CN114515153A - Self-adaptive esophageal electrode catheter system - Google Patents
Self-adaptive esophageal electrode catheter system Download PDFInfo
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- CN114515153A CN114515153A CN202210006440.2A CN202210006440A CN114515153A CN 114515153 A CN114515153 A CN 114515153A CN 202210006440 A CN202210006440 A CN 202210006440A CN 114515153 A CN114515153 A CN 114515153A
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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
- A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
- A61B5/25—Bioelectric electrodes therefor
- A61B5/279—Bioelectric electrodes therefor specially adapted for particular uses
- A61B5/28—Bioelectric electrodes therefor specially adapted for particular uses for electrocardiography [ECG]
- A61B5/283—Invasive
- A61B5/285—Endotracheal, oesophageal or gastric probes
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/02—Details
- A61N1/04—Electrodes
- A61N1/05—Electrodes for implantation or insertion into the body, e.g. heart electrode
- A61N1/0517—Esophageal electrodes
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
- A61N1/00—Electrotherapy; Circuits therefor
- A61N1/18—Applying electric currents by contact electrodes
- A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
- A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
- A61N1/362—Heart stimulators
- A61N1/365—Heart stimulators controlled by a physiological parameter, e.g. heart potential
Abstract
The invention discloses a self-adaptive esophageal electrode catheter system, which comprises a stimulation instrument and an esophageal electrode catheter, wherein the esophageal electrode catheter is provided with a plurality of electrodes which are arranged at intervals along the axial direction of the esophageal electrode catheter, and the electrodes are electrically connected with the stimulation instrument; the stimulator is used for identifying the electrocardio detection signals transmitted by the electrodes, determining the electrode in the optimal stimulation position in the electrodes according to the electrocardio detection signals of the electrodes, and sending a treatment electric signal to the electrode in the optimal stimulation position. Avoiding the excessive dependence on the human body and consuming a large amount of time in the process of adjusting the esophageal electrode catheter, and effectively improving the treatment effect and the treatment experience.
Description
Technical Field
The invention relates to the technical field of medical instruments, in particular to a self-adaptive esophageal electrode catheter system.
Background
The heart pulse regulation through esophagus is a non-invasive clinical electrophysiological diagnosis and treatment technology. The esophagus and the heart are closely in anatomical relationship and are positioned in the mediastinum, the heart is in front, the esophagus is behind, the front wall of the esophagus is closely adjacent to the left atrium, the esophagus is downward close to the left ventricle, and the esophagus electrodes are placed by utilizing the anatomical relationship, so that the heart detection data can be synchronously recorded. The electrophysiological adjustments and arrhythmic mechanisms of the heart can be analyzed based on the clear data presented when adjusted to the optimal recording position, and the left atrium and left ventricle can be paced indirectly using esophageal electrode catheters.
However, the existing esophageal electrode catheter is difficult to stably capture the ventricle because the shape structure does not conform to the anatomical structure of the stomach, and the esophageal electrode catheter structure is not adaptive, so that the esophageal electrode catheter needs to be manually and repeatedly inserted by depending on experience to judge the optimal electrocardiographic position. When the electrode catheter is inserted in an inappropriate depth, the esophageal electrode catheter is also manually inserted or withdrawn. Because the esophageal electrode catheter is adjusted to the recorded optimal position, the requirement on the operation experience of an operator is very high, a large amount of time is consumed in the process of adjusting the esophageal electrode catheter, discomfort is easily caused to a patient, the esophageal electrode catheter cannot be normally used for detection, recording and stimulation due to electrode displacement caused by position adjustment of the patient inevitably in the recognition process, and the treatment effect and the treatment experience need to be improved.
Disclosure of Invention
The invention mainly aims to provide a self-adaptive esophageal electrode catheter system, which determines an electrode at the optimal stimulation position in a plurality of electrodes according to electrocardio detection signals of the electrodes of the esophageal electrode catheter by a stimulator, automatically identifies the optimal stimulation position of the heart, avoids over-dependence on manpower, consumes a large amount of time in the process of adjusting the esophageal electrode catheter, and effectively improves the treatment effect and treatment experience.
To achieve the above object, the present invention provides an adaptive esophageal electrode catheter system comprising:
a stimulator;
the esophagus electrode catheter is provided with a plurality of electrodes which are arranged at intervals along the axial direction of the esophagus electrode catheter, and the electrodes are electrically connected with the stimulation instrument;
the stimulator is used for identifying electrocardio detection signals transmitted by the electrodes, determining the electrode in the optimal stimulation position in the electrodes according to the electrocardio detection signals of the electrodes, and sending a treatment electric signal to the electrode in the optimal stimulation position.
In one embodiment, the optimal stimulation locations include a cardiac atrial location and a cardiac ventricular location.
In one embodiment, the stimulator has an atrial pacing mode in which the stimulator is used to pace stimulation to a cardiac atrial location;
the stimulator has a ventricular pacing mode in which the stimulator is configured to perform pacing stimulation to a ventricular location of a heart;
the stimulator has an atrial and ventricular therapy mode, and under the atrial and ventricular sequential pacing mode, the stimulator firstly determines the positions of a cardiac atrium and the cardiac ventricle, and performs atrial pacing stimulation firstly and then performs ventricular pacing stimulation during cardiac pacing.
In one embodiment, the stimulator has an input unit for inputting a pacing control signal to correspondingly initiate the atrial pacing mode, the ventricular pacing mode, or the atrial-ventricular therapy mode.
In one embodiment, the esophageal electrode catheter has a gastric tube section for extending into the stomach, and a plurality of electrodes are arranged at intervals between the beginning and the end of the gastric tube section.
In one embodiment, the electrodes are disposed on the peripheral wall of the esophageal electrode catheter in a ring shape and/or a dot shape.
In one embodiment, the electrode is embedded in the peripheral wall of the esophageal electrode catheter.
In one embodiment, the electrode catheter further comprises a body surface auxiliary electrode which is electrically connected with the stimulator and used for detecting body surface electrocardiosignals on the body surface of the human body;
the stimulation instrument is also used for determining the electrode in the optimal stimulation position in the plurality of electrodes according to the body surface electrocardio signals and the electrocardio detection signals of the plurality of electrodes.
In an embodiment, the stimulator is further configured to determine a recording electrode from the plurality of electrodes according to the electrocardiographic detection signals of the plurality of electrodes, and the stimulator is further configured to receive the electrocardiographic detection signal fed back by the recording electrode and output an electrocardiographic detection result according to the electrocardiographic detection signal fed back by the recording electrode.
In one embodiment, the stimulator further has a display for displaying the ecg signal on the display in the form of a graph and/or a numerical value.
Compared with the prior art, the invention has the following beneficial effects:
1. the self-adaptive esophageal electrode catheter system provided by the invention has the advantages that in order to avoid the situation that the position which is most suitable for recording and stimulation needs to be found by manually inserting and adjusting the depth repeatedly due to the too small number of electrode assemblies, a plurality of electrodes are arranged on the esophageal electrode catheter in cooperation with the anatomical structure of the esophagus heart;
2. in order to avoid overlong manual repeated debugging or stimulation sending interval time, a plurality of electrodes are arranged at intervals along the axial direction of the esophageal electrode catheter, and when the electrodes are displaced, the electrodes in the optimal positions are determined again by the stimulation instrument;
3. the stimulation instrument is used for receiving and identifying electrocardio detection signals transmitted by the electrodes and determining the electrode at the optimal position according to the electrocardio detection signals of the electrodes so as to realize automatic identification of the optimal stimulation position;
4. the stimulation instrument sends therapeutic electric signals to the electrodes at the optimal stimulation positions, and the electrodes deliver stimulation to the heart according to the acquired therapeutic electric signals, so that the cardiac pacing is realized.
Drawings
In order to more clearly illustrate the embodiments of the present invention or the technical solutions in the prior art, the drawings used in the description of the embodiments or the prior art will be briefly described below, it is obvious that the drawings in the following description are only some embodiments of the present invention, and for those skilled in the art, other drawings can be obtained according to the structures shown in the drawings without creative efforts.
FIG. 1 is a schematic structural diagram of an embodiment of the present invention;
FIG. 2 is a schematic diagram of an esophageal electrode catheter in accordance with one embodiment of the present invention;
FIG. 3 is a schematic diagram of the front end of an esophageal electrode catheter in accordance with an embodiment of the present invention;
FIG. 4 is a schematic diagram of the front end of an esophageal electrode catheter in accordance with another embodiment of the present invention;
FIG. 5 is a schematic diagram of an esophageal electrode catheter in accordance with an embodiment of the present invention;
FIG. 6 is a flow chart of a method for applying an adaptive esophageal electrode catheter system in accordance with an embodiment of the present invention;
FIG. 7 is a flow chart of a method of applying an adaptive esophageal electrode catheter system in atrial pacing mode according to an embodiment of the present invention;
FIG. 8 is a flow chart of an application method of an adaptive esophageal electrode catheter system in ventricular pacing mode according to an embodiment of the present invention;
FIG. 9 is a flow chart of a method of applying an adaptive esophageal electrode catheter system in atrioventricular therapy mode in accordance with an embodiment of the present invention;
FIG. 10 is a flowchart illustrating the detailed step S2 according to an embodiment of the present invention;
FIG. 11 is a flowchart illustrating step S2 according to another embodiment of the present invention;
in the figure: 100. a stimulator; 101. an input unit; 102. a display; 103. a memory; 104. an alarm; 201. an esophageal electrode catheter; 2011. the front end of the esophagus electrode catheter; 2012. an electrode; 2013. an electrode cap; 2014. scale marks are marked; 2015. a catheter body; 202. a body surface auxiliary electrode.
The implementation, functional features and advantages of the objects of the present invention will be further explained with reference to the accompanying drawings.
Detailed Description
The technical solutions in the embodiments of the present invention will be clearly and completely described below with reference to the drawings in the embodiments of the present invention, and it is obvious that the described embodiments are only a part of the embodiments of the present invention, and not all of the embodiments. All other embodiments, which can be derived by a person skilled in the art from the embodiments given herein without making any creative effort, shall fall within the protection scope of the present invention.
It should be noted that, if all the directional indications in the embodiments of the present invention are only used to explain the relative position relationship, the motion situation, etc. of each component in a certain posture, if the certain posture is changed, the directional indication is changed accordingly.
If in the present invention the description referring to "first", "second", etc. is used for descriptive purposes only and not to be construed as indicating or implying a relative importance or an implicit indication of the number of technical features indicated. Thus, a feature defined as "first" or "second" may explicitly or implicitly include at least one such feature. If the description of "a and/or B" is referred to in the present invention, it means that either scheme a or scheme B is included, or both scheme a and scheme B are included. In addition, technical solutions between the embodiments may be combined with each other, but must be based on the realization of the technical solutions by a person skilled in the art, and when the technical solutions are contradictory to each other or cannot be realized, such a combination should not be considered to exist, and is not within the protection scope of the present invention.
The present invention provides an adaptive esophageal electrode catheter system, as shown in fig. 1 to 11, comprising a stimulation instrument 100 and an esophageal electrode catheter 201.
The esophageal electrode catheter 201 is provided with a plurality of electrodes 2012, and the plurality of electrodes 2012 are arranged at intervals along the axial direction of the esophageal electrode catheter 201.
Specifically, a plurality of electrodes 2012 are arranged along the esophageal electrode catheter body 2015 at intervals in the axial direction, a gap exists between two adjacent electrodes, the esophageal electrode catheter 201 can be installed on the esophageal electrode catheter 201 via installation grooves and the like, and the gap can be the esophageal electrode catheter body spaced between the corresponding installation grooves. Of course, without limiting the present application, a plurality of electrodes 2012 may be disposed on the socket or the mounting member adapted to the esophageal electrode catheter 201, and two adjacent electrodes are spaced by the spacing position or the edge position of the socket or the mounting member.
The electrodes 2012 are connected to the stimulation instrument 100, and after the esophageal electrode catheter 201 is inserted into the stomach, the electrocardiographic detection signals corresponding to the positions of the electrodes 2012 are transmitted to the stimulation instrument 100. Specifically, the electrical connection is adopted, that is, the plurality of electrodes are electrically connected with the stimulation instrument, and the term "electrically connected" as used herein means that current can pass between two connecting components, but does not mean that current can always pass between two connecting components, and the term "electrically connected the plurality of electrodes with the stimulation instrument" means that current can flow between the plurality of electrodes and the stimulation instrument. It should be noted that, the stimulation instrument herein has an interface for signal input and output, so as to realize signal transmission.
The stimulator 100 is configured to acquire and identify electrocardiographic detection signals transmitted by the plurality of electrodes 2012, and the stimulator 100 determines, according to the electrocardiographic detection signals of the plurality of electrodes 2012, an electrode of the plurality of electrodes 2012 that is at an optimal stimulation position, and further configured to send a therapeutic electrical signal to the electrode that is at the optimal stimulation position.
Specifically, the stimulator 100 acquires and recognizes electrocardiographic detection signals fed back by the plurality of electrodes 2012, and determines the plurality of electrodes at the optimal stimulation positions according to the acquired electrocardiographic detection signals respectively corresponding to the plurality of electrodes 2012. It should be noted that, since the esophageal electrode catheter 201 of the present application has a plurality of electrodes 2012, there may be more than one electrode at the optimal stimulation position during the detection process, and there is no less than one electrode at the determined optimal stimulation position, according to the actual operation, the stimulation apparatus selects one of the at least one electrode at the determined optimal stimulation position and sends a therapeutic electrical signal to the selected electrode, and the electrode at the optimal stimulation position delivers the stimulation to the heart.
In the actual operation process, the situation of electrode displacement is inevitably caused due to individual difference of patients, posture adjustment and transformation and other factors, and because the esophageal electrode catheter disclosed by the application document is provided with a plurality of electrodes, after the electrodes are displaced, namely the electrodes are subjected to position deviation with the original detection positions, the stimulator can also re-determine the electrodes at the optimal stimulation positions, specifically, the electrodes at the optimal stimulation positions in the plurality of electrodes can be re-determined through the electrocardio detection signals of the plurality of electrodes, and certainly, the electrodes at the optimal stimulation positions can also be searched in the plurality of electrodes determined to be at the optimal stimulation positions.
In this document, after determining the electrode in the optimal stimulation position among the plurality of electrodes, the stimulator may perform self-checking, that is, repeatedly determine the optimal stimulation position suitable for implementing pacing stimulation for many times, and adjust the optimal stimulation position according to actual needs. Specifically, the stimulator of the present application can be connected to an electrophysiology examination apparatus, and when the stimulator is used, after determining an electrode in the optimal stimulation position among the plurality of electrodes, when the determined electrode is not less than one, the stimulator determines whether any one or more of the electrodes needs to be adjusted, and if so, the stimulator automatically adjusts any one of the electrodes and connects the electrophysiology examination apparatus in parallel to determine the optimal stimulation position suitable for achieving pacing stimulation.
The term "stimulator" as used herein refers to a device for controlling or processing at least one operation and transmitting a therapeutic electrical signal such as a stimulation pulse signal, and the stimulator has a control system or a part thereof for implementing at least one operation of the adaptive esophageal electrode catheter system described herein, such as a device that can be implemented in hardware, circuitry, firmware or software, or a combination of at least two of the foregoing, and the control system or the part thereof is disposed inside the stimulator 100 in a form of being integrated into an internal circuit board or a packaging housing of the stimulator, or the like, or may be disposed outside the stimulator 100 in a form of being disposed in a supporting manner by using other devices or housings as carriers.
Without limiting the present application, the adaptive esophageal electrode catheter system has a controller or a control circuit independent from the stimulation device, and since the functions and electrical connection relationship achieved by the controller or the control circuit are easily understood by those skilled in the art, the operation of the adaptive esophageal electrode catheter system is substantially consistent with the operation of the stimulation device described in the present application, and for the specific implementation method of the attached controller or control circuit, reference may be made to the implementation scheme of the stimulation device described in the present application, and details are not repeated herein.
Further, the optimal stimulation locations include a cardiac atrial location and a cardiac ventricular location.
The stimulator may send therapeutic electrical signals to electrodes located in either an atrial or ventricular position of the heart to effect cardiac pacing stimulation of either or both of the atrium and ventricle of the heart.
As a preferred example herein, the stimulator has any one or more of an atrial pacing mode, a ventricular pacing mode, and an atrial ventricular therapy mode.
In the atrial pacing mode, the stimulation instrument identifies the position of the cardiac atrium through the electrode at the optimal stimulation position, is used for pacing stimulation to the position of the cardiac atrium, and sends stimulation to the atrium through the electrode at the optimal stimulation position to realize atrial pacing stimulation.
In the ventricular pacing mode, the stimulation instrument identifies the position of the heart ventricle through the electrode at the optimal stimulation position, is used for pacing stimulation to the position of the heart ventricle, and delivers stimulation to the ventricle through the electrode at the optimal stimulation position to realize ventricular pacing stimulation.
In the atrial and ventricular sequential pacing mode, the stimulator determines the position of the heart atrium and the position of the heart ventricle, sends stimulation to the atrium through the electrode in the optimal stimulation position to realize atrial pacing stimulation, and then sends stimulation to the ventricle through the electrode in the optimal stimulation position to realize ventricular pacing stimulation.
Further, the stimulator 100 has an input unit 101 for inputting a pacing control signal to correspondingly activate the atrial pacing mode, the ventricular pacing mode or the atrial-ventricular therapy mode.
As an example, the input unit 101 may employ an input device such as a hardware button, a keyboard, a touch screen, and the like, for acquiring a pacing control signal input by a medical staff to determine to select any one of the atrial pacing mode, the ventricular pacing mode, and the atrial-ventricular therapy mode to implement pacing stimulation.
Specifically, in the implementation process, the esophageal electrode catheter 201 enters the human body from the nose/mouth, extends into the stomach of the human body through the esophagus, detects electrocardiographic detection signals corresponding to the positions of the electrodes 2012 extending into the stomach, determines the electrode in the optimal stimulation position in the plurality of electrodes according to the electrocardiographic detection signals of the electrodes 2012 by the stimulator 100, and is further used for sending a therapeutic electrical signal to the electrode in the optimal stimulation position.
As an example, the stimulator 100 obtains the electrocardiographic detection signals transmitted by the plurality of electrodes 2012, and is configured to screen an optimal position for implementing pacing stimulation according to the electrocardiographic detection signals of the plurality of electrodes 2012 within a preset detection time, and further determine the electrode at the optimal stimulation position.
Here, the preset detection time is set according to a time period for the stimulator to automatically recognize the electrode at the optimal stimulation position, and may be specifically set on the stimulator 100 shown in this document, and it should be noted that the preset detection time is estimated according to clinical operation, the possibility of body position change, and the daily turning frequency of ICU comatose patients, and the detection time is set to 1min to 1 day according to actual use.
As an example, when the stimulator apparatus of the present invention is shipped, a time default value is set, and the time default value can be inputted through the input unit 101 of the stimulator apparatus 100, and stored in the internal memory 103 of the stimulator apparatus 100 as a default value at a preset time. Of course, the detection time can be set automatically in the subsequent use according to different requirements of actual use. Here, the stimulator 100 having a memory function is used, and the memory 103 may be integrated inside or outside the stimulator 100 and electrically connected to the stimulator 100 according to different requirements in actual use.
Further, the esophageal electrode catheter 201 has a gastric tube section for extending into the stomach, and a plurality of electrodes are arranged at intervals between the beginning and the end of the gastric tube section.
Specifically, as a preferred example herein, a gastric tube section is provided on the esophageal electrode catheter 201, the gastric tube section refers to a portion of the esophageal electrode catheter 201 that can contact the stomach wall and detect the optimal stimulation location after being inserted into the stomach, and the gastric tube section represents a portion of the esophageal electrode catheter 201 extending into the stomach, and may or may not include one end portion of the esophageal electrode catheter 201 extending into the esophagus. Of course, in practice, depending on the depth of insertion of the esophageal electrode catheter 201, the portion of the gastric tube that does not reach the stomach may stay in the esophagus and occupy a portion or all of the esophagus from where it meets the stomach, without limitation.
In order to find the position which is most suitable for recording and stimulating the heart, and avoid the situation that the insertion depth of the esophageal electrode catheter 201 needs to be adjusted manually and repeatedly even the position for recording electrocardio is judged due to too few electrodes, the gastric tube section of the esophageal electrode catheter 201 is provided with a plurality of electrodes 2012, and the plurality of electrodes 2012 are arranged between the beginning and the end of the gastric tube section at intervals, namely, the electrodes are arranged from one end of the gastric tube section to the other end of the gastric tube section at intervals, so that the electrodes can be bent and rotated to enter the stomach in the process of being inserted into the stomach, further go deep into the stomach, and the stomach is effectively prevented from being scratched or discomfort is caused to a patient.
Specifically, in order to further optimize the insertion depth, as shown in fig. 2 to 5, electrodes are disposed on the peripheral wall of the esophageal electrode catheter 201 in a ring shape and/or a dot shape. According to practical applications, the electrodes may be embedded, fastened, etc. to the peripheral wall of the esophageal electrode catheter 201.
Further, the electrode is embedded in the outer peripheral wall of the esophageal electrode catheter 201. The plurality of electrodes 2012 are made of non-insulating material, and the esophageal catheter body 2015 between the electrodes is made of an insulator, and as a preferred example, the electrodes are made of stainless steel 316L, and the esophageal catheter body is made of medical grade TPE plastic.
Compared with the existing esophageal electrode catheter, the esophageal electrode catheter only comprises one group of electrodes and is used for sending stimulation signals after electrocardio detection signals are detected. Further, as shown in fig. 2 to 4, the esophageal electrode catheter 201 of the present invention employs a multi-stage catheter, and at least 4 electrodes of the esophageal electrode catheter 201 are disposed for detecting electrocardiographic signals from the atrium to the ventricle. The front end 2011 of the esophageal electrode catheter can flexibly enter deeper parts of the stomach of a human body along the esophagus, and the optimal stimulation position is automatically determined by the stimulation instrument 100 without manually adjusting the depth. If the posture of the patient changes, the electrodes arranged on the esophageal electrode catheter 201 are arranged at intervals and in a large number, so that the electrodes acting on the optimal stimulation position can be re-determined even if the original electrodes at the optimal position are displaced, namely, the electrodes and the original detection position are subjected to position deviation, and the optimal stimulation state is automatically recovered.
As a further preferred example, the esophageal electrode catheter 201 used herein comprises ten to tens of electrodes, and is inserted deeper than conventional electrode catheters of the prior art, so that no matter how the patient's posture changes after insertion into the body, it is possible to ensure that there is always one set of electrodes in the optimal position with respect to the heart, as long as there is no significant accumulation of gas in the esophagus and stomach. Of course, the optimal position includes, but is not limited to, an optimal recording position, an optimal stimulation position.
As an example, the tip of the front end 2011 of the esophageal electrode catheter according to the present invention is configured with an electrode cap 2013 suitable for sealing the esophageal electrode catheter 201, so as to enhance the sealing performance of the esophageal electrode catheter 201, reduce the foreign body sensation inserted into the esophagus through the nose/mouth, and effectively prevent the esophageal electrode catheter 201 from scratching the esophagus when it is inserted into the esophagus. Here, the front end 2011 of the esophageal electrode catheter refers to the end of the esophageal electrode catheter 201 extending into the stomach, and the other end of the esophageal electrode catheter is connected to the stimulation instrument via a cable.
In the practice of the present invention, the esophageal electrode catheter 201 is inserted about 40cm from the nose. In order to avoid influencing practical use, the length of the front end 2011 of the esophageal electrode catheter from the electrode cap 2013 to the last electrode is less than 40 cm. In order to observe the insertion depth of the esophageal electrode catheter more intuitively, the scale marks 2014 can be arranged on the esophageal electrode catheter, the scale marks 2014 are arranged at intervals of 10cm at the front end of the esophageal electrode catheter from the electrode cap, the scale marks 2014 can be arranged from 10cm to 40cm, a ring-shaped mark line is taken as 10cm, and more ring-shaped mark lines are arranged at intervals of 10cm away from the end part of the front end of the esophageal electrode catheter and are taken as marked scale marks 2014.
It should be noted that, inserting the esophageal electrode catheter 201 about 40cm is a preferred example of this document, and the insertion depth can be adjusted according to different requirements of actual use.
Further, the length of the gastric tube segment provided with the plurality of electrodes 2012 at intervals is not more than 40cm, and the interval between any two adjacent electrodes is 1mm-30 mm.
Specifically, the electrode outer diameter of the esophageal electrode catheter is 0.5-30mm, and as a further preferable example, the electrode outer diameter of the esophageal electrode catheter is 1-30 mm.
Further, the electrode catheter also comprises a body surface auxiliary electrode 202, wherein the body surface auxiliary electrode 202 is electrically connected with the stimulator 100 and is used for detecting body surface electrocardiosignals on the body surface of a human body; the stimulation instrument 100 is further configured to determine an electrode in the plurality of electrodes 2012, which is located at the optimal stimulation position, according to the body surface electrocardio signal and the electrocardio detection signals of the plurality of electrodes.
Taking pacing stimulation on an atrium of a heart as an example, the stimulator 100 according to the present application obtains esophageal P-wave data corresponding to a position where each electrode is located according to an electrocardiographic detection signal fed back by the plurality of electrodes 2012, obtains a maximum value or a maximum voltage value of an amplitude of the esophageal P-wave according to the electrocardiographic detection signal, and directly compares the esophageal P-wave data with the maximum value or the maximum voltage value of the amplitude of the esophageal P-wave when reading the esophageal P-wave data without manually observing the display 102 to determine and select an optimal position one by one according to the form and the amplitude of the P-wave. Of course, the maximum value of the P-wave amplitude of the esophagus or the maximum voltage value may also be preset in the memory 103, and the stimulator 100 compares the obtained P-wave data of the esophagus with the preset maximum value of the P-wave amplitude of the esophagus or the maximum voltage value to determine whether the corresponding positions of the electrodes 2012 are the optimal positions.
In other non-optimal positions, the esophagus P wave amplitude is not as high as that of the optimal position; if a body surface auxiliary electrode 202 is added on the body surface, at this time, if the P waves of the body surface electrocardiosignals and the electrocardio detection signals of the plurality of electrodes are in a positive and negative two-way mode, and the positive direction is slightly higher than the negative direction, the esophageal electrode catheter electrode is the electrode in the optimal stimulation position in the plurality of electrodes.
Further, the stimulator 100 is further configured to determine a recording electrode from the plurality of electrodes according to the electrocardiographic detection signals of the plurality of electrodes, and the stimulator 100 is further configured to receive the electrocardiographic detection signal fed back by the recording electrode and output an electrocardiographic detection result according to the electrocardiographic detection signal fed back by the recording electrode. As an example, in actual operation, the recording electrode is arranged adjacent to the electrode of the optimal stimulation location.
In order to more intuitively display the electrocardiographic detection data and facilitate medical diagnosis for medical staff, the stimulator 100 of the present invention further has a display 102, and the stimulator 100 is configured to display the electrocardiographic detection signal on the display 102 in a form of graph and/or value. The display 102 displays the electrocardiographic detection signals and the body surface electrocardiographic data in the form of graphs/numerical values by adopting P wave images, QRS wave images and the like, and outputs electrocardiographic detection results. Medical personnel can directly know the maximum amplitude value or the maximum voltage value of the P wave and the QRS wave through the display 102, and the data displayed by the display 102 assists in deciding the electrode and the recording electrode which are positioned at the optimal stimulation position, so that the medical personnel can judge the electrocardio condition of the patient and determine whether to perform atrial pacing or not again or perform atrial and ventricular sequential pacing.
Further, the display 102 of the present document also has an alarm 104, and the alarm 104 is connected to the stimulation instrument 100. If the best position cannot be found within the preset detection time, the stimulator 100 drives the alarm 104 to give an alarm, and the medical staff determines the reason for the bad position or the bad signal. The alarm 104 may be attached to any position of an apparatus using the adaptive esophageal electrode catheter system, and the alarm 104 may be connected to the stimulation apparatus 100 through an electrical connection or a wireless connection, without limiting the present disclosure.
By way of example, in an adaptive esophageal electrode catheter system of the present invention, the stimulator 100 is implemented to include the following steps:
step S1, recognizing the electrocardio detection signals of a plurality of electrodes within preset detection time;
step S2, determining the electrode at the best stimulation position in the plurality of electrodes according to the electrocardio detection signals of the plurality of electrodes;
step S3, displaying the electrocardio detection signal on a display in a graph and/or numerical value form;
and step S4, according to the pacing control signal input by the input unit, sending a therapeutic electric signal to the electrode at the optimal stimulation position so as to correspondingly start an atrial pacing mode, a ventricular pacing mode or an atrial-ventricular therapy mode.
After determining the electrode and the recording electrode at the optimal stimulation position, the stimulator can perform self-checking within a set time, and repeatedly determine the optimal position suitable for recording and stimulation.
As one of the preferred examples, an atrial pacing mode is initiated, in which the stimulator is used to perform pacing stimulation to the cardiac atrial location, and specifically includes the following steps:
step S11, recognizing the electrocardio detection signals of a plurality of electrodes within preset detection time;
step S21, determining the position of the heart atrium and the electrode at the optimal stimulation position of the heart atrium in the plurality of electrodes according to the electrocardio detection signals of the plurality of electrodes;
step S31, displaying the electrocardio detection signal on a display in a P wave pattern form;
and step S41, sending therapeutic electric signals to the electrode at the optimal stimulation position of the atrium of the heart according to the pacing control signals input by the input unit, and enabling the electrode at the optimal stimulation position to send the therapeutic electric signals to the atrium.
It should be noted that, after determining the electrode at the optimal stimulation position in the plurality of electrodes, sending a therapeutic electrical signal to the electrode at the optimal stimulation position, so that the electrode at the optimal stimulation position delivers the therapeutic electrical signal to the atrium, and a time interval exists between the identification and the delivery of the stimulation, where the time interval is set according to actual operations, and the following embodiments can be analogized and will not be described again.
As a second preferred example, a ventricular pacing mode is started, in which the stimulator 100 is configured to perform pacing stimulation to a ventricular position of the heart, specifically including the following steps:
step S12, recognizing the electrocardio detection signals of a plurality of electrodes within preset detection time;
step S22, determining the position of the heart ventricle and the electrode at the optimal stimulation position of the heart ventricle in the plurality of electrodes according to the electrocardio detection signals of the plurality of electrodes;
step S32, displaying the electrocardio detection signal on a display in a QRS wave graph mode;
and step S42, according to the pacing control signal input by the input unit, sending a therapeutic electric signal to the electrode at the optimal stimulation position of the heart ventricle, so that the electrode at the optimal stimulation position sends the therapeutic electric signal to the ventricle.
As a third preferred example, an atrial-ventricular therapy mode is selected, and in the atrial-ventricular sequential pacing mode, the stimulator 100 determines the positions of the atrium and the ventricle of the heart first, performs atrial pacing stimulation, and then performs ventricular pacing stimulation, specifically including the following steps:
step S13, recognizing the electrocardio detection signals of a plurality of electrodes within preset detection time;
step S23, determining the positions of the atrium and the ventricle of the heart and the electrode at the optimal stimulation position of the atrium and the ventricle of the heart in the plurality of electrodes according to the electrocardio detection signals of the plurality of electrodes;
step S33, displaying the electrocardio detection signals on a display in a form of P wave and QRS wave graphs;
step S43, according to the pace-making control signal input by the input unit, sending a therapeutic electric signal to the electrode at the optimal stimulation position of the heart atrium, and enabling the electrode at the optimal stimulation position to send the therapeutic electric signal to the atrium;
and step S53, sending therapeutic electric signals to the electrodes at the optimal stimulation position of the heart ventricle within the preset stimulation time, so that the electrodes at the optimal stimulation position send the therapeutic electric signals to the ventricle.
It should be noted that, the electrodes automatically detect the beating heart to obtain the electrocardiographic detection signals, and after the heart completes a cardiac cycle, the P waves and QRS waves for obtaining the atria and ventricles of the heart are automatically identified, so that the positions of the atria and ventricles can be automatically determined.
The preset stimulation time refers to a time interval for performing ventricular pacing after atrial pacing is completed according to actual operation, and the time interval needs to be set according to actual operation needs of a patient, and is not described herein again.
Preferably, the cardiac electrical signal is displayed on the display in the form of a P-wave pattern, for example, to initiate an atrial pacing mode. In the case where no body surface auxiliary electrode is provided or no instrument auxiliary electrode is used as a reference, the above-mentioned stimulator determines the electrode at the optimal stimulation position among the plurality of electrodes according to the electrocardiographic detection signals of the plurality of electrodes, that is, step S2 specifically includes the following steps:
acquiring P-wave data corresponding to the position of each electrode according to the electrocardio detection signals of the plurality of electrodes;
judging whether the P wave data is matched with the maximum amplitude value or the maximum voltage value of the P wave:
if so, taking a group of electrodes corresponding to the P wave data as a target electrode group, determining an electrode and a recording electrode which are positioned at the optimal stimulation position in the plurality of electrodes according to the target electrode group, and outputting an electrocardio detection result according to an electrocardio detection signal fed back by the recording electrode;
if the target electrode group can not be screened out by reading the P-wave data corresponding to the plurality of electrodes for multiple times within the preset detection time, repeatedly identifying the electrocardio detection signals of the plurality of electrodes, and repeatedly executing the steps;
and if the target electrode group can not be screened out after the preset detection time is exceeded, driving the alarm to work.
And determining the optimal position according to the form and amplitude of the P wave, and taking a group of electrodes with the highest P wave amplitude or the highest voltage as the optimal position electrode combination.
As another preferable example, the medical treatment device further comprises a body surface auxiliary electrode, and when the medical treatment device is at other non-optimal positions, the amplitude of the P wave is not as high as that at the optimal position; if a body surface auxiliary electrode is added on the body surface, at the moment, if the P waves of the body surface electrocardiosignals and the electrocardio detection signals of the plurality of electrodes are in a positive and negative two-way mode, and the positive direction is slightly higher than the negative direction, the esophageal electrode catheter electrode is the electrode in the optimal stimulation position in the plurality of electrodes. Specifically, step S2 specifically includes the following steps:
acquiring P-wave data corresponding to the position of each electrode according to the electrocardio detection signals of the plurality of electrodes;
judging whether the P wave data is matched with the maximum amplitude value or the maximum voltage value of the P wave:
if so, taking a group of electrodes corresponding to the P wave data as a target electrode group, determining an electrode and a recording electrode which are positioned at the optimal stimulation position in the plurality of electrodes according to the target electrode group, and outputting an electrocardio detection result according to an electrocardio detection signal fed back by the recording electrode;
otherwise, comparing the P wave data with the acquired body surface detection data, and determining the electrode corresponding to the P wave data as the electrode at the optimal stimulation position in the plurality of electrodes when the body surface P wave data of the P wave data and the body surface detection data are in positive and negative directions and the positive direction is slightly higher than the negative direction;
if the electrode at the optimal stimulation position still cannot be screened out by reading the P wave data corresponding to any one electrode for multiple times within the preset detection time, repeatedly reading and identifying the electrocardio detection signals transmitted by the electrodes, and repeatedly executing the steps to determine the electrode closest to the cardiac stimulation position;
and if the target electrode group can not be screened out after the preset detection time is exceeded, driving the alarm to work.
It should be noted that, in this embodiment, the P-wave data is used to determine the electrode located in the optimal stimulation position of the heart atrium among the plurality of electrodes, when the electrode is close to the ventricular position, the waveform amplitude of the QRS wave is the largest, and the electrode located in the optimal stimulation position of the heart ventricle among the plurality of electrodes is determined by the waveform amplitude, which is not described herein again.
It should be noted that, whether to start the atrial-ventricular therapy mode, the atrial pacing mode, or the ventricular pacing mode is determined by medical staff in advance according to the patient condition, and in most cases, only the atrial pacing mode needs to be started, and only under the conditions of II ° two-type and III ° atrioventricular conduction block, ventricular pacing may be needed. Sequential pacing may only be required where prolonged ventricular pacing is required in conjunction with poor cardiac function.
The self-adaptive esophageal electrode catheter system disclosed by the application comprises the following specific implementation steps:
1. the patient takes the supine position, lubricates the esophageal electrode catheter, and inserts the esophageal electrode catheter slowly through one nostril or mouth to ensure that the stomach tube section of the esophageal electrode catheter enters the stomach.
It should be noted that before inserting the esophageal electrode catheter into the human body, it is necessary to determine whether the patient is adult.
Preferably, when the patient is an adult, the esophageal electrode catheter is inserted about 40cm through the nose or mouth; when the patient is a child, the approximate distance for extending the electrode front end into the stomach is calculated according to the distance from the nose tip to the ear lobe + the distance from the nose tip to the xiphoid process of the patient.
2. The electrodes arranged along the esophageal electrode catheter body at intervals in the axial direction can receive the electric signals transmitted by the stimulator and can also send therapeutic electric signals to the heart. The method comprises the steps of starting up self-checking, identifying electrocardio detection signals of a plurality of electrodes by a stimulator within preset detection time, determining the electrode at the optimal stimulation position in the plurality of electrodes according to the electrocardio detection signals of the plurality of electrodes, displaying the electrocardio detection signals on a display in a graph and/or numerical value mode, and judging by manual assistance.
It should be noted that, after determining the electrode at the optimal stimulation position among the plurality of electrodes, the stimulator may perform self-test within a preset test time, repeatedly determine the electrode at the optimal stimulation position, and adjust according to actual needs.
Specifically, the stimulator performs self-detection within a preset detection time, repeatedly determines the electrodes at the optimal stimulation position, determines whether any two electrodes at the optimal stimulation position are reasonable or whether the electrodes need to be adjusted during use, and if the electrodes need to be adjusted, the stimulator automatically adjusts any one of the electrodes and accesses the electrophysiological examination instrument to determine the optimal stimulation position suitable for realizing pacing stimulation. The method comprises the following specific steps:
if the judgment is reasonable, the next step is executed;
if the stimulation is not reasonable, the stimulation instrument automatically adjusts the stimulation position and re-identifies the electrode at the optimal stimulation position;
if the detection time is not reasonable and exceeds the preset detection time, an alarm is given.
The preset detection time can be set on an instrument and is set to be 1min-1 day.
3. According to the operation of the medical staff on the input unit, any one of the following cardiac paces is carried out:
3.1, atrial pacing mode;
3.2, ventricular pacing mode;
3.3, atrial ventricular therapy mode.
And according to the pacing control signal input by the input unit, the stimulation instrument sends a therapeutic electric signal to the electrode at the optimal stimulation position so as to correspondingly start an atrial pacing mode, a ventricular pacing mode or an atrial-ventricular therapy mode.
Corresponding to the atrial pacing mode, the ventricular pacing mode or the atrial-ventricular therapy mode, the specific operations are as above, and are not described herein again.
The above description is only an alternative embodiment of the present invention, and is not intended to limit the scope of the present invention, and all modifications and equivalents made by the contents of the present specification and the accompanying drawings, or directly/indirectly applied to other related technical fields, which are within the spirit of the present invention, are included in the scope of the present invention.
Claims (10)
1. An adaptive esophageal electrode catheter system, comprising:
a stimulator;
the esophagus electrode catheter is provided with a plurality of electrodes which are arranged at intervals along the axial direction of the esophagus electrode catheter, and the electrodes are connected with the stimulation instrument;
the stimulator is used for identifying the electrocardio detection signals transmitted by the electrodes, determining the electrode in the optimal stimulation position in the electrodes according to the electrocardio detection signals of the electrodes, and sending a treatment electric signal to the electrode in the optimal stimulation position.
2. The adaptive esophageal electrode catheter system of claim 1, wherein the optimal stimulation locations comprise a cardiac atrial location and a cardiac ventricular location.
3. The adaptive esophageal electrode catheter system of claim 2, wherein the stimulation meter has an atrial pacing mode in which the stimulation meter is configured to pace stimulation to a cardiac atrial location;
the stimulator has a ventricular pacing mode in which the stimulator is configured to perform pacing stimulation to a ventricular location of a heart;
the stimulator has an atrial and ventricular therapy mode, and under the atrial and ventricular sequential pacing mode, the stimulator firstly determines the positions of a cardiac atrium and the cardiac ventricle, and performs atrial pacing stimulation firstly and then performs ventricular pacing stimulation during cardiac pacing.
4. The adaptive esophageal electrode catheter system of claim 3, wherein the stimulator has an input unit for inputting a pacing control signal to correspondingly initiate the atrial pacing mode, the ventricular pacing mode, or the atrial ventricular therapy mode.
5. The adaptive esophageal electrode catheter system of any one of claims 1-4, wherein the esophageal electrode catheter has a gastric tube segment for insertion into the stomach, and wherein a plurality of said electrodes are spaced between the beginning and end of said gastric tube segment.
6. The adaptive esophageal electrode-catheter system of any of claims 1-4, wherein the electrodes are disposed in a ring and/or dot shape on the peripheral wall of the esophageal electrode-catheter.
7. The adaptive esophageal electrode catheter system of claim 6, wherein the electrode is embedded in the outer peripheral wall of the esophageal electrode catheter.
8. The adaptive esophageal electrode-catheter system according to claim 1, wherein the electrode-catheter further comprises a body surface auxiliary electrode electrically connected to the stimulator for detecting body surface electrocardiosignals on the body surface of the human body;
the stimulation instrument is also used for determining the electrode in the optimal stimulation position in the plurality of electrodes according to the body surface electrocardio signals and the electrocardio detection signals of the plurality of electrodes.
9. The adaptive esophageal electrode catheter system of claim 1, wherein the stimulator is further configured to determine a recording electrode from the plurality of electrodes according to the electrocardiographic detection signals of the plurality of electrodes, and the stimulator is further configured to receive the electrocardiographic detection signal fed back by the recording electrode and output an electrocardiographic detection result according to the electrocardiographic detection signal fed back by the recording electrode.
10. The adaptive esophageal electrode catheter system of claim 9, wherein the stimulator further comprises a display, and wherein the stimulator is configured to display the electrocardiographic detection signal on the display in a graphical and/or numerical form.
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| CN202210006440.2A CN114515153A (en) | 2022-01-04 | 2022-01-04 | Self-adaptive esophageal electrode catheter system |
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