JP5048227B2 - ECG analyzer - Google Patents

Description

The present invention relates to an electrocardiogram analyzer for analyzing an electrocardiogram , and more particularly to an electrocardiogram analyzer suitable for analyzing an electrocardiogram for a long time as recorded by a Holter electrocardiograph .

  Conventionally, long-term electrocardiogram data recorded by a Holter electrocardiograph or the like includes a very large number (for example, 100,000 times or more) of heartbeat waveforms, so that even if an abnormal heartbeat waveform is found, for example, it is not realistic to perform it manually. . Therefore, the electrocardiogram data is used after the automatic classification according to the characteristics of individual heartbeat waveforms and the intervals between adjacent heartbeat feature points, the detection of abnormal waveforms, the number of occurrences, etc. Is common. By adding information such as serial number, classification, and R-R interval (R-wave time interval) to the previous heartbeat for each heartbeat by the analysis device and storing it, for example, only heartbeat waveforms having similar characteristics are displayed together Efficient use of ECG data for a long time can be realized.

  More specifically, the analysis apparatus analyzes each waveform for each heartbeat included in the electrocardiogram data according to a predetermined classification condition such as a waveform (mainly QRS wave shape) and an RR interval from the previous heartbeat. ,Classify. Then, a heartbeat waveform group (morphology group) determined to have similar characteristics is generated. In addition, the presence or absence of extrasystole, fibrillation, tachycardia, ST change or the like is detected, and the corresponding heart rate is counted or the amount of fluctuation is measured.

  Examples of classification (morphology classification) generated by the automatic classification process include ventricular extrasystole (V), normal heartbeat (N), supraventricular extrasystole (S), paced heartbeat (P), and noise. . In addition, the classification is not only automatically assigned, but it is generally possible for the user to newly give or change the classification after the automatic classification. The function of assigning or changing the classification is called a morphology editing function.

JP 2004-298444 A (FIG. 6)

  The automatic analysis results by the analysis device are usually processed into data (statistical processing) into a form that is considered necessary for easy use by analysts and doctors, and displayed as an analysis result report with subject information added. Printed out (Patent Document 1, FIG. 6).

  However, as disclosed in Patent Document 1, the report provided by the conventional analysis apparatus is the total number of heartbeats, the ratio of the number of abnormal heartbeats automatically classified, and the ratio of the total number of heartbeats per minute and the maximum ST level. In general, numerical values such as minimum and average values, maximum values, and times when minimum values were observed were listed.

  The output position of the numerical information is fixed, and the items are displayed in the same row without distinction. Therefore, if the correspondence between items and numerical values is not confirmed, the importance of the information presented by the analysis results (for example, whether there is a problem or whether it is not so urgent should immediately consider other tests and treatments). Cannot be determined. Furthermore, the importance of the information presented by the report cannot be communicated unless a person who understands the meaning of the numerical values is confirmed.

  In Patent Literature 1, the diagnostic result of a predetermined item is scored in the preliminary analysis device, and the importance determined from the total and the content of the subject's complaint is included in the preliminary analysis report, thereby analyzing the importance of the analysis. It has been proposed that the center and doctors can understand.

  However, in patent document 1, the total importance is determined in consideration of the total of analysis results regarding a plurality of items and complaints heard from the subject in advance. For this reason, it is necessary to grasp from the enumerated numerical values as to how much problematic analysis results are obtained for which items.

  In addition, a person who understands the meaning of the numerical value may not have the knowledge of what kind of treatment should be performed, but in a conventional report, information (feature, cause) And general information such as possible actions) were not provided.

  Moreover, it is a report about the result of an automatic analysis to the last, Comprising: It was not considered at all about filling in the diagnostic result etc. which the doctor who looked at the result performed. Therefore, in practice, it is not always necessary to file a report in a medical record, and a doctor sometimes writes a finding after copying the numerical value of the report in the medical record.

The present invention has been made in view of the problems of the prior art, and an object thereof is to provide an output capable electrocardiogram analyzer analysis result report better form convenient.

That is, the gist of the present invention is an electrocardiogram analysis apparatus for analyzing an electrocardiogram, an analysis unit for analyzing the electrocardiogram based on a predetermined determination condition, and a report output for outputting an analysis result by the analysis unit as an analysis report The report output means presents information on each of a plurality of abnormal states estimated from the analysis results, and the position in the region and the severity are associated with each type of abnormal state. And check items that are determined for each type of abnormal condition and are pre-arranged at positions in the regions that are determined according to the contents. The present invention resides in an electrocardiogram analyzer characterized by outputting an analysis report shown in a state in which it is displayed .

Another gist of the present invention is an electrocardiogram analysis apparatus that analyzes an electrocardiogram, and analyzes the electrocardiogram based on a predetermined determination condition, and outputs an analysis result by the analysis means as an analysis report. and a report output means, analysis reports, a plurality of items representing each of a plurality of abnormal conditions estimated from analysis results, the abnormal item presentation area for presenting the order being determined to have a high severity, An electrocardiogram analysis apparatus having an actually measured waveform presenting region for presenting an actually measured waveform corresponding to an item presented in an abnormal item presenting region.

Another gist of the present invention is an electrocardiogram analysis apparatus that analyzes an electrocardiogram, and analyzes the electrocardiogram based on a predetermined determination condition, and outputs an analysis result by the analysis means as an analysis report. Report output means, and the analysis report presents an item that represents the abnormal state judged to be the highest severity among the multiple abnormal states estimated from the analysis results , and an explanation of the abnormal state An electrocardiogram analysis apparatus having an area and an actual waveform presentation area that presents an actual waveform corresponding to an item.

With this configuration, the electrocardiogram analyzer that by the present invention, depending on the severity of the abnormal state to be estimated from the results of the analysis, it is possible to output a more analytical report good form convenient.

Hereinafter, the present invention will be described in detail based on preferred embodiments with reference to the drawings.
<First Embodiment>
(Configuration of electrocardiogram analyzer)
FIG. 1 is a block diagram illustrating a functional configuration example of an electrocardiogram analyzer according to the first embodiment of the present invention.

  The data input unit 110 is, for example, a memory card reader or a network interface, and is an interface that reads and inputs electrocardiogram data recorded in advance from a recording medium or another device. The filter processing unit 120 performs a filtering process typified by waveform shaping processing such as noise removal and baseline fluctuation removal on the electrocardiogram data input from the data input unit 110, and writes the processed electrocardiogram data to the storage unit 130. .

  The storage unit 130 is composed of a large-capacity storage device such as a hard disk drive, and stores a long-time electrocardiogram recorded by a Holter electrocardiograph for the entire time. The waveform memory 140 is a memory for storing a plurality of types of standard waveforms for classifying heartbeats from waveforms, and a part of the storage unit 130 can also be used. The waveform memory 140 may store the waveform itself, but may store data such as feature points corresponding to the waveform instead.

  The classification processing unit 150 performs waveform analysis and classification processing. That is, for all heartbeats stored in the storage unit 130, processing such as QRS waveform detection and RR interval calculation with at least one adjacent heartbeat is performed. Further, it is classified into the morphology classification and the morphology group in the morphology classification based on the waveform data stored in the waveform memory 140 or a predetermined condition, and is written back to the storage unit 130. Furthermore, simultaneously with the classification process, the classification processing unit 150 assigns a continuous number to each heartbeat, calculates abnormal heartbeat counts, whether or not the ST level has increased, and calculates statistical data such as the number of heartbeats per minute. .

The waveform search unit 160 searches the total heart rate data recorded in the storage unit 130 for a specified condition, for example, a heart rate included in a specific morphology classification or morphology group, and supplies the result to the control unit 170.
It is also possible to create an index file for each morphology classification or morphology group and record the specific information (for example, serial number) of the corresponding pulse in the index file. In this way, it is possible to specify a pulse group that is classified into a desired morphology classification or morphology group without searching all heart rate data.

  The control unit 170 is, for example, a CPU, and controls the operation of the entire electrocardiogram analyzer by executing a control program recorded in the storage unit 130, for example. The input unit 180 is at least one input device typified by a keyboard and a pointing device (mouse, trackball, etc.), and is used when the user makes various settings and instructions. The display unit 190 is a display device such as an LCD or a CRT, and displays various information such as an electrocardiogram and an analysis report according to the control of the control unit 170. Note that not only the display unit 190 but also a printer 195 can be connected as an output device.

  The electrocardiogram analyzer of the present embodiment having such a configuration can be realized by using a general-purpose computer device that is commercially available as a personal computer, for example. The filter processing unit 120, the classification processing unit 150, and the waveform search unit 160 may be realized by individual hardware, or may be realized by software by a CPU executing a program that realizes the function of each unit. good.

(Electrocardiogram analysis / classification processing)
Next, the flow of electrocardiogram data analysis / classification processing in the electrocardiogram analyzer of the present embodiment will be described with reference to the flowchart shown in FIG. For convenience, it is assumed here that the electrocardiogram data already processed by the filter processing unit 120 is stored in the storage unit 130 at the time of starting the heart rate classification processing, but the data input processing and the heart rate classification processing are performed in parallel. You can go. In addition, since the ECG data of a plurality of channels is generally measured and recorded, the ECG data of the plurality of channels can be processed even in the analysis apparatus of this embodiment. However, only the data processing of one channel is performed for the sake of simplicity. explain.

  First, in step S210, for example, when execution of analysis processing is instructed via the input unit 180, the control unit 170 detects it and instructs the classification processing unit 150 to execute analysis / classification processing. The classification processing unit 150 reads electrocardiogram data for a predetermined time from the storage unit 130 according to a time series. Then, a QRS waveform is detected from the read electrocardiogram data by a known method, and other features (P wave, T wave, U wave) and the like are searched for based on the R wave.

  Then, the waveform data for one heartbeat is cut out. The separation may be performed between the P wave and the U wave, or may be performed for a certain period of time before and after the R wave as a reference (for example, 1 second 400 ms before and 600 ms after the R wave position) (step S220). . At this time, information (additional information) regarding characteristics for each heartbeat is also acquired. This includes the amount of ST increase, the PR interval, and the R wave position (for example, relative time or absolute time when the start of recording of the entire electrocardiogram data is set to 0:00:00). The acquired information is temporarily stored.

  Next, in step S230, the R wave position stored as the additional information of the previous heartbeat and the RR interval obtained from the R wave position of the heartbeat are obtained. Then, based on the determination conditions such as the RR interval, the additional information already obtained, and the waveform comparison result based on the data (reference waveform information) related to the reference waveform stored in the waveform memory 140, the heartbeat is considered to be applicable. Determine the morphology classification that will be used.

  How to determine the morphology classification using the RR interval, the additional information, and the reference waveform information can be appropriately determined. First, it is determined whether the morphology classification can be clearly distinguished from the waveform, and the waveform is determined. If it is not possible to discriminate from the above, it is generally efficient to classify in consideration of the RR interval.

  Next, additional information is added to the classified ECG data for one beat (step S250). FIG. 3 shows an example of an electrocardiogram data format for one beat in the present embodiment. The electrocardiogram data is composed of a header portion and a waveform data portion, and additional information is stored in the header portion. The additional information includes a serial number from the heartbeat waveform recorded first, a symbol representing the classified morphology group, an R wave position of the heartbeat, an ST variation, a PR interval, a start time, and an end time. Actually, more additional information may be recorded, but the description is omitted because it is not directly related to the present embodiment. Further, information that can be obtained from the waveform is not necessarily added as additional information.

  The electrocardiogram data to which the additional information is added is written back to the storage unit 130. Since only the morphology classification is determined at this time, the morphology group information in the additional information is a symbol representing the morphology classification (for example, as described above, N for normal heartbeats, and extraventricular extrasystole. S, V, etc. if it is an intervening ventricular extrasystole.

  While performing such processing for each heartbeat, the waveform classification unit 150 also performs statistical processing for obtaining numerical data, and detection and recording of specific events. That is, as a statistical process, the heart rate is counted every minute, and the maximum value, the minimum value, and the average value are sequentially updated. For example, the number of heartbeats determined to be extrasystole is accumulated. .

  Also, occurrence of predefined events such as tachycardia, resting heartbeat (when RR interval exceeds a predetermined time), ST change exceeding a predetermined value, etc. is detected based on pre-registered criteria To do. The detected event is stored as an event file in which a type, numerical information (event start time, various measurement values, etc.), and a heartbeat waveform for a predetermined time (for example, 10 seconds) immediately before the event detection or detection are associated. . Even if the event file is stored as a separate file associated with the data file for recording the total heart rate, the bibliographic information of the subject, etc., the event information excluding the waveform data and the reading position of the corresponding waveform data are specified. It is also possible to record information as a set by storing it in a partial area of the data file.

  In this specification, normal conditions such as extrasystole, tachycardia, resting heartbeat (when the RR interval is greater than or equal to a predetermined time), ST change greater than or equal to a predetermined value, which are estimated by analysis of an electrocardiogram. A state determined to be not is collectively referred to as an abnormal state.

In step S260, it is determined whether or not the processing is completed for the electrocardiogram data for all the heartbeats recorded in the recording unit 130. If there is unprocessed data, the process returns to step S210.
On the other hand, if it is determined that the processing for all the heartbeats has been completed, the process proceeds to step S270, and further, classification processing into a morphology group is performed.

  In step S <b> 270, the control unit 170 instructs the waveform search unit 160 to search the electrocardiogram data to which the same morphology classification symbol is assigned from the storage unit 130 and supply the result to the classification processing unit 150. The waveform search unit 160 searches for electrocardiogram data for each morphology classification in accordance with a predetermined order in accordance with this instruction, and supplies it to the classification processing unit 150.

The classification processing unit 150 generates, for example, a morphology group having the first supplied waveform as the top waveform (reference waveform) of the morphology group, and the morphology classification symbol in the additional information of the electrocardiogram data classified into the morphology group, It is rewritten to a symbol (morphology group symbol) having a configuration of morphological classification symbol + serial group number.
For example, since the first electrocardiogram data of the morphology classification V is the first waveform of the first morphology group in the morphology classification V, the morphology classification symbol of the additional information is rewritten from V to V1.

  Then, when the next electrocardiogram data is supplied, the similarity (correlation) with the top waveform is calculated by a well-known method, and when the degree of correlation is larger than a predetermined value, to belong to the same morphology group, The same morphology group symbol V1 as the top waveform is given. On the other hand, if the degree of correlation is less than or equal to the predetermined value, the top waveform of another morphology group is used, and the same morphology classification symbol + serial group number, and thus the morphology group symbol V2, is assigned.

As described above, as long as the electrocardiogram data having a correlation degree larger than the predetermined value continues, the ECG data is classified into the same morphology group. When the electrocardiogram data having the correlation degree equal to or less than the predetermined value is supplied, a new morphology group is generated. By repeating this process, a plurality of morphology groups (Xn: integer of n ≧ 1) are generated in the same morphology classification (X). The electrocardiogram data that has been classified into the morphology group is written back to the storage unit 130 again.
When such a classification process into the morphology group is performed for all the morphology classifications, the classification process is terminated.

(Analysis report generation and output processing)
FIG. 4 is a flowchart showing an overall flow of analysis report generation and output processing in the analysis apparatus according to the present embodiment. The following processing is mainly performed by the control unit 170 unless otherwise specified.

  First, in step S <b> 101, a screen (data selection screen) for selecting data for which a report is to be created is displayed on the display unit 190. FIG. 8 shows an example of the data selection screen. The present embodiment exemplifies a case where so-called tab-type screen display is employed, in order to instruct switching to various report display screens described later (that is, report display) in addition to the tab 201 of the data selection screen. Tabs 202 to 204, and tabs 205 and 206 for displaying a print screen and an end screen are shown.

  The data selection screen includes a list display field 215 for displaying a list of data stored in the storage unit 130, a selected data display field 210 for displaying the full path of the currently selected data, and a file provided by the OS. A reference button 211 for selecting a desired data file using the designation screen is included.

The list display field 215 displays not the file name of the data but the name of the subject or the client, the ID of the subject, the recording date and time, the analysis, editing, and printing status. These pieces of information can be recorded in a header or a predetermined area of each data file, and can be read and displayed.
In the selected data display field 210, it is possible to directly input characters, and it is also possible to directly input a desired data path and specify a data file.

  Returning to FIG. 4, in step S <b> 103, it is checked whether any of the other tabs 202 to 206 has been selected on the data selection screen, that is, whether it has been selected by an input (such as a mouse click) from the input unit 180. If there is no input, the process waits through steps S109 and S113 described later.

If any of the report tabs 202 to 204 is selected, the process proceeds to step S105. If any other tab is selected, the process proceeds to step S109.
Here, a case where any one of the report tabs 202 to 204 is selected will be described first. In step S105, it is checked whether there is data for which a report is to be generated. Specifically, first, the selected data display column 210 of the data selection screen is not blank, a character string specifying a file is input, or the data specified in the selected data display column 210 actually exists. Check if you want to.

  If any of these conditions is not found, an error message is displayed without switching the screen display to the report display screen, and the data selection screen is waited (return to step S101).

  In step S105, if the data specified in the selected data display field 210 actually exists, it is determined which report tab has been selected (step S107), and the report is generated and displayed in accordance with the tab. (Steps S110, S120, S130). Details of a specific report format and generation processing will be described later. When another tab is selected from the report display screen, the process returns to step S103.

  If the selected tab is other than the report tabs 202 to 204 (and the data selection tab 201) in step S103, it is checked in step S109 whether the print tab 205 has been selected.

  If the print tab 205 is selected, print processing is performed in step S111. Specifically, a print instruction screen as shown in FIG. 12 is displayed, and a report is printed according to the state of the report selection area 620 when the print button 610 is clicked. In the report selection area 620, the user can instruct to print all the reports at once or by specifying the type by selecting a button to be exclusively selected from “print” and “not print” with the mouse. it can.

  At the time of printing, printing is realized by performing a process similar to a report generation process, which will be described later, on a report designated for printing, and performing an output process using the printer 195 instead of the display unit 190 as an output device. When printing is completed, the process returns to step S101. If another tab is selected while the print instruction screen is displayed, the process returns to step S103.

  If the print tab is not selected in step S109, it is checked in step S113 whether the end tab is selected. If not selected, the process returns to step S101. If the end tab is selected, an end confirmation screen as shown in FIG. 13 is displayed. If the “Yes” button is clicked, the process ends. On the other hand, if the “No” button is clicked, the process returns to step S101. If another tab is selected while the end confirmation screen is displayed, the process returns to step S103.

(Summary report generation / display processing)
Next, the format and generation / display processing of each report will be described.
FIG. 5 is a flowchart illustrating details of the summary report generation / display process executed in step S110 in FIG.

  First, in step S <b> 301, the control unit 170 reads the data file selected on the data selection screen from the storage unit 130. Then, a summary report is generated based on the layout predetermined in step S303 and displayed on the display unit 190.

A specific example of the summary report is shown in FIG.
The summary report includes a basic rhythm information column 310, arrhythmia information columns 320 and 330, an ST presentation information column 340 information presentation column, and a comment input column 350. In addition to this, a report title, information unique to the subject, information on data recording time, and the like are arranged.

  The summary report associates the position in the information presentation column with the severity. Specifically, the information presentation column includes a plurality of areas corresponding to the severity (in this embodiment, normal state (◯) and three levels of abnormalities). It is divided into states (from the least severe one to ☆ ~ ☆☆☆). By placing items that can be determined from automatic analysis and items that can be determined by a doctor in advance for each abnormal state at positions determined according to the contents of the items, the severity level that the item means is visually determined. We are trying to grasp it. Here, the items and their arrangement positions are set in advance, but the setting may be changed.

And, by displaying the report with the check box provided corresponding to the item checked based on the analysis result, it is possible to determine at a glance how heavy the symptom is suspected as a result of the analysis Is possible. Note that check boxes corresponding to items are collectively referred to as check items.
In addition, a plurality of areas corresponding to the severity are color-coded in the present embodiment, thereby making it easy to visually grasp the relationship between the arrangement of items and the severity.

  In addition, the summary report of the present embodiment not only shows the automatic analysis result but also makes it possible to add or reflect the judgment of the doctor. Specifically, as described above, the items to be judged by the doctor are also laid out and displayed in advance according to the severity, and the doctor checks the check box corresponding to the item using the mouse of the input unit 180 or the like. To be able to.

  The items that can be estimated from automatic analysis are limited, but it is necessary to copy the contents of the summary report in the medical record by allowing the symptoms and disease names determined by the physician to be reflected in the report. Disappear. Moreover, since only the check box needs to be checked, the burden on the doctor is reduced.

  In this embodiment, the shape of the check box is changed so that the item (◇ or ◆) determined by the automatic analysis and the item (□ or ■) determined by the doctor can be distinguished. Note that the doctor can change the items determined by the automatic analysis.

Explaining each column, the basic rhythm information column 310 shows basic statistical data such as total heart rate, average / maximum and minimum heart rate included in the data file by numerical values.
Also, doctor judgment items include sinus rhythm, artificial pacemaker rhythm, WPW syndrome (including designation of single or persistent type), leg block (including designation of single or persistent type), and others (including specific findings input) ) Is placed in the normal area. In addition, the presence or absence of atrial fibrillation (including designation of type of seizure or persistence) and the presence or absence of atrial flutter (including designation of type of seizure or persistence) are arranged in severity ☆☆.

Then, the doctor can check necessary items among these items based on the personal information of the subject and the actual measurement waveform.
Similarly, items are arranged in the arrhythmia information fields 320 and 330 for each name of the arrhythmia case that may occur.

  Among these, for example, the item corresponding to the extraventricular extrasystole at the top of the arrhythmia information column 320 is an automatic analysis item. Therefore, at the time of report generation, the state of the check box of the automatic analysis item is determined based on information such as the number of heartbeats classified as supraventricular premature contraction, the presence or absence of continuous occurrence, and the number of continuous occurrences. For example, if there is no heartbeat determined to be a supraventricular extrasystole, a summary report is generated with the check box provided to the left of the item “none” placed in the normal region being checked (filled). If the total number of heartbeats classified as supraventricular extrasystole is 1000 or less, sporadic is checked, and if it exceeds 1000, frequent occurrence is checked. If there is a continuous occurrence, check the item of repeated firing and show the maximum number of repeated firings to the right.

In addition, as an automatic analysis item in the present embodiment,
Arrhythmia information column, supraventricular tachycardia: presence,
・ Extraventricular contraction: Presence / absence, total number, presence / absence and number of consecutive, RonT /
-Ventricular tachycardia: Presence / absence and number of times-Heartbeat stop (RR interval of a predetermined time or more): Presence / absence and maximum RR interval ST change information column-ST rise: Presence / absence and degree of rise (0.3 mV, 0. 5 mV) and measured value / ST drop: Presence / absence, degree of drop (0.1 mV, 0.3 mV) and measured value are provided.
In addition, for the atrioventricular block and sinoatrial block in the arrhythmia information column, only the doctor determination item is arranged.

  The comment column 350 is a text box for the doctor to input a comment that the doctor wants to save with the summary report, such as a finding. Like a normal input form, it is possible to input a comment from the keyboard with the focus moved to the text box by clicking in the text box with the mouse or using the tab key.

  Returning to FIG. 5, when the layout display is performed in step S303, none of the doctor determination items is checked. In step S305, it is checked whether or not the determination item has been operated (clicked). If an operation is detected, the check state of the operated check box is reversed (step S307). Here, the check boxes that can be operated by the doctor are not limited to the doctor determination items, but also include check boxes for automatic analysis items.

Next, in step S309, it is checked whether or not a comment is input in the comment field 350. If there is an input, the input content is reflected (displayed) in the comment field 350 (step S311).
In step S313, it is checked whether another tab has been selected. If a selection is detected, the report state (at least the check item state and comment) at that time is saved (step S315), and the step of FIG. Return to S103.
The report can be saved in any form as long as the state of the latest display can be restored when the display of the same report is instructed again.

In this way, in summary reports, analysis results are not simply presented as a list of numerical values, but numerical information is kept to the minimum necessary, and cases assumed from the analysis results are positioned according to their severity. By presenting it, the severity can be intuitively grasped from the report.
In addition to automatic analysis results, items that doctors may want to include in the same report, in other words, items that can be determined by doctors from waveform information, are still being reported in an arrangement that considers the severity. Included. Therefore, the trouble of copying the report result in the medical chart becomes unnecessary, and the determination result of the doctor can be included in the report by a simple operation of checking the item, thereby reducing the trouble of the doctor.

Furthermore, since comments can be freely input, findings and the like can be saved together with the report.
Here, an example is shown in which the severity is divided into four stages of a normal state and three abnormal states, but the number of abnormal state divisions may be two steps or less or four or more steps. Moreover, the arrangement | positioning of the item in the example shown in FIG. 9 is a mere example, and it may change suitably as what severity each item is arrange | positioned.

(Comprehensive report generation / display processing)
Next, details of the comprehensive report generation / display process executed in step S120 in FIG. 4 will be described with reference to the flowchart in FIG.
First, in step S401, the control unit 170 reads the data file selected on the data selection screen from the storage unit 130. Then, based on the layout determined in advance in step S403, a comprehensive report is generated and displayed on the display unit 190.

A specific example of the comprehensive report is shown in FIG.
The comprehensive report is a bibliographic information column 410 that presents bibliographic items such as personal information of the subject, and a comprehensive judgment result column that lists symptoms and doctor judgment items estimated by analysis in descending order of severity. 420, an overall comment column 430 that presents a comprehensive comment on the symptoms listed in the comprehensive judgment result column 420, and details of measurement results that are the basis for each symptom listed in the comprehensive judgment result column A representative observation field 440 and a comment field 450 for the user to enter a comment.

  In the bibliographic information column 410, various bibliographic information such as a subject's name and ID, sex, age, presence of medication, and subjective symptoms are presented. Such information may be registered at the time of data analysis, or may be acquired by the control unit 170 through the data input unit 110 from another system that manages the bibliographic information of the subject such as an electronic medical record system. Good.

The comprehensive judgment result column 420 corresponds to the items (■ or ◆) checked by the automatic analysis and the doctor described in the summary report, and the checked items are listed in order from the highest severity. It is.
List items include not only symptom names but also actual measurement values (ST variation, extended R-R interval, etc.) and the like, so that a rough state can be confirmed from the list items. By default, the list is displayed in descending order of severity, but it is also possible to change the order according to the user's wishes by dragging and dropping the list items up and down using the mouse.

The overall comment column 430 presents high-order items among the symptoms listed in the comprehensive determination result column 420 together with notes and the like.
The representative finding column 440 presents information related to the recording of abnormal heartbeats that is the basis for estimating the items listed at the top of the current comprehensive determination result column 420 and the measured waveform. The representative finding column 440 is roughly divided into an upper part and a lower part, and the upper part lists the recording start time of the abnormal heartbeat, the recorded heart rate, and the maximum number of continuous occurrences for each detected period (event). . In the example of FIG. 10, a case where ventricular tachycardia is detected in three periods is shown, sorted and presented in the order of events having a large number of consecutive occurrences.

  Note that the upper list field of the representative finding field 440 is configured to be scrollable, and when the number of events is large, it is possible to check events that are not displayed by operating the scroll bar with a mouse. Further, the display position of the event can be switched according to the user's wish, like the items in the comprehensive determination result column 420.

  Below the representative finding column 440, a measured waveform presentation column is provided. Here, the measured waveform corresponding to the event shown at the top in the upper list column is presented. The actually measured waveform is a waveform for a predetermined number of seconds (for example, 10 seconds) from the start (or immediately before) of the detection of the abnormal waveform. This waveform can be displayed using an event file generated and recorded at the time of analysis. For an event for which an actually measured waveform is presented, an index <enlarged waveform> is presented in the upper list column.

  Returning to FIG. 6, when the comprehensive report as shown in FIG. 10 is created and displayed, whether or not there is an operation on the item listed in the comprehensive determination result column 420, specifically, changes to the top item in step S405. Check if there was. If there is a change, in step S407, the display of the comprehensive determination result column 420 and the display of the representative finding column 440 are updated in accordance with the item listed as the new top item.

  Next, in step S409, it is checked whether or not there has been an operation on the event item in the list field of the representative finding field 440, specifically, whether or not the top item has changed. If there is a change, in step S411, the contents of the list field and the measured waveform presentation field of the representative finding field 440 are updated according to the event item listed as the new top item.

  Here, the detailed information of the item listed at the top of the comprehensive judgment result column 420 is presented in the representative finding column 440, and the event actually listed at the top in the upper list column of the representative finding column 440 is measured. A waveform was presented. However, it is also possible to perform a detailed display in the representative finding column 440 or display an actually measured waveform in accordance with a user instruction regardless of the position of the listing.

Next, in step S413, it is checked whether or not a comment is input in the comment field 450. If there is an input, the input content is reflected (displayed) in the comment field 450 (step S415).
In step S417, it is checked whether another tab has been selected, and if a selection is detected, the state of the report at that time (at least the state and comments of the comprehensive judgment result column 420 and the representative finding column 440) is saved ( Step S419) and the process returns to Step S103 in FIG.

  In this way, in the comprehensive report, the analysis results are not simply presented as a list of numerical values, but the numerical information is kept to the minimum necessary, and the cases assumed from the analysis results and the cases determined by the doctor are By presenting according to the severity, it is possible to intuitively grasp the severity from the report.

  Further, since the actual measurement value and the actual measurement waveform that are the basis of the determination are presented together, it is possible to check the actual waveform, which is also useful for diagnosis by a doctor. In particular, since an actual measurement waveform can be presented for each event, it is possible to select a waveform that seems to be the most characteristic and include it in the report.

  In addition, since the overall comment is presented, it is possible to grasp the meaning of the report. Furthermore, since comments can be freely input, findings and the like can be saved together with the report.

(Detailed report generation / display processing)
Next, details of the detailed report generation / display process executed in step S130 in FIG. 4 will be described with reference to the flowchart of FIG.
First, in step S <b> 501, the control unit 170 reads the data file selected on the data selection screen from the storage unit 130. Then, based on the layout predetermined in step S503, a detailed report is generated and displayed on the display unit 190.

A specific example of the detailed report is shown in FIG.
The detailed report is a report that presents detailed information regarding an item ranked in the highest severity among abnormal items determined by analysis (or a doctor). Here, similarly to the example of the comprehensive report shown in FIG. 10, it is assumed that the ventricular tachycardia having the severity of ☆☆ to ☆☆☆ is the highest ranked item.

  The detailed report is provided with an explanation column 510 presenting the explanation of the corresponding case on the left side, and an event list column 520 and an actual waveform presentation column 530 similar to the representative finding column 440 of the comprehensive report on the right side. .

  An explanation column 510 includes an example of a typical waveform of a case (a typical waveform, not an actual measurement waveform), information such as waveform characteristics, and information that can be used as an index when determining a case from an electrocardiogram, and an assumed cause ( Information on physiological causes, drug causes, pathological causes) and information on prevention and treatment. Such information may be stored in advance in the storage unit 130 in association with a case, or may be acquired from an external device via the input unit 110.

  The event list column 520 and the measured waveform presentation column 530 are the representative report column 440 of the comprehensive report, except that the waveform display in the measured waveform presentation column 530 can present waveforms for two events in the event list column 520. Is almost the same. Here, the measured waveforms for the top two events in the event list column 520 are presented in the measured waveform presentation column 530.

  Therefore, during the display, it is checked in step S509 whether or not the top two items have been changed by operating the event list field 520. If there is a change, the contents of the event list field 520 and the measured waveform presentation field 530 are displayed in step S511. Update.

  In step S513, it is checked whether another tab has been selected. If a selection is detected, the report state (at least the state of the list field 520) at that time is saved (step S515), and step S103 in FIG. 4 is saved. Return to.

As described above, the detailed report presents a detailed explanation of the case determined to have the highest severity. For this reason, the user can easily obtain information on what kind of measures should be taken and what kind of characteristics the disease is on the spot and is useful.
In addition, information that can be used as a judgment index, including waveforms that are representative of symptoms, and measured waveforms can be compared for easy confirmation of whether or not the disease is actually likely. Can do.

  As described above, in the present embodiment, in the analysis result report of the electrocardiogram, the numerical values obtained by the analysis are not simply arranged, but the cases estimated from the results of the automatic analysis are intuitively given the severity. By showing the information so that it can be grasped, important information can be accurately transmitted to the user from among a large amount of information obtained by the analysis.

  In addition, since the doctor's judgment and comments can be reflected in the report, it is possible to save the trouble of copying the contents of the report in the medical record and to cover all necessary information in one report.

  Further, according to the report in which the determined case and the actually measured waveform used for the determination are included in the same report, it is possible to confirm the certainty of the determination with the actually measured waveform. In addition, detailed explanations of the judged cases that are considered the most severe are included, so that users can easily obtain accurate information on the spot, achieving various effects. Is done.

It is a block diagram which shows the function structural example of the analyzer which concerns on embodiment of this invention. It is a flowchart explaining the waveform classification | category process operation which the analyzer which concerns on embodiment performs. It is a figure which shows the data structural example of the electrocardiogram data for 1 heartbeat. It is a flowchart which shows the whole flow of an analysis report production | generation and output process in the analyzer which concerns on this embodiment. It is a flowchart explaining the detail of the summary report production | generation / display process performed by step S110 in FIG. It is a flowchart explaining the detail of the comprehensive report production | generation / display process performed by step S120 in FIG. It is a flowchart explaining the detail of the detailed report production | generation / display process performed by step S130 in FIG. It is a figure which shows the example of the data selection screen displayed in the analyzer of this embodiment. It is a figure which shows the example of the summary report output in the analyzer of this embodiment. It is a figure which shows the example of the comprehensive report output in the analyzer of this embodiment. It is a figure which shows the example of the detailed report output in the analyzer of this embodiment. It is a figure which shows the example of the printing instruction | indication screen displayed in the analyzer of this embodiment. It is a figure which shows the example of the completion | finish confirmation screen displayed in the analyzer of this embodiment.

Claims (7)

An electrocardiogram analyzer for analyzing an electrocardiogram ,
An analysis means for analyzing an electrocardiogram based on a predetermined determination condition;
Report output means for outputting an analysis result by the analysis means as an analysis report;
The report output means,
An area presenting information on each of a plurality of abnormal states estimated from the analysis result, and a region in which the position and severity in the region are associated with each type of abnormal state,
A check item that is defined for each type of the abnormal state and is arranged in advance in a position in the region that is determined according to the content;
According to the analysis result, an electrocardiogram analysis apparatus is provided that outputs an analysis report indicating that a check item corresponding to the check items is checked . The electrocardiogram analysis apparatus according to claim 1, wherein the check items include items for a doctor to check. An electrocardiogram analyzer for analyzing an electrocardiogram,
An analysis means for analyzing an electrocardiogram based on a predetermined determination condition;
Report output means for outputting an analysis result by the analysis means as an analysis report;
The analysis report is
A plurality of items representing each of a plurality of abnormal conditions that are estimated from the analysis results, the abnormal item presentation area for presenting the order being determined to have a high severity,
An electrocardiogram analysis apparatus comprising: an actually measured waveform presenting region for presenting an actually measured waveform corresponding to the item presented in the abnormal item presenting region. 4. The electrocardiogram analysis apparatus according to claim 3, wherein an actual waveform corresponding to an item presented as having the highest severity in the abnormal item presentation region is presented in the actual waveform presentation region. When an actually measured waveform in a different period corresponds to one item presented in the abnormal item presenting area, the actually measured waveform in a period with the largest number of consecutive occurrences of abnormal heartbeats is presented in the actually measured waveform presenting area. The electrocardiogram analysis apparatus according to claim 3 or 4, wherein the electrocardiogram analysis apparatus is characterized . An electrocardiogram analyzer for analyzing an electrocardiogram,
An analysis means for analyzing an electrocardiogram based on a predetermined determination condition;
Report output means for outputting an analysis result by the analysis means as an analysis report;
The analysis report is
Of the plurality of abnormal states estimated from the analysis results, items representing abnormal states determined to have the highest severity, a comment presentation area for presenting commentary on the abnormal states,
An electrocardiogram analysis apparatus comprising: an actual measurement waveform presentation area for presenting an actual measurement waveform corresponding to the item. The said explanation includes at least one of general characteristics and representative waveform examples on the electrocardiogram of the abnormal state, causes of the abnormal state, prevention of the abnormal state, and countermeasures. ECG analyzer .