CN108619598A - A kind for the treatment of pressure of lung ventilator is from titration system and method - Google Patents
A kind for the treatment of pressure of lung ventilator is from titration system and method Download PDFInfo
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- CN108619598A CN108619598A CN201710161266.8A CN201710161266A CN108619598A CN 108619598 A CN108619598 A CN 108619598A CN 201710161266 A CN201710161266 A CN 201710161266A CN 108619598 A CN108619598 A CN 108619598A
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/08—Detecting, measuring or recording devices for evaluating the respiratory organs
- A61B5/0826—Detecting or evaluating apnoea events
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/48—Other medical applications
- A61B5/4806—Sleep evaluation
- A61B5/4818—Sleep apnoea
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
- A61M16/0003—Accessories therefor, e.g. sensors, vibrators, negative pressure
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
- A61M16/0003—Accessories therefor, e.g. sensors, vibrators, negative pressure
- A61M2016/0027—Accessories therefor, e.g. sensors, vibrators, negative pressure pressure meter
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M2205/00—General characteristics of the apparatus
- A61M2205/33—Controlling, regulating or measuring
- A61M2205/3327—Measuring
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M2205/00—General characteristics of the apparatus
- A61M2205/33—Controlling, regulating or measuring
- A61M2205/3331—Pressure; Flow
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M2230/00—Measuring parameters of the user
- A61M2230/40—Respiratory characteristics
Abstract
The invention discloses a kind of respirator treatment pressure from titration system and method, module and treatment pressure adjusting module are lowered including respiration case monitoring modular, event boost module, flow limitation boost module, pressure, the event boost module, flow limitation boost module, pressure lower module and are separately connected respiration case monitoring modular, the adjusting for the treatment of pressure is carried out according to the output control treatment pressure adjusting module of respiration case monitoring in real time, for having monitored whether apnea, low pass gas, snoring events occur for the respiration case monitoring modular；The treatment pressure output of lung ventilator is adjusted in the control that the treatment pressure adjusting module is used to lower module according to event boost module, flow limitation boost module and pressure.This invention simplifies the complicated processes of manual titration treatment pressure, preferably protect patient, more accurately output treatment pressure, increase the breathing comfort of patient.
Description
Technical field
The present invention relates to the treatment pressure of a kind of lung ventilator more particularly to a kind of lung ventilator from titration system and side
Method.
Background technology
Obstruction sleep apnea-hypopnea syndrome (OSAHS, Obstructive sleep apnea hypopnea
Syndrome patient) more can effectively improve the symptom and health status of daytime drowsiness using correct continuous positive pressure.Selection is closed
Suitable treatment pressure is the basis that lung ventilator is effectively treated.Receive before long-term continuous positive airway pressure it needs to be determined that most closing
Suitable treatment pressure, this process are known as " pressure titration ".In sleep procedure, as sleep position change and epithelium healing are soft
Tissue tension constantly changes whole night or between different nights, or even passage at any time, and required treatment pressure may all occur
Variation.In terms of long-term treatment, patient's weight, living habit and the change of other diseases situation all may be to required treatment pressures
Power has an impact.Therefore an automatic Titration system is needed, by detecting the generation of respiration case in therapeutic process, is changed in real time
Become output pressure, cope with various respiration cases, simplify the complicated processes of manual titration treatment pressure, preferably protect patient,
More accurately output treatment pressure, increases the breathing comfort of patient.
Chinese Patent Application No. is to be provided a kind of to patient's offer pressure in technological document disclosed in 201080009257.3
The method that power is supported, according to the reason of the opening of patient airway, sleep disordered breathing event and patient is to being supplied to patient
Gas stream previous pressure variation response sexually revise treatment pressure, finally titrate out treatment pressure；Chinese Patent Application No.
For in technological document disclosed in 201020676343.7, it is proposed that a kind of sleep-respiratory machine of built-in automatic titration expert system, it should
Lung ventilator includes flow pressure generator, flow pressure control unit, parameter detecting unit and expert system, passes through flow pressure
Force controller unit sends out control instruction and parameter detecting unit detection parameters and feeds back to expert system, which is sleep
Apnea treats a kind of from titration expert system of pressure titration.
Chinese Patent Application No. discloses a kind of method providing pressure support ventilation to patient, the party for 201080009257.3
The reason of, sleep apnea disorder event open according to patient airway and patient is described in detail to being supplied to patient in method
The response of previous pressure variation of gas stream sexually revise treatment pressure titration treatment pressure, but this method process is troublesome；In
State's number of patent application is a kind of 201020676343.7 built-in automatic titration expert systems for disclosing sleep-respiratory machine, this method energy
Sleep-respiratory is enough titrated out by flow pressure generator, flow pressure control unit, parameter detecting unit and expert system
The treatment pressure of pause, but the knowledge base in the expert system needs the titration experience of numerous medical experts, increases titration
Preparation.
Therefore, the existing technology needs to be improved and developed.
Invention content
The purpose of the present invention is to provide a kind for the treatment of pressure of lung ventilator from titration system and method, it is intended to solve existing
Treatment pressure it is cumbersome from titration system or procedure, the preparation amount of early period is big, can not simplify manual titration treatment pressure
The problem of complicated processes of power.
Technical scheme is as follows：
A kind for the treatment of pressure of lung ventilator is from titration system comprising respiration case monitoring modular, event boost module, gas
Stream is limited boost module, pressure lowers module and treatment pressure adjusting module, the event boost module, flow limitation boosting mould
Block, pressure lower module and are separately connected respiration case monitoring modular, treat pressure according to the output control of respiration case monitoring in real time
Power adjustment module carry out treatment pressure adjusting, the respiration case monitoring modular for monitored whether occur apnea,
Low pass gas, snoring events；The treatment pressure adjusting module is used for according to event boost module, flow limitation boost module and pressure
The treatment pressure output of lung ventilator is adjusted in the control that power lowers module.
For the treatment pressure from titration system, the event boost module is specifically to monitor apnea, low
Ventilation event and snoring events carry out boost operations, and the step-up method of the event boost module is primary for response in every 2 minutes, and
Boosting mode is directly to be adjusted to goal pressure, only can carry out boosting rectifier control to respiration event in 2 minutes, and be according to event
The priority of time of origin priority is handled.
A kind for the treatment of pressure of lung ventilator is from titration method comprising following steps：
Step S1：After starting respirator treatment, control lung ventilator rapidly rises to the minimum treatment pressure value of setting；
Step S2：Current sleep-respiratory event is monitored in real time；
Step S3：Real-time judge currently whether there is respiration case, if there is currently sleep-respiratory events, according to sleep
The type of respiration case selects event boost module or flow limitation boost module to carry out treatment pressure up-regulation control；If working as
Before there is no sleep-respiratory event then to execute next step；
Step S4：Judge whether the pressure currently titrated is more than the treatment pressure of setting, if more than pressure downward is then started
Module is depressured；If the pressure of titration is equal to the treatment pressure of setting, current titration pressure is kept；
Step S5：After event boost module, the boosting of flow limitation boost module or pressure lower module decompression, step is executed
S2, until stopping therapeutic process.
Beneficial effects of the present invention：The present invention is lowered by event booster system, flow limitation booster system and pressure
The result adjustment for the treatment of pressure that system is monitored according to respiration case in real time, simplifies the complicated processes of manual titration treatment pressure,
Preferably protection patient, more accurately output treatment pressure, increase the breathing comfort of patient.
Description of the drawings
Fig. 1 is flow diagram of the respirator treatment pressure of the present invention from titration method.
Fig. 2 is the event step-up method flow diagram in the present invention.
Fig. 3 is the pressure decreasing method flow diagram in the present invention.
Fig. 4 is that the pressure in the present invention lowers the method flow block diagram that module lowers pressure.
Specific implementation mode
To make the objectives, technical solutions, and advantages of the present invention clearer and more explicit, develop simultaneously embodiment pair referring to the drawings
The present invention is further described.
As shown in Figure 1, treatment pressure provided by the invention from the pressure control procedure of titration system be a dynamic change
Process, needs to monitor respiration case always that a situation arises, and real-time adjustment for the treatment of pressure, adapts to the need of patient treatment pressure
It asks, specifically includes：Respiration case monitoring modular, event boost module, flow limitation boost module, pressure lower module and treatment
Pressure adjusting module.Wherein, the event boost module, flow limitation boost module, pressure lower module and are separately connected breathing
Event monitoring module carries out the tune for the treatment of pressure according to the output control treatment pressure adjusting module of respiration case monitoring in real time
Section.
For having monitored whether apnea, low pass gas, snoring events occur for the respiration case monitoring modular.
The event boost module is used to carry out boosting rectifier control to the parameter that various respiration case recognizers are transmitted,
In, the step-up method of the event boost module is that response in every 2 minutes is primary, and boosting mode is directly to be adjusted to goal pressure.2
Can only boosting rectifier control be carried out to respiration event, and be at the priority according to Time To Event priority in minute
Reason.
Respiration case of the present invention includes but not limited to apnea, low pass gas event and snoring events, is originally existed
It is only described in detail with above-mentioned three kinds of respiration cases in specific implementation mode.
The flow limitation boost module is used to carry out boosting rectifier control in the case where respiratory air flow is limited, wherein described
The step-up method of flow limitation boost module is that response in every 1 minute is primary, and boosting mode is directly to be adjusted to target therapeutic pressure.
The pressure is lowered the treatment pressure downward that module is used for when monitoring that apnea event occurs according to setting and is worked as
Preceding treatment pressure.
The treatment pressure adjusting module is used for according to mode transfer under event boost module, flow limitation boost module and pressure
The treatment pressure output of lung ventilator is adjusted in the control of block.
The event boost module is primarily directed to respiration cases such as apnea, low pass gas, snoring.
Wherein, when the apnea occurs：It is more than certain time in case of the time of apnea
Then by detection trigger signal, treatment pressure is changed simultaneously.
The treatment pressure boost amount expression formula of apnea is：
Papn=2* (napn+500)/Napn,maxcmH2O
In formula, PapnTo need the pressure changed, n when apneaapnFor the points of system detectio apnea, Napn,max
It counts for the upper limit；If the boost value P being calculatedapn＜ 0.8cmH2O, then it is 0.8cmH2O to fix minimum boosting；If calculating
The boost value P arrivedapn＞ 2cmH2O, then it is 2cmH2O to fix highest boosting；In general, the time of apnea arrives in 10s
It between 120s, then treats pressure and changes by above-mentioned formula, increase stressed ranging from 0.8cmH2O~2cmH2O.
Wherein, when the low pass gas event occurs：Pressure is treated with rate per minute 1cmH2O to increase.
Wherein, when the snoring events occur：Treatment pressure boosting is carried out according to snoring index, amount of boost expression formula
For：
Psno=1.5* ηsnocmH2O
In formula, PsnoIt is snoring amount of boost, ηsnoIt is snoring index, variation range is 0 to 1.It is continuously examined in pressurization
It measures 3 snoring events and increases treatment pressure, and snoring index increases by 0.1 every time, snoring, which does not occur, can then reduce by 0.1, continuously
In the case of snoring twice or repeatedly, snoring index is cumulative.
The flow limitation boost module is similar with event boost module, when flow limitation respiration case occurs, in real time
Boost value is calculated, and exports treatment pressure, flow limitation boost module can be carried out at the same time independently of event boost module.
Flow limitation boost module is primary every response in 1 minute, and boosting mode is directly to be adjusted to target therapeutic pressure, is risen
Pressure amount expression formula is：
Plim=(0.08- λlim)/0.08cmH2O
In formula, PlimAmount of boost when being flow limitation, λlimFor flow limitation index, variation range is 0 to 0.07.
The pressure lowers module with PdecRate lower treatment pressure, expression formula is：
Pdec=0.1* (Pset-Pmin)/(Pmax-Pmin)cmH2O/Min (4)
In formula, PsetFor Current therapeutic pressure, PminFor the minimum pressure of setting, PmaxFor maximum pressure；I.e. when setting pressure
It is bigger with minimum treatment differing pressure, then its lower speed change rate is also bigger, it is up to 0.1cmH2O/Min.
Start pressure from before titration system, first sets pressure from the minimum treatment pressure value of titration system, maximum therapy
Pressure value and normal therapeutic pressure value；Wherein, " minimum pressure " is the treatment attainable minimum value of pressure in therapeutic process；
" maximum pressure " refers to the treatment attainable maximum value of pressure；When " treatment pressure " is that apnea event occurs in titration process
Treat pressure.
Referring to Fig. 2, the present invention provided on the basis of above-mentioned treatment pressure is from titration system it is corresponding from titration method, specifically
Include the following steps：
Step S1：After starting respirator treatment, control lung ventilator rapidly rises to the minimum treatment pressure value of setting；
Step S2：Current sleep-respiratory event is monitored in real time；
Step S3：Real-time judge currently whether there is respiration case, if there is currently sleep-respiratory events, according to sleep
The type of respiration case selects event boost module or flow limitation boost module to carry out treatment pressure up-regulation control；If working as
Before there is no sleep-respiratory event then to execute next step；
Step S4：Judge whether the pressure currently titrated is more than the treatment pressure of setting, if more than pressure downward is then started
Module is depressured；If the pressure of titration is equal to the treatment pressure of setting, current titration pressure is kept；
Step S5：After event boost module, the boosting of flow limitation boost module or pressure lower module decompression, step is executed
S2, until stopping therapeutic process.
Referring to Fig. 3, the step-up method of the respirator treatment pressure from the event boost module in titration system include with
Lower step：
Step S1 '：Monitor current sleep-respiratory event, including apnea, low pass gas, snoring；
Step S2 '：If no sleep-respiratory event occurs, terminate to boost；
Step S3 '：If there is sleep-respiratory event, boost value is calculated according to current sleep-respiratory event；
Step S4 '：By the treatment pressure output of titration；
Step S5 '：Return to step S1 '.
After boosting is stablized, since event boosting causes to treat hypertonia, causes patient uncomfortable, need to start under pressure
Mode transfer block reduces treatment pressure and no longer reduces treatment pressure until respiration case does not occur in time.
Referring to Fig. 4, the respirator treatment pressure lowers the method stream that module lowers pressure from the pressure in titration system
Cheng Wei：
Step S1 "：Monitor current sleep-respiratory event, including apnea, low pass gas, snoring, flow limitation；
Step S2 "：If there is sleep-respiratory event, stop being depressured；
Step S3 "：If no sleep-respiratory event occurs, step-down value is calculated according to current sleep respiration case；
Step S4 "：New treatment pressure is exported, and is compared with setting treatment pressure；
Step S5 "：If new treatment pressure is equal to the treatment pressure of setting, it is that treatment is pressed to keep current titration pressure
Power,
Step S6 "：If new treatment pressure is more than the treatment pressure of setting, step S1 " is returned to.
When the respiration cases such as apnea, low pass gas, snoring occurs in patient, treatment pressure starts event from titration system
Booster system is boosted with different rate of pressure rise, until respiration case terminates；When there is flow limitation respiration case in patient,
Start flow limitation booster system, elevation treatment pressure, until flow limitation event terminates；Event booster system is independently of air-flow
Limited booster system.After respiration case, starts adjusting system under pressure, continuously decrease treatment pressure, make patient respiratory more
It is happy.
It should be understood that the application of the present invention is not limited to the above for those of ordinary skills can
With improvement or transformation based on the above description, all these modifications and variations should all belong to the guarantor of appended claims of the present invention
Protect range.
Claims (10)
1. a kind for the treatment of pressure of lung ventilator is from titration system, which is characterized in that boost including respiration case monitoring modular, event
Module, flow limitation boost module, pressure lower module and treatment pressure adjusting module, the event boost module, air-flow by
Limit boost module, pressure lower module and are separately connected respiration case monitoring modular, the result control monitored in real time according to respiration case
System treatment pressure adjusting module carries out the adjusting for the treatment of pressure, and the respiration case monitoring modular is for having monitored whether to exhale
Inhale pause, low pass gas, snoring events；The treatment pressure adjusting module is used to be boosted according to event boost module, flow limitation
The treatment pressure output of lung ventilator is adjusted in the control that module and pressure lower module.
2. treatment pressure according to claim 1 is from titration system, which is characterized in that the event boost module is specifically
It monitors apnea, low pass gas event and snoring events and carries out boost operations, the step-up method of the event boost module
It is primary for response in every 2 minutes, and boosting mode is directly to be adjusted to goal pressure, can only be carried out to respiration event in 2 minutes
Boosting rectifier control, and handled according to the priority of Time To Event priority.
3. treatment pressure according to claim 1 or 2 is from titration system, which is characterized in that the event boost module inspection
When measuring apnea, by detection trigger signal if the time that apnea occurs is more than certain time, and press
According to setting formula change treatment pressure, it is described set formula as：Papn=2* (napn+500)/Napn,maxCmH2O,
In formula, PapnTo need the pressure changed, n when apneaapnFor the points of system detectio apnea, Napn,maxIt is upper
Point of accumulation number；If the boost value P being calculatedapn＜ 0.8cmH2O, then it is 0.8cmH2O to fix minimum boosting；If being calculated
Boost value Papn＞ 2cmH2O, then it is 2cmH2O to fix highest boosting；In general, the time of apnea is in 10s to 120s
Between, then it treats pressure and changes by above-mentioned formula, increase stressed ranging from 0.8cmH2O~2cmH2O.
4. treatment pressure according to claim 1 or 2 is from titration system, which is characterized in that the event boost module inspection
When measuring low pass gas event, treatment pressure is increased with rate per minute 1cmH2O.
5. treatment pressure according to claim 1 or 2 is from titration system, which is characterized in that the event boost module inspection
When measuring snoring events, treatment pressure is boosted according to snoring index, and specific amount of boost expression formula is：Psno=1.5* ηsnoCmH2O,
In formula, PsnoIt is snoring amount of boost, ηsnoIt is snoring index, variation range is 0 to 1, and 3 are consecutively detected in pressurization
Secondary snoring events increase treatment pressure, and snoring index increases by 0.1 every time, and snoring, which does not occur, can then reduce by 0.1, twice in succession or
Repeatedly in the case of snoring, snoring index is cumulative.
6. treatment pressure according to claim 1 is from titration system, which is characterized in that the flow limitation boost module inspection
When measuring flow limitation respiration case, boost value is calculated in real time, and exports treatment pressure, and flow limitation boost module is independently of thing
Part boost module boosts, and step-up method is that response in every 1 minute is primary, and boosting mode is directly to be adjusted to goal treatment pressure
Power, specific boost pressure calculation formula are：Plim=(0.08- λlim)/0.08cmH2O,
In formula, PlimAmount of boost when being flow limitation, λlimFor flow limitation index, variation range is 0 to 0.07.
7. treatment pressure according to claim 1 is from titration system, which is characterized in that the pressure is lowered to be recuperated under medical treatment under module
Treat pressure method be：
Pdec=0.1* (Pset-Pmin)/(Pmax-Pmin) cmH2O/Min,
In formula, PsetFor Current therapeutic pressure, PminFor the minimum pressure of setting, PmaxFor maximum pressure；When setting pressure and minimum
Treatment differing pressure is bigger, and lower speed change rate is bigger, is up to 0.1cmH2O/Min.
8. a kind for the treatment of pressure of lung ventilator is from titration method, it is characterised in that include the following steps：
Step S1：After starting respirator treatment, control lung ventilator rapidly rises to the minimum treatment pressure value of setting；
Step S2：Current sleep-respiratory event is monitored in real time；
Step S3：Real-time judge currently whether there is respiration case, if there is currently sleep-respiratory events, according to sleep-respiratory
The type of event selects event boost module or flow limitation boost module to carry out treatment pressure up-regulation control；If not having currently
There is sleep-respiratory event then to execute next step；
Step S4：Judge whether the pressure currently titrated is more than the treatment pressure of setting, if more than then starting pressure and lowering module
It is depressured；If the pressure of titration is equal to the treatment pressure of setting, current titration pressure is kept；
Step S5：After event boost module, the boosting of flow limitation boost module or pressure lower module decompression, step S2 is executed,
Until stopping therapeutic process.
9. the treatment pressure of lung ventilator according to claim 1 is from titration method, which is characterized in that the event is boosted mould
The method that block carries out treatment pressure up-regulation control specifically includes following steps：
Step S1 '：Monitor current sleep-respiratory event, including apnea, low pass gas, snoring；
Step S2 '：If no sleep-respiratory event occurs, terminate to boost；
Step S3 '：If there is sleep-respiratory event, boost value is calculated according to current sleep-respiratory event；
Step S4 '：By the treatment pressure output of titration；
Step S5 '：Return to step S1 '.
10. the treatment pressure of lung ventilator according to claim 1 is from titration method, which is characterized in that the pressure is lowered
Module carries out the method that treatment pressure lowers control and specifically includes following steps：
Step S1 "：Monitor current sleep-respiratory event, including apnea, low pass gas, snoring, flow limitation；
Step S2 "：If there is sleep-respiratory event, stop being depressured；
Step S3 "：If no sleep-respiratory event occurs, step-down value is calculated according to current sleep respiration case；
Step S4 "：New treatment pressure is exported, and is compared with setting treatment pressure；
Step S5 "：If the treatment pressure of titration is equal to the treatment pressure of setting, current titration pressure is kept；
Step S6 "：If the treatment pressure of titration is more than the treatment pressure of setting, step S1 " is returned to.
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