CN101239222A - Myocardial ischemia therapeutic instruments - Google Patents
Myocardial ischemia therapeutic instruments Download PDFInfo
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- CN101239222A CN101239222A CNA200810069283XA CN200810069283A CN101239222A CN 101239222 A CN101239222 A CN 101239222A CN A200810069283X A CNA200810069283X A CN A200810069283XA CN 200810069283 A CN200810069283 A CN 200810069283A CN 101239222 A CN101239222 A CN 101239222A
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Abstract
The present invention provides a therapy instrument for myocardial ischemia, which is combined with power circuit, generation circuit of modulation wave, shaping circuit of modulation wave, modulation circuit, constant current source circuit, stimulating electrode, CPLD carrier generation circuit, carrier shaping circuit, output intensity control circuit and MCU. The therapy instrument has characters of non-invasive, non-pain sense electrical stimulation, overcoming body adaptability etc., and can treat patient with comfortable sense. The therapy instrument can assistant treat myocardial ischemia by skin spinal cord and fastigial nucleus electrical stimulation. The therapy instrument modulates the random signal of low-frequency slow change rhythm on the MF carrier signal with special spectrum structure by method of pulse amplitude modulation, and loads LF current to human skin spinal cord and fastigial nucleus with forms of current by surface electrode. The therapy instrument can treat myocardial ischemia by improving coronary blood flow, reducing myocardial oxygen consumption, controlling pain and protecting neurogenic neuroprotection.
Description
Technical field
The present invention relates to a kind of hospital that is used for to the device that the myocardial ischemia patient carries out complementary naturopathy, belong to technical field of medical instruments.
Background technology
Coronary heart disease is one of principal disease that threatens at present human health, life.It is that the heart change that causes luminal stenosis or obstruction to cause is principal character with the cardiac blood supply deficiency, thereby is called ischemic heart desease again because coronary artery and branch thereof are atherosis.Improve myocardial ischemia, the control angina pectoris is the basic principle of treatment coronary heart disease.The method of treatment myocardial ischemia is a lot, comprise change lifestyles, various Drug therapy, revascularization, bypass operation of coronary artery etc.By the standard care scheme, most humans energy controlling symptoms, myocardial ischemia improves.Yet, the side effect of Drug therapy and drug resistance, expenses of surgical treatment is expensive and be subjected to the restriction of patient, and these all can not be ignored; And still have greatly patient clinically, invalid or produce little effect to the standard care mode.
The neuron of control cardiovascular activity be distributed in the central nervous system from spinal cord to corticocerebral each level, comprised the cardiovascular center that oblongata cardiovascular center and oblongata are above.Cardiovascular system is subjected to sympathetic nerve and parasympathetic adjusting, stimulates these nerves that coronary artery blood flow is had direct effect or indirect action.Since the sixties in last century Shealy etc. find the spinal cord stimulation trial method (Spinal cord stimulation, SCS) have analgesic activity after, the spinal epidural cavity electrical stimulating therapy is applied to treating cardiovascular disease such as intractable angina pectoris and myocardial ischemia gradually.In addition, cerebellum is except being regulated every movement instruction of brain, and (Fastigial NucleusStimulation FNS) can change cardiovascular activity to the electricity irritation cerebellar fastigial nucleus.Neurogenic neuroprotective by electricity irritation cerebellar fastigial nucleus (FNS) produces can realize the protection to vitals such as heart and brain, prevents and treats its ischemic pathological changes.More domestic scholars; on the rat heart muscle infarction model, inquired into the potential using value that FNS prevents and treats relevant cardiovascular disease from the anti-oxidative damage angle, find that FNS can alleviate rat myocardium from injury behind the myocardial infarction; reduce myocardial infarction area, infer that FNS has protective effect to heart.
At present, both at home and abroad the Therapeutic Method of myocardial ischemia is mainly comprised: change lifestyles, various Drug therapy, revascularization, bypass operation of coronary artery, installation intravascular stent, external counterpulsation etc.By these treatments, most humans energy controlling symptoms, myocardial ischemia improves.Yet, the side effect of Drug therapy and drug resistance, expenses of surgical treatment is expensive and be subjected to the restriction of factors such as patient, still has patient greatly clinically, can't be treated surgically and invalid or produce little effect to the Drug therapy mode.Utilize spinal cord stimulation trial ruling by law to treat cardiovascular disease such as intractable angina pectoris and myocardial ischemia, also only resting on by the electrode that is implanted in spinal epidural cavity stimulates having on the wound property Therapeutic Method of spinal cord.
Summary of the invention
At the prior art above shortcomings; the purpose of this invention is to provide a kind of spinal cord stimulation trial (SpinalCord Stimulation that utilizes; effect and cerebellar fastigial nucleus electricity irritation (FastigialNucleus Stimulation such as analgesia SCS) and minimizing myocardial oxygen consumption; FNS) neurogenic protection philosophy stimulates spinal cord and cerebellar nuclei to administer the therapeutic equipments of myocardial ischemia by external electrode non-invasively.
The object of the present invention is achieved like this: a kind of myocardial ischemia therapeutic instruments is characterized in that being combined by power circuit, modulation wave generation circuit, modulating wave shaping circuit, modulation circuit, constant-current source circuit, stimulating electrode, CPLD carrier wave generation circuit, carrier wave shaping circuit, output intensity control circuit and single-chip microcomputer; Wherein, power circuit is connected with each circuit respectively, for it provides power supply; Modulation wave generation circuit, modulating wave shaping circuit are connected successively with modulation circuit, and CPLD carrier wave generation circuit is connected with modulation circuit through the carrier wave shaping circuit, and the output of modulation circuit links to each other with stimulating electrode through constant-current source circuit; Single-chip microcomputer connects respectively and controls and modulate wave generation circuit, CPLD carrier wave generation circuit and output intensity control circuit.
Described stimulating electrode is a two-way, produce the output of two independent stimulating current, wherein one the tunnel will treat electric current via the external electrode that is affixed on C7 and seventh dorsal vertebra place respectively and be loaded into spinal cord in the vertebra, the cerebellar fastigial nucleus that electric current is loaded into the intracranial depths will be treated via being affixed on two external electrodes of picking up the ears mastoid process place, back respectively in another road.
Compared to existing technology, the present invention has following advantage:
1, proposed a kind of therapeutic equipment of new physiotherapy, come the auxiliary treatment myocardial ischemia by percutaneous spinal cord stimulation trial and cerebellar fastigial nucleus electricity irritation;
2, non-invasive, by the somatic stimulation electrode stable stimulating current is loaded into spinal cord and cerebellar fastigial nucleus effectively;
3, painless electrification stimulates, by optimal design to stimulus waveform, reach and the stimulating current cerebellar fastigial nucleus in the spinal cord in external electrode is delivered to vertebra and intracranial deep effectively can not produced sensation of pricking to skin surface again, the patient is treated in comfort;
4, overcome the adaptability of body, adopt the electric current at random that changes slowly that spinal cord and cerebellar fastigial nucleus are carried out long-time effectively subthreshold stimulus, overcome the adaptability of body stimulating current;
5, therapeutic instrument has the output of two independent stimulating current, wherein one the tunnel will treat electric current via the external electrode that is affixed on C7 and seventh dorsal vertebra place respectively and be loaded into spinal cord in the vertebra, the cerebellar fastigial nucleus that electric current is loaded into the intracranial depths will be treated via being affixed on two external electrodes of picking up the ears mastoid process place, back respectively in another road.
The therapeutic instrument of myocardial ischemia of the present invention, serial advanced new and high technology developments such as application modern biomedical technology, microelectric technique, computer technology, mainly form by several parts such as central processing unit, display screen, waveform combiner circuit, constant-current circuit, electrode outputs; It is stochastic signal with the slow variation rule of low frequency; mode with pulse amplitude modulation; be modulated on the intercarrier signal with specific frequency spectrum structure; from external low-frequency current is loaded into the spinal cord and the cerebellar fastigial nucleus of human body with the form of electric current by external electrode, by improving coronary blood flow, reducing the therapeutical effect that myocardial oxygen consumption, pain management and neurogenic neuroprotective reach the treatment myocardial ischemia.
Description of drawings
Fig. 1 is a therapeutic instrument ultimate principle structured flowchart of the present invention.
Fig. 2 is the nonpolarity exponential pulse oscillogram of stochastic signal amplitude modulation.
The specific embodiment
As shown in Figure 1, a kind of myocardial ischemia therapeutic instruments is made by power circuit (omitting among the figure), modulation wave generation circuit 1, modulating wave shaping circuit 2, modulation circuit 3, constant-current source circuit 4, stimulating electrode 5, CPLD carrier wave generation circuit 6, carrier wave shaping circuit 7, output intensity control circuit 8 and single-chip microcomputer 9 combinations; Wherein, power circuit is connected with each circuit respectively, for it provides power supply; Modulation wave generation circuit 1, modulating wave shaping circuit 2 are connected successively with modulation circuit 3, and CPLD carrier wave generation circuit 6 is connected with modulation circuit 3 through carrier wave shaping circuit 7, and the output of modulation circuit 3 links to each other with stimulating electrode 5 through constant-current source circuit 4; Single-chip microcomputer 9 connects respectively and controls and modulate wave generation circuit 1, CPLD carrier wave generation circuit 6 and output intensity control circuit 8.In addition, single-chip microcomputer 9 can also be respectively with data storage 10 with link to each other with PC 12 with communication interface circuit 11 by data command.
Described power circuit is that the alternating current of outside input or unidirectional current are changed at the required dc source of each circuit of this instrument; Described modulation wave generation circuit 1 and modulating wave shaping circuit 2 are realized the selection of modulation waveform 1,2,3,4 under the setting of single-chip microcomputer 9, adjust the ripple signal and export to modulation circuit 3; CPLD carrier wave generation circuit 6 and carrier wave shaping circuit 7 are under the control of single-chip microcomputer 9, and producing the pulse frequency scope is the 1kHz-2kHz impulse wave, and can control its pulse by single, double and continuous multipulse form output, and carrier signal is exported to modulation circuit 3; Simultaneously, modulation circuit 3 is under the control of single-chip microcomputer 9 and output intensity control circuit 8, the output intensity (the output peak point current of its amplitude-modulated wave is adjustable continuously between 0-30mA) of control modulating wave and CPLD carrier wave acts on the experimenter through constant-current source circuit 4 and the needed boost pulse of stimulating electrode 5 outputs again.Described stimulating electrode 5 is a two-way, produce the output of two independent stimulating current, wherein one the tunnel will treat electric current via the external electrode that is affixed on C7 and seventh dorsal vertebra place respectively and be loaded into spinal cord in the vertebra, the cerebellar fastigial nucleus that electric current is loaded into the intracranial depths will be treated via being affixed on two external electrodes of picking up the ears mastoid process place, back respectively in another road.
Electric elements of the present invention are commercial this area conventional products.
PC as host computer is the function control of system and the core of date processing, and slave computer is a sub-control unit of realizing specific function, is the function of whole system and the characteristic indication of application type, and the design has adopted the control centre of single-chip microcomputer as slave computer.The hardware designs of this structural system, main task are that the function of slave computer realizes.On PC, move application software, succinct, friendly user interface is provided, make things convenient for user to treat operation by software.Carry out the mutual of data and order by communication interface circuit between PC and single-chip microcomputer.Single-chip microcomputer receives the various command of PC, and realizes user's operation by the work of each element circuit of control slave computer.Modulating wave, carrier wave generation shaping circuit and modulation circuit are controlled by single-chip microcomputer, produce stimulus signal and are transferred to constant-current source circuit, produce the needed function of current at last in the experimenter.
After the operator started treatment, the flow process of system works can be divided into following step:
(1) application program on the PC is temporary in data storage by communication interface circuit, single-chip microcomputer corresponding modulating wave data according to therapeutic modality;
(2) Wave data that regularly reads in the data storage of single-chip microcomputer generates corresponding modulating wave;
(3) Single-chip Controlling carrier wave generation circuit produces carrier signal, and is shaped as the derivative-type exponential pulse;
(4) modulating wave and exponential pulse act on one's body the patient through modulation circuit, constant-current source circuit, stimulating electrode.
In therapeutic process, the operator can revise treatment parameters such as the intensity of treatment and mode.
The function expression of stochastic signal amplitude modulation treatment waveform is:
In the formula, A be (V ,+obey the stochastic variable of laplacian distribution between V), its normalization probability density function is
Φ
nBe in [0,2 π], to obey equally distributed stochastic variable, and A and Φ n statistics independence.The nonpolarity exponential pulse waveform of stochastic signal amplitude modulation as shown in Figure 2.
Use method of the present invention to be: after connecting external power supply,, to adjust the control sequence of single-chip microcomputer 9, select the adjustment ripple signal and the CPLD carrier signal that need according to patient's practical situation; Stimulus signal is transferred to constant-current source circuit, and somatic stimulation electrode 5 places the C7 of human body and seventh dorsal vertebra place, the two mastoid process place, back of picking up the ears respectively, with the needed function of current that produces at last in the experimenter.Therapeutic instrument adopts the two independent stimulating current to be output as suitable, wherein one the tunnel will treat electric current via the external electrode that is affixed on C7 and seventh dorsal vertebra place respectively and be loaded into spinal cord in the vertebra, the cerebellar fastigial nucleus that electric current is loaded into the intracranial depths will be treated via being affixed on two external electrodes of picking up the ears mastoid process place, back respectively in another road.
The mechanism of utilizing spinal cord stimulation trial and cerebellar fastigial nucleus electronic stimulation myocardial ischemia of the present invention:
The mechanism of spinal cord stimulation trial treatment myocardial ischemia mainly contains the factor of three aspects: improve coronary blood flow, reduce myocardial oxygen consumption, pain management itself.Between these factors be connect each other, interactional, be that multiple factor exists simultaneously.
1, improves coronary blood flow and reduction myocardial oxygen consumption
The domination heart sympathetic, parasympathetic nervous is very abundant.The arteria coronaria blood vessel contains α
1, α
2Adrenoreceptor, discharged by teleneuron when it or blood in norepinephrine activate after, can cause contractile response.On the contrary, vagus nerve stimulation can make coronary vasodilation, and this expansion can be blocked by atropine by the acetylcholine mediation.Can control cardiovascular system by the descending fiber that send the marginal portion of brain.Early there are some researches show, can change coronary blood flow after some structures of limbic system are upset, behind the spinal cord electricity thorn, patient's coronary blood flow speed obviously increases.
Existing studies show that, SCS can suppress sympathetic nerve and spread out of, and blocks anginal reflex arc, reduces orthosympathetic undue activation.Emanuelsson etc. discover that SCS can reduce systolic pressure, reduce epinephrine and noradrenaline levels in the blood, show that SCS has the ischemia resisting effect.Hautvast etc. discover through position emissron tomography (PET), after SCS treated for 6 weeks, carry out double density when reaching not (persantin) Road test in the ischemia stage, filling rate is significantly greater than non-ischemic region again, because when total groundwater increment no change, SCS can cause non-ischemic region to redistribute to the blood flow of ischemic region.
Rate pressure product is considered to weigh the good index of coronary heart disease people cardiac muscle oxygen consumption.The research group of Mannheimer is found, SCS is the blood flow of not obvious increase coronary sinus also, but can reduce the product of heart rate-blood pressure, reduces myocardial oxygen consumption, the effect of this effect and beta-blocker is similar, and the ischemia resisting effect of prompting SCS is secondary to the minimizing of myocardial oxygen consumption.
Can determine according to above-mentioned result of study, stimulate the spinal cord dorsal rear flank can cause the neural emission of stage of some, sympathetic tone is reduced, body circulation Adrenaline Concentration reduces, orthosympathetic active reflexive descends, increase blood supply of cardiac muscle, reduce myocardial oxygen consumption, increase the blood supply of ischemic region simultaneously.
2, alleviating pain
SCS mainly is used to treat intractable pain in early days, imports retardancy pain such as phantom pain into around mainly being meant, and postoperative pain, has now expanded to all intractable pains, comprise behind the herpes zoster around property neuralgia, pain after Spinal Cord Injury etc.
The analgesia mechanism of SCS mainly contains following several hypothesis.(1) pain sensation that antidromicity is got excited and direct motion the is transmitted impulsion that stimulates funiculus posterior medullae spinalis to produce clashes (collision); (2) the antidromicity impulsion that stimulates funiculus posterior medullae spinalis to produce produces " gate " in posterior horn of spinal cord; (3) stimulate the back root to produce " gate "; (4) owing to stimulate the funiculus posterior medullae spinalis uplink, produce interference effect at medulla oblongata, brain stem, thalamus and cerebral cortex; (5) activation of the descending property inhibition path of funiculus posterior medullae spinalis anterograde impulsion; (6) participation of endogenous analgesic matter.Except that above-mentioned hypothesis, some and the indirect related phenomena of analgesic activity are pointed out, and stimulate spinal cord to produce: the sympathetic activity inhibitory action; The musculation inhibitory action; Neural plasticity changes (neurological functional recovery effect clinically); Nervous function, metabolic activation etc.
The sensor of heart is made of teleneuron, wherein is mainly SNE.The local metabolite that produces stimulates these sensors when myocardial ischemia, anoxia, cause unusual neural impulse, these impulsions enter paravertebral ganglia through orthosympathetic centripetal fiber (primary afferent fiber), these information are transmitted to relief angle neuron of corresponding spinal cord section and intersect that the lateral spinothalamic tract of offside is up goes into thalamus at this, import brain at last into, cerebral cortex is being perceiveed this " abnormal sensory " back generation pain.Upload in the process of maincenter at neural impulse, this information is constantly regulated and control, and wherein topmost regulation and control position is at spinal cord.The gate theory shows that little nerve fiber is transmitted pain sensation information to brain, and big nerve fiber is transmitted non-pain sensation information to brain, stimulates big nerve fiber can " flood " pain sensation information that little nerve fiber is transmitted to brain.The SCS mechanism of action has met gate control theory, and promptly anginal neural impulse is subjected to the inhibition of thicker centripetal fiber afferent impulse.
The cerebellar fastigial nucleus electricity irritation all has neuroprotective to the infringement of ischemic lesions and other multiple character; There is a group autonomic neuron in cerebellar fastigial nucleus, and the excitement of these autonomic neurons can produce the protection of tangible ischemic to vitals such as the heart, brains, ischemic injuries is alleviated or does not occur, and the scope of ischemic injuries is obviously dwindled.
Claims (7)
1, a kind of myocardial ischemia therapeutic instruments is characterized in that being combined by power circuit, modulation wave generation circuit (1), modulating wave shaping circuit (2), modulation circuit (3), constant-current source circuit (4), stimulating electrode (5), CPLD carrier wave generation circuit (6), carrier wave shaping circuit (7), output intensity control circuit (8) and single-chip microcomputer (9); Wherein, power circuit is connected with each circuit respectively, for it provides power supply; Modulation wave generation circuit (1), modulating wave shaping circuit (2) are connected successively with modulation circuit (3), CPLD carrier wave generation circuit (6) is connected with modulation circuit (3) through carrier wave shaping circuit (7), and the output of modulation circuit (3) links to each other with stimulating electrode (5) through constant-current source circuit (4); Single-chip microcomputer (9) connects respectively and controls and modulate wave generation circuit (1), CPLD carrier wave generation circuit (6) and output intensity control circuit (8).
2, a kind of myocardial ischemia therapeutic instruments according to claim 1, it is characterized in that described single-chip microcomputer (9) also respectively with data storage (10) with link to each other with PC (12) with communication interface circuit (11) by data command.
3, a kind of myocardial ischemia therapeutic instruments according to claim 1 is characterized in that described modulation wave generation circuit (1) produces the random wave that low frequency changes slowly.
4, a kind of myocardial ischemia therapeutic instruments according to claim 1 is characterized in that it is the 1kHz-2kHz impulse wave that described CPLD carrier wave generation circuit (6) produces the pulse frequency scope, and can control its pulse by single, double and continuous multipulse form output.
5, a kind of myocardial ischemia therapeutic instruments according to claim 1 is characterized in that the final pulse of described stimulating electrode (5) output is that the synthetic frequency of random wave that amplitude is changed slowly by low frequency is the exponential pulse ripple of 1kHz-2kHz.
6, a kind of myocardial ischemia therapeutic instruments according to claim 1 is characterized in that the final pulse of described stimulating electrode (5) output is direct current or AC type, is set in advance by single-chip microcomputer (9).
7, according to claim 1,5 or 6 described a kind of myocardial ischemia therapeutic instruments, it is characterized in that described stimulating electrode (5) is a two-way, produce the output of two independent stimulating current.
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Cited By (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN102488966A (en) * | 2011-12-27 | 2012-06-13 | 四川大学 | Electric needle |
| US9289610B2 (en) | 2008-05-15 | 2016-03-22 | Boston Scientific Neuromodulation Corporation | Fractionalized stimulation pulses in an implantable stimulator device |
| CN110833656A (en) * | 2019-12-16 | 2020-02-25 | 大连理工大学 | Constant-current output intermediate frequency therapeutic instrument system |
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| CN1125658C (en) * | 1998-10-15 | 2003-10-29 | 庄永基 | Current-stimulating therapeutic apparatus able to generate bionic current waveforms by digital frequency synthesis |
| CN1391961A (en) * | 2001-06-15 | 2003-01-22 | 乔路生 | Phsiotherapeutic instrument for coronary heart disease |
| CN1421249A (en) * | 2001-11-29 | 2003-06-04 | 同济大学 | Functional electric-stimulation controller with monochip computer and LCD |
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Cited By (8)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| US9289610B2 (en) | 2008-05-15 | 2016-03-22 | Boston Scientific Neuromodulation Corporation | Fractionalized stimulation pulses in an implantable stimulator device |
| US9393423B2 (en) | 2008-05-15 | 2016-07-19 | Boston Scientific Neuromodulation Corporation | Fractionalized stimulation pulses in an implantable stimulator device |
| US9782593B2 (en) | 2008-05-15 | 2017-10-10 | Boston Scientific Neuromodulation Corporation | Fractionalized stimulation pulses in an implantable stimulator device |
| US10293166B2 (en) | 2008-05-15 | 2019-05-21 | Boston Scientific Neuromodulation Corporation | Fractionalized stimulation pulses in an implantable stimulator device |
| CN102488966A (en) * | 2011-12-27 | 2012-06-13 | 四川大学 | Electric needle |
| CN102488966B (en) * | 2011-12-27 | 2014-01-22 | 四川大学 | Electric needle |
| CN110833656A (en) * | 2019-12-16 | 2020-02-25 | 大连理工大学 | Constant-current output intermediate frequency therapeutic instrument system |
| CN110833656B (en) * | 2019-12-16 | 2021-03-26 | 大连理工大学 | Constant-current output intermediate frequency therapeutic instrument system |
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