JP2002204830A - Positive pressure type artificial respiration aid instrument - Google Patents
Positive pressure type artificial respiration aid instrumentInfo
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- JP2002204830A JP2002204830A JP2001002388A JP2001002388A JP2002204830A JP 2002204830 A JP2002204830 A JP 2002204830A JP 2001002388 A JP2001002388 A JP 2001002388A JP 2001002388 A JP2001002388 A JP 2001002388A JP 2002204830 A JP2002204830 A JP 2002204830A
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- Prior art keywords
- expiration
- pressure
- positive pressure
- positive
- artificial respiration
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
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Abstract
Description
【０００１】[0001]
【発明の属する技術分野】本発明は医療用人工呼吸補助
装置に関する。さらに詳細には、高炭酸ガス血症のよう
な換気不全患者の治療に適する陽圧換気療法（IPPV：In
termittent Positive Pressure Ventilation）に使用す
る陽圧式人工呼吸補助装置に関する。The present invention relates to a medical artificial respiration assist device. More specifically, Positive Pressure Ventilation Therapy (IPPV: In) suitable for treating patients with ventilatory insufficiency such as hypercapnia
The present invention relates to a positive pressure type artificial respiration assist device used for termittent positive pressure ventilation.
【０００２】[0002]
【従来の技術】医療用陽圧式人工呼吸補助装置は、肺結
核後遺症や慢性閉塞性肺疾患（COPD）、肺気腫など自発
呼吸だけでは十分に換気することができない換気不全使
用者の呼吸をサポートするために使用される。2. Description of the Related Art Positive respiratory assist devices for medical use are used to support respiratory failure of users who cannot sufficiently ventilate by spontaneous breathing alone such as pulmonary tuberculosis sequelae, chronic obstructive pulmonary disease (COPD) and emphysema. Used for
【０００３】陽圧式人工呼吸補助装置の中でも最も一般
的な鼻マスクを用いるタイプを、図１を用いて説明す
る。本体１は２〜３０cmH2O程度の陽圧ガスを間欠的に
発生し、導管２に送る。中でも、使用者７の吸気と呼気
に合わせて２レベルの圧力、例えば図２に示すように、
吸気時陽圧（IPAP：Inspiration Positive Airway Pres
sure）：１２〜１５cmH2O、呼気時陽圧（EPAP：Expirat
ion Positive Airway Pressure）：２〜４cmH2Oの設定
圧力で陽圧ガスを使用者に供給するタイプが主流であ
る。導管２は、マスククッション６を固定するマスクフ
レーム５に繋がり、マスククッション６を通して、陽圧
ガスを使用者７の鼻腔へ送る。呼気排出孔３は使用者７
の呼気ガスを呼吸回路外へ排出するために設けてあり、
また、酸素など治療用ガスの混入を必要とする場合に
は、治療用ガス混入ポート４より治療用ガスを混入して
使用する。特に、呼吸インターフェースが鼻マスクであ
るものは扱いも簡単なため、近年では在宅医療用機器と
しても使用者が急激に増加している。[0003] The most common type of the positive pressure type artificial respiration apparatus using a nasal mask will be described with reference to FIG. The main body 1 intermittently generates a positive pressure gas of about 2 to 30 cmH 2 O and sends it to the conduit 2. Above all, two levels of pressure in accordance with the inspiration and expiration of the user 7, for example, as shown in FIG.
Positive Airway Pres (IPAP)
sure): 12-15 cmH 2 O, positive pressure during expiration (EPAP: Expirat
ion Positive Airway Pressure): The type that supplies a positive pressure gas to a user at a set pressure of 2 to 4 cmH 2 O is mainly used. The conduit 2 is connected to a mask frame 5 to which a mask cushion 6 is fixed, and sends the positive pressure gas to the nasal cavity of the user 7 through the mask cushion 6. Exhalation vent 3 is user 7
It is provided to discharge the exhaled gas out of the breathing circuit,
When it is necessary to mix a therapeutic gas such as oxygen, the therapeutic gas is mixed into the therapeutic gas mixing port 4 for use. In particular, since a respiratory interface having a nasal mask is easy to handle, the number of users as home medical devices has been rapidly increasing in recent years.
【０００４】治療効果としては、次のようなことが国内
外で報告されている。すなわち、使用者の肺胞換気量
を増大させることによって血中二酸化炭素濃度を減少さ
せる、圧力補助によって呼吸筋疲労が減少する、呼
気時供給圧力（PEEP：Positive End Expiratory Pressu
re）によって気道閉塞や肺胞の虚脱を防ぐ、などであ
る。The following effects have been reported in Japan and overseas as therapeutic effects. That is, blood carbon dioxide concentration is reduced by increasing alveolar ventilation of the user, respiratory muscle fatigue is reduced by pressure assistance, and expiratory supply pressure (PEEP: Positive End Expiratory Pressu).
re) prevents airway obstruction and collapse of the alveoli.
【０００５】[0005]
【発明が解決しようとする課題】ところが、ある種の疾
患では上述したような陽圧換気療法を施しても思うよう
な治療効果が得られないケースや、使用者が呼吸し難さ
を訴えて治療を断念せざるを得ないケースも報告されて
いる。However, in the case of certain diseases, even if the above-described positive pressure ventilation therapy does not provide a therapeutic effect as expected, or if the user complains of difficulty in breathing. In some cases, treatment has to be abandoned.
【０００６】一般に換気障害は、肺結核後遺症などを含
む拘束性換気障害と肺気腫などを含む閉塞性換気障害に
大別される。拘束性換気障害は、肺実質の変化、あるい
は胸膜、胸壁、および神経、筋組織の病変のために肺の
拡張が制限されるような病態である。この病態は、安静
時一回換気量の減少で特徴付けられるが、陽圧換気療法
のサポートによって一回換気量を増やしてやれば正常な
換気に近づき、陽圧式人工呼吸補助装置による治療効果
は高い。[0006] Generally, ventilation disorders are roughly classified into restricted ventilation disorders including sequelae of pulmonary tuberculosis and obstructive ventilation disorders including emphysema. Restrictive ventilatory impairment is a condition in which changes in the lung parenchyma or lesions of the pleura, chest wall, and nerves and musculature limit the expansion of the lung. This condition is characterized by a decrease in tidal volume at rest.However, if the tidal volume is increased with the support of positive pressure ventilation, normal ventilation will be approached, and the therapeutic effect of the positive pressure ventilation assist device will be reduced. high.
【０００７】一方の閉塞性換気障害は、呼気時気道閉塞
によって気道抵抗が増大するため呼出障害を呈すること
で特徴付けられる。特に、呼気後半部分でのみ呼出障害
が起こり、呼気の前半部分では正常に吐きだせるものが
ほとんどである。また、高い肺気量位で気道閉塞が起こ
るために、残気量は増大し呼吸困難感を感じる。このよ
うな病態に対して、従来のIPAPとEPAPの圧力を供給する
ような陽圧式人工呼吸補助装置を用いても、効果的に換
気補助ができないケースがある。例えば、一般的によく
用いられる４cmH2Oの呼気時設定圧力を供給したとして
も、呼気時圧力が低いために気道閉塞を消し去ることが
できないことがある。この場合、呼出障害に加え、気道
閉塞が起きたまま吸気に移るため努力吸気となり、吸気
筋疲労も併発してしまう。また、気道閉塞を消し去るた
めに呼気時圧力を高くする方法が考えられるが、呼気時
にあまり高い圧力をかけると、かえって患者は吐きだし
難さを感じてしまう。On the other hand, obstructive ventilation disorders are characterized by exhibiting expiration disorders due to increased airway resistance due to airway obstruction during expiration. In particular, in most cases, a dysfunction occurs only in the latter half of the expiration and normal exhalation is possible in the first half of the expiration. In addition, since airway obstruction occurs at a high lung volume level, the residual volume increases, and a feeling of dyspnea is felt. For such a condition, there is a case where even if a conventional positive pressure type artificial respiration assist device for supplying the pressure of IPAP and EPAP is used, the ventilation assist cannot be effectively provided. For example, even if a commonly used 4 cmH 2 O expiration setting pressure is supplied, the airway obstruction may not be able to be eliminated due to the low expiration pressure. In this case, in addition to the respiratory disturbance, forced inspiration is performed because the airway obstruction occurs and the inhalation is performed, and inspiratory muscle fatigue also occurs. In addition, a method of increasing the expiratory pressure to eliminate airway obstruction is conceivable. However, if excessively high pressure is applied during expiration, the patient will rather find it difficult to exhale.
【０００８】特開平８−３２２９３６号公報には、気道
挿管などにより肺内圧力を過度に低下させることなく、
肺に多量の新鮮空気を供給する人工呼吸器が記載されて
いる。かかる装置では、呼気前半は呼気圧力を設定値よ
りも低くなるように制御し、その後呼気流量が減少する
に従って、呼気圧力を設定値に向かって上昇させる制御
を行う装置である。[0008] Japanese Patent Application Laid-Open No. 8-322936 discloses that the pressure in the lung is not excessively reduced by airway intubation or the like.
A ventilator for supplying large volumes of fresh air to the lungs has been described. In such a device, the exhalation pressure is controlled to be lower than a set value in the first half of exhalation, and thereafter, the exhalation pressure is controlled to increase toward the set value as the exhalation flow rate decreases.
【０００９】かかる人工呼吸器は、呼気前半でよりたく
さんの換気をさせるように呼気前半圧力を低くするもの
で、拘束性換気障害に対しては適するものの、呼気後半
で気道閉塞を起す閉塞性換気障害の患者には適用するこ
とができない。[0009] Such a ventilator lowers the pressure of the first half of expiration so as to provide more ventilation in the first half of expiration, and is suitable for restrictive ventilation disorders, but is obstructive ventilation which causes airway obstruction in the second half of expiration. Not applicable to disabled patients.
【００１０】更にかかる人工呼吸器の様に、圧力調整に
呼気弁を用いると呼吸回路が複雑になり、特に呼吸用マ
スク（鼻マスク、鼻口マスク）を用いるような場合には
マスク周りが重くなってしまい、患者への負担となる。
また、呼吸用インターフェースに治療用ガスを混入して
用いる場合には、呼気弁を開放している期間に呼気弁か
ら投入された治療用ガスが逃げてしまい、治療用ガスの
無駄になる問題も存在する。Further, when an exhalation valve is used for pressure adjustment as in such a ventilator, the breathing circuit becomes complicated. In particular, when a respiratory mask (nose mask, nasal mouth mask) is used, the area around the mask becomes heavy. It becomes a burden on the patient.
In addition, when the therapeutic gas is mixed into the respiratory interface and used, the therapeutic gas supplied from the exhalation valve escapes during the period when the exhalation valve is opened, and there is a problem that the therapeutic gas is wasted. Exists.
【００１１】本発明は、陽圧換気療法において、呼気後
半部分に気道閉塞を呈するような使用者に対して、気道
閉塞を消し去り、かつ、吸気に移りやすくなるような陽
圧式人工呼吸補助装置を提供することを課題とする。[0011] The present invention provides a positive pressure artificial respiration assist device for a user who presents an airway obstruction in the latter half of expiration in positive pressure ventilation therapy so as to eliminate the airway obstruction and facilitate the transition to inspiration. The task is to provide
【００１２】[0012]
【課題を解決するための手段】かかる課題を達成するた
め、本発明者は鋭意検討した結果、使用者の呼気期間中
に呼気時陽圧を段階的に下げるような陽圧式人工呼吸補
助装置を提供することによって課題を解決できることを
見出した。Means for Solving the Problems In order to achieve the above object, the present inventors have made intensive studies and as a result, have developed a positive pressure type artificial respiration assist device which gradually lowers the positive pressure during expiration during the expiration period of the user. We found that the problem could be solved by providing.
【００１３】即ち本発明は、使用者に陽圧ガスを供給す
る陽圧ガス発生手段、使用者の呼吸に対応して吸気時に
吸気時圧力（IPAP）及び呼気時にそれよりも低い呼気時
圧力（EPAP）の陽圧ガスを供給する該陽圧ガス発生手段
の制御手段、使用者に該陽圧ガスを供給するための呼吸
用インターフェース、および該陽圧ガス発生手段と該呼
吸用インターフェースを繋ぐ導管手段を備えた陽圧式人
工呼吸補助装置において、該制御手段が、使用者の呼気
時に該呼気時圧力を段階的に下げる制御を行う手段であ
ることを特徴とする陽圧式人工呼吸補助装置を提供する
ものである。That is, the present invention provides a positive pressure gas generating means for supplying a positive pressure gas to a user, an inspiratory pressure (IPAP) during inhalation and a lower expiratory pressure (IPAP) during exhalation corresponding to the user's breathing. EPAP) control means for the positive pressure gas generating means for supplying the positive pressure gas, a respiratory interface for supplying the positive pressure gas to the user, and a conduit connecting the positive pressure gas generating means to the respiratory interface A positive pressure type artificial respiration assist device provided with a positive pressure type artificial respiration assist device, wherein the control means is a means for performing stepwise reduction of the expiration pressure when the user exhales. Is what you do.
【００１４】また本発明は、かかる制御手段が、呼気前
半時に該吸気時圧力よりも低い呼気前半時設定圧力、お
よび呼気後半時に該呼気前半時設定圧力よりも低い呼気
後半時設定圧力で陽圧ガスを発生する制御手段であるこ
とを特徴とする陽圧式人工呼吸補助装置を提供するもの
である。Further, according to the present invention, the control means preferably comprises a first-expiration set pressure lower than the inspiratory pressure during the first half of expiration and a second-expiration set pressure lower than the first-expiration set pressure during the second half of expiration. An object of the present invention is to provide a positive-pressure artificial respiration assist device characterized in that it is control means for generating gas.
【００１５】また本発明は、かかる陽圧式人工呼吸補助
装置の呼吸回路中に使用者の呼吸流量を測定する手段を
備え、該制御手段が、呼気期間中の呼気流量が最大値を
示した後に変曲点をとった時点で、該呼気前半時設定圧
力から該呼気後半時設定圧力に切り替える制御を行う手
段であることを特徴とする陽圧式人工呼吸補助装置を提
供するものである。The present invention further comprises means for measuring a user's respiratory flow rate in a breathing circuit of the positive pressure type artificial respiration assist device, wherein the control means determines whether or not the expiratory flow rate during the expiration period indicates a maximum value. A positive pressure artificial respiration assist device characterized in that it is means for performing control to switch from the first half-expiration set pressure to the second half-expiration set pressure at the point of inflection.
【００１６】また本発明は、かかる陽圧式人工呼吸補助
装置の呼吸回路中に使用者の呼吸流量を測定する手段を
備え、該制御手段が、該呼吸流量を時間積分して換気量
を演算する手段を備え、呼気時の換気量が直前の吸気時
に吸入した量に対して予め設定した割合だけ呼出した時
点で、該呼気前半時設定圧力から該呼気後半時設定圧力
に切り替える制御を行う手段であることを特徴とする陽
圧式人工呼吸補助装置を提供するものである。The present invention further comprises means for measuring the respiratory flow of the user in the respiratory circuit of the positive pressure type artificial respiration assist device, and the control means calculates the ventilation volume by integrating the respiratory flow with time. Means for controlling the switching from the first half-expiration setting pressure to the second half-expiration setting pressure at the time when the ventilation volume at the time of expiration calls up a preset ratio with respect to the volume inhaled during the immediately preceding inhalation. Another object of the present invention is to provide a positive-pressure artificial respiration assist device characterized in that:
【００１７】また本発明は、かかる陽圧式人工呼吸補助
装置に使用者の呼気開始点を検出する手段を備え、該制
御手段が、呼気開始点から予め設定された時間が経過し
た時点で、該呼気前半時設定圧力から該呼気後半時設定
圧力に切り替えるような制御を行う手段であることを特
徴とする陽圧式人工呼吸補助装置を提供するものであ
る。Further, the present invention further comprises means for detecting the start point of expiration of the user in the positive pressure type artificial respiration assist apparatus, wherein the control means sets the time when a preset time elapses from the start point of expiration. A positive pressure artificial respiration assist device characterized in that it is means for performing control for switching from the first half-expiration set pressure to the second half-expiration set pressure.
【００１８】また本発明は、かかる陽圧式人工呼吸補助
装置の呼吸回路中に使用者の呼吸流量を測定する手段を
備え、該制御手段が、呼気期間中の呼気流量が最大値を
示した時点で、該呼気前半時設定圧力から該呼気後半時
設定圧力に切り替える制御を行う手段であるを特徴とす
る陽圧式人工呼吸補助装置を提供するものである。The present invention further comprises means for measuring the respiratory flow rate of the user in the respiratory circuit of the positive pressure type artificial respiration assist device, wherein the control means determines whether the expiratory flow rate during the expiration period indicates a maximum value. Therefore, a positive pressure artificial respiration assist device characterized in that it is means for performing control for switching from the first half-expiration set pressure to the second half-expiration set pressure.
【００１９】更に本発明は、かかる陽圧ガス発生手段
が、回転数を制御することによって所定圧力の陽圧ガス
を発生させるブロア手段であり、該呼吸用インターフェ
ースが呼吸用マスク手段であることを特徴とする陽圧式
人工呼吸補助装置を提供するものである。Further, according to the present invention, the positive pressure gas generating means is a blower means for generating a positive pressure gas having a predetermined pressure by controlling the number of revolutions, and the respiratory interface is a respiratory mask means. It is intended to provide a positive pressure artificial respiration assist device characterized by the following.
【００２０】[0020]
【発明の実施の形態】本発明者は、健常人、拘束性肺疾
患患者、閉塞性肺疾患患者における、従来の陽圧式人工
呼吸補助装置（IPAPとEPAPを間欠的に供給）使用時、お
よび自発呼吸時の呼吸パターンを調査した結果、図３に
示すように、健常人、拘束性肺疾患患者では呼気時の呼
吸パターン（流量ｖｓ時間）が、比較的単純な下に凸形
状を示すのに対して、閉塞性肺疾患患者では、呼気流量
が最大値を示した後に上に凸形状を示し、呼気時呼吸パ
ターンに気道閉塞に基づく変曲点が存在し、変曲点以降
に気道閉塞が発生していることを見出した。また、閉塞
性肺疾患患者の呼気時気道閉塞は、自発呼吸時より陽圧
式人工呼吸補助装置使用時の方がより顕著であり、EPAP
を一定とした場合には、患者へのサポート圧（＝IPAP−
EPAP）が大きいほど、気道閉塞の度合いがより大きくな
る傾向があることを見出した。このことは、サポート圧
が大きい場合、即ち一回換気量が大きく呼気流速が速い
ほど気道内圧が低下し、気道閉塞が発生しやすいことを
示している。更に、呼気流速の速い呼気前半部分で一旦
気道閉塞が発生すると、呼気期間の最後まで気道閉塞が
続いてしまうため、呼気前半部分での気道閉塞を防ぐこ
とが本治療の鍵となる。本発明者は、呼気流速の速い呼
気前半部分に比較的高い圧力を供給することによって呼
気流速の上昇を防止し、さらに呼気後半部分で圧力を下
げることによって、患者に不必要に負担をかけることな
く気道閉塞を防止することができることを見出した。本
発明の陽圧式人工呼吸補助装置は、使用者の呼吸に対応
して陽圧ガスを発生する陽圧ガス発生手段、使用者に該
陽圧ガスを供給するための呼吸用インターフェース、お
よび該陽圧ガス発生装置と該呼吸用インターフェースを
繋ぐ導管手段から構成される。BEST MODE FOR CARRYING OUT THE INVENTION The present inventors have studied the use of a conventional positive pressure ventilation assist device (intermittent supply of IPAP and EPAP) in healthy persons, patients with restrictive lung disease, and patients with obstructive lung disease; As a result of examining the breathing pattern during spontaneous breathing, as shown in FIG. 3, in a healthy person and a patient with restrictive lung disease, the breathing pattern (flow vs time) during expiration shows a relatively simple downward convex shape. In contrast, in patients with obstructive pulmonary disease, the expiratory flow rate shows a maximum value and then shows a convex shape, and there is an inflection point based on airway obstruction in the expiratory breathing pattern. Has occurred. In addition, airway obstruction during expiration in patients with obstructive pulmonary disease is more pronounced when using a positive-pressure ventilator than during spontaneous breathing.
Is constant, the support pressure on the patient (= IPAP-
It was found that the greater the EPAP, the greater the tendency for airway obstruction. This indicates that when the support pressure is large, that is, as the tidal volume is large and the expiration flow rate is fast, the airway pressure is reduced and airway obstruction is likely to occur. Furthermore, once airway obstruction occurs in the first half of expiration at a high expiratory flow rate, airway obstruction continues until the end of the expiration period. Therefore, prevention of airway obstruction in the first half of expiration is the key to this treatment. The inventor of the present invention prevents an increase in expiratory flow rate by supplying a relatively high pressure to the first half of expiratory flow with a high expiratory flow rate, and further unnecessarily burdens the patient by lowering the pressure in the latter half of expiratory flow. It has been found that airway obstruction can be prevented without any problem. The positive pressure artificial respiration assist device of the present invention includes a positive pressure gas generating means for generating a positive pressure gas in response to a user's breathing, a breathing interface for supplying the user with the positive pressure gas, and It comprises a conduit means connecting the pressurized gas generator and the breathing interface.
【００２１】かかる陽圧ガス発生手段は、空気を加圧し
て陽圧ガスを発生する手段であり、ブロアが用いられ
る。陽圧ガス供給の制御は、使用者の医師の処方圧力に
合わせて吸気時間に吸気時陽圧を供給し、呼気時に段階
的に圧力を下げるように制御するものである。好ましく
は、使用者の吸気時に吸気時陽圧、呼気前半時に呼気前
半時陽圧、および呼気後半時に呼気後半時陽圧のガスを
供給するように、陽圧ガス発生手段の発生を制御するも
のであり、陽圧ガス発生手段出口から導管手段、呼吸用
インターフェース内の呼吸回路に圧力センサー、流量セ
ンサー等を設けることにより患者の吸気開始点、呼気前
半開始点、および呼気後半開始点を検出し、これに応じ
て陽圧ガス発生手段の供給圧力を切り替え制御する方法
や、吸気時間、呼気前半時間、および呼気後半時間を予
め設定しておき、それに従って陽圧ガス発生手段の供給
圧力を切り替え制御し、使用者がそれに呼吸を合わせる
方法が使用される。The positive pressure gas generating means is a means for generating positive pressure gas by pressurizing air, and uses a blower. The control of the supply of the positive pressure gas is such that the positive pressure during inspiration is supplied during the inhalation time in accordance with the prescription pressure of the user's doctor, and the pressure is reduced stepwise during exhalation. Preferably, the generation of the positive pressure gas generating means is controlled so as to supply a gas at the positive pressure during inspiration during the user's inhalation, a positive pressure during the first half of expiration during the first half of expiration, and a positive pressure during the second half of expiration during the second half of expiration. By providing a pressure sensor, a flow sensor, and the like in the breathing circuit in the breathing interface from the outlet of the positive-pressure gas generating means to the conduit means, the inspiratory start point, the first half of the expiration, and the second half of the expiration are detected. According to this, the method of switching and controlling the supply pressure of the positive pressure gas generating means and the inhalation time, the first half of expiration, and the second half of expiration are set in advance, and the supply pressure of the positive pressure gas generating means is switched accordingly. A method of controlling and the user adjusting his / her breath is used.
【００２２】呼気前半時から呼気後半時への圧力切り替
えポイントは、呼気期間中の呼気流量が最大値を示した
後に変曲点をとった時点とすれば良い。かかる変曲点
は、呼吸回路中に使用者の呼吸流量を測定する手段を備
え、呼気流量が最大値を示した時点以降で、測定値を２
回微分した値が初めてゼロになる点を演算することによ
り求めることが出来る。具体的には、まず、測定したデ
ジタル呼吸流量値において、前後する２つのデータの差
を取ることで微分値（呼吸流量の加速度）を導く。さら
に前後する微分値の差を取った値が２回微分値である。
デジタル呼吸流量値は、使用者の呼吸に短時間で応答す
るために、１〜１０msec.のサンプリングレートで測定
した値を用いるのが望ましい。呼吸流量の最大値は、微
分値がマイナス側からプラス側に変わる点を演算するこ
とによって、求めることができる。The pressure switching point from the first half of expiration to the second half of expiration may be the time when the inflection point is taken after the exhalation flow rate during the expiration period shows the maximum value. The inflection point is provided with a means for measuring the user's respiratory flow in the breathing circuit, and the measured value is increased by 2 after the time when the expiratory flow shows the maximum value.
It can be obtained by calculating the point at which the differentiated value becomes zero for the first time. Specifically, first, a differential value (acceleration of the respiratory flow) is derived by taking a difference between two preceding and succeeding data in the measured digital respiratory flow value. The value obtained by taking the difference between the preceding and following differential values is the twice differential value.
As the digital respiratory flow value, it is desirable to use a value measured at a sampling rate of 1 to 10 msec. In order to respond to the user's breathing in a short time. The maximum value of the respiratory flow can be obtained by calculating a point at which the differential value changes from a minus side to a plus side.
【００２３】呼吸流量を測定する手段としては、差圧式
流量センサー、熱線式流量センサー等を用いることがで
きるが、使用者に十分な圧力を供給するために、圧損の
少ない流量計を使用する必要がある。また、流量センサ
ーは、陽圧ガス発生装置から呼吸用インターフェースま
での呼吸回路中に設置することができる。特に、正確な
値を測定するために、使用者と流量センサーとの間に漏
れが無いことが望ましい。また、呼気排出孔よりも上流
側に流量センサーを設ける場合には、測定したガス流量
の一部が、呼気排出孔から排出される分を含むため、呼
気排出孔からの流出流量を算出し、これを差し引くこと
により流量データを補正することができる。呼吸用マス
ク等からの漏れがある場合には、その分も同様に補正す
る必要がある。また、測定値は、ノイズ除去のために移
動平均を取るのが望ましい。As a means for measuring the respiratory flow, a differential pressure type flow sensor, a hot wire type flow sensor or the like can be used, but in order to supply a sufficient pressure to the user, it is necessary to use a flow meter with a small pressure loss. There is. Also, the flow sensor can be installed in the breathing circuit from the positive pressure gas generator to the breathing interface. In particular, it is desirable that there is no leakage between the user and the flow sensor in order to measure an accurate value. Also, when a flow sensor is provided on the upstream side of the exhalation discharge hole, a part of the measured gas flow includes the amount discharged from the exhalation discharge hole. By subtracting this, the flow rate data can be corrected. If there is a leak from a respiratory mask or the like, it is necessary to make a correction in the same manner. In addition, it is desirable to take a moving average of the measured value to remove noise.
【００２４】また別の方法として、本発明は、かかる陽
圧式人工呼吸補助装置の呼吸回路中に使用者の呼吸流量
を測定する手段、および呼吸流量を時間積分して換気量
を演算する手段を備え、呼気時の換気量が直前の吸気時
に吸入した量に対して予め設定した割合だけ呼出した時
点を呼気後半開始点とし、これに応じて供給圧力を制御
する方法を用いることができる。As another method, the present invention provides a means for measuring a user's respiratory flow in a breathing circuit of such a positive pressure artificial respiration assist device and a means for calculating a ventilation volume by integrating the respiratory flow with time. In addition, a method can be used in which the time when the ventilation volume at the time of expiration is exhaled by a preset ratio with respect to the amount inhaled at the time of the immediately preceding inhalation is set as the second half of the expiration start point, and the supply pressure is controlled accordingly.
【００２５】吸気時に吸入した量、および換気量は、各
吸気および呼気において、Σ（呼吸流量値×サンプリン
グレート）で求めることができる。呼気時の換気量が直
前の吸気時に吸入した量に対して１０〜３０％だけ呼出
した時点で呼気後半圧力へ切り替えることが望ましい。The amount inhaled during inspiration and the amount of ventilation can be determined by Σ (respiratory flow value × sampling rate) in each inspiration and expiration. It is desirable to switch to the second half of the expiration pressure when the ventilation volume during expiration is 10 to 30% of the volume inhaled during the immediately preceding inspiration.
【００２６】また別の方法として、かかる陽圧式人工呼
吸補助装置に使用者の呼気前半開始点を検出する手段を
備え、呼気前半開始点から予め設定された時間が経過し
た時点を呼気後半開始点とし、呼気後半時圧力へ切り替
える制御を行う方法を用いることが出来る。呼気前半開
始点から呼気後半圧力への切り替えは、呼気期間中であ
ればいくらにでも設定できるが、望ましくは呼気前半開
始後0.1〜1秒後である。As another method, the positive pressure type artificial respiration apparatus includes means for detecting the start point of the first half of expiration of the user, and the time when a predetermined time has elapsed from the start point of the first half of expiration is determined by the start point of the second half of the expiration. Then, a method of controlling to switch to the latter half of the expiration pressure can be used. The switching from the first expiration start point to the second half expiration pressure can be set at any time during the expiration period, but is desirably 0.1 to 1 second after the start of the first half expiration.
【００２７】さらに別の方法として、かかる陽圧式人工
呼吸補助装置の呼吸回路中に使用者の呼吸流量を測定す
る手段を備え、呼気期間中の呼気流量が最大値を示した
時点を呼気後半開始点とし、呼気後半時設定圧力へ切り
替えるように制御する方法を用いることができる。As still another method, a means for measuring the respiratory flow of the user is provided in the breathing circuit of the positive pressure type artificial respiration assist device, and the second half of the expiration is started when the expiratory flow during the expiration period shows the maximum value. As a point, a method of controlling to switch to the set pressure in the latter half of expiration can be used.
【００２８】呼気前半時圧力および呼気後半時圧力は、
使用する患者の気道閉塞状態によって設定する圧力が異
なるが、呼気前半時圧力が６〜１０cmH2O、呼気後半時
圧力が２〜６cmH2Oの圧力値に制御し用いることが出来
る。The pressure during the first half of expiration and the pressure during the second half of expiration are:
Although the pressure to be set varies depending on the airway obstruction state of the patient to be used, the pressure can be controlled to a pressure value of 6 to 10 cmH2O in the first half of expiration and 2 to 6 cmH2O in the second half of expiration.
【００２９】[0029]
【実施例】本発明の陽圧式人工呼吸補助装置の実施例
を、図４を用いて更に詳細に説明する。陽圧ガス発生装
置出口端部に差圧式流量計を備え、差圧式流量計によっ
て測定した流量値を演算手段に送る。演算手段では、呼
気排出孔からのガス排出量および鼻マスクからの漏れを
補正する。また演算手段は、上述してきた方法によっ
て、吸気開始点、呼気前半開始点、および呼気後半開始
点を演算し、ブロア回転数制御手段へ入力する。ブロア
回転制御手段は、ブロア回転数を制御するものであり、
入力されてきた各圧力供給期間に応じて、予め決められ
た吸気時圧力、呼気前半時設定圧力、および呼気後半時
設定圧力に相当する電圧を陽圧ガス発生手段に入力す
る。陽圧ガス発生手段は入力された電圧に応じた陽圧ガ
スを発生し、導管へ送る。また、設定値入力用手段は、
吸気時圧力、呼気前半時設定圧力、および呼気後半時設
定圧力等、医師が設定すべき項目を入力することがで
き、演算手段、またはブロア回転数制御手段に送る。DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS An embodiment of the positive pressure type artificial respiration apparatus of the present invention will be described in more detail with reference to FIG. A differential pressure type flow meter is provided at the outlet end of the positive pressure gas generator, and the flow rate value measured by the differential pressure type flow meter is sent to the calculating means. The calculating means corrects the amount of gas discharged from the exhalation discharge hole and the leak from the nasal mask. Further, the calculating means calculates the inspiration start point, the first half of the expiration, and the second half of the expiration by the above-described method, and inputs them to the blower rotation speed control means. The blower rotation control means controls the blower rotation speed,
A voltage corresponding to a predetermined inspiratory pressure, a first half expiration set pressure, and a second half expiration set pressure is input to the positive pressure gas generating means in accordance with each input pressure supply period. Positive pressure gas generating means generates positive pressure gas corresponding to the input voltage and sends it to the conduit. In addition, the setting value input means includes:
The physician can input items to be set, such as the pressure during inhalation, the pressure set during the first half of expiration, and the pressure set during the second half of expiration, and sends them to the calculation means or the blower rotation speed control means.
【００３０】図５は、本発明の好適な供給圧力パターン
である。呼気時の段階的な圧力低下は、本発明のように
前半/後半の２段階だけでなく、より細かく区切って圧
力を下げていくことや、スロープ状に圧力を下げること
も可能である。FIG. 5 is a preferred supply pressure pattern of the present invention. The stepwise pressure drop during expiration is not limited to the two steps of the first half and the second half as in the present invention, but the pressure can be reduced more finely and the pressure can be reduced in a slope shape.
【００３１】こうして呼気前半時に呼気後半時圧力より
も高い圧力を供給することにより、呼気時気道閉塞を呈
する使用者の気道を広げ、呼気を出し易くすることによ
って、治療効果が向上する。また、気道を広げることに
よって、使用者が努力吸気することなく吸気に移ること
が可能となり、患者の治療コンプライアンスも向上す
る。By supplying a pressure higher than the latter half of the expiration pressure during the first half of expiration in this way, the airway of the user exhibiting airway obstruction during expiration is widened, and exhalation is facilitated, thereby improving the therapeutic effect. Also, widening the airway allows the user to switch to inspiration without forcing inspiration, thereby improving patient compliance.
【図１】鼻マスク式の陽圧式人工呼吸補助装置。FIG. 1 is a nasal mask type positive pressure artificial respiration assist device.
【図２】一般的な陽圧式人工呼吸補助装置における供給
圧力パターン。FIG. 2 is a supply pressure pattern in a general positive pressure type artificial respiration assist device.
【図３】各疾患別呼吸パターン。FIG. 3 is a respiratory pattern for each disease.
【図４】本発明の陽圧式人工呼吸補助装置の好適な実施
例。FIG. 4 shows a preferred embodiment of the positive pressure artificial respiration assist device of the present invention.
【図５】本発明の好適な供給圧力パターン。FIG. 5 is a preferred supply pressure pattern of the present invention.
１．人工呼吸器本体 ２．導管 ３．呼気排出孔 ４．治療用ガス混入ポート ５．マスクフレーム ６．鼻マスク ７．使用者 ８．差圧式流量計 1. 1. Respirator body Conduit 3. Exhalation vent 4. 4. Therapeutic gas mixing port Mask frame 6. Nasal mask 7. User 8. Differential pressure flow meter
Claims (7)
生手段、使用者の呼吸に対応して吸気時に吸気時圧力
（IPAP）及び呼気時にそれよりも低い呼気時圧力（EPA
P）の陽圧ガスを供給する該陽圧ガス発生手段の制御手
段、使用者に該陽圧ガスを供給するための呼吸用インタ
ーフェース、および該陽圧ガス発生手段と該呼吸用イン
ターフェースを繋ぐ導管手段を備えた陽圧式人工呼吸補
助装置において、該制御手段が、使用者の呼気時に該呼
気時圧力を段階的に下げる制御を行う手段であることを
特徴とする陽圧式人工呼吸補助装置。1. A positive pressure gas generating means for supplying a positive pressure gas to a user, an inspiratory pressure (IPAP) during inspiration and a lower expiratory pressure (EPA) during inhalation corresponding to the user's breathing.
P) means for controlling the positive-pressure gas generating means for supplying the positive-pressure gas, a respiratory interface for supplying the positive-pressure gas to the user, and a conduit connecting the positive-pressure gas generating means to the respiratory interface A positive pressure artificial respiration assist device comprising: a positive pressure artificial respiration assist device, wherein said control means is means for performing step-by-step control of decreasing the expiration pressure when a user exhales.
力よりも低い呼気前半時設定圧力、および呼気後半時に
該呼気前半時設定圧力よりも低い呼気後半時設定圧力で
陽圧ガスを発生する制御手段であることを特徴とする請
求項１に記載の陽圧式人工呼吸補助装置。2. The positive pressure gas is generated at the first half expiration set pressure lower than the inspiratory pressure during the first half of expiration and at the second half expiration set pressure lower than the first half of the expiration set pressure during the second half of expiration. The positive pressure type artificial respiration assist apparatus according to claim 1, wherein the control means performs control.
に使用者の呼吸流量を測定する手段を備え、該制御手段
が、呼気期間中の呼気流量が最大値を示した後に変曲点
をとった時点で、該呼気前半時設定圧力から該呼気後半
時設定圧力に切り替える制御を行う手段であることを特
徴とする請求項２に記載の陽圧式人工呼吸補助装置。3. A means for measuring a user's respiratory flow rate in a breathing circuit of the positive pressure assisted ventilation apparatus, wherein the control means determines an inflection point after the exhalation flow rate during the expiration period shows a maximum value. The positive pressure artificial respiration assist device according to claim 2, characterized in that it is means for performing control to switch from the first half-expiration set pressure to the second half-expiration set pressure at the time of taking.
に使用者の呼吸流量を測定する手段を備え、該制御手段
が、該呼吸流量を時間積分して換気量を演算する手段を
備え、呼気時の換気量が直前の吸気時に吸入した量に対
して予め設定した割合だけ呼出した時点で、該呼気前半
時設定圧力から該呼気後半時設定圧力に切り替える制御
を行う手段であることを特徴とする請求項２に記載の陽
圧式人工呼吸補助装置。4. A means for measuring a respiratory flow rate of a user in a breathing circuit of the positive-pressure ventilator, and a control means for calculating a ventilation volume by integrating the respiratory flow rate over time. A means for performing control to switch from the first-half-expiration setting pressure to the second-half-expiration setting pressure at the time when the ventilation volume at the time of expiration calls up a preset ratio with respect to the amount inhaled during the immediately preceding inhalation. The positive pressure type artificial respiration assist device according to claim 2, wherein
気開始点を検出する手段を備え、該制御手段が、呼気開
始点から予め設定された時間が経過した時点で、該呼気
前半時設定圧力から該呼気後半時設定圧力に切り替える
ような制御を行う手段であることを特徴とする請求項２
に記載の陽圧式人工呼吸補助装置。5. The positive pressure type artificial respiration assist device further comprises means for detecting a user's expiration start point, and said control means sets the first half of the expiration when a preset time has elapsed from the expiration start point. 3. A means for performing control for switching from a set pressure to a set pressure in the latter half of expiration.
The positive-pressure artificial respiration assist device according to claim 1.
に使用者の呼吸流量を測定する手段を備え、該制御手段
が、呼気期間中の呼気流量が最大値を示した時点で、該
呼気前半時設定圧力から該呼気後半時設定圧力に切り替
える制御を行う手段であるを特徴とする請求項２に記載
の陽圧式人工呼吸補助装置。6. A means for measuring a user's respiratory flow rate in a breathing circuit of the positive pressure type artificial respiration assist device, wherein the control means sets the expiratory flow rate during the expiration period to a maximum value. The positive pressure artificial respiration assist device according to claim 2, characterized in that it is means for performing control for switching from the first half-expiration set pressure to the second half-expiration set pressure.
ることによって所定圧力の陽圧ガスを発生させるブロア
手段であり、該呼吸用インターフェースが呼吸用マスク
手段であることを特徴とする請求項１〜６に記載の陽圧
式人工呼吸補助装置。7. The positive pressure gas generating means is blower means for generating a positive pressure gas of a predetermined pressure by controlling the number of revolutions, and the respiratory interface is a respiratory mask means. The positive pressure artificial respiration assist device according to claim 1.
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|---|---|---|---|
| JP2001002388A JP4212778B2 (en) | 2001-01-10 | 2001-01-10 | Positive pressure ventilator |
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| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| JP2001002388A JP4212778B2 (en) | 2001-01-10 | 2001-01-10 | Positive pressure ventilator |
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| Publication Number | Publication Date |
|---|---|
| JP2002204830A true JP2002204830A (en) | 2002-07-23 |
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| JP4212778B2 JP4212778B2 (en) | 2009-01-21 |
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