CN112569417A

CN112569417A - Heparin administration monitoring system

Info

Publication number: CN112569417A
Application number: CN202011447950.0A
Authority: CN
Inventors: 李白翎; 唐杨烽; 廖紫琳; 徐志云
Original assignee: First Affiliated Hospital of Naval Military Medical University of PLA
Current assignee: First Affiliated Hospital of Naval Military Medical University of PLA
Priority date: 2020-12-09
Filing date: 2020-12-09
Publication date: 2021-03-30

Abstract

The invention provides a heparin administration monitoring system, which is characterized by mainly comprising the following components: a data acquisition unit, a time determination setting unit, an adjustment method setting unit, a target dose calculation unit, and a dose conversion unit. The time determination setting part determines a corresponding time interval according to the activated partial thromboplastin time or the activated blood coagulation time acquired by the data acquisition part and sets the time interval as a specific time interval, the adjusting method setting part sets a dosage adjusting method corresponding to the specific time interval as a target dosage adjusting method, the target dosage calculating part calculates a target dosage according to the target dosage adjusting method and a historical dosage, and the dose conversion part converts the target dosage and the patient weight according to a dose calculation rule to obtain a dose to be injected. The system can enable medical staff to accurately know the patient condition in real time, provide reference related to heparin administration adjustment for the medical staff, save administration conversion time and avoid conversion error caused by shift.

Description

Heparin administration monitoring system

Technical Field

The invention particularly relates to a heparin administration monitoring system.

Background

ECMO is widely applied to various cardiogenic shock, heart failure and the final stage of ARDS caused by various reasons as a heart/lung auxiliary mode. Thrombotic events are a well-known complication of ECMO and are one of the major causes of ECMO failure, with incidence rates as high as 50%. Therefore, it is a very important concern for patients and medical staff to prevent thrombus formation caused by the contact of blood with a large amount of foreign material surface in clinical practice.

Heparin is the most common anticoagulant drug for preventing thrombosis in ECMO, the metabolic conditions of heparin in different patients are very different, the metabolic conditions are poor in correlation with heparin dosage, and the heparin effect cannot be estimated, so that the anticoagulant activity of heparin needs to be closely monitored, and the dosage of heparin or the anticoagulant drug needs to be adjusted.

Patients with ECMO are currently monitored for anticoagulation by physicians using different monitoring methods (e.g., ACT, APTT, Anti-Xa, etc.). Under the situation, doctors with relatively low experience may not be able to quickly determine how to adjust heparin administration, and need to find doctors with old seniors to discuss the adjustment, so that the treatment time of the ECMO patient is delayed, and serious consequences may be brought. Meanwhile, when a doctor changes over, the standard of heparin adjustment for the doctor may be different from that of the previous doctor, thereby reducing the accuracy of heparin administration.

Currently, the specifications for heparin administration are expressed in units of dosage (i.e., U), rather than in units of milligrams (i.e., mg). However, in clinical practice, heparin medication is ordered in "mg", which involves a conversion problem between the two. When the dosage of heparin is adjusted, a doctor expresses the dosage by U; when the order is recorded, the doctor expresses mg. When two doctors are handed over, the current doctor needs to obtain U based on mg conversion in the medical advice for adjusting the heparin dosage, and the problem of manual calculation error may occur, so that the life of a patient using ECMO is damaged.

Disclosure of Invention

In order to solve the problems, the invention provides a heparin administration monitoring system which provides a heparin administration adjusting scheme and automatically converts the heparin administration adjusting scheme according to the activated partial thromboplastin time and the activated thromboplastin time of a patient which are obtained in real time, and the technical scheme is as follows:

the invention provides a heparin administration monitoring system, which is used for monitoring heparin administration of a patient using ECMO so as to remind medical staff of heparin administration adjustment, and is characterized by comprising the following steps: a weight information storage unit for storing the weight of the patient; a time interval storage unit for storing a plurality of predetermined time intervals corresponding to activated partial thromboplastin times or activated clotting times; an adjustment method storage unit for storing a usage adjustment method corresponding to a predetermined time interval; a historical dose storage part for storing the historical injection dose of heparin medication; a picture storage part for storing a picture of an adjustment scheme and a picture of a dose to be injected; a data acquisition part for acquiring activated partial thromboplastin time of a patient as time to be determined in a first preset interval time and acquiring activated thromboplastin time of the patient as time to be determined in a second preset interval time; a time determination setting unit configured to determine a predetermined time interval to which the time to be determined belongs, and set the predetermined time interval as a specific time interval; an adjustment method setting unit that sets a usage adjustment method corresponding to the specific time interval as a target usage adjustment method; a historical dose conversion part which obtains the historical implantation dose from the historical dose storage part and converts the historical implantation dose by using a preset historical dose conversion rule to obtain the historical dose corresponding to the historical implantation dose; a display part for displaying the adjustment scheme picture and simultaneously displaying the target usage adjustment method and the historical usage for the reference of the medical care personnel; a target usage calculating part, which calculates the target usage based on the historical usage by using a usage adjusting method corresponding to the specific time interval; and a dose conversion part which converts the target dosage and the body weight by using a preset dose operation rule to obtain the dose to be injected, once the dose conversion part converts the dose to be injected, the display part displays a picture of the dose to be injected and displays the dose to be injected so as to enable medical staff to adjust heparin administration, wherein the preset dose operation rule is as follows:

in the formula, the target dosage is the pumping dosage, and the dosage to be injected is the pump speed.

The heparin administration monitoring system provided by the invention can also have the technical characteristics that the first preset interval time is greater than the second preset interval time.

The heparin administration monitoring system provided by the invention can also have the technical characteristics that the historical dosage conversion rule is as follows:

the heparin administration monitoring system provided by the invention can also have the technical characteristics that when the historical dosage conversion part fails to acquire the historical injection dosage from the historical dosage storage part, the dosage conversion part directly calculates the primary dosage according to the disposable target dosage and the body weight through a preset primary calculation rule, and the primary dosage is used as the dosage to be injected, wherein the primary calculation rule is as follows:

in the formula, the one-time target dosage belongs to [60U/kg, 80U/kg ], and the first dosage is the liquid dosage for diluting heparin.

The heparin administration monitoring system provided by the invention can also have the technical characteristics that: once the target dosage is calculated by the target dosage calculation part, the target dosage storage part stores the target dosage as a new historical dosage, the dosage upper limit judgment part judges whether the historical dosage exceeds a threshold value, and the activity detection reminding part sends an activity detection reminding of heparin administration when the target dosage calculation part judges that the historical dosage exceeds the threshold value, so that medical staff is reminded to perform heparin activity detection.

Action and Effect of the invention

According to the heparin administration monitoring system, the time judgment setting part determines the preset time interval according to the activated partial thromboplastin time or the activated blood coagulation time and sets the preset time interval as the specific time interval, the adjusting method setting part further sets the dosage adjusting method corresponding to the specific time interval as the target dosage adjusting method, and the display part finally displays the adjusting scheme picture and the target dosage adjusting method, so that medical workers can accurately grasp the condition of a patient in real time according to two anticoagulation monitoring methods, and can adjust heparin administration by referring to the target dosage adjusting method provided by the system, the decision time for heparin administration adjustment is saved, and the accuracy of heparin administration is improved.

The medical staff can determine the time of unit conversion after determining the dosage according to the target dosage adjusting method and avoid the situation that the medical staff has calculation errors due to shift.

Drawings

Fig. 1 is a block diagram of a heparin administration monitoring system according to an embodiment of the present invention;

FIG. 2 is a reference diagram of APTT heparin dosage adjustment according to an embodiment of the present invention;

FIG. 3 is a diagram of adjusting the amount of ACT heparin used in accordance with an embodiment of the present invention; and

fig. 4 is a flowchart of a heparin administration monitoring system according to an embodiment of the present invention.

Detailed Description

In order to make the technical means, the inventive features, the achievement objects and the effects of the present invention easy to understand, the following describes a head orientation method of an audio-visual cooperative humanoid robot in detail with reference to the embodiments and the accompanying drawings.

< example >

Fig. 1 is a block diagram of a heparin administration monitoring system according to an embodiment of the present invention.

As shown in fig. 1, the heparin administration monitoring system 10 includes a weight information storage unit 11, a time interval storage unit 12, an adjustment method storage unit 13, a historical dose storage unit 14, a screen storage unit 15, a data acquisition unit 16, a time determination setting unit 17, an adjustment method setting unit 18, a display unit 19, a historical dose conversion unit 20, a target dose calculation unit 21, a dose conversion unit 22, a historical dose storage unit 23, an upper limit dose determination unit 24, an activity detection reminding unit 25, and a control unit 26.

The weight information storage unit 11 stores the weight of the patient.

In this embodiment, the weight is stored as basic information of the patient in a central workstation of the hospital.

The time interval storage unit 12 stores a plurality of predetermined time intervals corresponding to activated partial thromboplastin times or activated clotting times.

Wherein, the Activated Partial Thromboplastin Time (APTT) and the activated blood coagulation time (ACT) are measured by related instruments. The measuring frequency of the ACT is measured once every 2 to 4 hours, and the method has the advantages that the method can be carried out beside a sickbed, is simple to operate and is generally applied; the disadvantage is that the measured values are inaccurate and variable. The APTT is measured once every 12 to 24 hours, and the method has the advantages of accurate measurement value, incapability of being carried out beside a hospital bed and no common application range of ACT.

In this embodiment, the predetermined time interval is obtained by summarizing the experience of the doctor. When the measured APTT value or ACT value is within a certain time interval, a corresponding heparin dosage adjusting method is provided.

The adjustment method storage unit 13 stores a usage adjustment method corresponding to a predetermined time interval.

The dosage adjusting method comprises an APTT heparin dosage adjusting method and an ACT heparin dosage adjusting method according to an APTT value or an ACT value obtained through measurement. Both the APTT heparin dosage adjustment method and the ACT heparin dosage adjustment method are obtained according to the summary of historical clinical experience.

FIG. 2 is a reference diagram of APTT heparin dosage adjustment in accordance with an embodiment of the present invention.

As shown in fig. 2, when the APTT value is in the time interval of 45 seconds or less, the corresponding heparin dosage is adjusted to be increased by 4U/(kg · h) from the previous one;

when the APTT value is in the time interval of 46 seconds to 55 seconds, the corresponding heparin dosage is adjusted to be increased by 2U/(kg.h) on the previous basis;

when the APTT value is in the time interval of 56 seconds to 65 seconds, the dosage of the heparin is kept unchanged;

when the APTT value is in the time interval of 66 seconds to 75 seconds, the corresponding heparin dosage is adjusted to be reduced by 1U/(kg.h) on the previous basis;

when the APTT value is in the time interval of 76 seconds to 90 seconds, the corresponding heparin dosage is adjusted to be reduced by 2U/(kg.h) on the previous basis;

when the APTT value is in the time interval of 91 seconds to 100 seconds, the corresponding heparin dosage is adjusted to stop the heparin for 1 hour, and then the dosage is reduced by 3U/(kg.h);

when the APTT value is in a time interval of more than 100 seconds, the corresponding heparin dosage is adjusted to be firstly stopped for 2 hours and then reduced by 4U/(kg.h).

FIG. 3 is a diagram of adjusting the amount of ACT heparin used in accordance with an embodiment of the present invention.

As shown in fig. 3, when the ACT value is in the time interval of 140 seconds or less, the corresponding heparin dosage is adjusted to be increased by 30% from the previous dosage;

when the ACT value is in the time interval of 141 seconds to 160 seconds, the corresponding heparin dosage is adjusted to be increased by 20 percent on the basis of the prior dosage;

when the ACT value is in the time interval of 161 seconds to 179 seconds, the corresponding heparin dosage is adjusted to be increased by 10 percent on the previous basis;

when the ACT value is in the time interval of 180 seconds to 210 seconds, the dosage of heparin is kept unchanged;

when the ACT value is in the time interval of 211 seconds to 240 seconds, the corresponding heparin dosage is adjusted to be reduced by 10 percent on the previous basis;

when the ACT value is in the time interval of 241 seconds to 270 seconds, the corresponding heparin dosage is adjusted to be firstly stopped for 30 minutes and then reduced by 20 percent on the previous basis;

when the ACT value is in a time interval greater than 270 seconds, the corresponding heparin dosage is adjusted to be off heparin for 60 minutes, a 30% reduction from the previous one.

The historical dose storage unit 14 stores a historical injection dose of heparin administration.

In this embodiment, the medical staff records a medical order (for example, 100mg heparin dose and 100ml sodium chloride dilution) including the drug dose (mg) of heparin sodium and the liquid volume (ml) of diluted heparin in the electronic medical record, and the historical dose storage unit 14 stores each heparin injection dose as a historical injection dose based on the medical order.

The screen storage unit 15 stores an adjustment plan screen, a dose to be injected screen, and a target dose input screen.

The display unit 19 displays the screen.

The data acquisition unit 16 is used for acquiring the activated partial thromboplastin time of the patient as a time to be determined in a first predetermined interval time and acquiring the activated thromboplastin time of the patient as a time to be determined in a second predetermined interval time.

Wherein the first predetermined interval is greater than the second predetermined interval.

In the present embodiment, the first predetermined interval is 12 hours, and the second predetermined interval is 2 hours, that is, the APTT value is measured every 12 hours, and the ACT value is measured every 2 hours.

When the APTT value and the ACT value are obtained simultaneously, only the APTT value is considered, and the method for adjusting the heparin dosage corresponding to the APTT value is taken as the standard.

The time determination setting portion 17 determines which predetermined time interval the time to be determined belongs to when the data acquisition portion 16 acquires the time to be determined, and sets the predetermined time interval to which the APTT or ACT belongs as the specific time interval.

The adjustment method setting unit 18 sets the usage adjustment method corresponding to the specific time interval as the target usage adjustment method.

Wherein, when the data acquisition part 16 acquires the APTT, the target usage adjustment method is determined according to fig. 2; when the data obtaining portion 16 obtains the ACT, the target usage adjustment method is determined according to fig. 3.

The historical dose conversion unit 20 obtains the historical implant dose from the historical dose storage unit 14, and converts the historical dose into a historical dose corresponding to the historical implant dose using a predetermined historical dose conversion rule.

Wherein, the historical dose conversion rule is as follows:

when the historical dose conversion part 20 cannot obtain the historical injection dose (i.e. heparin administration is the first administration) from the historical dose storage part 14, the dose conversion part 22 directly calculates the first dose according to the disposable target dose and the body weight by a predetermined first calculation rule, and takes the first dose as the dose to be injected.

Wherein, the first calculation rule is as follows:

In this embodiment, the disposable target dose is generally relatively fixed and is 62.5U/kg, the disposable target dose calculated from the body weight is the loading dose of heparin, which is completed by intravenous injection, and the subsequently adjusted heparin is injected by ECMO pump.

When the adjustment method setting unit 18 outputs the target dose adjustment method and the history dose conversion unit 20 outputs the history dose, the display unit 19 displays the adjustment plan screen while displaying the target dose adjustment method and the history dose to provide reference to the medical staff.

In this embodiment, the medical staff may adjust the heparin administration directly according to the target amount adjustment method displayed on the display unit 19, or may determine the adjustment of the heparin administration according to his own judgment or experience, and then directly input the target amount in the target amount input screen.

The target usage calculating unit 21 calculates the target usage based on the historical usage by using the usage adjusting method corresponding to the specific time interval.

When the target usage calculating unit 21 calculates the target usage, the history usage storing unit 23 stores the target usage as a new history usage.

The upper limit usage determination unit 24 determines whether or not the history usage exceeds a threshold.

In this example, the threshold value is 35U/(kg · h).

When the historical dosage exceeds the threshold value, the activity detection reminding part 25 sends out the activity detection reminding of heparin administration so as to remind medical staff of heparin activity detection. Heparin activity can be determined by ATIII, and if ATIII activity is less than 70%, alternative drugs to heparin, such as bivalirudin, argatroban, dada hepatica sodium, etc., need to be considered.

The dose conversion unit 22 converts the target dose and the body weight according to a predetermined dose calculation rule to obtain the dose to be injected.

Wherein, the dose operation rule is as follows:

Once the dose conversion unit 22 converts the dose to be injected, the display unit 19 displays a screen of the dose to be injected and displays the dose to be injected, so that the medical staff can adjust the heparin administration for the ECMO patient.

The control unit 26 is configured to control the weight information storage unit 11, the time interval storage unit 12, the adjustment method storage unit 13, the historical dose storage unit 14, the screen storage unit 15, the data acquisition unit 16, the time determination setting unit 17, the adjustment method setting unit 18, the display unit 19, the historical dose conversion unit 20, the target dose calculation unit 21, the dose conversion unit 22, the historical dose storage unit 23, the upper limit dose determination unit 24, and the activity detection reminding unit 25.

In addition, when the APTT value is less than 35 seconds or 100 seconds, the system can also send out a reminder that the patient is at coagulation risk, so as to draw the attention of medical personnel, and relevant medical personnel can timely inject heparin medicine into the patient.

Fig. 4 is a flowchart of the heparin administration monitoring system 10 according to the embodiment of the present invention.

As shown in fig. 4, the workflow of heparin injection by pump in the heparin administration monitoring system 10 includes the following steps:

in step S1, the data acquisition unit 16 acquires APTT for a first predetermined interval, acquires ACT for a second predetermined interval, and then proceeds to step S2;

step S2, the time determination setting unit 17 determines the time interval to which it belongs from the acquired APTT or ACT, sets the time interval as a specific time interval, and then proceeds to step S3;

step S3, the adjustment method setting unit 18 determines the corresponding usage adjustment method according to the specific time interval, sets the usage adjustment method as the target usage adjustment method, and then proceeds to step S4;

step S4, the historical dose conversion unit 20 calculates the historical dose according to the historical implantation dose by the historical dose conversion rule, and then the process goes to step S5;

step S5, the display unit 19 displays the adjustment plan screen and displays the target usage adjustment method and the historical usage for the medical staff to refer to, and then the process proceeds to step S6;

step S6, the control unit 26 determines whether the medical staff determines to adjust the heparin administration by the target dose adjustment method, if so, proceeds to step S7, otherwise, proceeds to step S8;

step S7, the target consumption calculator 21 calculates the target consumption according to the consumption adjustment method and the historical consumption, and then the process goes to step S9;

step S8, the medical staff inputs the target dosage and then enters step S9;

step S9, the dose conversion unit 22 converts the target dose and the body weight according to the dose calculation rule to obtain the dose to be injected, and then the process goes to step S10;

in step S10, the display unit 19 displays the dose to be injected for the medical staff to refer to, and then enters an end state.

Examples effects and effects

According to the heparin administration monitoring system provided by the embodiment, the time judgment setting part determines the preset time interval according to the activated partial thromboplastin time or the activated blood coagulation time and sets the preset time interval as the specific time interval, the adjustment method setting part further sets the dosage adjustment method corresponding to the specific time interval as the target dosage adjustment method, and the display part finally displays the adjustment scheme picture and the target dosage adjustment method, so that medical staff can accurately grasp the condition of a patient in real time according to the two anticoagulation monitoring methods and adjust heparin administration by referring to the target dosage adjustment method provided by the system, the decision time for heparin administration adjustment is saved, and the accuracy of heparin administration is improved.

In addition, in the embodiment, when no historical dose exists, the dose conversion part calculates the first dose according to the first calculation rule and displays the dose to be injected as the dose to be injected, so that the conversion of the disposable heparin loading dose of the medical staff during the first administration is saved.

In addition, in the embodiment, the medical staff can be reminded to carry out heparin activity detection when the heparin dosage exceeds the threshold value through the historical dosage storage part, the dosage upper limit judging part and the activity detection reminding part, so that whether the heparin needs to be replaced or not is considered, and the anticoagulant medication is adjusted in time.

The above-described embodiments are merely illustrative of specific embodiments of the present invention, and the present invention is not limited to the description of the above-described embodiments.

In the above embodiment, the measurement frequency of the APTT is once every 12 hours, and the measurement frequency of the ACT is once every 2 hours, but the present invention may also adjust the measurement frequency of the APTT and the ACT according to the actual condition of the patient.

In the above embodiment, there are 7 corresponding time intervals of the APTT and the ACT, and there are 7 usage adjustment methods corresponding to the time intervals, in other schemes, there are 6 or 8 corresponding time intervals of the APTT and the ACT, and there are 6 or 8 usage adjustment methods corresponding to the time intervals, which can be adjusted according to actual requirements.

Claims

1. The utility model provides a heparin is used medicine monitoring system for thereby carry out the monitoring that heparin was used medicine to the disease that uses ECMO reminds medical personnel to carry out heparin to use medicine adjustment to the disease, a serial communication port, include:

a weight information storage unit for storing the weight of the patient;

a time interval storage unit for storing a plurality of predetermined time intervals corresponding to activated partial thromboplastin times or activated clotting times;

an adjustment method storage unit for storing a usage adjustment method corresponding to the predetermined time interval;

a historical dose storage unit for storing a historical injection dose of the heparin administration;

a picture storage part for storing a picture of an adjustment scheme and a picture of a dose to be injected;

a data acquisition part for acquiring the activated partial thromboplastin time of the patient as a time to be determined within a first predetermined interval time and acquiring the activated thromboplastin time of the patient as a time to be determined within a second predetermined interval time;

a time determination setting unit configured to determine the predetermined time interval to which the time to be determined belongs, and set the predetermined time interval as a specific time interval;

an adjustment method setting unit that sets the usage adjustment method corresponding to the specific time interval as a target usage adjustment method;

a historical dose conversion unit which obtains the historical implantation dose from the historical dose storage unit and converts the historical implantation dose into a historical dose corresponding to the historical implantation dose by using a preset historical dose conversion rule;

a display unit that displays the adjustment plan screen and displays the target usage adjustment method and the historical usage for reference by the medical staff;

a target usage calculating part, which calculates the target usage based on the historical usage by using the usage adjusting method corresponding to the specific time interval; and

a dose conversion unit for converting the target dose and the body weight by a predetermined dose calculation rule to obtain a dose to be injected,

once the dose conversion part converts the dose to be injected, the display part displays the dose picture to be injected and displays the dose to be injected so as to allow the medical staff to adjust the heparin administration,

wherein the predetermined dose calculation rule is:

in the formula, the target dosage is a pumping dosage, and the dosage to be injected is a pumping speed.

2. Heparin administration monitoring system according to claim 1, characterized in that:

3. Heparin administration monitoring system according to claim 1, characterized in that:

wherein the historical dose conversion rule is as follows:

4. heparin administration monitoring system according to claim 1, characterized in that:

wherein, when the historical dose conversion part fails to acquire the historical injection dose from the historical dose storage part, the dose conversion part directly calculates a first dose according to a disposable target dose and the body weight through a preset first calculation rule and takes the first dose as the dose to be injected,

the first calculation rule is as follows:

wherein the one-time target dosage is within the range of 60U/kg and 80U/kg, and the first dosage is the liquid dosage for diluting the heparin.

5. The heparin administration monitoring system of claim 1, further comprising:

a history usage storage part, an upper limit usage judgment part and an activity detection reminding part,

the target usage storage portion stores the target usage as a new history usage once the target usage is calculated by the target usage calculation portion,

the upper limit usage determination section determines whether or not the history usage exceeds a threshold,

and the activity detection reminding part sends out the activity detection reminding of the heparin administration when the target dosage calculation part judges that the target dosage calculation part is yes, so as to remind the medical staff of heparin activity detection.