CN103933648B - 一种膈肌刺激吸排气系统 - Google Patents

一种膈肌刺激吸排气系统 Download PDF

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CN103933648B
CN103933648B CN201410116218.3A CN201410116218A CN103933648B CN 103933648 B CN103933648 B CN 103933648B CN 201410116218 A CN201410116218 A CN 201410116218A CN 103933648 B CN103933648 B CN 103933648B
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module
valve
patient interface
flow
air
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CN103933648A (zh
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韦宏卫
李春
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BEIJING YAGUO SCIENCE AND TECHNOLOGY Co Ltd
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BEIJING YAGUO SCIENCE AND TECHNOLOGY Co Ltd
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Priority to CN201580000283.2A priority patent/CN105451798B/zh
Priority to US15/128,877 priority patent/US10463817B2/en
Priority to CN201711076662.7A priority patent/CN107789710B/zh
Priority to ES15768007T priority patent/ES2908982T3/es
Priority to JP2017501452A priority patent/JP6588526B2/ja
Priority to PCT/CN2015/075100 priority patent/WO2015144064A1/zh
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Abstract

本发明涉及医疗卫生领域,提供了一种膈肌刺激吸排气系统,包括正压通气模块,负压吸引模块,病人接口模块,中央处理模块,电/磁刺激模块,其中:正压通气模块,用于产生正压气流;负压吸引模块,用于产生负压气流;病人接口模块,允许正压以及负压气流流过;正压通气模块、负压吸引模块和病人接口模块三者之间通过一个三通装置连接;中央处理模块与三通装置以及电/磁刺激模块相连;所述中央处理模块,通过三通装置,控制正压通气模块、负压吸引模块与病人接口模块之间的通断,以及控制电/磁刺激模块工作与否。

Description

一种膈肌刺激吸排气系统
技术领域
本发明涉及医疗卫生领域,提供了一种膈肌刺激吸排气系统。
背景技术
对于机械通气病人,将肺深部的分泌物排出,对于预防呼吸机相关肺炎非常重要。目前临床常用吸痰法有开放式吸痰和密闭式吸痰。开放式吸痰方法指病人脱开呼吸机,将吸痰管轻轻插入呼吸道,按负压吸引器吸痰,此时呼吸机无法正常工作,故吸痰时间次数受限制;密闭式吸痰指不需脱开呼吸机或停止机械通气的吸痰操作,吸痰管外套有透明膜,整个吸痰过程都是在密闭情况下完成。以上两种吸痰法不仅需要工作人员具有熟练的操作技巧,并且吸痰效果跟吸痰管所处位置有关,无法将肺部细小气管中的痰吸出。肺内支气管可达20级,用吸痰管,只能吸主气道内的痰液。另外肺部并不对称,吸痰管只能吸到右肺那一侧的痰,左肺吸不到。呼吸机相关肺炎多在左肺,就有这个原因。使用吸痰管吸痰,还有气道划伤、带入细菌、血流动力学上的冲击等风险。
对于自动咳痰装置,目前市场上有飞利浦公司生产的cough assist咳痰机,原理是向气道提供一次较大的正压通气后快速转变为负压吸气,模拟咳嗽气流把深部的痰吸出。但由于使用时需要断开呼吸机,无法作为经常性的排痰手段;较大的正压通气或负压吸引会造成肺损伤,,致使患者很不舒服,严重者可致肺泡塌陷;其吸气和呼气使用同一管路,有交叉感染的风险。
另外专利WO2007/054829 A2发明了一种机械吸排气装置,它通过呼吸机吸入足够气流,随之快速、短促地呼出气体来模拟人体咳嗽,使淤积在气道和气管分支中的痰液顺利排出。这种系统通过检测气流自动控制吸气和呼气,减轻了工作人员的负担。通过连续几次间断性的负压呼气咳出痰液,既防止了负压过大致使肺泡萎陷,而且能影响到十几级的支气管,将痰从肺的深部排出。
人体咳嗽全部动作包括短声吸气、声门关闭、膈肌下降、呼气肌和腹肌迅速收缩,使肺内压力增高,然后声门展开、膈肌收缩,使肺内高压空气喷射而出。以上两种自动咳痰装置都只是模拟了咳嗽的气流,而与咳嗽相关的呼吸肌都没有参与运动。对于机械通气病人来说,长期缺氧及全身营养不佳,使膈肌纤维减少和萎缩,以至膈肌移动度减少。如果在模拟咳痰中只是模拟气流运动,不对主要呼吸肌-膈肌进行刺激,将影响咳嗽、咳痰动作的强度,不利于痰液的排出。而且,只从气流上模拟咳嗽,如果肌肉不能随之收缩,将会造成肺损伤,甚至肺泡塌陷。
发明内容
(一)解决的技术问题
本发明针对现有技术的不足,提供了一种膈肌刺激吸排气系统,通过该吸排气系统,有效的降低了呼吸机相关性肺炎的发病几率。
(二)技术方案
本发明提供了一种膈肌刺激吸排气系统,主要包括正压通气模块,负压吸引模块,病人接口模块,中央处理模块,电/磁刺激模块,其中:
正压通气模块,用于产生正压气流;
负压吸引模块,用于产生负压气流;
病人接口模块,允许正压以及负压气流流过;
正压通气模块、负压吸引模块和病人接口模块三者之间通过一个三通装置连接;
中央处理模块与三通装置以及电/磁刺激模块相连;
所述中央处理模块控制所述三通装置的第一阀门使得所述正压通气模块与所述病人接口模块相通时,关闭所述负压吸引模块与所述病人接口模块之间的通路以及关闭电/磁刺激模块;
所述中央处理模块控制所述三通装置的第二阀门使得所述负压吸引模块与所述病人接口模块相通时,关闭所述正压通气模块与所述病人接口模块之间的通路以及开启电/磁刺激模块。
进一步地,还包括传感器模块和显示模块,所述传感器模块和所述显示模块与中央处理模块相连。
进一步地,所述传感器模块位于正压通气模块与病人接口模块之间的通路上。
进一步地,所述正压通气模块为呼吸机。
进一步地,所述三通装置中设有第一阀和第二阀,第一阀选择性的阻断正压通气模块到病人接口模块的气流;第二阀位于从负压源到病人接口单元的气路上,选择性的阻断从病人接口单元到负压吸引模块的气流。
进一步地,所述中央处理模块启动第一阀时,关闭第二阀,并关闭电/磁刺激模块;所述中央处理模块启动第二阀时,关闭第一阀,并开启电/磁刺激模块。
进一步地,所述第一阀和所述第二阀为气动膜片。
进一步地,允许的负压气流量为14L/minute~800L/minute。
进一步地,所述电/磁刺激模块包括作用于两侧膈神经上的一对电极和作用于胸大肌表面上的一对电极。
进一步地,所述电/磁刺激模块包括充电电容和刺激线圈,利用存储电能的电容对刺激线圈放电,从而产生脉冲电流。
(三)有益效果
1)本发明首次将体外膈肌起搏联合机械吸排气咳痰用于ICU中的危重病人的救治中,在呼吸机正压吸气达到设定峰值时,控制负压呼气并同时联动膈肌起搏,实现在危重病人快速呼气的同时匹配适当的膈肌刺激,二者同步联动,既可实现机械通气更好的人机同步性、减少人机对抗,又可让膈肌更多地参与到机械通气过程中,有效地减缓负压吸气所致的相关损伤。
2)本发明将体外膈肌起搏引入重症医疗中的机械通气促排痰的联动中,不但有助于危重病人在机械通气时最大程度地避免机械通气相关肺损伤(VILI)和相关性肺炎(VAP),还可以改善膈肌功能,保持膈肌活力,有效地防治呼吸机引起的横膈功能障碍(VIDD),为一直以来困扰ICU医生的这三种合并症提出前所未有的解决办法,还可以减少为避免VILI、VAP的药物使用,减轻病患的医疗负担和副作用。
附图说明
图1是本发明的膈肌刺激吸排气系统的结构示意图。
具体实施方式
以下将结合附图,对本发明的膈肌刺激吸排气系统作出进一步的详细说明:
一种膈肌刺激吸排气系统包括正压通气模块,负压吸引模块,病人接口模块,中央处理模块,显示模块,传感器模块,电/磁刺激模块,其中:
正压通气模块,用于产生正压气流,可以是呼吸机;负压吸引模块,用于产生负压气流;病人接口模块,允许正压以及负压气流流过;正压通气模块、负压吸引模块和病人接口模块三者之间由一个三通装置及三根管道连接,此三通装置中有两个阀,第一个阀选择性的阻断正压通气模块到病人接口模块的气流;在负压吸引源与病人接口单元之间的气路上,有第二个阀,第二个阀选择性的阻断从病人接口单元到吸引模块的气流。
在正压气流流过的管道上,镶嵌有一个传感器,用于正压下向病人肺部吹气的气流的标定。
在第一个阀门中包含一个气动的膜片,当此膜片没有被吹起时,是平放在三通装置的第一个分支的内腔里的,膜片被吹起时,发生鼓胀阻塞以第一分支的内腔。即,第一个阀打开,在正压下将气流从呼吸机传送到病人肺部,此时第二个阀门关闭防止了病人肺部暴露在负压下;当病人接口模块内产生吸气峰值气压时,关闭第一个阀,打开第二个阀;当开启负压,使病人肺部排气时,关闭第一个阀并且打开第二个阀,使病人肺部暴露在负压下,允许的负压气流量为14L/minute~800L/minute,此时开启膈肌起搏,膈肌起搏的次数和持续时间与负压吸引同步。在预设的一段时间之后,关闭第二个阀同时打开第一个阀来停止排气。
膈肌刺激吸排气系统包括一个中央处理器,用于实现以下步骤:选择性的开关第一个阀门以允许或停止呼吸机的正压气流为病人的肺部充气;选择性的开关第二个阀门以允许或停止负压气流为病人的肺部排气,同时开启膈肌起搏器工作。
膈肌刺激吸排气系统可选择用膈肌刺激方式或磁刺激方式。膈肌刺激方式由一个单片机产生方波脉冲信号并经过整形和放大,膈肌刺激方式包括两对电极,一对为治疗电极,作用于患者的两侧膈神经,一对为无关电极,作用于患者的胸大肌表面;磁刺激方式包括一个充电电容和一个刺激线圈,利用储存电能的电容对刺激线圈放电,产生脉冲电流刺激人体。
本发明公开一种膈肌刺激吸排气系统,用于机械通气病人的呼吸道排痰。通过呼吸机正压通气吸入气流,当肺内气压达到一定值时转换为负压吸气,在快速、短促地呼出气流的同时,在电或磁刺激作用下膈肌快速、短促地收缩。在整个呼气过程中膈肌收缩的次数和持续时间与气流的吸入和吸出同步。
对于机械通气病人来说,在接入负压吸引模拟咳嗽的呼气模式时,同时启动膈肌刺激,会促使膈肌收缩,增加膈肌活动度,提高膈肌肌力,加强咳嗽、咳痰动作的强度,并增加通气量,增强氧合作用,改善呼吸道纤毛运动功能,促进痰液的排出。
以上所述仅是本发明的优选实施方式,应当指出,对于本技术领域的普通技术人员来说,在不脱离本发明原理的前提下,还可以做出若干改进和润饰,这些改进和润饰也应视为本发明的保护范围。

Claims (10)

1.一种膈肌刺激吸排气系统,其特征在于,包括正压通气模块,负压吸引模块,病人接口模块,中央处理模块,刺激膈肌收缩的电/磁刺激模块,其中:
正压通气模块,用于产生正压气流;
负压吸引模块,用于产生负压气流;
病人接口模块,允许正压以及负压气流流过;
正压通气模块、负压吸引模块和病人接口模块三者之间通过一个三通装置连接;
中央处理模块与三通装置以及电/磁刺激模块相连;
所述中央处理模块控制所述三通装置的第一个阀使得所述正压通气模块与所述病人接口模块相通时,关闭所述负压吸引模块与所述病人接口模块之间的通路以及关闭电/磁刺激模块;
所述中央处理模块控制所述三通装置的第二个阀使得所述负压吸引模块与所述病人接口模块相通时,关闭所述正压通气模块与所述病人接口模块之间的通路以及开启电/磁刺激模块,以在接入负压吸引模拟咳嗽的呼气模式时,同时启动膈肌刺激促使膈肌收缩。
2.根据权利要求1所述的系统,其特征在于:还包括传感器模块和显示模块,所述传感器模块和所述显示模块与中央处理模块相连。
3.根据权利要求2所述的系统,其特征在于:所述传感器模块中的一个传感器位于正压通气模块与病人接口模块之间的通路上,用于正压下向病人肺部吹气的气流的标定;所述三通装置中有两个阀,第一个阀选择性的阻断正压通气模块到病人接口模块的气流;第二个阀选择性的阻断从病人接口单元到负压吸引模块的气流,当所述病人接口模块内产生吸气峰值气压时,关闭第一个阀,打开第二个阀,在预设的一段时间之后,关闭第二个阀同时打开第一个阀来停止排气。
4.根据权利要求1-3之一所述的系统,其特征在于:所述正压通气模块为呼吸机。
5.根据权利要求1所述的系统,其特征在于:所述三通装置中设有第一个阀和第二个阀,第一个阀选择性的阻断正压通气模块到病人接口模块的气流;第二个阀位于从负压源到病人接口单元的气路上,选择性的阻断从病人接口单元到负压吸引模块的气流。
6.根据权利要求3或5所述的系统,其特征在于:所述中央处理模块启动第一个阀时,关闭第二个阀,并关闭电/磁刺激模块;所述中央处理模块启动第二个阀时,关闭第一个阀,并开启电/磁刺激模块。
7.根据权利要求3或5所述的系统,其特征在于:在第一个阀中包含一个气动的膜片,当此膜片没有被吹起时,是平放在三通装置的第一个分支的内腔里的,膜片被吹起时,发生鼓胀阻塞以第一分支的内腔。
8.根据权利要求1所述的系统,其特征在于:允许的负压气流量为14L/minute~800L/minute。
9.根据权利要求1所述的系统,其特征在于:所述电/磁刺激模块包括作用于两侧膈神经上的一对电极和作用于胸大肌表面上的一对电极。
10.根据权利要求1所述的系统,其特征在于:所述电/磁刺激模块包括充电电容和刺激线圈,利用存储电能的电容对刺激线圈放电,从而产生脉冲电流。
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