CN102416213B - 用于辅助患者呼吸的方法和装置以及气管假体和导管 - Google Patents

用于辅助患者呼吸的方法和装置以及气管假体和导管 Download PDF

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CN102416213B
CN102416213B CN201110213023.7A CN201110213023A CN102416213B CN 102416213 B CN102416213 B CN 102416213B CN 201110213023 A CN201110213023 A CN 201110213023A CN 102416213 B CN102416213 B CN 102416213B
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卢茨·弗赖塔格
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Abstract

本发明涉及一种用于辅助患者呼吸的方法和装置以及一种气管假体。根据本发明，通过传感器检测患者的自主呼吸，并且在一个吸气过程结束时对肺供给一个附加的氧气量。由此改善了吸气时的氧气吸入。在需要时，患者的呼气过程可通过一个逆流来阻制，以避免呼吸道瘪下。该方法通过一种装置来实现，它包括一个可以连接到一个氧气源上去的氧气泵和一个气管假体，它们可以通过一个导管连接。通过传感器来检测患者的自主呼吸，这些传感器与一个用于起动氧气泵的控制单元相连接。该气管假体具有一个管状的支承体，后者具有一个用于所述导管的接头，其中，这些传感器中的两个配置给支承体。该支承体和集成的或者可插入的喷射导管被这样定尺寸，使得患者可无障碍地自由呼吸和讲话。

Description

用于辅助患者呼吸的方法和装置以及气管假体和导管
本申请是申请日为2004年7月23日、申请号为200480029872.5(PCT/DE2004/001646)、发明名称为“用于辅助患者呼吸的方法和装置以及气管假体和导管”的发明专利申请的分案申请。
技术领域
本发明涉及一种用于辅助患者呼吸的方法和装置以及为此所使用的气管假体和导管。
背景技术
为了使身体能够吸入氧气并呼出二氧化碳，呼吸支气管系统的两个部分必须都正常工作。肺作为气体交换器官，而呼吸泵作为通气器官将空气送入肺中并输送出来。大脑中的呼吸中枢、中枢和末梢神经、胸部的骨骼和呼吸肌肉组织以及通畅稳定的呼吸道都属于呼吸泵的正常功能。
在生某些疾病时呼吸泵经受长期的超负荷或者衰竭。典型的病例是肺气肿，其横膈膜平坦，没有收缩能力。在患肺气肿时，呼吸道通常都极其松弛、萎缩。横膈膜平坦、过度伸展的后果是使患者的吸气不够深。此外，患者还由于萎缩的呼吸道而不能足够地呼气。这导致供氧不足造成的呼吸不足，并且血液中的二氧化碳升高，也就是所谓的换气不足。
通常通过呼吸机来进行对于吸气虚弱的处理。所谓的家内吸氧是一种人工供吸氧，用于支持呼吸泵或者完全地使呼吸泵卸荷。
该供吸氧可通过一个软管和一个鼻面罩或者口/鼻面罩非侵入式地(nicht-invasiv)实现，患者可以根据需要自己戴上或者取下该面罩。不过，患者的自由呼吸和讲话因此受到妨碍。此外，还可以将一个封闭的气管插管放入气管中去。这样也同样导致患者不再能讲话。
在侵入式供吸氧中，通常是通过一个气管开孔来实现这一点的。在此，它是通过手术在气管上开设的开口。通过该开口将一个手指粗的、具有一个阻塞气囊(Blockungsballon)的导管插入气管中，并且将其连接到一个呼吸机上。这样实现了足够深的呼吸，但是也妨碍了患者讲话。除了供吸氧外还有通过更细的导管进行的经气管的供氧。相应的建议在US-A-5 181 509或者US-A-5 279 288中给出。按照这种方式，以固定设置的频率用连续的气流给患者供应高剂量的氧气。通过一个节流装置来手动调节氧气流。不可能达到与患者的自然呼吸过程适配。呼吸不能加深。伸入到气管之中的导管端部还会导致发炎及周围组织的局部创伤，其方式是它会由于呼吸运动撞击气管或者通过喷射气流使周围的组织发干。
此外，还已知所谓的“Montgomery-T型小管”，它被置入气管内。这样，患者可以通过T形件向外引出的腿获得氧气。此外，患者还可以在需要时自己吸排分泌物。患者可以自由呼吸并在前部的腿封闭时可讲话，但是，通过“Montgomery-T型小管”进行供吸氧却是不可能的，因为导入的空气向上偏移进入到口腔或咽喉腔内。
发明内容
以现有技术为基础，本发明的任务是：提供一种改善效率的、用于辅助患者呼吸的方法及一种实现此方法的装置，该装置也可以由患者随身携带并且在使用上安全可靠。此外，本发明的目的还在于提供一种气管假体和一种导管，它们能够实现与患者的自主呼吸同步的辅助呼吸，而且不影响讲话能力。
本发明的方法部分的解决方案在于具有权利要求1所给出的措施的方法。
根据该方法，通过传感器检测患者的自主呼吸并且在吸气过程结束时对肺供给一附加的氧气量。这可以是以氧气脉冲的形式通过一个喷射导管由氧气储存器给出。这里，辅助呼吸与患者的自然呼吸实现同步。这样，因呼吸泵超负荷或者衰竭而减弱的呼吸深度得到补偿。通过额外的氧气量将呼吸维持在足够的水平上。避免了供氧不足及血液中二氧化碳的升高。
合乎目的的是，如权利要求2所设计的那样，额外的氧气量在25ml至150ml之间。
根据需要，可以选择性地通过一个逆流来阻制患者的呼气过程。如果患者的呼吸道已经萎缩了，即在呼气过程的瞬间瘪下去，这样，会极大地阻止呼气过程，那么上述方式是值得推荐的。上面的问题通过权利要求3的措施来避免，其方式是：在呼气期间，施加一个逆流，由此使呼吸道保持敞开并且避免呼吸道萎缩。
对于本发明所面对的问题的一种具体的解决方案可在具有权利要求4所述特征的装置中看到。它设置有一个可以连接到一个氧气源上去的氧气泵和气管假体，它们通过一个导管可以在需要时在使用另一输送软管的情况下来进行连接。导管的出流侧的端部对氧气流产生喷嘴特性的效果。这一点可以诸如通过横截面的减小来实现。原则上导管的端部也可以装备一个喷射喷嘴。此外，还设置有传感器来检测患者的自主呼吸，这些传感器与一个用于起动氧气泵的控制单元相连接。气管假体具有一个管状的(tubulaer)支承体，后者具有一个用于导管的接头。支承体和集成的导管被这样定尺寸，使得患者能够无障碍地自由呼吸和讲话。主呼吸是通过气管假体的较大的内腔实现的。自主呼吸、咳嗽和讲话不受阻碍。此外，在支承体上设置有至少两个属于该装置的传感器。
气管假体植入患者的气管内。通过一个小的气管切口为导管制造出朝外的入口。导管可以通过接头用一个端部直接插到支承体中。也可以从外部通过一个接合装置将导管与接头连接起来。
这些传感器用来检测患者的自主呼吸。可以使用不同类型的呼吸传感器，如呼吸气流传感器或者压力传感器。特别有利的是热敏电阻。它是具有依赖于温度的电阻的半导体元件。利用电阻的温度依赖特性来检测吸气和呼气过程，因为气管中由肺呼出的空气自然地比吸入的空气热一些。
根据权利要求5所述特征，以有利的方式在支承体的内壁上固定一个传感器。另一个传感器设置在支承体的外壁上或者嵌入支承体本身中。
通过一个桥式电路来完成处于内侧和外侧的传感器所获得的测量值之间的差别的补偿。通过这种双重设置能够补偿环境因素的影响，如温度的波动等。
根据权利要求6所述的特征，导管的处于支承体内的端部被基本上平行于其纵轴线地弯转并且在端侧装备有一个喷射喷嘴。在此，它也可以是一个单独的喷嘴。但是，该喷射喷嘴也可以以一个横截面收缩结构的形式构型在导管的端部上。这样就可以将通过导管导入的空气或者氧气流向着肺部的方向引导，确切地说，呈现层流形式。阻止了氧气偏出进入口腔或咽喉腔。接收导管端部或者说端部件的支承件避免了周边组织的脱水发干。此外，也避免了气管及周边组织例如因导管端部的运动造成创伤。
合乎目的的是，氧气泵构造成活塞泵。尤其是使用具有双向作用的活塞或者可移动的膜片的缸。这样的氧气泵的突出特点是其结构紧凑。此外，还能够对输出的氧气量进行可靠的调节，确切地说，不仅用于吸气过程的辅助，而且用于呼气过程的辅助。因为每次喷射行程的最大空气量是通过缸的尺寸限定的，因此，可以避免肺的过度膨胀及由此导致的压力创伤。
在本发明的装置的范围内，可以使用两个导管，其中，一个喷射导管设计用于辅助吸气过程，而另一个导管用于实现对呼气过程的有目的的阻制。当然也可以将一个导管构造成双内腔式的，如权利要求8所设计的那样。通过双内腔的导管，提供了分开的通道，以在吸气过程和呼气过程中供应氧气。
如果设置另外的呼吸传感器，则实现装置的可靠性的提高。这里指的是用来检测患者的自主呼吸的传感器。它们例如可固定在患者的胸腔上，从而能够通过测量胸腔阻抗(Thoraximpedanz)来监视自主呼吸。也可以考虑在患者的口部或者鼻部测量声音或者气流。通过在一个调节—控制单元中对所接收的、来自气管和其它呼吸传感器的信号的调整，以及对氧气泵的相应控制，来实施吸气或呼气的辅助。额外的呼吸传感器保证冗余的实施并有贡献于装置的可靠性。
根据权利要求10，对于根据本发明的气管假体要求一个独立的保护。它具有一个管状的支承体，后者具有一个用于导管的接头，其中，在支承体上至少设置两个传感器。该气管假体的特点是：利用它可以测量患者的呼吸。这样，能够实现外部的辅助呼吸与患者的自身呼吸的同步化。
一个传感器以有利的方式固定于支承体的内壁上(权利要求11)。在本发明的范围内，热敏电阻被认为是特别合适的。通过将热敏电阻组合在一个桥式电路中，可以对处于内部和外部的热敏电阻之间的温度实现补偿。桥式电路中传感器的这种双重设置补偿了外部环境的影响，比如温度的波动或者由分泌物造成的影响，后者粘附于内部传感器上并且造成局部的冷却或者变热。
此外，根据权利要求12，有利的是使导管端部在支承体内平行于其纵轴线地导入。这样，就实现了氧气流向着支气管部分的方向的定向地供应，确切地说，以层流的流动关系供应。
此外，根据权利要求13，对于导管要求独立的保护，在其出流侧上至少固定了一个传感器。合乎目的的是，在这里设置两个传感器，以便能够在一个桥式电路中进行测量值差别的补偿。
这样的导管可以从外部插入到支承体内。这样的支承体中可以例如是公知的“Montgomery-T型Stent”。通过T形件的可以从外部触及的支腿将导管导入，从而通过它来辅助呼吸。
根据权利要求14所述的特征，导管的端部具有一个喷射喷嘴。如上已述的那样，它可以例如通过端部的横截面收缩结构来构成。但是，也可以是一个独立的喷射喷嘴。
优选导管的端部弯曲状地构造，如权利要求15所设计的那样。这样，插入到气管或支承体中的端部自动地向着支气管部分的方向地平行于支承体的纵轴线地定向。
附图说明
以下借助于所附的附图对本发明进行详细描述。图示为：
图1患者的上身，携带着一个根据本发明的、用于辅助呼吸的装置；
图2肺气肿患者在未用和使用辅助呼吸装置时呼吸气流的曲线图；
图3本发明的气管假体的技术上简化的示图；
图4一个气管假体的另一个实施形式；
图5同样示意性地示出属于本发明装置的氧气泵，以及空气导送装置和一个控制单元；
图6本发明的导管的端侧的部分，及
图7被插入到支承体内的、图6所示的导管。
具体实施方式
图1中P代表患者，他患有肺气肿，其呼吸泵处于超负荷状态并已经衰竭。因此该患者不能足够深地吸气。此外，呼气过程受到松弛和萎缩的呼吸道的阻碍。
在图2中的左半侧示出这样一个具有吸气(吸气气流)和呼气(呼气气流)的、在没有呼吸辅助装置时的呼吸过程。吸气曲线以E1标示，而呼气曲线以A1标示。
为了辅助该呼吸泵或者说为了使该呼吸泵卸荷，对患者的自主呼吸用传感器进行检测，并在吸气过程结束时对肺供给额外的氧气量。该呼吸气流在图2中的右半侧示出。根据曲线E2，额外的氧气量使吸气时的呼吸气体体积增加了上部曲线中涂黑表示的、以E3标示的体积差。额外的氧气量的体积可以在25ml至150ml之间。
此外，患者的呼气过程被一个逆流阻制。这样，呼气时的呼吸气流根据用A2标示的曲线变化。通过该有针对性的、与呼气相反作用的阻力，避免了呼吸道在呼气时发生萎缩。以这种方式，呼气的体积增大了同样涂黑表示的、以A3标示的体积。
结果是通过这种方法避免了供氧不足造成的呼吸不足和血液中二氧化碳升高。患者P大大地提高了负载能力和可动性，此外他不再感觉到短气或者这种感觉很轻微。
为了实施对患者P的呼吸辅助，设计了一种装置，它包括一个可以连接到氧气源上去的氧气泵1(见图5)和一个气管假体2、3(见图3和4)。根据图1，氧气泵1是一个紧凑的可移动呼吸机4的组成部分。氧气泵1和气管假体2或3通过一个导管5相连接。
如图3和4所示，每个气管假体2或3具有一个管状的支承体6，后者具有一个用于导管5的接头7。为了检测患者的自主呼吸，为支承体6配置了两个热敏电阻形式的传感器8、9。这里，一个传感器8固定在支承体6的内壁10上，相反，另一个传感器9则位于支承体6的外壁11上。这些传感器8、9与一个控制单元12相连接，以起动氧气泵1。控制单元12在图5中以其输入-和输出端示意性示出。如已经提到过的，这些传感器8、9为热敏电阻，即依赖于温度的电阻。它们在该装置内部连接成桥式电路，因此，对于内部传感器8和外部传感器9之间因为环境影响造成的测量值差进行了补偿。
此外，在图1中还可以看到：还设置有另外的呼吸传感器13、14。这里，它们也是用于检测患者P的自主呼吸的传感器。通过均衡通过传感器8和9以及传感器13、14的测量值，可以获得患者P的呼吸过程的准确图像。此外，提高了防止误测量或这些传感器8、9及13、14之一的失灵的可靠性。
在根据图3的气管假体2中，喷射导管5通过接头7插入到支承体6中。这里，喷射导管5的位于支承体6内的端部15大致平行于其纵轴线地导入或者说弯转。由传感器8、9到控制单元12的数据传输线用16和17标示。它们在导管5内延伸。在出流侧，喷射导管5的端部15被构型为喷射喷嘴25。它可以通过导管横截面的收缩来实现。这样氧气流从导管5中流出时的速度被提高并且被向着支气管部分的方向引导。支承体6的直径具有足够自由的内腔地被这样定尺寸，使得患者P即使在集成有导管5时也能够自由地呼吸和讲话。
在根据图4的气管假体3中，在接头7上设置有一个独立的接合装置18，通过它使导管5与气管假体3连接起来。在这种情况下，在支承体6内设置有一个与纵轴线平行地定向、固定的纵向区段19来作为导管端部，其中氧气流通过一个喷射喷嘴26被向着支气管部分的方向引导。
图5中示意性示出了氧气泵1。它是一个活塞泵，具有一个设置在一个缸27内的双向作用的活塞20。该装置总共具有四个阀V1至V4。通过接头21从一个外部的氧气存储器中输入氧气。阀V1至V4的开关状态或者说输入及输出由字母a至g标示出。
在辅助呼吸时，氧气泵1在装置内的功能如下：
当阀V1从c向a敞开(由b向c关闭)并且阀V2从b向e敞开(e向d关闭)时，活塞20在图纸平面内向左运动并且氧气通过出口22和喷射导管5流向患者P。在患者P的吸气过程时进行附加的的氧气量E3的供给。
当阀V1从b向c敞开(c向a关闭)并且阀V2由e向d敞开(b向e关闭)时，则活塞20在图纸平面内向右移动并且使氧气向着阀V3的方向流动。阀V3通过一个出口23与循环空气相连接。如果阀V3从d向g敞开，则氧气没有呼气阻制地流出：也就是说，呼气过程没有通过逆流来阻制。
如果阀V3由d向g被关闭并且由d向f敞开，则氧气通过附加管道(Zuweg)24朝向出口22和导管5流动，以便在呼气过程时供给患者P并且阻制呼吸气流。通过该逆流避免呼吸道瘪下并且使之保持敞开。这样使得一个更深的呼气成为可能。
在装置的附加管道24中，还连接接了阀V4，通过它可以可变地调节流量(由f到a)。该阀优选是一个具有脉冲宽度调制功能的比例阀。
图6示出一个导管28，它具有一个长距离的柔性软管29和一个在弯曲段30上弯出的、出流侧的端部31。在该端部上固定着两个传感器32、33，用来检测患者P的自主呼吸。这些传感器32、33优选是热敏电阻。为简单起见这里没有示出数据传输线。它们延伸穿过导管28或者导管壁。以34标示了一个止挡。
此外还可以看到，导管28的端部31装备有一个喷射喷嘴35。在喷射喷嘴35中，流动横截面相对于导管的横截面缩小了，因此输入的氧气的流出速度升高。
导管28可以插入到一个支承体36中，如图7所示。支承体35处于患者P的气管内。其与外部的连接是通过一个接头37来实现的。
支承体36可以是一个传统的“Montgomery-T型Stent”。
参考标号表

Claims (28)

1.一种用于辅助自主呼吸患者呼吸的换气装置，包括：
a)连接到氧气源的氧气泵；
b)管，所述管具有第一端部和第二端部，第一端部连接到氧气泵，第二端部适于并构造成不妨碍患者的自主呼吸过程；
c)适于检测患者的自主呼吸过程的至少一个呼吸传感器；以及
d)与所述至少一个呼吸传感器通信的控制单元，所述控制单元适于并构造成控制氧气泵，以与患者的自主呼吸过程的一部分同步地向所述管输送辅助气体量。
2.如权利要求1所述的装置，其特征在于，还包括：用于将所述管连接到位于气管内的气管装置的接头，且所述管未插入所述气管中。
3.如权利要求1所述的装置，其特征在于，还包括气管假体，所述气管假体具有管状支承体，所述管状支承体包括用于连接管的接头，且所述管未插入管状支承体中，而且所述气管假体被设计成未阻碍呼吸道。
4.如权利要求3所述的装置，其特征在于，还包括：与管状支承体的纵轴线平行地设置且位于管状支承体内的固定的纵向区段。
5.如权利要求4所述的装置，其特征在于，还包括：位于固定的纵向区段的远端上的喷射喷嘴。
6.如权利要求1所述的装置，其特征在于，还包括：气管假体，所述气管假体具有管状支承体，所述管状支承体包括用于连接所述管的接头，且所述管插入管状支承体中，而且管和气管假体被设计成未阻碍呼吸道。
7.如权利要求1所述的装置，其特征在于，还包括气管假体，所述气管假体具有支承体，且所述至少一个呼吸传感器固定于支承体的内壁上。
8.如权利要求7所述的装置，其特征在于，所述管的第二端部位于支承体中，且与支承体的纵轴线近似平行地弯折，而且在所述第二端部上设有喷射喷嘴。
9.如权利要求1所述的装置，其特征在于，氧气泵是活塞泵。
10.如权利要求1所述的装置，其特征在于，所述至少一个呼吸传感器包括至少两个传感器。
11.如权利要求1所述的装置，其特征在于，所述管具有双腔结构。
12.如权利要求1所述的装置，其特征在于，还包括另外的呼吸传感器。
13.如权利要求1所述的装置，其特征在于，所述至少一个呼吸传感器适于设置在所述管的用于定位于气管中的第二端部上。
14.如权利要求1所述的装置，其特征在于，氧气泵和控制单元被构造成由自主呼吸患者佩戴。
15.如权利要求1所述的装置，其特征在于，所述管具有喷射喷嘴，且喷射喷嘴的横截面小于管的横截面，使得供给的氧气的排放速率增大。
16.如权利要求1所述的装置，其特征在于，所述呼吸传感器是依赖温度的传感器。
17.如权利要求1所述的装置，其特征在于，还包括用于将所述管连接到气管装置的接头，其中，所述呼吸传感器包括两个分别处于气管装置的内侧和外侧的热敏电阻，所述两个热敏电阻组合在一个桥式电路中，以补偿测量的值差。
18.如权利要求1所述的装置，其特征在于，还包括用于控制呼气逆流的阀。
19.如权利要求1所述的装置，其特征在于，还包括一个或多个阀。
20.如权利要求1所述的装置，其特征在于，还包括用于可变地调节流量的比例阀。
21.如权利要求1所述的装置，其特征在于，所述管还包括喷射喷嘴。
22.一种气管假体，包括：
管状支承体，所述管状支承体具有第一端部和第二端部以及位于第一端部和第二端部之间的内腔，其中，管状支承体的尺寸和结构被配置成沿着气管的一部分限定在所述气管的一部分内，而不妨碍呼吸道，同时允许患者通过内腔自主地呼吸；
位于管状支承体上第一端部和第二端部之间的接头，所述接头被构造成连接到管；
所述管具有第一端部和第二端部以及位于第一端部和第二端部之间的内腔，其中，所述管的第一端部连接到所述接头；以及
与管状支承体连接的至少一个呼吸传感器，其中，所述至少一个呼吸传感器适于检测患者的自主呼吸过程。
23.如权利要求22所述的气管假体，其特征在于，所述至少一个呼吸传感器固定于气管中的支承体的内壁上。
24.如权利要求22所述的气管假体，其特征在于，所述呼吸传感器包括两个分别处于支承体的内侧和外侧的热敏电阻，所述两个热敏电阻组合在一个桥式电路中，以补偿测量的值差。
25.如权利要求22所述的气管假体，其特征在于，所述管是喷射导管。
26.一种用于使患者换气的管，包括：
细长体，所述细长体具有第一端部、第二端部以及位于第一端部和第二端部之间的内腔，其中，第一端部适于并构造成用于连接到氧气泵的出口，使得从出口流动的气体移动通过内腔；
细长体的第二端部适于并构造成不妨碍患者的呼吸道；以及
定位于细长体的第二端部上的至少一个呼吸传感器，其适于检测患者的自主呼吸过程。
27.如权利要求26所述的管，其特征在于，第二端部的末端包括喷射喷嘴。
28.如权利要求27所述的管，其特征在于，第二端部具有弯曲形状。
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CN102416213A (zh) 2012-04-18
US20090151726A1 (en) 2009-06-18
JP2007501666A (ja) 2007-02-01
CA2535450C (en) 2015-11-24
DE10337138A1 (de) 2005-03-17
US20110209705A1 (en) 2011-09-01
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US7487778B2 (en) 2009-02-10
CN1867371A (zh) 2006-11-22
EP1654023A2 (de) 2006-05-10
US20080041371A1 (en) 2008-02-21
JP4931586B2 (ja) 2012-05-16
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US20100252043A1 (en) 2010-10-07
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