CN102762144B - 基于尿液值供给药物的系统及方法 - Google Patents

基于尿液值供给药物的系统及方法 Download PDF

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CN102762144B
CN102762144B CN201180009383.3A CN201180009383A CN102762144B CN 102762144 B CN102762144 B CN 102762144B CN 201180009383 A CN201180009383 A CN 201180009383A CN 102762144 B CN102762144 B CN 102762144B
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CN102762144A (zh
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汉斯-奥托·麦尔
霍斯特·萧莫
马蒂亚斯·裴措特
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B Braun Melsungen AG
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Abstract

本发明涉及用于向病人供给药物的系统及方法，包括：用于测量病人（2）的尿液的尿液值的至少一个第一测量装置（7,8）；用于评估测量出的尿液值（6a）的至少一个第一评估装置（6）；用于基于评估的、测量出的尿液值（6a）计算待供给到各个病人（2）的药物的第一药剂参数的至少一个第一计算装置（13）；以及用于传送具有计算出的、共有的药剂参数的各个药物的至少一个传送装置（1）。

Description

基于尿液值供给药物的系统及方法
技术领域
本发明涉及用于向病人供给药物的系统及方法。
背景技术
病人，特别是在特护病房中的，照惯例通过一个或更多个供给装置用药物与适用情况下的合成营养进行治疗，例如静脉注射。供给装置可为输液泵，保持病人的生命血液值处于可预先确定的水平以应对先前在病人的血液循环中进行的血象/血气分析。
该类型的所有供给装置，同样当被集成到用于供给药物和/或营养素的系统中，预先需要由医生或高级临床人员通过供给装置输入值以便为供给形成基础。例如数量值、进行供给的时间间隔、间歇性供给等在此可被输入作为随后供给药物的基础。
在前述供给之前通常用手工从病人提取血液标本，这需要临床人员的介入。而且需要具有例如为输液泵的供给装置的输入功能的必要专业知识的高级临床人员，以便随后实施前述供给。
目前，通常如此输液治疗，特别是当涉及尿液值的时候，并非针对值来确定。确切地说通常的过程是基于根据临床人员的经验和/或预先确定的标准、协议、指令、说明或类似的尿液值状态和/或血液值状态来确定输液速率。
发明内容
因此本发明的目标是提供用于向病人供给药物的系统及方法，并且考虑到尿液值，允许以自动的方式提供具有正确药剂参数的药物。
该目标由具有权利要求1的特征的系统及由具有权利要求10的特征的方法达到。
本发明的核心概念是用于向病人供给药物的系统，包括以下装置：
用于测量病人的尿液的尿液值的至少一个第一测量装置；
用于分析测量出的尿液值的至少一个第一分析装置；
用于基于分析出和测量出的尿液值计算待供给的药物的第一药剂参数的至少一个第一计算装置；以及
用于供给具有共有的计算出的药剂参数的各个药物的至少一个供给装置。
如此系统有利地允许在计算将由供给装置供给的药物的药剂参数时考虑到测量出的尿液值。例如通过分析和计算装置，有效物质呋塞米（furosemide）在先前测量的尿液和血液值的作用下可通过供给装置被自动供给到病人。这允许为了有效物质的优化供给与为了输液速率的优化设置而测量的值的额外控制，其中取代有效物质呋塞米，其它药物也可被供给。
抵触值，例如来自尿液值测量和血液分析评估的尿素（urea）、肌酸酐（creatinine）、胞内蛋白酶（lysc）等，也有可能通过计算装置被检测出并被自动校正。计算装置也可考虑到在计算优化的输液值时在单独的测量值之间和前述值之间的联系中出现的差异并因此不依赖于绝对值的测量。而且计算装置在计算例如为输液速率的输液值时可考虑前述病人的先前测量的值的排列顺序表和序列及其相对重要性。
由第一测量装置测量出的尿液值，和前述的值一样，可为高级尿液值，例如pH值、蛋白质含量、尿液的葡萄糖含量、尿液的亚硝酸盐含量、尿液的胆红素含量、尿液的酮含量、尿液的细菌含量和/或尿沉渣结果。
优选地，第二测量装置测量由病人排出的尿液的量且相连接的第二分析装置可被用于分析测量出的尿液量。而且第二测量装置也可测量来自病人的伤处的分泌物的量且第二分析装置可进行相应分析。
这用于确保通过第二计算装置，病人的身体的液体平衡可从排出的液体和供给的液体的量被计算出来。排出的液体例如可为先前分析的测量出的尿液量和分析的测量出的分泌物量，且供给的液体可为液体药剂供给物。第二药剂参数由此被计算出来。
第三测量装置用于测量病人的生命值，比如心电图（ECG）、脑电图（EEG）及类似数据，且相连接的分析装置用于分析测量出的生命值。通过第三计算装置，基于分析的测量出的生命值，第三药剂参数被计算出来。
优选地以自动的方式，共有药剂参数可通过共有计算装置从第一、第二及第三药剂参数被计算出来。这样的结果是源于计算的尿液值、计算的血液值、液体平衡值以及生命值的所有药剂参数都可被考虑到用以计算优化的共有药剂参数以便以最佳输液速率开始输液。
优选地通过第一测量装置，病人的血液值也可被测量出，可通过第一分析装置被分析并通过第一计算装置被使用以计算第一药剂参数。
如此考虑到大量测量出的值，特别是考虑尿液值，应提供用于供给药物的完整系统及相关方法的自动功能，其中各个值、药剂参数及其它数据的传输可自动进行。也可以想到为了用于治疗病人的输液计划而确定的药剂参数和营养素参数可被显示在待治疗的病人的病床的相应显示器上作为建议的参数或各数据来帮助临床人员，以便临床人员可通过前述显示的和输入的数据安排输液泵给病人。
为了确保从单独的测量装置、分析装置及计算装置自动安全地传输到其中任一方且到例如为一个或更多个输液泵的输液系统，前述数据通过包含病人ID、进行测量的时间、进行取样的时间、有关测量装置的标识、测量装置的质量等级以及更多质量特征的数据协议被传输。
并且优选地，液体平衡自动进行且排出的液体的测定不必通过复杂的称量技术进行。更有，所有排出的可测量液体的量优选为自动被确定并且由人体丧失的剩余的液体通过计算被模拟出。前述排出的液体被与易于确定的、以液体药剂或营养素形式供给的液体作比较。
在根据本发明的用于向病人供给药物的方法中，进行以下步骤：
通过至少一个第一测量装置测量病人的尿液的尿液值；
通过至少一个第一分析装置分析测量出的尿液值；
通过至少一个第一计算装置，基于分析的测量出的尿液值计算待供给到各个病人的药物的第一药剂参数；以及
通过至少一个供给装置供给具有计算出的共有药剂参数的各个药物。
根据优选的实施例，在根据本发明的方法中，病人的身体的液体平衡通过排出的液体的测量与计算和供给的液体的测量与计算被计算出和/或确定并进行。
更多较佳实施例由从属权利要求中得出。
附图说明
优点与技术特征由以下结合附图的说明得出。
图1为根据本发明的用于供给药物的系统的一个实施例的示意图。
具体实施方式
图中显示的用于自动供给药物（例如有效物质或药物，比如呋塞米、胰岛素等）的系统为具有用于处理个别错误确定的病人2身体内的值的大量输液泵的自动输液系统1。
按照参考标号3，重症监护中的病人2因此从自动输液系统1以关联的输液速率接受药物，在适当情况下考虑到在药剂数量、供给期间及更多参数中的变化。
重症监护中的病人2可从各个方面被分析，优选为从他的尿液值中，通过一个或更多个测量装置4、7、8或9。
例如通过测量装置8，尿液值和/或血液值可在重症监护病房中通过从病人2提取尿液与血液标本被自动测量出。单独地，按照参考标号6a，尿液值为尿液的pH值、尿液的蛋白质含量、尿液的葡萄糖含量、尿液的亚硝酸盐（nitrite）含量、尿液的胆红素（bilirubin）含量、尿液的酮(ketone)含量、尿液的细菌含量以及尿沉渣(urine sediment)结果。血液值单独地为葡萄糖值、乳酸(lactate)值、电解质(electrolyte)值（Na+、CL+、K+）、氧分压(pO2)值、二氧化碳分压（pCO2）值、药剂水平值、钙拮抗剂（calcium antagonist）值（血压）以及异丙酚（propofol）值（镇静）。
血液值按照参考标号6b所示。
另外，尿液和分泌物量的值优选为自动地通过第二测量装置9被测量出。由此，尿液量与分泌物量的值通过分析装置10被确定。
通过第三测量装置4，优选为通过传感器，生命参数例如心电图和脑电图值及类似值被自动确定，在第三分析装置5中被分析。
来自所有分析装置5、6及10的分析的值优选地被自动传送到各个关联的第一、第二及第三计算装置11、12及13。该传输按照参考标号14、21及22通过另外包括例如为病人的标识编号、进行测量的时间、提取标本的时间、各个测量装置的标识、测量装置的质量等级以及分配的质量特征的数据的数据协议进行。
在计算装置11中，进行计算用于通过输液泵1供给药物和/或营养的相关药剂参数与营养素参数。此处，为了进行液体平衡，根据供给装置1，由例如为测量出的分泌物量与尿液量的所有排出的液体和例如为液体药剂与液体营养的供给的液体生成平衡。
以下说明适于如此输入的液体与排出的液体的相对的液体平衡：人们知道人类以各种方式排出液体。首先，可为重症监护中的病人自动地、直接地测量出排出的尿液量与伤处分泌物的量。除了可直接测量的液体外，还有可被间接确定的更多液体，例如由呼吸排出的水汽、通过身体的皮肤排汗以及通过面部及类似排出液体。前述液体的量通过生理模型考虑到身体表面面积、身体温度及类似来确定。
通过计算装置12，可计算出通过输液系统1供给的药物与适当情况下的相关营养的第二药剂参数。
通过计算装置13，基于测量出的尿液和/或血液值，可计算出用于通过输液系统1供给的药物与营养素的药剂参数与营养素参数。
计算出的药剂参数与营养素参数按照参考标号15、16及17被传送到输液系统1，硬接线地或无线地，优选为加密的。
在改变输液的输液速率或待供给的各个药物和/或营养素时，按照参考标号18、19及20进行反馈到计算装置11、12及13以便前述改变在药剂参数和/或营养素参数的重新计算中可被考虑到。
所有计算装置11、12及13结合在共有计算装置内。
还有，尿液值与血液值也可通过化验室内的测量装置7被确定。
计算装置11、12及13可考虑到通过不同测量装置测量出的抵触值并应用相应的校正，考虑到单独的测量装置的权重及其测量出的值。
也可以想到，计算装置在确定药剂参数和/或营养素参数时考虑到测量的排列顺序表、测量的序列以及测量的质量。在确定药剂参数和/或营养素参数时，还有单独的确定值的互相之间的以及与来自其它测量装置的其它值的联系与差异被考虑到。
本申请文件中揭露的、相对于现有技术具有新颖性的单独或组合中的所有特征均被要求为本发明必要的。
参考标号列表
1 输液系统
2 病人
3 药物
4 第三测量装置
5 第三分析装置
6 第一分析装置
6a 尿液值
6b 血液值
7 化验室中的第一测量装置
8 重症监护病房的第一测量装置
9 第二测量装置
10 第二分析装置
11 第一计算装置
12 第二计算装置
13 第三计算装置
14 通过数据协议传输值
15 传输药剂与营养素参数到输液系统
16 传输药剂与营养素参数到输液系统
17 传输药剂与营养素参数到输液系统
18 反馈到计算装置
19 反馈到计算装置
20 反馈到计算装置
21 通过数据协议传输值
21 通过数据协议传输值

Claims (10)

1.用于向病人(2)供给液体药剂和/或营养素的系统，包括：
用于向所述病人(2)供给液体药剂和/或营养素的至少一个供给装置(1)；
用于测量病人(2)的尿液的尿液值的至少一个第一测量装置(7,8)；
用于分析所述测量出的尿液值(6a)的至少一个第一分析装置(6)；以及
用于基于所述分析的测量出的尿液值(6a)计算与待供给到所述病人(2)的液体药剂和/或营养素相关的第一药剂参数的至少一个第一计算装置(13)；
其特征在于：
用于测量由所述病人(2)排出的尿液的量的第二测量装置(9)；
用于分析所述测量出的尿液量的第二分析装置(10)；以及
用于从所述排出的尿液的量和从由所述至少一个供给装置(1)供给的所述液体药剂和/或营养素的量计算所述病人(2)的身体的液体平衡并计算第二药剂参数的第二计算装置(11)；其中
所述至少一个供给装置(1)供给具有基于所述第一药剂参数和所述第二药剂参数计算出的共有药剂参数的所述液体药剂和/或营养素。
2.根据权利要求1所述的系统，其特征在于：作为尿液值(6a)，尿液的pH值、尿液的蛋白质含量、尿液的葡萄糖含量、尿液的亚硝酸盐含量、尿液的胆红素含量、尿液的酮含量、尿液的细菌含量和/或尿沉渣结果可通过所述第一测量装置(7,8)被测量出。
3.根据权利要求1所述的系统，其特征在于：从所述病人(2)的伤处排出的分泌物的量亦可通过所述第二测量装置(9)被测量出并由所述第二分析装置(10)分析。
4.根据权利要求3所述的系统，其特征在于：所述第二计算装置(11)用于从所述分析的测量出的尿液量与所述分析的测量出的分泌物的量和从所述供给的液体药剂和/或营养素的量计算所述病人(2)的身体的液体平衡并计算所述第二药剂参数。
5.根据权利要求1-4中任一权利要求所述的系统，其特征在于：包括用于测量所述病人(2)的生命值的第三测量装置(4)和与其相连接用于分析所述测量出的生命值的第三分析装置(5)。
6.根据权利要求5所述的系统，其特征在于：包括用于基于所述分析的测量出的生命值计算第三药剂参数的第三计算装置(12)。
7.根据权利要求6所述的系统，其特征在于：包括从所述第一、第二及第三药剂参数计算共有药剂参数的共有计算装置。
8.根据权利要求1所述的系统，其特征在于：所述病人(2)的血液值(6b)亦可通过所述第一测量装置(7,8)被测量出且通过所述第一分析装置(6)被分析并通过所述第一计算装置(13)被使用以计算所述第一药剂参数。
9.用于计算待供给至病人(2)的液体药剂和/或营养素的药剂参数的方法，包括以下步骤：
测量所述病人(2)的尿液的尿液值；
分析所述测量出的尿液值(6a)；
基于所述分析的测量出的尿液值(6a)计算与待供给到所述病人(2)的液体药剂和/或营养素相关的第一药剂参数；
其特征在于，包括：
测量由所述病人(2)排出的尿液的量；
分析所述测量出的尿液量；以及
从所述排出的尿液的量和从供给至所述病人(2)的液体药剂和/或营养素的量计算所述病人(2)的身体的液体平衡并计算第二药剂参数；
基于所述第一药剂参数和所述第二药剂参数计算共有药剂参数。
10.根据权利要求9所述的方法，其特征在于进一步包括以下步骤：
测量从所述病人(2)的伤处排出的分泌物的量；
从排出的尿液的量和分泌物的量和从供给至所述病人(2)的液体药剂和/或营养素的量计算所述病人(2)的身体的液体平衡并计算所述第二药剂参数。
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