JP5770512B2 - Limb compression device - Google Patents

Description

  The present invention controls limb compression by alternately switching between an ischemic state (compressed state) and a perfusion state (released state) of a patient's upper limb and / or lower limb by controlling compression and release on the upper limb and / or lower limb. It relates to the device.

  In the treatment of ischemic diseases, it is an indispensable problem to reduce the influence on myocardial cells due to myocardial ischemia. Early reperfusion is important to protect the myocardium and is generally treated with a thrombolytic agent. Recently, angiography with angio is also performed, and PTCA treatment is performed in which reperfusion is performed using a catheter while observing an ischemic site.

  While the effects of these treatments to achieve early reperfusion are enormous, the damage to the myocardium is also significant. Specifically, there is a possibility of a problem (reperfusion syndrome) that the site of ischemic injury expands due to the occurrence of damage or inflammation to cardiomyocytes due to reperfusion, which is a major therapeutic problem. It has become.

  The cause of this is active oxygen produced by cardiomyocytes, and it is important to suppress this production during reperfusion.

  On the other hand, before reperfusion, by compressing and releasing the part away from the ischemic site, for example, the upper arm part and the lower limb part, the ischemic state and the reperfusion state are changed alternately. In addition, a remote short-term repeated ischemia method has been proposed that suppresses the generation of active oxygen that harms the myocardium, which is the site of ischemia.

  According to the remote short-term repetitive ischemia method, repetitive stimulation causes intracellular mediators to undergo intracellular mutations or intercellular mutations, thereby suppressing the induction of kinases, which are enzymes that contribute to the generation of active oxygen. In addition, cell activity can be suppressed by suppressing ATP metabolism in cardiomyocytes and adjusting the function of mitochondria in the cardiomyocytes, thereby suppressing the production of active oxygen.

  Conventionally, a limb compression device has been proposed as a device that realizes a remote short-term repeated ischemia method for suppressing such reperfusion syndrome. For example, Patent Document 1 below discloses a configuration in which ischemia time, perfusion time, ischemic pressure, and the like can be arbitrarily set, and further control for making the pressure during ischemia constant is possible. It is described that it is.

JP 2010-512176 A

  On the other hand, the remote short-term repeated ischemia method has a heavy burden on the patient. Therefore, when performing the remote short-term repeated ischemia method, it is necessary to know the state of the patient during the treatment. is there. Then, in order to ensure the safety of the patient, it is indispensable to take measures such as immediately stopping the treatment when the patient's condition changes.

  However, in the case of the above-mentioned Patent Document 1, since the ischemic state and the perfusion state are repeated regardless of the state of the patient under treatment, if there is a change in the patient's condition, Unless the user himself / herself detects this and takes measures such as stopping the treatment, the safety of the patient cannot be ensured.

  The present invention has been made in view of the above problems, and is configured to operate according to the state of a patient during treatment in a limb compression device that performs treatment by remote short-term repeated ischemia on a patient. The purpose of this is to ensure patient safety.

  The limb compression device according to the present invention includes a plurality of pressure control units to which a cuff wound around the limb can be connected via a cuff tube, and the pressure control unit supplies air to the cuff connected to the cuff. And a limb compression device that repeats compression and release of the limbs over a predetermined number of cycles by controlling the exhaust from the cuff unit, wherein the number of cycles of the compression and release of the limbs is predetermined. Control means for controlling the pressure control unit to which the cuff portion is connected among the plurality of pressure control units to repeat, and signals detected by a plurality of induction methods for detecting an electrocardiographic waveform by the electrocardiographic induction method Generating an electrocardiogram waveform based on the signal acquired by the acquisition unit, and whether the waveform change related to arrhythmia is detected for the generated electrocardiogram waveform. Determination means for cutting, for the pressure control unit to which the cuff portion is connected among the plurality of pressure control units, after starting the operation to repeat the compression and release of the limb, The determination means stops the operation when it is determined that a waveform change related to the arrhythmia has occurred, and does not operate a pressure control unit to which a cuff portion is not connected among the plurality of pressure control units.

  According to the present invention, a limb compression device that performs treatment by remote short-term repeated ischemia on a patient is configured to operate according to the condition of the patient during treatment, thereby improving patient safety. It is possible to ensure with certainty.

It is a figure which shows the external appearance structure of the limb compression apparatus 100 which concerns on one Embodiment of this invention. It is a figure which shows an example of the display screen displayed on the display part of the limb compression apparatus. It is the figure which showed a mode that the treatment by a remote part short time ischemia method was performed with respect to a patient using the limb compression apparatus 100. FIG. It is a figure which shows the function structure of the limb compression apparatus. 7 is a flowchart showing a flow of remote short-term repeated ischemia processing in the limb compression apparatus 100. 7 is a flowchart showing a flow of remote short-term repeated ischemia processing in the limb compression apparatus 100. 7 is a flowchart showing a flow of remote short-term repeated ischemia processing in the limb compression apparatus 100.

  Hereinafter, embodiments of the present invention will be described with reference to the drawings.

[First Embodiment]
1. External configuration of limb compression device First, an external configuration of a limb compression device 100 according to an embodiment of the present invention will be described. FIG. 1 is a diagram showing an external configuration of a limb compression device 100 according to an embodiment of the present invention.

  In FIG. 1, reference numeral 101 denotes a housing, and cuff tubes 111 to 114 to which cuff portions (not shown) wound around the right lower limb portion, the left lower limb portion, the upper right arm portion and the left upper arm portion are attached on the upper side surface. The connector part to which is connected is arranged. Further, on the right side surface, in order to acquire an electrocardiogram waveform, a connector part (connector 115 to which a wiring 116 connected to an electrode attached to a chest of a patient (subject) is extended (connected) (Not shown).

  Reference numeral 102 denotes a switch for instructing the start / stop of the remote-part short-time repeated ischemia process, which is configured to start the process with a single press and stop the process with a second press.

  Reference numeral 103 denotes a display unit that displays various setting values for executing the remote-part short-time repeated ischemia processing, the state of execution, and the like. Details of the display screen displayed on the display unit 103 will be described later.

  A set value input unit 108 ischemic time setting switches 104 and 105 for increasing and decreasing the set value of the ischemic time, and ischemic pressure setting switches 106 and 107 for increasing and decreasing the set value of the ischemic pressure. Is provided.

2. Configuration of Display Screen Next, a display screen displayed on the display unit 103 will be described. FIG. 2 is a diagram illustrating an example of a display screen displayed on the display unit 103. In FIG. 2, 201 is a display area for displaying a set ischemic time, and 202 is a display area for displaying a set ischemic pressure.

  Reference numeral 203 denotes a display area indicating that ischemia is lit during ischemia. Reference numeral 204 denotes a display area indicating that the perfusion is being performed, and is lit during the perfusion. 205 is a remaining time display area, which displays the remaining time until the ischemic state is completed if it is under ischemia, and displays the remaining time until the perfusion state is completed if it is during perfusion.

  Reference numeral 206 denotes a remaining cycle number display area for displaying the remaining cycle number. The limb compression device according to the present embodiment is configured to automatically stop after operating for four cycles when ischemia / perfusion is one cycle.

  Reference numeral 207 denotes a cuff pressure display area for displaying the current cuff pressure value. In addition, four types of cuff parts for the right lower limb part, the left lower limb part, the upper right arm part, and the left upper arm part are connected, but the cuff pressure value of which cuff part is displayed is arbitrary. It can be set.

  Reference numeral 208 denotes an alarm display area, which blinks when the limb compression apparatus 100 detects any abnormality and notifies the user that an abnormality has occurred.

3. Usage Mode of Limb Compression Device Next, the usage mode of the limb compression device 100 will be described. FIG. 3 is a diagram showing a state in which treatment using the limb compression device 100 is performed on a patient by a remote short-term repeated ischemia method.

  As shown in FIG. 3, a cuff portion 302 for the left lower limb is attached to the tip of the cuff tube 111, and is wound around the left foot thigh in the example of FIG. 3. In addition, a cuff portion 301 for the right lower limb is attached to the tip of the cuff tube 112, and is wound around the right foot thigh in the example of FIG.

  Similarly, a cuff portion 303 for the left upper arm is attached to the distal end of the cuff tube 113 and is wound around the patient's left upper arm. A cuff portion 304 for the upper right arm is attached to the tip of the cuff tube 114 and is wound around the upper right arm of the patient.

  As described above, the limb compression apparatus 100 according to the present embodiment is configured so that the patient's limbs (four locations of the upper limb and two lower limbs) can be compressed with air pressure using the cuff portions 301 to 304. . Note that it is not always necessary to configure the four places of the upper limb and the two lower limbs to be compressed in parallel, and the cuff tube may be configured to be detachable so that an arbitrary position can be compressed.

  Furthermore, five electrodes (311 to 315) which are means for detecting an electrocardiographic waveform by an electrocardiographic induction method are connected to the limb compression device 100 according to the present embodiment via a connector 115 and a wiring 116. The electrode 315, which is an electrode for guiding CM5, is arranged on the upper end of the rib, and the electrode 312 is arranged on the rib near V5. Further, an electrode for NASA induction, which is a means for detecting an electrocardiographic waveform by an electrocardiographic method, the electrode 314 is at the lower end of the rib, the electrode 311 is at the upper end of the rib, and the electrode 313 (earth electrode) is the lowermost part of the right chest Arranged on the ribs. In addition to the above-described electrocardiographic induction method, 12-lead, monopolar limb guidance, or the like may be applied as means for acquiring an electrocardiographic waveform.

4). Functional configuration of limb compression device Next, the functional configuration of the limb compression device 100 will be described. FIG. 4 is a diagram illustrating a functional configuration of the limb compression device 100. As shown in FIG. 4, the limb compression device 100 includes pressure control units 400 to 430, a control unit 440, an operation unit 108, a display unit 103, and an electrocardiogram measurement unit 450. The control unit 440 includes a CPU such as a microcomputer, a ROM that stores a control program for the entire apparatus executed by the CPU and various data, and a RAM that temporarily stores measurement data and various data as a work area. Suppose that it is configured to perform processing and determination in each step.

  The pressure control units 400 to 430 are provided in a number corresponding to the number of cuff parts (301 to 304) that are pressure control objects, and the pressure control units 400 to 430 are separately pressured for each cuff part based on an instruction from the control part 440. It is configured to be controllable. In addition, since each pressure control unit 400-430 has the same structure, below, the pressure control unit 400 which performs the pressure control of the cuff part 301 is demonstrated.

  In the pressure control unit 400, 401 is a connector part, and the cuff tube 111 with the cuff part 301 attached to the tip is detachably connected. Reference numeral 408 denotes a connection sensor, which detects this when the cuff tube 111 is attached and transmits it to the control unit 440.

  Reference numeral 402 denotes a pressure transducer, which is connected to the connector unit 401 via an air pipe. The pressure converter 402 detects the air pressure in the cuff part 301 and converts it into an electrical signal. A pressure detection unit 403 amplifies the electrical signal output from the pressure transducer 402 and transmits the amplified signal to the control unit 440 as a cuff pressure signal.

  Reference numeral 404 denotes an exhaust valve, which is connected to the connector portion 401 via an air pipe. The exhaust valve 404 is used when the piping system is sealed during ischemia and when the air in the cuff part 301 is rapidly exhausted so as to transition from the ischemic state (pressed state) to the perfusion state (released state). .

  Reference numeral 405 denotes a valve drive unit that controls opening and closing of the exhaust valve 404 based on an instruction from the control unit 440.

  Reference numeral 406 denotes a pump, which is connected to the connector portion 401 via an air pipe and supplies air to the cuff bag in the cuff portion 301. Reference numeral 407 denotes a pump driving unit that controls driving / stopping of the pump 406 based on an instruction from the control unit 440.

  The control unit 440 stores a program for executing a remote short-time repeated ischemia process, which will be described later, based on an instruction from the operation unit 108 and an output from the pressure detection unit 403. The pump drive unit 407, the display unit 103, and the like are controlled.

  In an electrocardiogram measurement unit 450 including an acquisition unit that acquires signals detected by a plurality of guidance methods, reference numeral 451 denotes a connector unit, and a connector 115 connected to the electrodes 311 to 315 is detachably attached. Signals detected at the electrodes 311 to 315 are taken into the limb compression device 100 via the connector portion 451. Reference numeral 452 denotes a channel unit, where ch1 is used as a CM5 guiding channel and ch2 is used as a NASA guiding channel. An electrocardiogram detection / determination unit 453 generates an electrocardiogram waveform based on signals detected by a plurality of induction methods, CM5 and NASA, and based on the generated electrocardiogram waveform, Judgment is made on whether there is an increase, ventricular tachycardia, ventricular extrasystole, etc. (whether there is a waveform change related to arrhythmia), and changes in the patient's condition are detected. A ventricular arrhythmia is determined based on, for example, a QRS width, and is determined to be a ventricular arrhythmia when the QRS width is 0.12 seconds or more.

  When the electrocardiogram detection / determination unit 453 detects a change in the condition of the patient, the detection result is transmitted to the control unit 440, and the control unit 440 stops the remote unit short-term repeated ischemia process.

5. Flow of Remote Short-Time Repeated Ischemia Processing Next, the flow of remote short-time repeated ischemia processing executed in the control unit 440 of the limb compression device 100 will be described. FIG. 5 is a flowchart showing a flow of remote short-time repeated ischemia processing executed in the control unit 440 of the limb compression apparatus 100.

  After setting the ischemic time, the ischemic pressure, and the like, the switch 102 is pressed, and the start of the remote portion short-term repeated ischemia processing is instructed, whereby the flowchart shown in FIG. 5 is started.

  In step S501, initialization is performed. Specifically, zero is set as the initial pressure, and various timers (timer for measuring pressurization time, timer for measuring ischemia time or perfusion time) are reset. Further, a signal from the connection sensor 408 is detected, and control is performed so that the pressure control unit to which the cuff is not connected is not operated.

  In step S <b> 502, reception of the cuff pressure value output from the pressure detection unit 403 is started and displayed in the cuff pressure display area 207 of the display unit 103.

  In step S503, the electrocardiogram detection / determination unit 453 starts determination for generating an electrocardiogram waveform and detecting a change in the condition of the patient.

  In step S504, the valve drive unit 405 is instructed to fully close the exhaust valve 404.

  In step S505, the pump drive unit 407 is instructed to drive the pump 406. When driving of the pump 406 is started in step S505, a pressurization timer is started in step S506. In step S507, it is determined whether or not the timer value of the pressurization timer has reached a specified value (for example, 30 sec) or more. If it is determined in step S507 that the timer value of the pressurization timer is not equal to or greater than the specified value, the process proceeds to step S508, where the cuff pressure value output from the pressure detection unit 403 is a preset ischemic pressure. It is determined whether or not the force value is exceeded.

  If it is determined in step S508 that the cuff pressure value is not equal to or higher than the preset ischemic pressure value, the process returns to step S507 and whether the timer value of the pressurization timer is equal to or greater than the specified value. Determine whether. If it is determined in step S507 that the timer value of the pressurization timer has become equal to or greater than the specified value, the process advances to step S509 to instruct the pump drive unit 407 to stop driving the pump 406. In step S510, the valve drive unit 405 is instructed to fully open the exhaust valve 404. Further, in step S511, the alarm display area 208 blinks to notify the device abnormality.

  As described above, when the control unit 440 drives the pump 406 to start pressurization of the cuff unit 301, the control unit 440 monitors the cuff pressure in the cuff unit 301 and reaches the ischemic pressure value set within a specified time. If not, it is determined that there is some abnormality, the drive of the pump 406 is stopped, and an alarm is output to the user. Thereby, the user can detect an abnormality in the pressurization process at an early stage.

  When the ischemic pressure value set within the specified time is reached, the process proceeds from step S508 to step S521 in FIG. 6 and instructs the pump drive unit 407 to stop the operation of the pump 406.

  In step S522, a timer for measuring the ischemia time is started, and the display area 203 of the display unit 103 is turned on to notify the user that the ischemia is being performed. In step S523, the remaining time until the ischemic state is completed is displayed in the remaining time display area 205 of the display unit 103 based on the timer value of the timer. The remaining time is calculated by subtracting the timer value of the timer for measuring the ischemic time from the preset ischemic time.

  In step S524, the electrocardiogram detection / determination unit 453 determines the presence or absence of ventricular arrhythmia, ST elevation, ventricular tachycardia, ventricular extrasystole, and the like, and detects a change in the patient's condition. If a change in the condition of the patient is detected in step S524, the process proceeds to step S525, and the valve drive unit 405 is instructed to fully open the exhaust valve 404. Further, in step S526, after flashing in order to notify the electrocardiogram abnormality in the alarm display area 208, the remote portion short-term repeated ischemia processing is terminated.

  Thus, the limb compression apparatus 100 according to the present embodiment is configured to analyze the electrocardiogram waveform in the ischemic state and release the ischemic state when a change is detected in the patient's condition. Yes. This ensures the safety of the patient.

  On the other hand, if no change in the patient's condition is detected in step S524, the process proceeds to step S527, where the timer value for measuring the ischemic time is equal to or greater than the preset ischemic time. It is determined whether or not. If it is determined in step S527 that the timer value for measuring the ischemic time is not equal to or greater than the preset ischemic time, the process returns to step S523.

  On the other hand, when it is determined in step S527 that the timer value of the timer for measuring the ischemic time is equal to or greater than the preset ischemic time, the display area 203 is turned off, and the process proceeds to step S528. Then, the valve drive unit 405 is instructed to fully open the exhaust valve 404, and the process proceeds to step S529.

  In step S529, it is determined whether or not the cuff pressure value output from the pressure detection unit 403 is 15 mmHg or less. If it is determined in step S529 that the cuff pressure value is not 15 mmHg or less, the process waits until the cuff pressure value is 15 mmHg or less.

  On the other hand, if it is determined in step S529 that the cuff pressure value has become 15 mmHg or less, the process proceeds to step S530, where a timer for measuring the perfusion time is started and the display area 204 is turned on to prompt the user. Informs that it is perfusing.

  Further, the process proceeds from step S530 to step S541 in FIG. 7, and the remaining time until the perfusion state is completed is displayed in the remaining time display area 205 of the display unit 103 based on the timer value of the timer. The remaining time is calculated by subtracting the timer value of the timer for measuring the perfusion time from the preset perfusion time.

  In step S542, the electrocardiogram detection / determination unit 453 determines the presence or absence of ventricular arrhythmia, ST elevation, ventricular tachycardia, ventricular extrasystole, etc., and detects a change in the patient's condition. If a change in the condition of the patient is detected in step S542, the process proceeds to step S543 and blinks in order to report an electrocardiogram abnormality in the alarm display area 208, and then the remote portion short-term repeated ischemia processing is terminated. To do.

  As described above, in the limb compression device 100 according to the present embodiment, the electrocardiographic waveform is analyzed even in the perfusion state, and when a change is detected in the condition of the patient, the remote portion short-term repeated ischemia processing is terminated. It is configured to This ensures the safety of the patient.

  On the other hand, if no change in the condition of the patient is detected in step S542, the process proceeds to step S544, and whether or not the timer value for measuring the perfusion time is equal to or greater than the preset perfusion time. Determine whether. If it is determined in step S544 that the timer value for measuring the perfusion time is not equal to or longer than the preset perfusion time, the process returns to step S541.

  On the other hand, when it is determined in step S544 that the timer value of the timer for measuring the perfusion time is equal to or longer than the preset perfusion time, the display area 204 is turned off, and the process proceeds to step S545. The number of cycles is incremented (note that zero is input as the initial value for the count value of the number of cycles). In step S546, the remaining cycle number is displayed in the remaining cycle number display area 206 of the display unit 103. The remaining number of cycles is calculated by subtracting the counted current number of cycles from a predetermined number of cycles (4).

  In step S547, it is determined whether or not the counted number of cycles is greater than a predetermined number of cycles (4). If it is determined that the number is less than 4, the process returns to step S504. On the other hand, if it is determined that the number is 4 or more, the remote-part short-time repeated ischemia process is terminated.

  As is clear from the above description, the limb compression apparatus 100 according to the present embodiment acquires the patient's electrocardiogram waveform in parallel when performing the remote portion short-term repeated ischemia processing, A change in the condition is monitored, and when a change is detected in the condition of the patient, the remote short-term repeated ischemia treatment is immediately terminated. This has made it possible to ensure patient safety.

[Other Embodiments]
In the first embodiment, four cuff portions for the right lower limb portion, the left lower limb portion, the upper right arm portion, and the left upper arm portion are prepared, and pressure control is independently performed based on a common set value. Although configured, the present invention is not limited to this.

  For example, the number of cuff parts may be four or more or less than four. Further, it may be configured such that the set value can be set separately, or it may be configured such that several cuff portions are collectively pressure-controlled.

DESCRIPTION OF SYMBOLS 100: Limb part compression apparatus, 101: Housing, 102: Start / stop switch, 103: Display part, 104 * 105: Ischemic time setting switch, 106 * 107: Ischemic pressure setting switch, 108: Operation part, 111- 114: Cuff tube, 115: Connector, 116: Wiring, 201: Display area for displaying ischemic time, 202: Display area for displaying ischemic pressure, 203: Display area for indicating ischemia, 204: Display area indicating perfusion, 205: remaining time display area, 206: cycle number display area, 207: cuff pressure display area, 208: warning display area, 301: cuff for right lower limb, 302: left lower limb Part cuff part, 303: upper right arm cuff part, 304: left upper arm cuff part, 311 to 315: electrode

Claims (4)

A cuff portion wound around a limb includes a plurality of pressure control units that can be connected via a cuff tube, and the pressure control unit controls air supply to the cuff portion connected thereto and exhaust from the cuff portion. A limb compression device that repeats compression and release of the limb over a predetermined number of cycles,
And control means for controlling the pressure control unit cuff is connected among the plurality of pressure control unit to repeat over the number of cycles to a predetermined pressure and the release of pre-Symbol limb,
An acquisition means for acquiring signals detected by a plurality of induction methods in order to detect an electrocardiographic waveform by the electrocardiogram induction method ;
A means for generating an electrocardiogram based on the signal acquired by the acquisition means, and a determination means for determining the presence or absence of a waveform change related to arrhythmia for the generated electrocardiogram waveform;
For the pressure control unit to which a cuff portion is connected among the plurality of pressure control units , the control means starts the operation of repeating compression and release of the limb, and then the waveform relating to the arrhythmia is determined in the determination means. The operation is stopped when it is determined that there is a change, and the pressure control unit to which the cuff portion is not connected among the plurality of pressure control units is not operated.
A limb compression device characterized by that. The control means, the pressure control unit cuff is connected among the plurality of pressure control unit, in pressed state, if it is determined that a waveform change regarding the arrhythmia by said determining means, said cuff portion The limb compression device according to claim 1, wherein the control is stopped after instructing exhaust of the limb.   The limb compression device according to claim 1, wherein the acquisition unit acquires signals detected using CM5 guidance and NASA guidance.   The limb compression device according to claim 1, wherein the waveform change related to the arrhythmia includes any one of ventricular arrhythmia, ST elevation, ventricular tachycardia, and ventricular extrasystole.

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