuous measurement mode. Furthermore, S I N
When the GLE switch 65 is pressed, the measuring device goes into intermittent mode again.

When the device is in the continuous measurement mode and the continuous recording switch 56 is pressed, the blood temperature B
T (=Tb), Co (=CO+).

Blood flow velocity'/(V+) is output on plotter 50.

Figure 6 shows paper feed speed of 10mm/min, Figure 7 shows paper feed speed of 20mm/min.
It is output at a paper feed speed of mm/hour.

Although not shown in FIGS. 6 and 7, it goes without saying that various data such as the date shown in FIG. 5 are output together with the graph. In addition, in the example shown in Figure 7, the thermodilution method is used to measure the initial cardiac output and CO value again at around 4:30 pm, so changes in the graph appear around that time. .

<Configuration of Measuring Apparatus> The entire measuring apparatus ioo with the catheter 4 and the injectate temperature probe 12 connected is as shown in FIG. This measuring device consists of two electrically isolated measuring circuits 120 and 130. The circuit 120 mainly converts electrical signals (voltage) from the thermistors 1 and 2 in the catheter 4 and the thermistor 12a in the probe 12 into temperature data, and sends the data to the measurement recording circuit 130 via the optical communication circuit 108. send. The measurement recording circuit 130 determines the initial cardiac output value CO from the temperature data from the measurement circuit 120.
5. The blood flow velocity V, parameter S, continuous cardiac output COI, etc. are calculated and displayed on the plotter 5o or various displays. The local CPU 105 controls the measurement circuit 120, and the main CPU 133 controls the measurement recording circuit 130.

Measuring circuit 120> Now, the catheter-type sensor 150 shown in FIG. 9 uses the catheter 4 shown in FIG. Thermistor 2 detects the blood temperature inside
is built-in. This catheter-type sensor 150 is introduced to the pulmonary artery by right heart catheterization in a manner similar to that described above. Connector 15 of sensor 150
is coupled to the connector 73 of the main body 100. Thermistor 2
A constant voltage circuit 112 that drives the thermistor 2 and a blood temperature detection circuit 1 that measures the temperature of blood are connected via lead wires 24.
13.

The pulmonary artery blood temperature signal detected by the thermistor 2 is detected as a voltage signal E by the blood temperature detection circuit 113. On the other hand, the thermistor 1 is connected to the thermistor temperature detection circuit 115 and the constant current circuit 11 via the lead wire 22.
Connected to 1. Then, a predetermined current IC is supplied to the thermistor 1 from the constant current circuit 111, and the thermistor 1 is heated.

Further, the temperature signal detected by the thermistor 1 is sent to the thermistor temperature detection circuit 115, and this detection circuit 11
5, it is detected as voltage Et.

The thermistor 12a in the injection liquid temperature probe 12 is driven by a constant voltage circuit 101, and the temperature change is detected by the circuit 102.
This current is detected as a current change, and this current is further detected as a voltage value El. In this way, local CPU10
5 changes the output voltages EI + E t , E b from the three thermistors 12a, 1.2 to the temperature of the injection liquid T1. Resistance Rt of thermistor 1.

The temperature Tt of the thermistor 1 is converted into the blood temperature Tb.

This operation will be explained in more detail. Local cPU105
is an analog switch 10 with multiplexer function
EI by time division.

Et and Eb are manually input to the A/D converter 104, and the above voltage values are sequentially input into the RAM 107 as digital values. These voltage values are converted into temperature data from a voltage-to-temperature conversion table stored in the ROM 106. Further, the resistance value Rt of the thermistor 1 is calculated by Rt = E t / I c . Here, IC is the current flowing through the thermistor. The local CPU 105 uses these T
Data such as I, Rt, Tt, Tb, etc. are sent to the measurement recording circuit 130 via an optical communication line. The communication control (for example, polling/selecting method) is performed by the local CPU 105 and the main CPU 133.

<Measurement recording circuit 130> The measurement recording circuit 130 uses this simple communication control procedure to determine the temperature T1. Resistance Rt of thermistor 1,
Temperature Tt of thermistor 1, blood temperature T.

etc., and store them in the RAM 132 in chronological order. C
The PU 133 calculates the initial cardiac output value CO1, blood flow velocity V(V+), and continuous cardiac output CO, based on the above data.

An RTC (real-time clock circuit) 147 counts real time, and furthermore, for example, Tl-+ of the LED display unit 69.
7. It is used for time monitoring such as changes after 30 seconds.

<Calculation of initial cardiac output value CO> FIG. 10A shows the structure of data stored in RAM 132. The capacity of this RAM is an area (132a
), and from these data, an area (1
32b) and an area (132c) for storing 3-minute average values of data such as col etc. obtained by continuous calculation for 12 hours.

FIG. 10B shows the correspondence between three address counters 160, 161, and 162 for storing data in the RAM 132 and the three areas (132a, 132b, 132c). A data storage address counter (SC pointer) 160 stores data from the measurement circuit 120 in the RAM 13.
Points to the address when storing in 2. The data read address counter (RC pointer) 161 is
RAM1 for calculating the initial cardiac output value co.
32 and points to the address where the calculated value is to be stored. A data print address counter (PC pointer) 162 points to data to be accessed when outputting data on the plotter 5o. The reason why three pointers are used in this way is that data storage, data reading, data output, etc. are performed independently and in parallel as subroutines.

In Figure 11, the main cP0133 is the local cPU105
This routine receives measurement data from and stores it in the RAM 132. As described above, the Sc pointer 160 is used as a pointer at this time.

Figures 13A and B show the CP for measuring the initial cardiac output value Co value.
This is the control routine of U133.

First, in step S40, the READY state of the measuring device is confirmed. This state at least indicates that no hardware failure has occurred in the entire device.
AF! FTLM customer 1. ? , Nakanoru Mourning-IN state. Incidentally, when this state is detected, as mentioned above, S I
NGLE indicator 65 lights up. Step S
At step 41, it is determined whether the 5TART switch 72 has been pressed. If it has been pressed, the time t is read from the real-time clock RTC 147, and step S5
1, the RC pointer 161 is set based on that time t. In step S52, the injection liquid temperature TI is stored in the RAM 13.
Know from 2. In step S53, the RC pointer 161
In step S54, one T is read out from the RAM 132 according to the previous data. Detect. In step S55, ΔT
b (Figure 17) is calculated. In step S56, Σ
Calculate ΔT, (integral).

Steps S57 and S58 show control for dealing with the case where ΔTb is calculated due to noise in T. If it is noise, △T of this noise is the previous △T.
Although it increases compared to Tb, it is A11 + small eggplant h1^
Yokoka 1. The wide + 7 right nine of the training mackerel is detected, and when its maximum value is smaller than the threshold value a, it is determined to be noise and the integral ΣΔTb is cleared in step S59. If ΔTb has further increased in step S57, it cannot be determined that it is noise, and the process proceeds to step S61. If it is determined to be noise, the pointer RC is incremented by a predetermined amount in step S60. This b is the approximate time width of the noise component, which is known from experience.

Step S61 determines whether the thermodilution curve has converged to Tbo. That is, the above steps are repeated and the integration continues until convergence.

Next, a case will be described in which the 5TART switch 72 is not pressed in step S41. This control starts integration when it is determined that the change in Tb is a predetermined change. Note that the 5TART switch 72 in step S41
Since the pressing of is detected by an interrupt, step 34
If the above-mentioned interrupt occurs between step S2 and step S347, control is forcibly transferred to step S50. Now, step S
42, Tb is transferred to the RAM 13 according to the RC pointer 161.
Read from 2. In the loop of step 542 - step S43 → step S44 → step S42, in this embodiment, the change in ``rb'' is captured from the moving average (16 samples), so the required number of samples is stored in the memory 13.
It is meant to be obtained from 2. The moving amount of the moving average is one sample data. Once the required number of samples is obtained, from then on, when one sample data is read from the memory 132, the total number of samples for averaging is obtained. In step S45, this moving average value Tb(n) is determined. In step 346, the previous moving average value Tb(nt)
Find the difference between When this difference is greater than a predetermined threshold, it is determined that the change in blood temperature is due to the injection of the indicator fluid, and
In step S49, time t at the time of this change is calculated.

The subsequent control is the same as that using the 5TART switch 72 described above. If it is determined in step S47 that the change is less than the threshold value, in step 348 the current average value Tb(n) is moved to the previous average value T, (n-1) storage area.

Returning to the explanation of step 363. Now, as mentioned above,
According to the Stewart-Hamilton equation, 5L-CI・(Tb-TI)・vl where, CO: cardiac output, Sl: specific gravity of injected liquid CI = specific heat of injected liquid, Vl: amount of injected liquid Tl: injection Temperature of liquid, Tb: Temperature of blood Sb: Specific gravity of blood, Cb:
It is the specific heat of blood. The above formula becomes (T b - T dish) CO=A. Here, s, -C, ·V.

A=□b−Cb. In this correction constant A, S +, S b, Cb,
CI etc. are fixed, but (1) is affected by the fact that even if the indicator liquid is injected, it remains in the catheter and does not flow out into the blood. That is, the above V is only a nominal value. Conventionally, as mentioned above, A was obtained from Edwards' equation, but in this embodiment, with the aim of improving the reliability of operation by the operator, this correction constant A is tabulated (see Fig. 12). ) and stored in the ROM 131. When subtracting one correction constant A from this table, as shown in FIG. 12, the inner diameter Fr of the catheter 4 and the nominal liquid injection volume ml input from the switches 59 and 60 are used as address data. The correction constant data stored in the above table is obtained in advance from actual measurement results obtained when various amounts of injected liquid are changed for catheters of various sizes. If the catheter size and injection liquid volume used in the actual measurement of Co by the thermodilution method do not correspond to the above table, the corresponding correction constant A is determined by linear interpolation.

Return to the explanation of the flowchart. In step 361 and above,
When the calculation of the integral of ΣΔTb is completed, the inner diameter Fr of the catheter is set and inputted from the switches 59 and 60 as described above in step S63.

The correction constant A is read out from the table (FIG. 12) stored in the ROM 131 based on the indicated liquid amount m1 and the like.

In step S64, an initial cardiac output value CO is calculated based on the Stewart-Hamilton equation described above. In step S65, these values are outputted onto the plotter 50 as shown in FIGS. 4 and 5, for example.

(Continuous measurement of COI) First, the principle by which COI can be calculated continuously will be explained. If the resistance value of the thermistor 1 is Rt, and the current value given to the thermistor 1 by the constant current circuit 111 is Ic, then
The thermistor 1 is heated and the amount of heat generated per unit time is: 1c2.1. If the heated thermistor 1 is placed in blood at a blood flow velocity V, the heated thermistor 1 will be cooled down depending on the blood flow velocity V. The amount of heat cooled by blood flow is Tb, which is the blood temperature, and Tb, which is the heated thermistor temperature.
t, and the proportionality constant is K, then K−v·(Tt−Tb). Now, the temperature of the thermistor 1 is maintained at such a temperature that the amount of heat generated by heating and the amount of heat cooled are equal. This temperature is the thermally balanced salt.

If the above is expressed in a formula, it becomes the following formula (2).

I o”・Ftt−=−V・(Tt −Tb
)... (2) From equation (2), equation (3) for determining the blood flow velocity V is derived.

■ = (1/K) (Ic"Rt)/ ("rt-7b)...
(3) That is, the blood flow velocity V is determined from the data Rtt obtained from thermistor 1 and the blood temperature Tb obtained from thermistor 2. Note that since the heating thermistor 1 is driven by the constant current circuit 111, instead of detecting the resistance value, the potential difference v0 between both ends of the lead wire of the heating thermistor 1 is detected.
may be detected. Details of this case are described in the above-mentioned Japanese Patent Laid-Open No. 125329/1983. Furthermore, although the constant current value IC can be used even if the current of the constant current circuit 111 is detected, R
It is also possible to provide it in the OM131.

Now, when the blood vessel cross-sectional area of the pulmonary artery is S, there is a relationship between the initial cardiac output value CO and the initial blood flow velocity value V as shown in equation (4).

C0=S−v−(4) Therefore, from the initial cardiac output value CO and the initial blood flow velocity value V,
The blood vessel cross-sectional area S is determined according to equation (4), and this value S is held in the measurement recording circuit 130 as a calibration value (parameter). In this way, once the parameter S is determined,
The CPU 133 is connected to the computer 9;
By multiplying , L-l, I neck node → 4-ta S, it becomes possible to obtain a continuous cardiac output value Col.

That is, Co,=3-y.

= (S/K)・(IC”・Rt)/Crt −Tb
)...(5).

FIG. 14 shows the control procedure of the CPU 133 to calculate COr and store it in the RAM 132. Before starting this control, the initial cardiac output CO has already been measured. S85 is a control to obtain the above-mentioned parameter S.

In step S80, it is determined whether the measuring device 100 is in continuous mode. This mode is entered by pressing the C0NTINtJO-US switch 64.

If it is continuous mode, in step S81, the local CP
Instruct U 105 to heat the thermistor 1 via an optical communication path. In step S82, the thermistor 1 waits for the thermal equilibrium between heating and cooling to be reached. Eventually, Tt, R, Tb, etc. are sent from the local CPU and stored in the RAM 132 in chronological order according to the flowchart of FIG. Therefore, data in the RAM 132 is accessed using the RC pointer 161 according to time t when a certain period of time has elapsed. In step S84, the initial blood flow velocity V is calculated based on equation (3), and in step S85, (4
), the parameter S is determined from the relationship between the initial cardiac output value CO and the blood flow velocity V. Thus, continuous Cot
Ready for measurement. The following control is the initial Co and the Co at any time.

Since this is common in the calculation of , COI calculation control for vI at an arbitrary time will be explained.

In step S86, it is checked whether the continuous mode has been canceled. This is because the parameter S representing the blood vessel cross-sectional area usually changes over time. Therefore, - cross-sectional area of the dish tube S
Even if S is held as a parameter, an accurate cardiac output may not be obtained due to a change in the blood vessel cross-sectional area S. Therefore, the initial cardiac output Co is appropriately measured by thermodilution method in preparation for the next continuous measurement of Cot.

Unless the continuous mode is canceled, the process advances to step S87 and calculates C0I=v5·S. In step 388, Vl and COI are
Calculates the average value for the minute. These values are RAM 13
The data is stored in the area 132c within 2.

Then, in step S90, the RC pointer is incremented by 1 in order to calculate the next COI.

In this way, COI etc. can be continuously calculated each time T t + Rt + T b etc. are sent.

Thus, the cardiac output COI could be measured by measuring only the blood flow velocity Vl.

Recording of data> In addition to recording thermodilution curves and thermodilution values as shown in Figures 4 and 5, this measuring device also has a plotter 50 that records measured values in parallel with the continuous measurement of CO. Continuous recording function to output (by switch 56), recording and reproducing function to output measured values for the past 30 minutes to plotter 50 (by switch 55),
Progress chart output function (by switch 54) that outputs the past 12 hours' measured values (average values every 3 minutes) to the plotter 50
There are output functions such as

The output format by continuous recording and recording/playback is as shown in FIG. 6 (paper feeding speed 10 ms/min) and FIG. 7 (at 20 mSZ).

Figure 8 shows the output format of the progress chart. In this progress chart, 3
Co (=CO+) and blood temperature BT (=Tb) every hour
Record the value of along with the graph.

Now, this kind of recording is done in continuous mode (CONTINUO mode).
(when the US indicator 64 is lit), so in parallel with the output to the plotter 50,
- It is necessary to take in data from the local CPU 105, calculate/storage CO1, etc. For this control, access to the RA-M 132 uses the PC point Jj 162 for plotter output, the SC pointer 160 for data acquisition, and the RC pointer 160 for calculation/storage, as shown in FIG. 10B. ing.

<Substitute for injection liquid temperature> Since the indicator liquid to be injected is placed in a water-cooled container, it can be said that its temperature is almost determined by the ice-cooling temperature. Therefore, when this water cooling temperature is known (for example, zero degrees), it can be regarded as the indicated liquid temperature.

Therefore, in this measuring device, when the temperature probe 12 is not connected, it is detected and the temperature set by the switch 75 is regarded as the liquid temperature TI, and used for calculating the initial cardiac output CO. .

Therefore, since the thermistor 12a of the temperature probe 12 is connected to the constant voltage circuit 101, the injection liquid temperature detection circuit 102 detects the current flowing through the thermistor 12a as zero. Compatible with this zero current! .

When the local CPU 105 receives
U sends a signal to that effect to the main CPU 133. Alternatively, the CPU 105
When converting l into temperature TI, it is converted into an impossible value and sent to the main CPU 133. Due to these, the CPL 1133 can detect that the temperature probe 12 is not connected.

FIG. 15 shows this control procedure. Main C in Figure 13
Instead of step S52 in which the PU 133 reads T1 from the RAM 132, in step 5100 of FIG. 15, it is determined whether the TI sent from the local CPU 105 is data indicating that the probe 12 is not connected. . If the data indicates the connection state, step 510
1, the TI in this RAM 132 is used for measurement. If not connected, the data set in the switch 75 is taken in as TI in step 5102.

<Measurement of relative change in cardiac output> The embodiment of the measuring device described above actually determines the initial cardiac output value CO by the thermodilution method, and calculates the value from the relationship between this CO and the initial blood flow velocity V. After finding the parameter S, from then on, just measure the blood flow velocity v at any time, and continuously calculate the cardiac output CO.
It is distinctive in that it requires I. That is, COl(=に=:■1, and the change in ■5 reflects the relative change in Co.

Therefore, if you record the change in Vl, it will be directly reflected in the CO
This means that the relative change in I has been recorded. On the other hand, the approximate value of the parameter S is known if the subjects are the same and the measurer is aware of the parameter S during the measurement. Therefore, in the measuring device of this embodiment, this approximate parameter S
is input as the "initial CAL value" from the switch 62, thereby making it possible to omit measurement of the initial cardiac output value CO by thermodilution.

<Application to other dilution methods> As is clear from the explanation so far, the continuous cardiac output measurement of the above-mentioned embodiment is performed once the initial cardiac output CO is measured by some method. If so, then the parameter S is measured and held, and thereafter the cardiac output COI can be continuously determined by simply measuring the blood flow velocity v. Therefore, the present invention is not limited to obtaining the initial cardiac output CO by measurement using the thermodilution method as in the above-mentioned embodiments. It is also possible to obtain a quantity of CO. In this case, in the dye dilution method, the amount of dye in the blood is measured by measuring changes in illuminance at, for example, an earlobe, and in the electrolytic dilution method, changes in blood resistance are measured using two electrodes installed in a catheter. By this, the cardiac output CO is obtained.

In other words, the amount of data (for example,
The input function (Fr, ml) can also be applied to general indicator dilution methods using catheters. Further, the automatic measurement start function (2) is directly applied to detecting the points of change in the above-mentioned changes in illuminance and changes in resistance value. In addition, the continuous cardiac output measurement function (■) calculates the parameter S based on the initial cardiac output CO obtained by a general indicator dilution method, and then calculates the CO from the blood flow velocity Vl at any time. It is also applicable to calculating .

Furthermore, as another modification and modification, we propose the following mechanism for detecting the connection of the temperature probe 12. That is, a biased protrusion is provided at a portion of the main body of the measuring device to which the connector 16 of the probe is connected. When the connector 16 is connected, this protrusion is pushed back. When the protrusion is pressed, the end of the protrusion is arranged to provide a ground signal to the measurement circuit 120, for example. The measurement circuit 120 can determine whether the probe 12 is connected or disconnected based on the presence or absence of this ground signal. In addition, the above protrusion is
It is electrically insulated from the circuit 120 except for its ends. This is to keep the entire circuit 120 electrically floating.

As another modification, blood flow rate measurement using thermistor 1 not only detects thermal equilibrium under constant current, that is, changes in thermistor resistance using voltage, etc., but also detects the temperature difference necessary to keep the temperature difference from blood temperature constant. A current may be applied and the current may be measured. In other words, there is a method of controlling the thermistor temperature to an upper limit of 42°C that does not affect the living body, and measuring the current. Further, the blood flow rate sensor is not limited to a thermistor, and other means may be used.

[Effects of the Invention] As explained above, according to the cardiac output measuring device of the present invention, when there is no need to measure data related to an accurate indicator liquid, such as temperature data, the actual indicator liquid can be measured. By setting and inputting a data value close to the data from, for example, a switch instead, the cardiac output based on the thermodilution method can be measured, improving operability.

[Brief explanation of the drawing]

1A, 1B, and 1C are a plan view, a front view, and a rear view of a measuring device according to an embodiment, and FIG. The overall perspective view, main part sectional view, and opening sectional view of the catheter used; Figure 3 is a procedure diagram explaining the operating procedure of the measuring device of the example; Figures 4 and 5 show the thermodilution method using the example device. Figures 6 to 8 are diagrams showing examples of output results when cardiac output is measured based on the results of continuous measurement, and Figure 9 is a measurement The circuit diagrams of the main parts of the device, FIGS. 10A and 10B, are RA in the measuring device. Diagrams explaining the state of M management, Fig. 11, Fig. 13A, Fig. 13B, Fig. 14, Fig. 15
The figures are a flowchart showing the control procedure according to the embodiment, Figure 12 is a diagram showing a table storing the correction constant A, and Figures 16 and 17 are the principles of cardiac output measurement using the conventional thermodilution method. FIG. In the figure, 1.2, 12a... Thermistor, 4... Catheter, 6, 8, 10, 13. 14... Tube, 7°9.
11, 15. 16... Connector, 12... Infusate temperature probe, 50... Plotter, 52, 53, 54.
55, 56, 57.58... switch, 59°60.
61, 62.75...Setting input switch, 64.65
, 66.67.70.72...Switch/indicator, 68...4-digit LED display, 69...3-digit L
ED display, 71...LED bar graph, 73...
Catheter connection connector, 74...Temperature probe connection connector, 100...Measuring device, 101°112...
- Constant voltage circuit, 111... Constant current circuit, 102...
Injection liquid temperature detection circuit, 103...analog switch,
104...A/D converter, 105,133...CP
U, 106,131...ROM, 107,132...
- It is RAM. (Other names)';-4g word 11th ward broom 12th figure 15t! 1

Claims (2)

[Claims] (1) An indicator liquid data detection means for outputting data related to the indicator liquid before being injected into the blood vessel, and a blood data detection means for detecting and outputting blood data diluted by the indicator liquid injected into the blood vessel. and an integrating means for integrating the difference value between the blood data at each time and predetermined reference blood data, an input means for setting arbitrary data and inputting it as a data value of the indicator liquid, and from the input means. A cardiac output measuring device comprising cardiac output calculation means for calculating cardiac output based on data input as instruction liquid data and the integral value. (2) The cardiac output measuring device according to claim 1, wherein the indicator liquid data is the temperature of the indicator liquid.