JP2008113936A - Biological sound stethoscope - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To obtain a device that continuously monitors biological sounds from a patient for a fixed time and automatically determines his conditions. <P>SOLUTION: The device is provided with a sound detector 1 to be attached continuously and directly to a patient and a central processing unit 8 that previously stores the patient's normal and abnormal biological sound data 10a and 10b and compares them with biological sound data input from the sound detector 1. If the CPU 8 determines the results to be abnormal, it gives the alarm via an alarm means 9 or an image sound input/output means 3A. The CPU 8 can also be structured so that it can output patients' biological sound data to a medical institution 5 through a processor 2 and a communication means 4. Further a doctor can apply this biological sound stethoscope to a patient at home by specifying to him the sound detection position on his body through the bi-directional communications between the image sound input/output parts 3A and 3B on the patient's part and the medical institution 5's part. <P>COPYRIGHT: (C)2008,JPO&INPIT

Description

  The present invention relates to an auscultation apparatus capable of monitoring a heart sound or breathing sound of a human body in the vicinity or remotely, and continuously monitoring the sound, particularly for a patient having a respiratory disease or the like. Related to auscultation devices.

A stethoscope that is conventionally used in medical institutions is a collection that collects sounds (hereinafter referred to as “biological sounds” including the examples) that are directly applied to the skin of a measurement object such as a patient and emitted from the heart, lungs, blood vessels, and the like. It consists of a sound tube, an ear tube that is a hearing device that auscultators such as doctors apply to their ears, and a rubber tube that connects these ear tubes and the sound collecting unit. The following patent document discloses an electronic stethoscope that converts a sound collected in step 1 into an electric signal, transmits the signal as a wired or wireless signal, and outputs the signal as a sound by a microphone for auscultation. Some have been proposed.
JP-A-2002-153659 11-51067 JP 2001-149369 A Special table 2004-500219

  Each of the inventions described in the above patent documents corresponds to the above-described electronic stethoscope, and a sound collecting unit that outputs the collected biological sound information as an electrical signal and is transmitted from the sound collecting unit. And an output unit such as a microphone for outputting a signal as a sound.

  Each of the inventions described in the above-mentioned patent documents is such that a doctor or the like performs auscultation and examination on an object such as a patient via a wired or wireless transmission means, and the conventional stethoscope is digitized to serve as a stethoscope. It aims to improve usability and auscultation ability. In other words, the purpose of the invention is only a stethoscope, and its use is used by a person who performs auscultation such as a doctor whenever necessary for an auscultation target such as a patient, as in a conventional stethoscope. There is no difference from the conventional stethoscope.

  The invention described in the above patent document is only a stethoscope and is used for a relatively short time each time depending on the purpose, but depending on the auscultation target person (hereinafter referred to as “patient” including examples) If continuous monitoring of body sounds is possible for a relatively long period of time, there are not a few people who can detect changes in the patient's condition without delay and take appropriate measures. However, at present, no such body sound monitoring device has been proposed.

  For example, there is a disease called “Rett Syndrome” that affects only girls. This disease occurred in a girl who had been growing normally until about 6 months after birth, and gradually declined in motor function due to muscular weakness, etc. As a result, phlegm was caught in the throat due to a decrease in respiratory function and swallowing function. However, it has been reported that it is difficult or practically impossible to convey this fact to a third party due to a decline in language function.

  Therefore, for patients with Rett syndrome, whether they are hospitalized or at home, caregivers such as parents constantly monitor the patient's facial expression, inferring clogging from the change in facial expression, etc. If the suction operation is delayed or the change in facial expression is overlooked, the patient is at risk of death from suffocation. Such patient observation and sputum suction work need to be done day and night, and thus a caregiver who examines the patient has an unimaginable burden. In addition, it is difficult to detect changes in patients unless they are in contact with patients at all times, such as parents, to determine whether or not they are involved, and nursing can be easily delegated to a third party. There is also a dilemma that cannot be done.

  In addition to the above-mentioned Rett Syndrome, the need for continuous monitoring is the same for the bedridden elderly man's sputum or childhood asthma.In the case of childhood asthma, the signs are detected before the asthma attack occurs. If possible, there are various advantages such as reducing the degree of seizures by early medication and preventing seizures themselves.

  The present invention is configured to solve the above-mentioned problems, and before the occurrence of the entanglement of the sputum, the attack of asthma, etc., the respiratory sound of the patient, the sound of the blood vessel part due to changes in blood flow and blood pressure, etc. If the patient's body sound is continuously monitored, the change in the body sound is detected and an alarm is issued, etc. It is constructed based on the idea that it is possible to significantly reduce the burden on the patient and to avoid serious accidents such as mistakes in treatment due to caregiver fatigue and forgetting treatment.

  That is, the present invention mainly comprises a hearing part to be brought into contact with the patient's skin and a processing device for analyzing a patient's body sound heard by the hearing part. A biological sound monitoring apparatus comprising: means for analyzing and determining the state of a patient; and means for notifying the detection result as an alarm when a patient abnormality is detected from the acquired biological sound data.

  The patient's hearing part is continuously attached to the patient, and the processing device constantly monitors the body sound heard by the hearing part, and compares this monitored body sound with the body sound data that it has. By doing so, the patient's condition can be detected in real time. Therefore, when an abnormality of the patient is detected, a caregiver or a doctor can immediately perform an appropriate treatment on the patient by an alarm issued by the processing device.

  The patient's body sound is monitored and analyzed continuously and automatically by the processing device, so that the person who cares for the patient is freed from the work of observing the patient's condition without knowing day and night, and the burden on the caregiver is reduced. It will be greatly reduced.

  Furthermore, by connecting a specialized institution such as a medical institution and a processing device via communication means such as the Internet, the patient's body sound can be directly monitored by the specialized institution, or the judgment result of the processing device can be directly received by the medical institution. By doing so, it is possible to immediately carry out advanced medical judgments such as necessity of hospitalization from the state of the abnormality when the abnormality occurs.

  The hearing part attached to the patient has a built-in device for converting the heard signal into an electrical signal, and the electrical signal output from the hearing part is analyzed by a processing device that inputs processing software and data to a personal computer or the like. When the patient's condition is monitored and it is determined that the analysis result is abnormal, a means for generating an alarm is provided, and this alarm is configured so that a caregiver or a medical professional institution can quickly take an appropriate treatment.

FIG. 1 shows a first embodiment of the present invention.
The present invention has as a basic element a listening unit 1 for directly listening to a patient's body sound and a processing device 2 for inputting the body sound data heard by the listening unit 1 and analyzing the body sound data. The video / audio input / output unit 3A installed on the patient side and the video / audio input / output unit 3B installed on the medical institution 5 side via the communication means 4 such as the Internet and connected to the video / audio input / output unit 3A on the patient side. Is an auxiliary component.

First, the configuration of the listening section 1 and the processing device 2 will be specifically described.
First, the listening section 1 is configured as an auscultatory microphone and includes a microphone amplifier that amplifies a detection signal from the microphone. Also, the amplified biological sound signal of the patient is transmitted as it is to the processing device 2 as an analog signal, and the A / D conversion circuit is incorporated in the listening unit 1 and transmitted to the processing device 1 as a digital signal. Any configuration is possible. Signal transmission can be appropriately adopted, such as wireless connection using radio waves or connection by signal lines.

  Depending on the type and condition of the patient's illness, the listening part 1 is basically continuously attached to the patient for a relatively long time (for example, about 12 hours) when constant monitoring is required. It will be. As a mounting method, the listening part 1 is fixed to a predetermined position of the patient using a band, a medical adhesive tape, or the like.

  On the other hand, the processing device 2 is constituted by an arithmetic processing device of a level of a personal computer having a relatively large storage capacity and a relatively high calculation speed. Reference numeral 6 denotes a signal processing unit having an amplifier circuit, which amplifies the signal output from the listening unit 1 to such an extent that the processing is appropriately executed in the subsequent processing. Incidentally, the normal listening unit 1 also has an amplifier circuit, but the listening unit 1 gives priority to being made small and light in order to minimize the uncomfortable feeling to the patient when worn, so the signal from the listening unit 1 is It is not always amplified properly.

  In addition, when the listening unit 1 is not provided with an A / D conversion circuit and a biological sound signal is output from the listening unit 1 as an analog signal, the signal processing unit 6 converts the analog signal into a digital signal. An A / D conversion circuit is also provided.

Reference numeral 7 denotes a filter means for the biological sound digital signal output via the listening section 1.
When listening to the patient's body sound in the listening section 1, for example, sound noise other than body sound is generated due to patient movement such as turning over, rubbing clothes, etc., and this sound noise is generated when the sound section 1 generates sound noise. And a signal carrying this noise is output to the processing device 2.

The filter 7 removes such noise.
Specifically, the threshold value is set in advance and the method of removing high-frequency or low-frequency components that do not occur in the body sound is the simplest method, but other than this, normal value data that is waveform data described later If it is configured to detect the difference in waveform from the abnormal value data and remove the data component that does not match the waveform, the biological sound data can be extracted more accurately.

  Waveform data can be created by performing Fast Fourier Transform (FFT), but precise calculation requires a corresponding calculation speed and storage capacity. When the FFT software is installed, the performance is naturally limited, and if such PC-installed software is insufficient depending on the application, the signal of the signal processing unit 6 is temporarily output to the FFT dedicated device, and this FFT dedicated You may comprise so that the data after the waveform analysis in an apparatus may be input into the processing apparatus 2 again. The data passing through the filter 7 in this way is sent to the central processing unit 8.

  In addition to the above-described noise, if the level of the body sound signal from the listening unit 1 is suddenly reduced or almost disappeared, it is highly possible that the listening unit 1 has dropped from the patient. The unit issues an alarm directly at the alarm transmission means 9 or via the video / audio input / output unit 3A. It should be noted that the above-described decrease in the signal input level occurs not only when the listening section 1 is dropped, but also when the patient suddenly becomes in a dangerous (serious) state such as cardiac arrest or fine cardiac motion. Therefore, the alarm corresponding to the above-described state may be set in advance as an emergency alarm including such a dangerous state alarm.

  When there is no signal level lowering state as described above, the input body sound signal data is constantly compared with the normal value data 10a and abnormal value data 10b in the storage means 10 in the central processing unit 8, and the patient's state is continuous. To be monitored.

  Here, in this embodiment, both normal value data 10a and abnormal value data 10b are stored as waveform data. More specifically, first, the normal value data 10a is obtained when the patient to be monitored is in a normal state without an asthma attack, or when the patient has no wrinkles in the case of the Rett syndrome patient. A doctor or the like directly auscultates in advance when the patient is in a normal state, and stores this auscultation data as normal data (normal waveform data) 10a of the patient to be monitored by the processing apparatus 2.

Next, several seeding methods are conceivable for the abnormal data (abnormal waveform data) 10b. The most realistic method is as follows.
That is, before starting the continuous monitoring of the patient, the listening unit 1 is attached to the patient by the above-described method, and the monitoring of the body sound is started. At this time, only the normal data 10a is stored in the storage means 10 and the abnormal data 10b is not stored. Therefore, the central processing unit 8 determines that the biological sound data being monitored is the normal data 10a. It is only possible to determine whether they match. In this state, there are many uncertain factors in the judgment of the device, so it is preferable for the caregiver to continuously observe the patient. However, the caregiver confirms that the patient has an abnormality during this observation. In this case, the caregiver performs the treatment for the patient, and uses the input means such as a keyboard to capture the data as the abnormal data 10b into the storage means 10 of the processing device 2.

  Data is taken in for a predetermined time before and after the time of the data take-in command by the input means such as the keyboard. By doing this, it is possible to capture not only the patient's body sound data before the abnormality becomes apparent, that is, the data of the patient's body sound until the abnormality occurs, as well as the data at the time of the abnormality. . For this reason, if the data including the data before the occurrence of the abnormality is set as the abnormal data 10b, the abnormal data 10b is compared with the monitor data, so that the patient's abnormality can be generated earlier. Or, it is possible to increase the possibility of finding the abnormality before it becomes apparent.

  The body sound data of the patient monitored by the above-described process is not only used for monitoring the occurrence of abnormality between the processing device 2 installed in the home where the patient is home and the patient or the caregiver of the patient, It is possible to output the data to the medical institution 5 via the communication means 4 such as the Internet or a telephone line and to monitor the medical institution 5 as well. In this case, both the treatment device 2 at the patient's home and the treatment device installed at the medical institution 5 are monitored in parallel, and the nurse at the home side always takes care of the treatment at all times. It is also possible to configure to give a predetermined instruction to the caregiver from the monitored data via the video / audio input / output device 3A described later. Further, the alarm monitor means 11 is provided on the medical institution 5 side, and when the patient processing apparatus 2 issues an alarm, the alarm monitor means 11 is activated at the same time and the patient processing apparatus 2 issues an alarm. It is good to be configured to notify the doctor directly. Reference numerals 12 </ b> A and 12 </ b> B are information input / output I / O ports provided in the processing device 2 and the medical institution 5 server, respectively.

  With the above configuration, the body sound of the patient to be auscultated is automatically monitored at all times, and the caregiver can take appropriate measures for the patient without delay by issuing an alarm before the abnormality occurs or immediately after the abnormality has occurred. It can be performed.

FIG. 2 is a flowchart showing an example of an operating state of the apparatus having the above-described configuration.
When the listening unit 1 is attached to the patient, the listening unit 1 listens to the patient's body sound (SA1), and the processing unit 2 monitors the body sound data input by the above-described process, and normal or abnormal occurs. Is monitored (SA2), and if it is normal, the monitor is continued, and if it is determined to be abnormal, an alarm is issued (SA3) and appropriate measures are taken (SA4), while the medical institution 5 is connected via the communication means 4 (SA5). In this case, if the monitored data is also output to the medical institution at the same time as described above, the medical institution may analyze the output data and take care only for the caregiver, or separately It is also possible to contact the patient's home after determining whether or not to perform.

Next, an auscultation system using the video / audio input / output unit 3A installed on the patient side and the video / audio input / output unit 3B installed on the medical institution 5 side will be described.
First, the configuration of the image / audio input / output unit 3A will be described in detail. Incidentally, since the configuration of the audio / video input / output unit 3B is basically the same as that of the audio / video input / output unit 3A, the video / audio input / output unit 3A will be mainly described.

  The image / audio input / output unit 3A includes an imaging unit 3Aa, an image display unit 3Ab, and an audio input / output unit 3Ac. Specifically, the imaging unit 3Aa is a video camera such as a CCD, and the image display unit 3Ab is a liquid crystal screen or a CRT. The voice input / output means 3Ac is a speaker and a microphone, which are used as display means of a personal computer.

  Also on the medical institution 5 side, an image / audio input / output unit 3B including an image pickup unit 3Ba, an image display unit 3Bb, and an audio input / output unit 3Bc is installed, and between the image / audio input / output unit 3A and the image / audio input / output unit 3B. Thus, bidirectional communication is possible via communication means 4 such as the Internet. 1 shows a configuration in which the processing device 2 is interposed between the video / audio input / output unit 3A and the video / audio input / output unit 3B. However, the video / audio input / output unit is not provided with the processing device 2. It is also possible to configure the 3A and the video / audio input / output unit 3B to perform direct bidirectional communication.

  FIG. 3 shows a state in which a doctor performs auscultation (remote auscultation) of a patient by direct two-way communication between the above-described image / sound input / output unit 3A and the image / sound input / output unit 3B, and FIG. Is shown. Hereinafter, the remote auscultation system and procedure will be described with reference to FIGS.

  First, the patient goes to the image pickup means 3Aa of the image / sound input / output unit 3A with the upper body naked or underwear, and the image pickup means 3Aa picks up the patient in this state. It is displayed on the image display means 3Bb of the image / audio input / output unit 3B.

  On the other hand, an image D such as a doctor's face is displayed on the image display means 3Ab of the image / audio input / output unit 3A of the patient, and a state (psychological state) opposite to each other is set between the patient and the doctor, Bidirectional communication is started with images displayed on each other.

  The doctor looks at the patient displayed on the image display means 3Bb and instructs the arrangement position of the auscultation microphone. If the position of the auscultation microphone placed by the patient is correct, or if it is necessary to change the position, an instruction such as “slightly lower right” is given via the voice input / output means 3Bc, 3Ac while viewing the image. Put out. Of course, it is possible in the two-way communication that the patient side also actively asks the doctor when the position instruction is unknown. If the position is correct, the doctor gives instructions such as “hold the breath in that state”, “take a deep breath”, and monitor the patient's body sound in the indicated state. In this way, auscultation is performed by sequentially instructing the position of the auscultation microphone.

FIG. 4 shows the above-described procedure.
The patient's image is sent to the doctor-side image / audio input / output unit 3B (SB1), and the doctor instructs the arrangement position of the auscultation microphone (SB2). The doctor checks the arrangement position of the auscultation microphone by looking at the image (SB3). If the position is not correct, the doctor issues an instruction for the arrangement position again to indicate the correct position. If the arrangement position is correct from the beginning or is corrected to the correct position, the state at the time of auscultation such as “take deep breath” is instructed as described above, and the patient's body sound in this state is auscultated (SB4). .

  When the first auscultation is finished, the second auscultation is performed in the same procedure as the first auscultation as shown in steps SB5, SB6, and SB7. As shown in steps SB8, SB9, and SB10, auscultation is performed a plurality of times, finally comprehensive judgment is made (SB11), and the medical care is terminated.

  In the above description, the patient himself / herself places a living body sound microphone for auscultation of the patient. However, in cases where it is difficult to place the microphone yourself, such as a bedridden patient, It is of course possible to place the biological sound microphone at a predetermined position in response to the instruction.

  The two-way communication using the video / audio input / output units 3A and 3B is not only remote auscultation when the patient's medical condition is stable as described above, but also the processing device 2 issues an alarm such as the occurrence of clogging of wrinkles. In the event of an emergency, not only the hearing data is sent, but also by sending the patient's image, the sound emitted by the patient, etc. to the medical institution via the image / sound input / output units 3A, 3B It becomes possible to know the condition, and it is possible to issue an appropriate instruction in real time.

  As described above, the function of the present invention has been described by taking the case where the doctor and the patient are separated from each other. However, the doctor uses the listening unit 1 and the voice input / output means is a speaker, ear tube, earphone, or the like. By adopting a configuration in which the device is directly attached to the device, the device of the present invention can be used as an electronic stethoscope in which a doctor directly confronts a patient and performs auscultation.

  Although the present invention has been described as a medical device for automatically and sometimes remotely monitoring the patient's condition, the present invention can also be used as an industrial device. For example, a microphone is arranged for piping of various plants, and the flow sound of the liquid or gas inside, or the vibration sound of the piping itself is monitored. The vibration sound data at the normal time is input in advance, and an alarm is issued when the actually detected flowing sound deviates from the normal value data.

  In fact, the sodium spill accident in the fast breeder reactor Monju that occurred on June 7, 1996 was caused by the breakage of the thermocouple storage case inserted in the sodium pipe. In the fracture, the case vibrates due to the liquid sodium flowing at high speed around the case, and the vibration finally breaks due to this vibration. If a plurality of microphone parts of the present invention are installed in a sodium pipe, it is highly possible that abnormal vibrations have been found before breaking.

It is a block diagram which shows the structure of the biological sound auscultation apparatus which concerns on this invention. It is a flowchart which shows an example of the operation state of the apparatus shown in FIG. It is a figure which shows the display state in the image audio | voice input / output part at the time of using this invention as a remote auscultation system. It is a flowchart which shows the doctor's working state in the case of performing the system shown in FIG.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Sound listening part 2 Processing apparatus 3A, 3B Image audio | voice input / output part 3Aa, 3Ba Imaging means 3Ab, 3Bb Image display means 3Ac, 3Bc Audio | voice input / output means 4 Communication means 5 Medical institution 6 Signal processing part 7 Filter 8 Central processing part 9 Alarm Transmission means 10 Storage means 10a Normal data 10b Abnormal data 11 Alarm monitoring means 12A, 12B I / O port C Patient image D Doctor image

Claims (8)

A hearing unit that is brought into contact with the patient's skin, and a processing device that analyzes body sound data such as a patient's breathing sound, blood vessel sound due to changes in blood flow and blood pressure, and the like. A means for analyzing the body sound data of the patient listened at the section to determine the patient's condition, and a means for notifying the detection result as an alarm when the patient's abnormality is detected from the obtained body sound data. A biological sound auscultation device. 2. The biological sound according to claim 1, wherein the listening unit is continuously attached to the patient for a certain period of time, and the listening unit is configured to continuously output the biological sound data of the patient who listened to the processing device. Auscultation device. The means for analyzing the body sound data to determine the state of the patient is at least the body sound data in the normal state among the body sound data in the normal state of the patient and the body sound data in the case of abnormality in the patient. 3. The storage means for storing the sound and the means for comparing the body sound data of the patient acquired through the listening section with the body sound data stored in the storage means. Biological sound auscultation device. The biological sound auscultation apparatus according to claim 3, wherein the biological sound data stored in the storage means is waveform data of biological sounds. The biological sound auscultation apparatus according to claim 1, wherein the processing apparatus is connected to a medical institution via a communication unit. 6. The body sound auscultation apparatus according to claim 5, wherein an image / audio input / output unit is provided on each of the patient side and the medical institution, and bidirectional communication is possible via the image / audio input / output unit. . The biological sound auscultation apparatus according to claim 6, wherein the image / sound input / output unit includes an imaging unit, an image display unit, and a sound input / output unit. The biological sound auscultation apparatus according to claim 1, wherein the listening sound data of the listening part is configured to be wirelessly output to the processing device.

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