EP2265239B1 - Appliance for diagnosis, performance and/or regulation of physiological functions, in particular in an anaesthetized patient - Google Patents
Appliance for diagnosis, performance and/or regulation of physiological functions, in particular in an anaesthetized patient Download PDFInfo
- Publication number
- EP2265239B1 EP2265239B1 EP09732481.8A EP09732481A EP2265239B1 EP 2265239 B1 EP2265239 B1 EP 2265239B1 EP 09732481 A EP09732481 A EP 09732481A EP 2265239 B1 EP2265239 B1 EP 2265239B1
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- European Patent Office
- Prior art keywords
- pressure
- patient
- control device
- temperature
- sleeve
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Images
Classifications
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Definitions
- the invention relates to a device for the diagnosis, execution and / or regulation of physiological functions.
- ventilation is performed in a general anesthesia with positive pressures, whereby the redistribution of the circulating blood volume from intrathoracic to extrathoracic is intensified.
- a compensatory increase in heart rate usually remains, as the counter-regulation by the sympatheticus is inhibited by anesthetics.
- US 2008/045866 A1 discloses an apparatus for diagnosing, performing and / or regulating physiological functions, particularly in an anesthetized patient, comprising a pressure cuff adapted to be attached to at least one arm and / or at least one leg of a patient, the length of the Pressure cuff is selected such that the pressure cuff extends at least 20cm towards the heart, pressure increasing means and pressure decreasing means associated with the pressure cuff for applying external compression to the at least one arm and / or the at least one leg, at least one sensor for Detecting a blood pressure of the patient, and a controller arranged to receive signals from the at least one sensor and to control the pressure increasing and decreasing means in dependence on the signal values of the at least one sensor.
- the object of the present invention was to provide a device for the diagnosis, execution and / or regulation of physiological functions, which avoid the disadvantages of the prior art.
- the effects of an inventive device are at least partially compensated by the inventive device, at least partially, the effects of anesthesia introduction. It can be counteracted by the device according to the invention the redistribution of the circulating blood volume by suitable external compression. At the same time, the patient core temperature is thereby preferably also increased
- the diagnostic application is also opened up in order to determine whether the patient's heart would respond to a volume dose, i. whether it is volume-responsive, which determines which part of the Frank Starling curve the heart is working on.
- a volume dose i. whether it is volume-responsive, which determines which part of the Frank Starling curve the heart is working on.
- diagnostic compression e.g. There is an increase in the venous return current and increase in the preload of the heart, which increases the stroke volume of the volume-responsive heart in the extremities or the lower half of the body.
- the indication for the administration of cardiovascular active medication can be made.
- a pressure device (10) is a device with which an external pressure can be applied to at least part of the limb of the patient.
- the printing device 10 is based on the principle of compression
- the pressure device comprises at least one pressure cuff (11).
- a pressure cuff is a cuff that can be attached to a limb and then cause external compression by increasing or decreasing applied pressure.
- Such a pressure cuff can be designed similar to a piece of clothing and be designed, for example, as a pressure pants or sleeves or upper part.
- the pressure pants also includes the feet, the pressure leg also the respective foot and the pressure sleeve and the respective hand
- the pressure device extends over at least 20 cm, more preferably over at least 30 cm, most preferably over at least 40 cm of the body part towards the heart. Prints are applied in the printing device that are well below the arterial pressures.
- the pressure device is therefore designed to apply a pressure of less than the arterial pressure in the corresponding body part.
- the pressure device is therefore preferably designed to apply a pressure of less than 20 mmHg, particularly preferably less than 10 mmHg, above the corresponding venous pressure in the corresponding body part. Thus, the arterial circulation of this body part is not stopped.
- a body region or body part is an area or a part of the body of the patient, for example the upper body.
- a limb or limb is preferred at least part of the upper extremity (shoulder girdle, Arm, hand) or lower limb (hip, buttocks, thighs, lower legs, feet).
- shoulder girdle, Arm, hand or lower limb
- hip, buttocks, thighs, lower legs, feet In the foreground are the extremities, if there are no operations on them. In particular, it may also be the free extremities, for example arms or legs.
- the pressure device (10) is preferably designed for at least two extremities.
- the pressure device (10) is designed for at least one arm and / or at least one leg.
- the pressure increasing means (21) and pressure lowering means (22) are means which can increase or decrease the pressure in the pressure means (10). They represent a type of supply device for the printing device. By changing the pressure in the printing device, the externally applied pressure is changed. This can be done by the use of pumps that promote a suitable medium and thereby change the applied pressure.
- the pressure booster increases the pressure and thus increases the compression. Preferably, the pressure increase is 10 to 20 mmHg.
- the pressure used is according to the invention between the venous and the arterial blood pressure. With a human the mean venous blood pressure in the respective body regions is approximately 0 to 30 mmHg and the mean arterial blood pressure is approximately 60 to 140 mmHg.
- the procedure described above leads to a compression of the extrathoracic venous system primarily in the extremities and possibly in the abdomen.
- the thorax itself can not be used to compress the venous system.
- the applied pressure is lowered, for example in the corresponding chamber between the inside of the chamber and the skin of the patient, wherein in individual structures of the chamber, a greatly increased pressure can be used.
- the pressure on the inside of the chamber and the skin of the patient can be lowered below the atmospheric pressure.
- a suction effect is preferably exerted on the thorax, so that it comes in the expiratory phase to an enlargement of the chest and thus an inhalation of the patient can be effected.
- the exhalation may be effected passively by the retracting force of the ribcage and the lungs, or even forced (supported) exhalation may be effected by generating a positive pressure in the interior of the chamber by preferably reducing or shutting off the suction effect.
- the control device (30) is preferably a processor or a computer unit.
- the control device controls the pressure increase and decrease means.
- This control device can be discontinued exclusively for this task, for example, a processor that is installed and provided exclusively for the device according to the invention, or by a device with be taken, which already fulfills other tasks, such as an existing computer, especially a monitor that already applies to the patient.
- the control device is designed to control a pump which supplies a pressure medium via the pressure increase and decrease pressure means in the printing device or leaves out of the printing device.
- the control device may preferably also be associated with a memory.
- the pressure in the printing device is continuously controlled. It is thus possible to control the pressure preoperatively during the entire operation and the aftercare postoperatively or before anesthesia is initiated. It is thus possible to adjust the pressure again and again. By this constant adjustment of the pressure, a displacement of the blood volume within the patient can be effected. It is thus possible via the control device not only inflate the pressure device or drain medium, but to control the pressure targeted over time.
- a device in which the pressure device (10) has more than one pressure segment (15). This makes it possible to apply the external pressure even more accurate and more variant rich.
- the individual pressure segment can be controlled independently.
- a separate pressure can be set in each pressure segment by the control device, which is applied to the region of the extremity of this pressure segment.
- the pressure segments can also be controlled in groups. This makes it possible to apply a special print pattern, preferably to vary over time or to apply the same pressure in different combined into a group pressure segments. It is also conceivable to design the pressure segments jointly controllable, either with the same pressure or with different pressures in the pressure segments at the same time.
- the individual pressure segments are also tempered, also different temperature, in particular also over the time variable temperature. Temperable here means setting a temperature in the pressure segment, preferably on the conditioning of the pressure medium, more preferably the air or water, in the pressure segment of the pressure chamber or the pressure cuff. It can be an increase or a decrease of temperature.
- the segments may be at the e.g. lying on the back of patients in addition to the horizontal segmentation are also arranged vertically one above the other to be able to counteract the gravitational increased accumulation of blood in dependent (med.: dorsal or posterior) peripheral body regions by increased pressure in the lower vertical pressure segments stronger.
- an apparatus in which the pressure increasing means (21) comprise a fluid or a gas that can be supplied to the pressure device (10) or in which the pressure reduction means (22) comprise a fluid or a gas which is removable from the printing device (10). In this way, the pressure in the printing device can be easily controlled.
- a fluid is primarily water into consideration.
- the gas used is preferably room air.
- a negative pressure or subatmospheric pressure suction
- suction can thereby also be set between the inside of the chamber and the skin of the patient or by changing the segmental applied pressure according to a pressure pattern on the venous blood distribution in the patient and the venous blood flow into the relevant one peripheral body regions are influenced.
- a device is provided, in which the pressure device (10) can be controlled pneumatically or hydraulically. By a pneumatic control, for example, the compression pressure of the segments of the pressure can be easily adjusted.
- a device in which the printing device (10) is air-conditioned, in particular physiologically air-conditioned.
- Climatizable here means that the temperature and / or humidity is adjustable. This can be done by an air conditioning device. This preferably comprises tempering or a tempering and / or a moisture conditioning. In this way, it is additionally possible to regulate the body shell temperature of the patient in the area of the pressure device. It is preferably provided that the individual segments of a printing device can be individually conditioned or tempered.
- pressure chambers are provided over the lower half of the body, the arms, and possibly over the rib cage.
- the air (or the medium) in the Segments or chambers is pneumatically controlled and physiologically conditioned. All chambers are constructed either as reusable systems, but preferably as single-use systems.
- the pressure and temperature conditions in each pneumatic chamber are regulated by a supply and control device separately or together or grouped. Before induction of anesthesia can be warmed up by appropriate temperatures in the chambers (by continuous circulation tempered air or tempered water), the body shell, so that it does not lead to a drop in temperature in the body core with induction of anesthesia. This avoids the problems of intraoperative and postoperative hypothermia.
- the body shell temperature of the patient can preferably be lowered or raised in a targeted manner.
- external compression may be applied to extrathoracic body regions, particularly to the lower body and arms.
- blood from the low-pressure system venous vascular system
- the "squeezing" of the venous system is preferably carried out peristaltically, for example in a frequency range of 1-4 / minute.
- An additional applied higher-frequency modulation of the basic "Auspress" pressure leads to a vibration and even better promotion of both the arterial and the venous blood.
- the artificial infusion of fluids to maintain the intrathoracic blood volume is thereby partially or completely unnecessary.
- a tightly closing pressure chamber is provided above the thorax (chest) as a pressure device.
- the thorax chamber closes hermetically airtight around the thorax in a limp-flexible manner.
- pressure line structures are preferably incorporated (for example, pressure hoses), which take on filling with pressure medium corresponding pressure a more rigid, outwardly arching arc shape and thereby generate a negative pressure on the chest, resulting in air or breathing gas flowing into the Lungs to an enlargement of the thorax and thus leads to a Einamtung.
- the exhalation may be effected passively by the retracting force of the ribcage and the lungs, or even forced (supported) exhalation may be effected by generating a positive pressure in the interior of the chamber by, preferably, reducing or eliminating the suction effect.
- the enlargement of the thorax due to the external suction also causes an intrathoracic suction effect, which promotes the redistribution of the circulating blood volume from extra to intrathoracic.
- appropriate cyclic control of the pressure in the thoracic chamber stiffening system support or complete ventilation is possible. As a result, the same volumes could be realized in the respiratory cycle with less positive pressure of the ventilator and thus also with low intrathoracic pressures.
- control device (30) is set up to receive signals from at least one sensor (35). In this way, measured signals can be forwarded to the control device for further processing. The control device can then determine or apply a corresponding pattern for regulating the pressure in the pressure device as a function of these measured signals or measured values.
- the skin temperature, core temperature, the pulse oxymetric oxygen saturation and heart rate, conductivity and / or humidity can additionally be detected via this at least one sensor.
- at least one sensor may be provided in the thoracic chamber (s) for sensing the ECG and thoracic electrical impedance to measure heart rate, impedance cardiac output, impedance-thoracic fluid volume, and impedance tidal volume.
- a device in which the control device (30) is set up in order to be able to process venous return flow and / or preload of the heart and / or stroke volume of the heart. So can these values of the control device for adjusting the pressure are taken into account.
- a device is provided in which the control device (30) is set up, the temperature in the pressure device (10) as a function of the signal values of the sensors (35) and / or values derived therefrom, for example the pulse pressure variation PPV, global end diastolic volume, intrathoracic blood volume, cardiac output, arterial pressure, etc.
- an apparatus in which the control device (30) is arranged to control the pressure and / or the temperature in the pressure device (10) according to a pressure or temperature pattern that changes over time.
- a pressure or temperature pattern that changes over time.
- These pressure or temperature patterns are preferably variable or adjustable as a function of the measured values or the derived values.
- the control is thus preferably online, ie in a control loop in response to the measured or derived values.
- control device (30) is coupled to a monitor (39).
- the supply and control device preferably couples with a monitor.
- the monitor preferably records intrathoracic fluid and blood volumes as a sum or in individual compartments.
- the monitor preferably determines the heartbeat and cardiac output and / or continuously collects the body core temperature.
- the monitor is preferably caused to increase the compression pressure on user-selectively preselectable body compartments to a preselected maximum pressure (preferably peristaltically vibrating / oscillating) with decreasing intrathoracic fluid and blood volume and consequently decreasing cardiac output to move more blood back into the chest and increase cardiac output.
- a preselected maximum pressure preferably peristaltically vibrating / oscillating
- the compression pressure can also be lowered or even not applied at all.
- the pressure in the pressure cuff or the segments is not held constant sturdy, but there is a directed control of the individual pressure segments successively continuous pressure wave, which contributes blood quasi peristaltic with oscillating superposition of peripheral to pump centrally, for example with a Period of 15 s.
- Such a wave-like compression can be controlled the more accurate and effective, the more individual controllable pressure segments, for example, the pressure cuff or pressure pants for the lower Body region exists.
- the wave-like compression can - depending on need and cycle condition - start from atmospheric pressure or even a higher pressure and return to it.
- the peak pressure, that is the maximum pressure in the pressure pattern, of the pressure wave to be generated is chosen so that the average venous pressure in the body region to be compressed is safely exceeded, but certainly below the mean diastolic arterial pressure.
- the mean pressure of the applied pressure pattern can be below, equal to or above the venous pressure of the corresponding body region.
- the body core temperature can be controlled by appropriate heating of the peripheral and abdominal or thorax pressure chambers by appropriate control of the temperature of the air flowing through the chambers under pressure or by additional convective heating by means of other heat sources.
- the monitor preferably causes the supply and / or control device to run through a preselectable compression pressure pattern in preselectable time units in preselectable body compartments or pressure segments. This is preferably an increase and a release of the compression pressure, but it can also be a release of the compression pressure subsequent recovery.
- a device in which the pressure device (10) has at least one sealing collar (13).
- the pressure device (10) has at least one sealing collar (13).
- sealing sleeves are provided, which are formed tight fitting. These sealing cuffs can be provided, for example, around the hip at the pressure chamber compartment for the lower half of the body or at the upper arm at the extremity chambers.
- a device in which the at least one sealing collar (13) has at least one sensor (35).
- the thus accommodated sensors are so well on the patient due to the close body contact of the sealing cuff.
- the sealing cuffs therefore preferably have various noninvasive biosensors, e.g. for ECG, temperature, oscillometric or other blood pressure measurement, sphygmomanometry, pulse oximetry, electrical impedance tomography and / or electrical impedance cardiography.
- biosensors e.g. for ECG, temperature, oscillometric or other blood pressure measurement, sphygmomanometry, pulse oximetry, electrical impedance tomography and / or electrical impedance cardiography.
- disposable biosensors can also be provided in the corresponding disposable collars or already incorporated.
- the chamber system is designed so that it obstructs as little as possible the actually operation.
- the chamber systems for the lower half of the body could also serve as a storage surface for surgical instruments, etc.
- a pressure sleeve has been described as embodiment of the invention, which encloses the corresponding body part.
- the pressure cuff air is preferably used as the medium and in addition to the pneumatic control of the compression pressure is preferably a temperature of the cuff by continuous circulation tempered air to prevent heat loss of the body and to transfer heat to the body can.
- All sleeves can be constructed either as reusable systems, but preferably as disposable systems.
- the pressure cuffs are preferably designed individually for each of the legs, including the feet 2.
- the pressure cuffs are designed in the sense of a "pressure pants” as pants, which closes at the level of the pelvic girdle.
- single arm cuffs are provided with the inclusion of the hands, as well as a "pressure jacket”.
- a particular advantage of the pressure cuff is the almost ideal protection against storage damage which can be achieved at the same time.
- a whole-body surgical suit is provided. This can be attracted to the patient already on station.
- the surgical field is preferably previously prepared sterile on station and is located under a transparent window in the surgical suit.
- the sterile covers are preferably integrated in the suit and are only deployed at the beginning of the operation. All connections of the biosensors and the pneumatic / climatic control are preferably designed flange. This allows an enormous process advantage in the perioperative process.
- FIG. 1 shows a schematic view of an embodiment of an apparatus of the present invention.
- a device 1 for the diagnosis, execution and / or regulation of physiological functions, in particular in an anesthetized patient, comprises a pressure device 10.
- This pressure device 10 is designed as a pressure cuff in the form of a sleeve for an upper arm with an attached hand part in the form of a glove.
- a control device 30 is provided which is connected to a pressure increasing means 21 and a pressure reducing means 22.
- the pressure increasing means 21 and the pressure reducing means 22 are connected via lines 25.1 and 25.2 to the printing device 10.
- the printing device 10 consists of six pressure segments 15.1 to 15.6.
- pressure segments 15.1 to 15.6 are arranged along the arm to be encompassed by the printing device at regular intervals so that they represent approximately equal sections adjacent to each other.
- the first five pressure segments 15.1 to 15.5 are designed as pressure cuffs with a cylindrical cross section, in which the arm can be inserted.
- the sixth section is designed as a pressure segment 15.6 in the form of a glove into which the hand can be inserted.
- the individual pressure segments 15.1 to 15.6 are through the pressure increasing means 21 and pressure reducing means 22 via the lines 25.1 and 25.2 individually controllable.
- temperature control means 29 are connected, via which the medium used in the pressure increasing means 21 and pressure reducing means 22, here air, can be tempered.
- the temperature control means 29 is also connected to the control unit 30, so that it can be controlled via the control unit 30.
- the pressure cuff and sensors 35.1 and 35.2 are provided.
- the sensor 35.1 is a temperature sensor and the sensor 35.2 is a sensor for measuring the moisture of the skin.
- an arm of a patient is inserted into the pressure device 10 in the form of a sleeve with the glove section 15.6.
- the sensors 35.1 and 35.2 are fixed on the skin.
- the pressure segments 15.1 to 15.6 are now set to a predetermined pressure. This pressure is applied to the patient's arm.
- the controller 30 now controls the pressure increasing means 21 and the pressure reducing means 22 so that a pressure wave is sent across the segments 15.6 to 15.1.
- the segments 15.1 to 15.6 can also be controlled in groups and the pressure in all these segments can be increased and decreased periodically. This also shifts the blood volume in the body.
- the tempering device 29 can be used to temper the air or the pressurized fluid, which is then conducted into the sleeve. This allows the cuff to be heated or cooled to control the temperature of the arm. Alternatively, it would also be possible for the Tempering device 29 is incorporated directly as a heating coil in the pressure cuff and generates heat or cold there electrically or chemically.
- FIG. 2 shows a view of another embodiment of the present invention for the legs.
- the device for diagnosis, execution and / or regulation of physiological functions 1 comprises a pressure device 10, which is designed in the form of a "trouser". These "pants” each include a leg dress with bootlet and a section for the hip area. At the top, this pressure device 10 is limited by a sealing collar 13.
- the "pressure pants” 10 further comprises individual pressure segments 15. 1 to 15.7, which are arranged adjacent to each other from the hip area to the footlet.
- the pressure device 10 or the individual pressure segments 15.1 to 15.7 are connected via lines 25.1 to 25.7 with a control device 40.
- the control device 40 comprises pressure increasing means 21 and pressure reducing means 22, an air conditioning device 27 and a control device 30.
- the air conditioning device 27 comprises moisture conditioning means 28 and temperature control means 29.
- In the region of the sealing sleeve 13 is a sensor 35th arranged by the contact pressure of the Sealing collar 13 is fixed on the skin of the patient.
- the patient is now the "pressure pants" 10 is tightened and sealed by means of the sealing sleeve 13 in the hip area against the skin of the patient so that air from the pressure pants 10 can not escape.
- the control device 40 is now applied via the pressure increasing means 21 and pressure reducing means 22, a printing pattern.
- This ambient air is pressed or subtracted in the individual pressure segments.
- the pressure segments 15.2 to 15.7 can be joined together either for both legs, so that a print pattern acts in parallel on the corresponding body regions under the respective pressure segments. It is also conceivable to provide pressure segments 15.2 to 15.7 separately for the right and the left leg and to control the individual pressure segments 15.2 left to 15.7 left and 15.2 right to 15.7 right individually and separated from each other.
- the air conditioning device 27 it is possible to adjust the temperature or humidity of the air supplied via the lines 25.1 to 25.7.
- the jacket temperature of the patient can be regulated.
- Temperature or humidity of the patient or the air in the pressure chambers can be detected via the sensor 35. This measured value can be supplied again as the regulating device in order to readjust temperature and humidity via the air-conditioning device 27.
- Peristaltic and rhythmic compression can be used to avoid infusion. It can also promote the peripheral circulation become.
- these pressure pants embolic prophylaxis is possible.
- FIG. 3 shows a view of an example of the rib cage.
- a printing device 10 is provided in the form of a "vest".
- the sealing collars are designed to fit against the skin of the patient without exerting any pressure on the patient. Preferably, these sealing collars are sealed by using, for example, gel between the sealing sleeve and the skin.
- pressure segments 15.1 are provided in the form of tubular chambers and fixedly attached to the pressure vest.
- pressure segments 15.2 are also provided in the form of tubular chambers.
- These pressure segments 15.2 and 15.2 are preferably designed for a high pressure, preferably up to a bar and especially longitudinally stretchable, but not in diameter stretchable. They may be made of silicone, for example, so that change such hoses when using such pressures in length and thus lead to an expansion or a reduction of the vest. It is also conceivable that these tubular pressure chambers are ruffled applied to the vest or sewn, ie as a kind of Zieharmonikaschlauch. It would then be fixed on the side of the contact with the vest more material of the tubular pressure segment per stretch, as on the side facing away from the vest is present. This would also expand the vest when inflating such Zieharmonika Quilt Designen depending on the nature of the application.
- the pressure vest itself has at least one pressure segment 15.3, via which pressure can be applied directly to the surface of the patient in the region of the vest.
- the individual pressure segments 15.1 to 15.3 are connected via hose lines 25.1 to 25.3 with the control device 40 - for example, as in FIG. 2 - connected.
- About the pressure segments 15.3 can again similar to the embodiments of the FIGS. 1 and 2 a pressure pattern is exerted on the patient and the body temperature is regulated.
- the pressure is here in the venous pressure range or slightly above (0-30 torr).
- the pressure segment 15.3 is acted rhythmically and vibrating with pressure. About the tubular pressure segments 15.1 and 15.2, however, can be supported by appropriate action, the breathing of the patient or even performed independently. This should be based on the FIGS. 4a and 4b will be explained in more detail.
- FIG. 4 a shows another view of the example FIG. 3 in the inhaled state.
- the lines and the control device off FIG. 3 are not shown here again.
- Now compressed air has been introduced into the only longitudinally stretchable pressure segments 15.2 and these then expand.
- the pressure segments 15.1 are pressureless or even supplied with subatmospheric pressure, which is a Shortening causes and overall erecting the structure similar to the change in the rib position during spontaneous inhalation has the consequence.
- subatmospheric pressure which is a Shortening causes and overall erecting the structure similar to the change in the rib position during spontaneous inhalation has the consequence.
- the vest is widened and thereby exerted a suction effect on the chest.
- the chest raises and simultaneously the patient breathes.
- FIG. 4 b shows another view of the example FIG. 3 in the exhaled state.
- the compressed air from FIG. 4 a drained again and now the tubular pressure segments 15.2 pull back together (for acceleration or "forced exhalation" they can be contracted with subatmosppianm pressure), at the same time the pressure segments 15.1 are pressurized, which in total - as in spontaneous breathing - to lower the Rib cage leads.
- This is preferably supported by an appropriate choice of material for these tubular pressure segments 15.1 and 15.2, for example, by being formed from an elastic, only longitudinally stretchable material and biased so that they are in the deflated state of FIG. 4 b exercise a slight pressure on the chest.
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Description
Die Erfindung betrifft eine Vorrichtung zur Diagnose, Ausführung und/ oder Regulierung physiologischer Funktionen.The invention relates to a device for the diagnosis, execution and / or regulation of physiological functions.
Allein in Deutschland werden derzeit acht Millionen operative Eingriffe pro Jahr durchgeführt, der weit überwiegende Teil hiervon am anästhesierten Patienten. Eine Anästhesie in nahezu jeder Form, insbesondere eine Vollnarkose, ist jedoch grundsätzlich nicht nur mit einer Ausschaltung des Bewusstseins verbunden, sondern hiermit einhergehend auch mit einer partiellen Ausschaltung von neuro-humoralen Regulationsmechanismen, die der Aufrechterhaltung einer normalen Herzkreislauffunktion und eines normalen Stoffwechsels dienen. Durch die allgemeine Dämpfung des Zentralnervensystems kommt es auch zu einem verminderten Sympathikotonus mit folgenden Auswirkungen:
- Der Gefäßtonus wird allgemein vermindert, insbesondere jedoch auch im Niederdrucksystem. Infolge der Vasodilatation kommt es zu einer Umverteilung des zirkulierenden Blutvolumens von intrathorakal nach extrathorakal, der venöse Rückstrom und die Füllung des Herzens nehmen ab.
- The vascular tone is generally reduced, but especially in the low pressure system. As a result of vasodilation, there is a redistribution of the circulating blood volume from intrathoracic to extrathoracic, the venous return and the filling of the heart decrease.
Aufgrund der verminderten Herzfüllung reduziert sich das Schlagvolumen, als Folge hiervon ist ein Blutdruckabfall zu beobachten.Due to the reduced heart filling, the stroke volume is reduced, as a result of which a drop in blood pressure is observed.
Zusätzlich wird im Regelfall bei einer Allgemeinanästhesie mit positiven Drucken eine Beatmung durchgeführt, wodurch die Umverteilung des zirkulierenden Blutvolumens von intrathorakal nach extrathorakal verstärkt wird.In addition, as a rule, ventilation is performed in a general anesthesia with positive pressures, whereby the redistribution of the circulating blood volume from intrathoracic to extrathoracic is intensified.
Ein kompensatorischer Anstieg der Herzfrequenz bleibt in der Regel aus, da die Gegenregulation durch den Sympathikus durch Anästhetika gehemmt wird.A compensatory increase in heart rate usually remains, as the counter-regulation by the sympatheticus is inhibited by anesthetics.
Weiterhin bewirkt die Umverteilung des zirkulierenden Blutvolumens mit Einleitung einer Anästhesie eine Abnahme der Temperaturgradienten, die normalerweise zwischen Körperschale und Körperkern bestehen. Als Folge hiervon kommt es zu einem zentralen Temperaturabfall, während die Temperatur in den äußeren Körperschichten leicht ansteigt. Auch hier bleibt die Gegenregulation aus, da bekanntermaßen durch Anästhetika die Regelungsschwelle zu niedrigeren Temperaturen verschoben wird. Das Problem offenbart sich jedoch oft umso ausgeprägter am wieder erwachten Patienten, bei dem plötzlich aufgrund der erniedrigten Körperkerntemperatur eine massive Gegenregulation mit Kältezittern (shivering), etc. einsetzt. Dies stellt nicht selten eine erhebliche Belastung für Patienten in der Aufwachphase dar.Furthermore, the redistribution of the circulating blood volume with induction of anesthesia causes a decrease in the temperature gradients that normally exist between the body shell and the body core. As a result, there is a central temperature drop while the temperature in the outer body layers increases slightly. Here, too, the counterregulation remains, since it is known that anesthetics shift the regulatory threshold to lower temperatures. However, the problem often manifests itself more pronounced on the patient who has rereaded, in which suddenly a massive counterregulation with shivering, etc., starts due to the lowered body core temperature. This is often a significant burden for patients in the recovery phase.
Zur Zeit besteht die Standardmaßnahme, um diesen Auswirkungen einer Narkose entgegenzuwirken, in der Infusion von Volumen, in der Regel in Form von kristalloiden (z.B. Ringer-Laktat-Lösung, Kochsalzlösung, etc) oder auch kolloidalen Infusionslösungen (zB. Hydroxyaethylstärke,
Plasmaproteinlösung, etc) . Dieser Maßnahme liegt unter anderem die Vorstellung zu Grunde, dass intravasal durch das Gebot der präoperativen Nüchternheit ein Volumendefizit bestehen würde, welches durch die Narkoseeinleitung demaskiert würde. Diese Annahme hat sich jedoch als falsch erwiesen. Von der alternativen Gabe von vasokonstriktorischen (Gefäßverengenden) Substanzen hat man routinemäßig bislang Abstand genommen, da dies auch mit einer Verschlechterung der Durchblutung in bestimmten Organen bzw. Gefäßarealen einhergehen kann.Currently the standard measure to counteract these effects of anesthesia is infusion of volumes, usually in the form of crystalloid (eg Ringer's lactate solution, saline, etc) or colloidal infusion solutions (eg hydroxyethyl starch,
Plasma protein solution, etc). Among other things, this measure is based on the idea that intravascularly, due to the requirement of preoperative sobriety, there would be a volume deficit which would be unmasked by the induction of anesthesia. This assumption, however, has been wrong proved. The alternative administration of vasoconstrictive (vasoconstrictor) substances has routinely been refrained from, as this may also be accompanied by a deterioration in the blood flow in certain organs or vascular areas.
Aufgabe der vorliegenden Erfindung war es, eine Vorrichtung zur Diagnose, Ausführung und/ oder Regulierung physiologischer Funktionen bereitzustellen, die die Nachteile des Standes der Technik vermeiden.The object of the present invention was to provide a device for the diagnosis, execution and / or regulation of physiological functions, which avoid the disadvantages of the prior art.
Diese Aufgabe wird gelöst durch die Vorrichtung zur Diagnose, Ausführung und/ oder Regulierung physiologischer Funktionen gemäß des unabhängigen Anspruchs. Vorteilhafte Weiterbildungen sind in den abhängigen Ansprüchen definiert.This object is achieved by the device for diagnosis, execution and / or regulation of physiological functions according to the independent claim. Advantageous developments are defined in the dependent claims.
Damit werden durch die erfindungsgemäße Vorrichtung zumindest teilweise die Auswirkungen einer erfindungsgemäße Vorrichtung zumindest teilweise die Auswirkungen einer Anästhesieeinleitung kompensiert. Es kann mit der erfindungsgemäßen Vorrichtung der Umverteilung des zirkulierenden Blutvolumens durch geeignete externe Kompression entgegengewirkt werden. Bevorzugt wird dadurch gleichzeitig auch die Patientenkerntemperatur aufThus, the effects of an inventive device are at least partially compensated by the inventive device, at least partially, the effects of anesthesia introduction. It can be counteracted by the device according to the invention the redistribution of the circulating blood volume by suitable external compression. At the same time, the patient core temperature is thereby preferably also increased
Normalwerten gehalten oder aber auch gezielt gesenkt oder erhöht, indem beispielsweise laufend ausgetauschte temperierte Luft oder temperierte Flüssigkeit als Druckmedium verwendet wird. Zum anderen ist über die erfindungsgemäße Vorrichtung auch die diagnostische Anwendung eröffnet, um festzustellen, ob das Herz des Patienten auf eine Volumengabe reagieren würde, d.h. ob es volumenresponsiv ist, wodurch feststellbar ist, auf welchem Teil der Frank-Starling-Kurve das Herz wie arbeitet. Durch die entweder therapeutische oder auch diagnostische Kompression z.B. der Extremitäten oder auch der unteren Körperhälfte kommt es zu einer Zunahme des venösen Rückstroms und Erhöhung der Vorlast des Herzens, wodurch beim volumenresponsiven Herzen das Schlagvolumen steigt. Andererseits kann mit Hilfe der Vorrichtung beim nicht-volumenresponsiven Herzen die Indikation zur Gabe von herz- bzw. kreislaufwirksamen Medikamenten gestellt werden.Normal values held or deliberately lowered or increased, for example, by continuously exchanged tempered air or tempered liquid is used as the pressure medium. On the other hand, via the device according to the invention, the diagnostic application is also opened up in order to determine whether the patient's heart would respond to a volume dose, i. whether it is volume-responsive, which determines which part of the Frank Starling curve the heart is working on. By either therapeutic or also diagnostic compression e.g. There is an increase in the venous return current and increase in the preload of the heart, which increases the stroke volume of the volume-responsive heart in the extremities or the lower half of the body. On the other hand, with the help of the device in non-volume-responsive heart, the indication for the administration of cardiovascular active medication can be made.
Eine Druckeinrichtung (10) ist eine Einrichtung, mit der auf zumindestens einen Teil der Extremität des Patienten ein externer Druck appliziert werden kann. Die Druckeinrichtung (10) basiert4 auf dem Prinzip einer KompressionA pressure device (10) is a device with which an external pressure can be applied to at least part of the limb of the patient. The
Erfindungsgemäß umfasst die Druckeinrichtung mindestens eine Druckmanschette (11). Eine Druckmanschette ist eine Manschette, die an einer Extremität angebracht werden kann und dann eine externe Kompression durch Erhöhung bzw. Erniedrigung eines applizierten Drucks zu bewirken. Eine solche Druckmanschette kann ähnlich wie ein Bekleidungsstück ausgebildet sein und beispielsweise als Druckhose oder -ärmel bzw. -oberteil ausgebildet sein.According to the invention, the pressure device comprises at least one pressure cuff (11). A pressure cuff is a cuff that can be attached to a limb and then cause external compression by increasing or decreasing applied pressure. Such a pressure cuff can be designed similar to a piece of clothing and be designed, for example, as a pressure pants or sleeves or upper part.
Die Druckhose umfasst auch die Füße, der Druckbeinling auch den jeweiligen Fuß und der Druckärmel auch die jeweilige Hand Die Druckeinrichtung erstreckt sich über mindestens 20 cm, besonders bevorzugt über mindestens 30 cm, ganz besonders bevorzugt über mindestens 40 cm des Körperteils in Richtung Herzen. Es werden Drucke in der Druckeinrichtung angewandt, die deutlich unter den arteriellen Drucken liegen. Die Druckeinrichtung ist daher so ausgebildet, um einen Druck von weniger als dem arteriellen Druck im entsprechenden Körperteil zu applizieren. Bevorzugt ist die Druckeinrichtung daher so ausgebildet, um einen Druck von weniger als 20 mmHg, besonders bevorzugt von weniger als 10 mmHg über dem entsprechenden venösen Druck im entsprechenden Körperteil zu applizieren. Damit wird die arterielle Durchblutung dieses Körperteils nicht gestoppt.The pressure pants also includes the feet, the pressure leg also the respective foot and the pressure sleeve and the respective hand The pressure device extends over at least 20 cm, more preferably over at least 30 cm, most preferably over at least 40 cm of the body part towards the heart. Prints are applied in the printing device that are well below the arterial pressures. The pressure device is therefore designed to apply a pressure of less than the arterial pressure in the corresponding body part. The pressure device is therefore preferably designed to apply a pressure of less than 20 mmHg, particularly preferably less than 10 mmHg, above the corresponding venous pressure in the corresponding body part. Thus, the arterial circulation of this body part is not stopped.
Eine Körperregion bzw. ein Körperteil ist ein Bereich oder ein Teil des Körpers des Patienten, beispielsweise der Oberkörper. Eine Extremität oder ein Gliedmaß ist bevorzugt zumindestens ein Teil der oberen Extremität (Schultergürtel, Arm, Hand) oder der unteren Extremität (Hüfte, Gesäß, Oberschenkel, Unterschenkel, Fuß). Im Vordergrund stehen hierbei die Extremitäten, sofern an diesen keine Operationen stattfinden. Es kann sich insbesondere auch um die freien Extremitäten handeln, beispielsweise Arme oder Beine. Die Druckeinrichtung (10) ist bevorzugt für mindestens zwei Extremitäten ausgebildet.A body region or body part is an area or a part of the body of the patient, for example the upper body. A limb or limb is preferred at least part of the upper extremity (shoulder girdle, Arm, hand) or lower limb (hip, buttocks, thighs, lower legs, feet). In the foreground are the extremities, if there are no operations on them. In particular, it may also be the free extremities, for example arms or legs. The pressure device (10) is preferably designed for at least two extremities.
Die Druckeinrichtung (10) ist für mindestens einen Arm und/ oder mindestens ein Bein ausgebildet. Die Druckerhöhungsmittel (21) bzw. Druckerniedrigungsmittel (22) sind Einrichtungen, die den Druck in der Druckeinrichtung (10) erhöhen bzw. erniedrigen können. Sie stellen eine Art Versorgungsgerät für die Druckeinrichtung dar. Durch die Änderung des Drucks in der Druckeinrichtung wird der extern applizierte Druck verändert. Dies kann durch die Verwendung von Pumpen erfolgen, die ein entsprechendes Medium fördern und dadurch den applizierten Druck verändern. Durch die Druckerhöhungsmittel wird der Druck erhöht und damit die Kompression verstärkt. Bevorzugt beträgt die Druckerhöhung 10 bis 20 mmHg. Der eingesetzte Druck liegt dabei erfindungsgemäß zwischen dem venösen und dem arteriellen Blutdruck. Bei einem Menschen liegt der mittlere venöse Blutdruck in den betreffenden Körperregionen bei ca. 0 bis 30 mmHg und der mittlere arterielle Blutdruck bei ca. 60 bis 140 mmHg.The pressure device (10) is designed for at least one arm and / or at least one leg. The pressure increasing means (21) and pressure lowering means (22) are means which can increase or decrease the pressure in the pressure means (10). They represent a type of supply device for the printing device. By changing the pressure in the printing device, the externally applied pressure is changed. This can be done by the use of pumps that promote a suitable medium and thereby change the applied pressure. The pressure booster increases the pressure and thus increases the compression. Preferably, the pressure increase is 10 to 20 mmHg. The pressure used is according to the invention between the venous and the arterial blood pressure. With a human the mean venous blood pressure in the respective body regions is approximately 0 to 30 mmHg and the mean arterial blood pressure is approximately 60 to 140 mmHg.
Das wie zuvor beschriebene Procedere führt primär in den Extremitäten und gegebenenfalls im Bauchraum zu einer Kompression des extrathorakalen venösen Systems. Der Brustkorb selbst kann nicht zur Kompression des venösen Systems herangezogen werden.The procedure described above leads to a compression of the extrathoracic venous system primarily in the extremities and possibly in the abdomen. The thorax itself can not be used to compress the venous system.
Durch die Druckerniedrigungsmittel wird der applizierte Druck erniedrigt, beispielsweise in der entsprechenden Kammer zwischen Kammerinnenseite und Haut des Patienten, wobei in einzelnen Strukturen der Kammer ein stark erhöhter Druck verwendet werden kann. Bevorzugt kann der Druck an der Kammerinnenseite und Haut des Patienten bis unterhalb des atmosphärischen Drucks erniedrigt werden. Dadurch wird ein Sogeffekt vorzugsweise auf den Brustkorb ausgeübt, so dass es in der Ausatmungsphase zu einer Vergrößerung des Brustkorbs kommt und damit eine Einatmung des Patienten bewirkt werden kann. In der Einatmungsphase kann durch - bevorzugt - Reduzierung oder Abstellen des Sogeffektes die Ausatmung passiv durch die Retraktionskraft des Brustkorbs und der Lunge bewirkt werden, oder aber gar eine forcierte (unterstützte) Ausatmung durch Erzeugung eines positiven Druckes in der Kammerinnenseite bewirkt werden.By the pressure reducing means the applied pressure is lowered, for example in the corresponding chamber between the inside of the chamber and the skin of the patient, wherein in individual structures of the chamber, a greatly increased pressure can be used. Preferably, the pressure on the inside of the chamber and the skin of the patient can be lowered below the atmospheric pressure. As a result, a suction effect is preferably exerted on the thorax, so that it comes in the expiratory phase to an enlargement of the chest and thus an inhalation of the patient can be effected. In the inhalation phase, the exhalation may be effected passively by the retracting force of the ribcage and the lungs, or even forced (supported) exhalation may be effected by generating a positive pressure in the interior of the chamber by preferably reducing or shutting off the suction effect.
Die Steuereinrichtung (30) ist bevorzugt ein Prozessor oder eine Recheneinheit Über die Steuereinrichtung werden die Druckerhöhungs- und Druckerniedrigungsmittel angesteuert. Diese Steuereinrichtung kann abgesetzt exklusiv für diese Aufgabe ausgebildet sein, beispielsweise ein Prozessor, der exklusiv für die erfindungsgemäße Vorrichtung eingebaut und vorgesehen ist, oder durch eine Einrichtung mit übernommen werden, die bereits andere Aufgaben erfüllt, beispielsweise ein bereits vorhandener Computer, insbesondere ein Monitor, der bereits bei dem Patienten Anwendung findet. Bevorzugt ist die Steuereinrichtung ausgebildet, eine Pumpe anzusteuern, die ein Druckmedium über die Druckerhöhungs- und Druckerniedrigungsmittel in die Druckeinrichtung zuführt bzw. aus der Druckeinrichtung herauslässt. Der Steuereinrichtung kann bevorzugt auch ein Speicher zugeordnet sein.The control device (30) is preferably a processor or a computer unit. The control device controls the pressure increase and decrease means. This control device can be discontinued exclusively for this task, for example, a processor that is installed and provided exclusively for the device according to the invention, or by a device with be taken, which already fulfills other tasks, such as an existing computer, especially a monitor that already applies to the patient. Preferably, the control device is designed to control a pump which supplies a pressure medium via the pressure increase and decrease pressure means in the printing device or leaves out of the printing device. The control device may preferably also be associated with a memory.
Über die Steuereinrichtung wird der Druck in der Druckeinrichtung kontinuierlich gesteuert . Damit ist es möglich, den Druck genau und über die gesamte Zeit der Operation sowie der Nachbetreuung postoperativ bzw. vor Einleitung einer Narkose präoperativ zu steuern. Es ist damit möglich, den Druck immer wieder anzupassen. Durch diese ständige Anpassung des Drucks kann eine Verschiebung des Blutvolumens innerhalb des Patienten bewirkt werden. Es ist somit über die Steuereinrichtung möglich, die Druckeinrichtung nicht nur aufzupumpen oder Medium abzulassen, sondern den Druck gezielt über die Zeit zu steuern.About the controller, the pressure in the printing device is continuously controlled. It is thus possible to control the pressure preoperatively during the entire operation and the aftercare postoperatively or before anesthesia is initiated. It is thus possible to adjust the pressure again and again. By this constant adjustment of the pressure, a displacement of the blood volume within the patient can be effected. It is thus possible via the control device not only inflate the pressure device or drain medium, but to control the pressure targeted over time.
In einem weiteren Ausführungsbeispiel der vorliegenden Erfindung ist eine Vorrichtung vorgesehen, bei der die Druckeinrichtung (10) mehr als ein Drucksegment (15) aufweist. Dadurch ist es möglich, den externen Druck noch mal genauer und variantenreicher zu applizieren.In a further embodiment of the present invention, a device is provided in which the pressure device (10) has more than one pressure segment (15). This makes it possible to apply the external pressure even more accurate and more variant rich.
Bevorzugt ist das einzelne Drucksegment eigenständig ansteuerbar. So kann in jedem Drucksegment durch die Steuereinrichtung ein separater Druck eingestellt werden, der auf den Bereich der Extremität dieses Drucksegments appliziert wird. Besonders bevorzugt können die Drucksegmente auch in Gruppen angesteuert werden. Dadurch ist es möglich, ein spezielles Druckmuster zu applizieren, bevorzugt auch über die Zeit zu variieren bzw. den gleichen Druck in verschiedenen zu einer Gruppe zusammengefassten Drucksegmenten zu applizieren. Denkbar ist es auch, die Drucksegmente gemeinsam ansteuerbar auszugestalten, entweder mit dem gleichen Druck oder mit unterschiedlichen Drücken in den Drucksegmenten zur selben Zeit. Bevorzugt sind die einzelnen Drucksegmente auch temperierbar, auch unterschiedlich temperierbar, insbesondere auch über die Zeit variabel temperierbar. Temperierbar bedeutet hier das Einstellen einer Temperatur in dem Drucksegment, bevorzugt über die Konditionierung des Druckmediums, besonders bevorzugt der Luft oder von Wasser, in dem Drucksegment der Druckkammer oder der Druckmanschette. Es kann sich um die Erhöhung oder die Erniedrigung der Temperatur handeln.Preferably, the individual pressure segment can be controlled independently. Thus, a separate pressure can be set in each pressure segment by the control device, which is applied to the region of the extremity of this pressure segment. Particularly preferably, the pressure segments can also be controlled in groups. This makes it possible to apply a special print pattern, preferably to vary over time or to apply the same pressure in different combined into a group pressure segments. It is also conceivable to design the pressure segments jointly controllable, either with the same pressure or with different pressures in the pressure segments at the same time. Preferably, the individual pressure segments are also tempered, also different temperature, in particular also over the time variable temperature. Temperable here means setting a temperature in the pressure segment, preferably on the conditioning of the pressure medium, more preferably the air or water, in the pressure segment of the pressure chamber or the pressure cuff. It can be an increase or a decrease of temperature.
Die Segmente können beim z.B. auf dem Rücken liegenden Patienten zusätzlich zur horizontalen Segmentierung auch vertikal übereinander segmentiert angeordnet werden, um der schwerkraftabhängigen vermehrten Akkumulation von Blut in abhängigen (med.: dorsalen od posterioren) peripheren Körperregionen durch erhöhten Druck in den vertikal unten liegenden Drucksegmenten stärker entgegen wirken zu können.The segments may be at the e.g. lying on the back of patients in addition to the horizontal segmentation are also arranged vertically one above the other to be able to counteract the gravitational increased accumulation of blood in dependent (med.: dorsal or posterior) peripheral body regions by increased pressure in the lower vertical pressure segments stronger.
In einem weiteren Ausführungsbeispiel der vorliegenden Erfindung ist eine Vorrichtung vorgesehen, bei der die Druckerhöhungsmittel (21) ein Fluid oder ein Gas umfassen, das der Druckeinrichtung (10) zuführbar ist, bzw. bei der die Druckerniedrigungsmittel (22) ein Fluid oder ein Gas umfassen, das der Druckeinrichtung (10) abziehbar ist. Auf diese Weise kann der Druck in der Druckeinrichtung einfach geregelt werden.In a further embodiment of the present invention, an apparatus is provided in which the pressure increasing means (21) comprise a fluid or a gas that can be supplied to the pressure device (10) or in which the pressure reduction means (22) comprise a fluid or a gas which is removable from the printing device (10). In this way, the pressure in the printing device can be easily controlled.
Als Fluid kommt in erster Linie Wasser in Betracht. Als Gas wird bevorzugt Raumluft eingesetzt. Besonders bevorzugt kann durch die Druckeinrichtung dadurch auch zwischen Kammerinnenseite und Haut des Patienten ein Unterdruck bzw. subatmosphärischer Druck (Sog)eingestellt werden bzw. durch den Wechsel des segmental applizierten Drucks gemäß einem Druckmuster auf die venöse Blutverteilung im Patienten und den venösen Blutfluss in den betreffenden peripheren Körperregionen Einfluss genommen werden.
In einem weiteren Ausführungsbeispiel der vorliegenden Erfindung ist eine Vorrichtung vorgesehen, bei der die Druckeinrichtung (10) pneumatisch oder hydraulisch ansteuerbar ist. Durch eine pneumatischen Steuerung beispielsweise des Kompressionsdruckes der Segmente kann der Druck besonders einfach eingestellt werden.
In einem weiteren Ausführungsbeispiel der vorliegenden Erfindung ist eine Vorrichtung vorgesehen, bei der die Druckeinrichtung (10) klimatisierbar ist, insbesondere physiologisch klimatisierbar. Klimatisierbar bedeutet hier, dass die Temperatur und/ oder die Feuchte regulierbar ist. Dies kann durch eine Klimatisierungseinrichtung erfolgen. Diese umfasst bevorzugt Temperiermittel bzw. eine Temperiereinrichtung und/ oder eine Feuchtekonditioniereinrichtung. Auf diese Weise ist es zusätzlich möglich, die Körperschalentemperatur des Patienten im Bereich der Druckeinrichtung zu regeln. Bevorzugt ist vorgesehen, dass die einzelnen Segmente einer Druckeinrichtung individuell klimatisierbar bzw. temperierbar sind.As a fluid is primarily water into consideration. The gas used is preferably room air. Particularly preferably, a negative pressure or subatmospheric pressure (suction) can thereby also be set between the inside of the chamber and the skin of the patient or by changing the segmental applied pressure according to a pressure pattern on the venous blood distribution in the patient and the venous blood flow into the relevant one peripheral body regions are influenced.
In a further embodiment of the present invention, a device is provided, in which the pressure device (10) can be controlled pneumatically or hydraulically. By a pneumatic control, for example, the compression pressure of the segments of the pressure can be easily adjusted.
In a further embodiment of the present invention, a device is provided in which the printing device (10) is air-conditioned, in particular physiologically air-conditioned. Climatizable here means that the temperature and / or humidity is adjustable. This can be done by an air conditioning device. This preferably comprises tempering or a tempering and / or a moisture conditioning. In this way, it is additionally possible to regulate the body shell temperature of the patient in the area of the pressure device. It is preferably provided that the individual segments of a printing device can be individually conditioned or tempered.
Bei einem nicht von den Ansprüchen umfassten Beispiel sind Druckkammern über der unteren Körperhälfte, den Armen, sowie gegebenenfalls über dem Brustkorb vorgesehen. Die Luft (bzw. das Medium) in den Segmenten bzw. Kammern ist pneumatisch ansteuerbar und physiologisch klimatisiert. Sämtliche Kammern sind entweder als wiederverwendbare Systeme, vorzugsweise aber als Einmalsysteme konstruiert. Die Druck- und Temperaturverhältnisse in jeder pneumatischen Kammer werden von einem Versorgungs- und Steuerungsgerät separat oder gemeinsam oder gruppiert geregelt. Vor Einleitung einer Narkose kann durch entsprechende Temperaturen in den Kammern (durch kontinuierliche Zirkulation temperierter Luft oder temperierten Wassers) die Körperschale aufgewärmt werden, so dass es mit Einleitung der Narkose nicht zu einem Temperaturabfall im Körperkern kommt. Hierdurch werden die Probleme der intra- und postoperativen Hypothermie vermieden. Andererseits kann bevorzugt bei Verwendung eines Fluids als Druckmittel die Körperschalentemperatur des Patienten gezielt schnell gesenkt oder angehoben werden.In an example not encompassed by the claims, pressure chambers are provided over the lower half of the body, the arms, and possibly over the rib cage. The air (or the medium) in the Segments or chambers is pneumatically controlled and physiologically conditioned. All chambers are constructed either as reusable systems, but preferably as single-use systems. The pressure and temperature conditions in each pneumatic chamber are regulated by a supply and control device separately or together or grouped. Before induction of anesthesia can be warmed up by appropriate temperatures in the chambers (by continuous circulation tempered air or tempered water), the body shell, so that it does not lead to a drop in temperature in the body core with induction of anesthesia. This avoids the problems of intraoperative and postoperative hypothermia. On the other hand, when using a fluid as pressure medium, the body shell temperature of the patient can preferably be lowered or raised in a targeted manner.
Bei einem weiteren Ausführungsbeispiel kann mit Einleitung der Narkose eine externe Kompression auf extrathorakale Körperregionen, insbesondere auf die untere Körperhälfte sowie auf die Arme ausgeübt werden. Hierdurch wird Blut aus dem Niederdrucksystem (venösen Gefäßsystem) in Richtung des Herzens "ausgepresst" und nach intrathorakal verlagert. Die "Auspressung" des venösen Systems erfolgt hierbei vorzugsweise peristaltisch, beispielsweise in einem Frequenzbereich von 1-4/Minute. Eine zusätzliche angewendete höherfrequente Modulation des Grund-"auspress"druckes führt zu einer Vibration und einer noch besseren Förderung sowohl der arteriellen als auch der venösen Durchblutung. Die artifizielle Infusion von Flüssigkeiten zur Aufrechterhaltung des intrathorakalen Blutvolumens wird hierdurch teilweise oder gar ganz überflüssig.In another embodiment, upon induction of anesthesia, external compression may be applied to extrathoracic body regions, particularly to the lower body and arms. As a result, blood from the low-pressure system (venous vascular system) in the direction of the heart is "squeezed" and moved to intrathoracic. The "squeezing" of the venous system is preferably carried out peristaltically, for example in a frequency range of 1-4 / minute. An additional applied higher-frequency modulation of the basic "Auspress" pressure leads to a vibration and even better promotion of both the arterial and the venous blood. The artificial infusion of fluids to maintain the intrathoracic blood volume is thereby partially or completely unnecessary.
Bei einem weiteren nicht von den Ansprüchen umfassten Beispiel ist eine dicht schließende Druckkammer über dem Brustkorb (Thorax) als Druckeinrichtung vorgesehen. Im nicht mit Druck beaufschlagten Zustand schließt die Thoraxkammer dabei schlaff-flexibel hermetisch luftdicht um den Thorax ab. In die primär schlaff-flexible Thoraxkammer sind bevorzugt Druckleitungsstrukturen eingearbeitet (beispielsweise Druckschläuche), welche bei Füllung mit Druckmedium entsprechenden Druckes eine starrere, sich nach außen wölbende Bogenform annehmen und dadurch einen Unterdruck auf den Brustkorb erzeugen, was infolge Einströmens von Luft oder Beatmungsgas in die Lunge zu einer Vergrößerung des Brustkorbes und damit zu einer Einamtung führt. In der Einatmungsphase kann durch - bevorzugt - Reduzierung oder Abstellen des Sogeffektes die Ausatmung passiv durch die Retraktionskraft des Brustkorbs und der Lunge bewirkt werden, oder aber gar eine forcierte (unterstützte) Ausatmung durch Erzeugung eines positiven Druckes in der Kammerinnenseite bewirkt werden.
Bezüglich des Kreislaufs wird durch die Vergrößerung des Thorax infolge des externen Sogs auch ein intrathorakaler Sogeffekt bewirkt, der die Rückverteilung des zirkulierenden Blutvolumens von extra- nach intrathorakal unterstützt. Bei geeigneter zyklischer Steuerung des Drucks im Versteifungssystem der Thoraxkammer ist eine Unterstützung oder vollständige Beatmung möglich. Hierdurch könnten die gleichen Volumina im respiratorischen Zyklus mit geringerem positivem Druckaufwand des Beatmungsgerätes und damit auch mit geringen intrathorakalen Drucken realisiert werden. Im Idealfall ist eine vollständige externe mechanische Beatmung nach dem Prinzip der eisernen Lunge durch externen Sog am Brustkorb gewährleistet. In diesem Fall wäre lediglich eine Atemwegssicherung (Gewährleistung eines freien Atemwegszugangs) und eine Aspirationsschutz (Abdichtung des Atemweges zur Verhinderung von Einatmung von Magenflüssigkeit) z.B. durch eine Larynxmaske ausreichend, um die eine Anästhesie durchzuführen.In a further example not encompassed by the claims, a tightly closing pressure chamber is provided above the thorax (chest) as a pressure device. In the non-pressurized state, the thorax chamber closes hermetically airtight around the thorax in a limp-flexible manner. In the primarily flaccid-flexible thorax chamber pressure line structures are preferably incorporated (for example, pressure hoses), which take on filling with pressure medium corresponding pressure a more rigid, outwardly arching arc shape and thereby generate a negative pressure on the chest, resulting in air or breathing gas flowing into the Lungs to an enlargement of the thorax and thus leads to a Einamtung. In the inhalation phase, the exhalation may be effected passively by the retracting force of the ribcage and the lungs, or even forced (supported) exhalation may be effected by generating a positive pressure in the interior of the chamber by, preferably, reducing or eliminating the suction effect.
In terms of circulation, the enlargement of the thorax due to the external suction also causes an intrathoracic suction effect, which promotes the redistribution of the circulating blood volume from extra to intrathoracic. With appropriate cyclic control of the pressure in the thoracic chamber stiffening system, support or complete ventilation is possible. As a result, the same volumes could be realized in the respiratory cycle with less positive pressure of the ventilator and thus also with low intrathoracic pressures. Ideally, complete external mechanical ventilation based on the iron lung principle is ensured by external suction on the chest. In this case, only a respiratory protection (ensuring a free Airway access) and aspiration protection (seal the airway to prevent inhalation of gastric fluid), for example, through a laryngeal mask sufficient to perform the anesthesia.
Bei der erfindungsgemäßen Vorrichtung ist die Steuereinrichtung (30) eingerichtet, Signale mindestens eines Sensors (35) zu empfangen. Auf diese Weise können gemessene Signale zur weiteren Verarbeitung an die Steuereinrichtung weitergeleitet werden. Die Steuereinrichtung kann dann in Abhängigkeit von diesen gemessenen Signalen bzw. Messwerten ein entsprechendes Muster zur Regelung des Drucks in der Druckeinrichtung bestimmen bzw. applizieren.In the device according to the invention, the control device (30) is set up to receive signals from at least one sensor (35). In this way, measured signals can be forwarded to the control device for further processing. The control device can then determine or apply a corresponding pattern for regulating the pressure in the pressure device as a function of these measured signals or measured values.
In einem weiteren Ausführungsbeispiel der vorliegenden Erfindung ist vorgesehen, dass über diesen mindestens einen Sensor zusätzlich die Hauttemperatur, Kerntemperatur, die pulsoxymetrische Sauerstoffsättigung und Herzfrequenz, Leitfähigkeit und/ oder Feuchte erfassbar ist. Des Weiteren kann mindestens ein Sensor in der Thoraxkammer (n) zur Erfassung des EKG und der thorakalen elektrischen Impedanz zur Messung der Herzfrequenz, des Impedanz-Herzzeitvolumens, des Impedanz-Thoraxflüssigkeitsvolumens und des Impedanz-Atemzugvolumens vorgesehen sein.In a further exemplary embodiment of the present invention, it is provided that the skin temperature, core temperature, the pulse oxymetric oxygen saturation and heart rate, conductivity and / or humidity can additionally be detected via this at least one sensor. Furthermore, at least one sensor may be provided in the thoracic chamber (s) for sensing the ECG and thoracic electrical impedance to measure heart rate, impedance cardiac output, impedance-thoracic fluid volume, and impedance tidal volume.
In einem weiteren Ausführungsbeispiel der vorliegenden Erfindung ist eine Vorrichtung vorgesehen, bei der die Steuereinrichtung (30) eingerichtet ist, um venösen Rückstrom und/ oder Vorlast des Herzens und/ oder Schlagvolumen des Herzen verarbeiten zu können. So können auch diese Werte von der Steuereinrichtung zur Einstellung des Drucks berücksichtigt werden. In einem weiteren Ausführungsbeispiel der vorliegenden Erfindung ist eine Vorrichtung vorgesehen, bei der die Steuereinrichtung (30) eingerichtet ist, die Temperatur in der Druckeinrichtung (10) in Abhängigkeit von den Signalwerten der Sensoren (35) und/ oder daraus abgeleiteter Werte, beispielsweise der Pulsdruckvariation PPV, dem globalen end-diastolischen Volumen, dem intrathorakalen Blutvolumen, dem Herzzeitvolumen, dem arteriellen Druck etc. einzustellen.In a further embodiment of the present invention, a device is provided in which the control device (30) is set up in order to be able to process venous return flow and / or preload of the heart and / or stroke volume of the heart. So can these values of the control device for adjusting the pressure are taken into account. In a further exemplary embodiment of the present invention, a device is provided in which the control device (30) is set up, the temperature in the pressure device (10) as a function of the signal values of the sensors (35) and / or values derived therefrom, for example the pulse pressure variation PPV, global end diastolic volume, intrathoracic blood volume, cardiac output, arterial pressure, etc.
In einem weiteren Ausführungsbeispiel der vorliegenden Erfindung ist eine Vorrichtung vorgesehen, bei der die Steuereinrichtung (30) eingerichtet ist, den Druck und/ oder die Temperatur in der Druckeinrichtung (10) nach einem über die Zeit sich verändernden Druck- bzw. Temperaturmuster zu steuern. Durch derartige Muster über die Zeit ist es möglich, gezielt auf die Verschiebung von Körperflüssigkeiten, insbesondere Blut, einzuwirken. Auch eine Beatmung des Patienten durch ein Muster mit einem Wechsel sub- und supraatmosphärischen Drucks ist realisierbar. Diese Druck- bzw. Temperatur-Muster sind bevorzugt in Abhängigkeit der gemessenen Werte bzw. der abgeleiteten Werte variierbar bzw. einstellbar. So kann bei Veränderung eines Messwerts gezielt durch Änderung des applizierten Druckmusters reagiert werden. Die Regelung erfolgt somit bevorzugt online, d.h. in einer Regelungsschleife in Antwort auf die gemessenen bzw. abgeleiteten Werte.In a further embodiment of the present invention, an apparatus is provided in which the control device (30) is arranged to control the pressure and / or the temperature in the pressure device (10) according to a pressure or temperature pattern that changes over time. Through such patterns over time, it is possible to act specifically on the displacement of body fluids, especially blood. A ventilation of the patient by a pattern with a change of sub- and supraatmospheric pressure is feasible. These pressure or temperature patterns are preferably variable or adjustable as a function of the measured values or the derived values. Thus, when changing a measured value can be specifically responded by changing the applied pressure pattern. The control is thus preferably online, ie in a control loop in response to the measured or derived values.
In einem weiteren Ausführungsbeispiel der vorliegenden Erfindung ist eine Vorrichtung vorgesehen, bei der die Steuereinrichtung (30) mit einem Monitor (39) gekoppelt ist.In a further embodiment of the present invention, a device is provided in which the control device (30) is coupled to a monitor (39).
Bevorzugt ist auch möglich, das Versorgungs- und Steuerungsgerät mit einem Monitor zu koppeln. Der Monitor erfasst bevorzugt intrathorakale Flüssigkeits- und Blutvolumina als Summe oder in Einzelkompartmenten. Der Monitor bestimmt bevorzugt das Herzschlag- und Herzzeitvolumen und/ oder erfasst laufend die Körperkerntemperatur.Preferably, it is also possible to couple the supply and control device with a monitor. The monitor preferably records intrathoracic fluid and blood volumes as a sum or in individual compartments. The monitor preferably determines the heartbeat and cardiac output and / or continuously collects the body core temperature.
Im therapeutischen Rückkopplungsmodus wird das Versorgungs- und Steuerungsgerät durch den Monitor bevorzugt veranlasst, bei sinkendem intrathorakalem Flüssigkeits- und Blutvolumen und demzufolge sinkenden Herzzeitvolumen den Kompressionsdruck auf vom Benutzer selektiv vorwählbare Körperkompartimente bis zu einem vorgewählten Maximaldruck (bevorzugt peristaltisch vibrierend/oszillierend) zu steigern, um so wieder mehr Blut in den Brustkorb zu verschieben und das Herzzeitvolumen anzuheben. Andererseits kann bei steigenden intrathorakalen Flüssigkeits- und Blutvolumina der Kompressionsdruck auch gesenkt bzw. erst gar nicht angewendet werden.In the therapeutic feedback mode, the monitor is preferably caused to increase the compression pressure on user-selectively preselectable body compartments to a preselected maximum pressure (preferably peristaltically vibrating / oscillating) with decreasing intrathoracic fluid and blood volume and consequently decreasing cardiac output to move more blood back into the chest and increase cardiac output. On the other hand, with increasing intrathoracic volumes of fluid and blood, the compression pressure can also be lowered or even not applied at all.
Vorzugsweise wird der Druck in der Druckmanschette bzw. den Segmenten nicht stur konstant gehalten, sondern es erfolgt eine gerichtete Steuerung einer die einzelnen Drucksegmente sukzessiv durchlaufenden Druckwelle, die dazu beiträgt, Blut quasi peristaltisch mit oszillierender Überlagerung von peripher nach zentral zu pumpen, beispielsweise mit einer Periodendauer von 15 s. Eine derart gestaltete wellenartige Kompression lässt sich um so genauer und effektiver steuern, aus je mehr einzelnen ansteuerbaren Drucksegmenten beispielsweise die Druckmanschette oder Druckhose für die untere Körperregion besteht. Die wellenartige Kompression kann - je nach Bedarf und Kreislaufzustand - von Atmosphärendruck oder auch einem höheren Druck starten und wieder auf diesen zurückkehren. Üblicherweise wird der Peakdruck, das heißt der maximale Druck in dem Druckmuster, der zu generierenden Druckwelle so gewählt, dass dabei der durchschnittliche venöse Druck in der zu komprimierenden Körperregion sicher überschritten wird, jedoch dabei sicher unter dem mittleren diastolischen arteriellen Druck liegt. Der Mitteldruck des applizierten Druckmusters kann dabei unter, gleich oder über dem venösen Druck der entsprechenden Körperregion liegen. Gleichzeitig kann die Körperkerntemperatur durch entsprechende Aufheizung der peripheren und Unterleib- oder Thorax-Druckkammern durch entsprechende Regelung der Temperatur der die Kammern unter Druck durchströmenden Luft oder durch zusätzliche konvektive Heizung mittels anderer Wärmequellen geregelt werden.Preferably, the pressure in the pressure cuff or the segments is not held constant sturdy, but there is a directed control of the individual pressure segments successively continuous pressure wave, which contributes blood quasi peristaltic with oscillating superposition of peripheral to pump centrally, for example with a Period of 15 s. Such a wave-like compression can be controlled the more accurate and effective, the more individual controllable pressure segments, for example, the pressure cuff or pressure pants for the lower Body region exists. The wave-like compression can - depending on need and cycle condition - start from atmospheric pressure or even a higher pressure and return to it. Usually, the peak pressure, that is the maximum pressure in the pressure pattern, of the pressure wave to be generated is chosen so that the average venous pressure in the body region to be compressed is safely exceeded, but certainly below the mean diastolic arterial pressure. The mean pressure of the applied pressure pattern can be below, equal to or above the venous pressure of the corresponding body region. At the same time the body core temperature can be controlled by appropriate heating of the peripheral and abdominal or thorax pressure chambers by appropriate control of the temperature of the air flowing through the chambers under pressure or by additional convective heating by means of other heat sources.
Im diagnostischen Rückkopplungsmodus veranlasst der Monitor das Versorgungs- und/oder Steuerungsgerät bevorzugt, ein vorwählbares Kompressiondruckmuster in einer vorwählbaren Zeiteinheit in vorwählbaren Körperkompartimenten bzw. Drucksegmenten durchzufahren: Bevorzugt ist das ein Anstieg und wieder Ablassen des Kompressionsdruckes, es kann aber auch ein Ablassen des Kompressionsdruckes mit anschließendem Wiederanstieg sein.In the diagnostic feedback mode, the monitor preferably causes the supply and / or control device to run through a preselectable compression pressure pattern in preselectable time units in preselectable body compartments or pressure segments. This is preferably an increase and a release of the compression pressure, but it can also be a release of the compression pressure subsequent recovery.
Durch ein diagnostisches Manöver wie zuvor beschrieben wird entweder temporär das intrathorakale Blutvolumen und damit das Herzschlag- und Herzzeitvolumen angehoben oder alternativ, auch abgesenkt, dies passiert aber nur, wenn das Herz volumenresponsiv ist. Das Ergebnis eines solchen Manövers wird dem Benutzer am Monitor durch entsprechende Parameter wie die Pulsdruckvariation PPV, die Variation des photoplethysmografischen Pulssignals, durch Ansteigen des Schlag- und/oder des Herzzeitvolumens und ähnliche "Volume Challenge"-Parameter angezeigt und hilft ihm bei der Entscheidungsfindung, ob die Pumpleistung des Herzens durch Volumengabe (Infusionslösungen bzw. Blut) oder durch Gabe von herzstärkenden bzw. sog. vasoaktiven Medikamenten angehoben werden kann.By means of a diagnostic maneuver as described above, either the intrathoracic blood volume and thus the heartbeat and cardiac output are temporarily raised or, alternatively, also lowered, but this happens only if the heart is volume-responsive. The result of such a maneuver is presented to the user on the monitor by appropriate parameters such as the pulse pressure variation PPV, the variation of the photoplethysmographic pulse signal, by increasing the beat and / or the cardiac output and similar "Volume Challenge" parameters displayed and helps him in the decision as to whether the pumping power of the heart by volume (infusion solutions or blood) or by the administration of cardiac vasoactive drugs can be raised.
In einem weiteren Ausführungsbeispiel ist eine Vorrichtung vorgesehen, bei der die Druckeinrichtung (10) mindestens eine Abdichtungsmanschette (13) aufweist. Bei Beispielen, die nicht von den Ansprüchen umfasst sind, kann durch eine solche Abdichtungsmanschette sichergestellt werden, dass der Druck beim Übergang der Druckkammer zum Patienten nicht (wesentlich) entweicht bzw., im Falle der Thoraxkammer, dass der erzeugte Unterdruck nicht durch Einströmen von Fremdluft gestört bzw. abgeschwächt wird.In a further embodiment, a device is provided in which the pressure device (10) has at least one sealing collar (13). In examples which are not covered by the claims, it can be ensured by such a sealing cuff that the pressure does not escape during the transition of the pressure chamber to the patient or, in the case of the thorax chamber, that the generated negative pressure does not escape by the inflow of external air is disturbed or weakened.
Bei den nicht von den Ansprüchen umfassten Druckkammersystemen wird eine hydraulische Abdichtung an den jeweiligen Übergängen vorgesehen. Hierzu sind Abdichtungsmanschetten vorgesehen, die eng anliegend ausgebildet sind. Diese Abdichtungsmanschetten können beispielsweise rund um die Hüfte bei dem Druckkammerkompartment für die untere Körperhälfte, bzw. am Oberarm bei den Extremitätenkammern vorgesehen werden.In the pressure chamber systems not covered by the claims, a hydraulic seal is provided at the respective transitions. For this purpose, sealing sleeves are provided, which are formed tight fitting. These sealing cuffs can be provided, for example, around the hip at the pressure chamber compartment for the lower half of the body or at the upper arm at the extremity chambers.
In einem weiteren Ausführungsbeispiel der vorliegenden Erfindung ist eine Vorrichtung vorgesehen, bei der die mindestens eine Abdichtungsmanschette (13) mindestens einen Sensor (35) aufweist. Die so untergebrachten Sensoren liegen damit durch den engen Körperkontakt der Abdichtungsmanschette gut am Patienten an.In a further embodiment of the present invention, a device is provided in which the at least one sealing collar (13) has at least one sensor (35). The thus accommodated sensors are so well on the patient due to the close body contact of the sealing cuff.
Die Abdichtungsmanschetten weisen damit bevorzugt verschiedene nichtinvasive Biosensoren auf, z.B. für EKG, Temperatur, oszillometrische oder andersartige Blutdruckmessung, Sphygmomanometrie, Pulsoximetrie, elektrische Impedanztomographie und/oder elektrische Impedanzkardiographie. Bevorzugt können auch Einmalbiosensoren in den entsprechenden Einmalmanschetten vorgesehen werden bzw. schon eingearbeitet sein.The sealing cuffs therefore preferably have various noninvasive biosensors, e.g. for ECG, temperature, oscillometric or other blood pressure measurement, sphygmomanometry, pulse oximetry, electrical impedance tomography and / or electrical impedance cardiography. Preferably, disposable biosensors can also be provided in the corresponding disposable collars or already incorporated.
Im Falle der Druckkammer ist das Kammersystem so konstruiert, dass es möglichst wenig die eigentlich Operation behindern. So könnte beispielsweise das Kammersysteme für die untere Körperhälfte auch als Ablagefläche für Op-Instrumentarien dienen, etc. Je nach Konstruktion ist es aus hygienischen Gründen vorteilhaft, den Innenraum ebenso wie die Außenflächen mit hygienisch einwandfreien sterilen Systemen abzudecken.In the case of the pressure chamber, the chamber system is designed so that it obstructs as little as possible the actually operation. Thus, for example, the chamber systems for the lower half of the body could also serve as a storage surface for surgical instruments, etc. Depending on the design, it is advantageous for hygienic reasons to cover the interior as well as the outer surfaces with hygienically sound sterile systems.
Wie oben beschrieben, kann neben der Druckkammer eine äußere Kompression auch durch Materialien erzielt werden, die die entsprechenden Körperteile umhüllen. Im vorliegenden Fall ist als erfindungsgemäße Ausführung eine Druckmanschette beschrieben worden, die den entsprechenden Körperteil umschließt. Bei der Druckmanschette wird als Medium bevorzugt Luft eingesetzt und neben der pneumatischen Steuerung des Kompressionsdruckes erfolgt bevorzugt eine Temperierung der Manschette durch kontinuierliche Zirkulation temperierter Luft, um Wärmeverluste des Körpers zu vermeiden und um Wärme auf den Körper übertragen zu können.As described above, in addition to the pressure chamber, external compression can be achieved also by materials that envelop the respective body parts. In the present case, a pressure sleeve has been described as embodiment of the invention, which encloses the corresponding body part. In the pressure cuff air is preferably used as the medium and in addition to the pneumatic control of the compression pressure is preferably a temperature of the cuff by continuous circulation tempered air to prevent heat loss of the body and to transfer heat to the body can.
Sämtliche Manschetten können entweder als wiederverwendbare Systeme, vorzugsweise aber als Einmalsysteme konstruiert werden.All sleeves can be constructed either as reusable systems, but preferably as disposable systems.
Für die unter Körperhälfte sind die Druckmanschetten bevorzugt einzeln für jeweils die Beine unter Einschluss der Füße2, ausgeführt. Alternativ sind die Druckmanschetten im Sinne einer "Druckhose" als Hose ausgeführt, die auf Höhe des Beckengürtels abschließt. Auch für die obere Körperhälfte, sind einzelne Armmanschetten unter Einschluss der Hände vorgesehen, ebenso wie eine "Druckjacke".For the under half of the body, the pressure cuffs are preferably designed individually for each of the legs, including the feet 2. Alternatively, the pressure cuffs are designed in the sense of a "pressure pants" as pants, which closes at the level of the pelvic girdle. Also for the upper half of the body, single arm cuffs are provided with the inclusion of the hands, as well as a "pressure jacket".
Ein besonderer Vorteil der Druckmanschette besteht in dem gleichzeitig zu erzielenden nahezu idealen Schutz vor Lagerungsschäden.A particular advantage of the pressure cuff is the almost ideal protection against storage damage which can be achieved at the same time.
Bevorzugt ist ein Gesamtkörper-OP-Anzug vorgesehen. Dieser kann dem Patienten bereits auf Station angezogen werden. Das OP-Feld wird bevorzugt zuvor ebenfalls auf Station steril vorbereitet und befindet sich unter einem Klarsichtfenster im OP-Anzug. Die sterilen Abdeckungen sind bevorzugt im Anzug integriert und werden zu OP-Beginn lediglich entfaltet. Sämtliche Anschlüsse der Biosensoren und der pneumatischen/klimatischen Steuerung sind bevorzugt flanschartig ausgeführt. Hierdurch lässt sich ein enormer Prozessvorteil im perioperativen Ablauf erzielen.Preferably, a whole-body surgical suit is provided. This can be attracted to the patient already on station. The surgical field is preferably previously prepared sterile on station and is located under a transparent window in the surgical suit. The sterile covers are preferably integrated in the suit and are only deployed at the beginning of the operation. All connections of the biosensors and the pneumatic / climatic control are preferably designed flange. This allows an enormous process advantage in the perioperative process.
Die Erfindung soll nun anhand von Figuren näher erläutert werden, wobei die
- Fig. 1
- eine schematische Ansicht eines Ausführungsbeispiels einer Vorrichtung der vorliegenden Erfindung für einen Arm;
- Fig. 2
- eine Ansicht eines weiteren Ausführungsbeispiels der vorliegenden Erfindung für die Beine;
- Fig. 3
- eine Ansicht eines Beispiels für den Brustkorb;
- Fig. 4
- a eine weitere Ansicht des Beispiels aus
Figur 3 im eingeatmeten Zustand und - Fig. 4
- b eine weitere Ansicht des Beispiels aus
Figur 3 im ausgeatmeten Zustand.
- Fig. 1
- a schematic view of an embodiment of an apparatus of the present invention for an arm;
- Fig. 2
- a view of another embodiment of the present invention for the legs;
- Fig. 3
- a view of an example of the rib cage;
- Fig. 4
- a is another view of the example
FIG. 3 in the inhaled state and - Fig. 4
- b is another view of the example
FIG. 3 in the exhaled state.
In
Im Betrieb wird ein Arm eines Patienten in die Druckeinrichtung 10 in Form eines Ärmels mit dem Handschuhabschnitt 15.6 eingeführt. Dadurch werden auch die Sensoren 35.1 und 35.2 auf der Haut fixiert. Über die Druckerhöhungsmittel 21 werden nun die Drucksegmente 15.1 bis 15.6 auf einen vorbestimmten Druck eingestellt. Dieser Druck wird auf den Arm des Patienten appliziert. Die Steuervorrichtung 30 steuert nun die Druckerhöhungsmittel 21 und die Druckerniedrigungsmittel 22 derart an, dass eine Druckwelle über die Segmente 15.6 bis 15.1 gesandt wird. Dies geschieht beispielsweise derart, dass der Druck in dem Segment 15.6 erhöht wird und anschließend der Druck im Segment 15.5 erhöht wird und verzögert im Segment 15.4 erhöht wird, während dann zeitgleich der Druck im Segment 15.6 bereits wieder erniedrigt wird, dann wird der Druck im Segment 15.3 erhöht und in 15.5 erniedrigt, dann in 15.2 erhöht und in 15.4 erniedrigt, während zeitgleich der Druck wieder in 15.6 erhöht wird und von dort nun eine zweite Welle gestartet wird, die der ersten Welle nachläuft. Hierdurch wird Blut aus dem Arm zurück in den Körper verschoben, wie es bei einer Selbstinfusion auch der Fall wäre.In operation, an arm of a patient is inserted into the
Es können die Segmente 15.1 bis 15.6 auch gruppenweise angesteuert werden und der Druck in all diesen Segmenten periodisch erhöht und erniedrigt werden. Auch hierdurch wird das Blutvolumen im Körper verschoben.The segments 15.1 to 15.6 can also be controlled in groups and the pressure in all these segments can be increased and decreased periodically. This also shifts the blood volume in the body.
Optional kann über die Temperiereinrichtung 29 die Luft oder das Druckfluid temperiert werden, die bzw. das dann in die Manschette geleitet wird. Dadurch kann die Manschette erwärmt oder gekühlt werden, um die Temperatur des Armes zu regeln.
Alternativ wäre es auch möglich, dass die
Temperiereinrichtung 29 direkt als Heizwendel in der Druckmanschette eingearbeitet ist und Wärme bzw. Kälte dort elektrisch bzw. chemisch erzeugt.Optionally, the tempering
Alternatively, it would also be possible for the
Tempering
Abdichtungsmanschette 13 auf der Haut des Patienten fixiert wird.
Sealing
Dem Patienten wird nun die "Druckhose" 10 angezogen und diese mittels der Abdichtungsmanschette 13 im Hüftbereich gegenüber der Haut des Patienten so abgedichtet, dass Luft aus der Druckhose 10 nicht entweichen kann. Durch die Regelungseinrichtung 40 wird nun über die Druckerhöhungsmittel 21 und Druckerniedrigungsmittel 22 ein Druckmuster appliziert. Hierbei wird Umgebungsluft in die einzelnen Drucksegmente gepresst bzw. abgezogen. Die Drucksegmente 15.2 bis 15.7 können dabei entweder für beide Beine zusammengeschlossen sein, so dass ein Druckmuster parallel auf die entsprechenden Körperregionen unter den jeweiligen Drucksegmenten wirkt. Es ist auch denkbar, Drucksegmente 15.2 bis 15.7 getrennt für das rechte und das linke Bein vorzusehen und die einzelnen Drucksegmente 15.2 links bis 15.7 links sowie 15.2 rechts bis 15.7 rechts einzeln und getrennt voneinander anzusteuern. Über die Klimatisierungseinrichtung 27 ist es möglich, die Temperatur bzw. die Luftfeuchtigkeit der über die Leitungen 25.1 bis 25.7 zugeführten Luft einzustellen. Damit kann die Manteltemperatur des Patienten geregelt werden. Über den Sensor 35 können Temperatur bzw. Feuchte des Patienten bzw. der Luft in den Druckkammern erfasst werden. Dieser Messwert kann als der Regelungsvorrichtung wieder zugeführt werden, um über die Klimatisierungseinrichtung 27 Temperatur und Feuchte nachregeln zu können.The patient is now the "pressure pants" 10 is tightened and sealed by means of the sealing
Auf diese Weise lässt sich eine Verschiebung des Blutvolumens unterstützen. Durch peristaltische und rhythmische Kompression lässt sich damit eine Infusionsgabe vermeiden. Es kann damit auch die peripherale Durchblutung gefördert werden. Außerdem ist durch diese Druckhose eine Embolyprophylaxe möglich.In this way, a shift of the blood volume can be supported. Peristaltic and rhythmic compression can be used to avoid infusion. It can also promote the peripheral circulation become. In addition, these pressure pants embolic prophylaxis is possible.
Abdichtungsmanschetten 13. 1 bis 13.4 vorgesehen. Die Abdichtungsmanschetten sind so ausgelegt, dass sie an der Haut des Patienten anliegen, ohne einen eigenen Druck auf den Patienten auszuüben. Bevorzugt werden diese Abdichtungsmanschetten durch Verwendung von beispielsweise Gel zwischen der Abdichtungsmanschette und der Haut abgedichtet. Längs über den Brustkorb sind in Form von schlauchförmigen Kammern Drucksegmente 15.1 vorgesehen und fest an der Druckweste angebracht. Quer über den Brustkorb sind Drucksegmente 15.2 ebenfalls in Form schlauchförmiger Kammern vorgesehen. Diese Drucksegmente 15.2 und 15.2 sind dabei bevorzugt für einen hohen Druck, bevorzugt bis zu einem bar ausgelegt und vor allem longitudinal dehnbar, nicht jedoch im Durchmesser dehnbar. Sie können beispielsweise aus Silikon gefertigt sein, so dass sich derartige Schläuche bei Anwendung solcher Drücke in der Länge verändern und so zu einer Ausdehnung oder einer Verkleinerung der Druckweste führen. Denkbar ist auch, dass diese schlauchförmigen Druckkammern gerafft auf die Weste aufgebracht bzw. aufgenäht sind, d.h. als eine Art Zieharmonikaschlauch. Dabei wäre dann auf der Seite des Kontakts mit der Weste mehr Material des schlauchförmigen Drucksegments pro Strecke fixiert, als auf der der Weste abgewandten Seite vorhanden ist. Dadurch würde die Weste beim Aufpumpen derartiger Zieharmonikastrukturen ebenfalls je nach Art der Aufbringung ausgedehnt werden. Wenn die Raffung anders herumerfolgt, d.h. auf der abgewandten Seite das schlauchförmige Element gerafft ist, dann würde die Weste zusammengedrückt werden. Die Druckweste selbst weist mindestens ein Drucksegment 15.3 auf, über das Druck direkt auf die Oberfläche des Patienten im Bereich der Weste appliziert werden kann. Die einzelnen Drucksegmente 15.1 bis 15.3 sind über Schlauchleitungen 25.1 bis 25.3 mit der Regelungseinrichtung 40 - beispielsweise aufgebaut wie die in
Im Betrieb ist es nun möglich, Druckluft über die Leitungen 25.1 bis 25.3 in die Drucksegmente 15.1 bis 15.3 zu leiten bzw. abzuziehen. Über die Drucksegmente 15.3 kann dabei wieder ähnlich wie bei den Ausführungsbeispielen der
Über die schlauchförmig ausgebildeten Drucksegmente 15.1 bzw. 15.2 kann jedoch durch entsprechende Beaufschlagung die Atmung des Patienten unterstützt oder sogar eigenständig durchgeführt werden. Dies soll anhand der
Sealing
In operation, it is now possible to conduct compressed air via the lines 25.1 to 25.3 in the pressure segments 15.1 to 15.3 or subtract. About the pressure segments 15.3 can again similar to the embodiments of the
About the tubular pressure segments 15.1 and 15.2, however, can be supported by appropriate action, the breathing of the patient or even performed independently. This should be based on the
Es ist nun Druckluft in die nur longitudinal dehnbaren Drucksegmente 15.2 eingeleitet worden und diese dehnen sich daraufhin aus. Die Drucksegmente 15.1 sind dabei drucklos oder gar mit subatmosphärischem Druck versorgt, was eine Verkürzung bewirkt und insgesamt ein Aufrichten der Struktur ähnlich der Veränderung der Rippenstellung bei spontaner Einatmung zur Folge hat. Durch diese Ausdehnung und die feste Verbindung mit der Druckweste wird die Weste aufgeweitet und dadurch eine Sogwirkung auf den Brustkorb ausgeübt. Der Brustkorb hebt sich und simultan atmet der Patient ein.
Now compressed air has been introduced into the only longitudinally stretchable pressure segments 15.2 and these then expand. The pressure segments 15.1 are pressureless or even supplied with subatmospheric pressure, which is a Shortening causes and overall erecting the structure similar to the change in the rib position during spontaneous inhalation has the consequence. By this expansion and the firm connection with the vest, the vest is widened and thereby exerted a suction effect on the chest. The chest raises and simultaneously the patient breathes.
Hier wird nun die Druckluft aus
Here is the compressed air from
Auf diese Weise ist es möglich, mit dem Beispiel nach den
- 11
- Vorrichtung zur Diagnose, Ausführung und/ oder Regulierung physiologischer FunktionenDevice for the diagnosis, execution and / or regulation of physiological functions
- 1010
- Druckeinrichtungprint Setup
- 1111
- Druckmanschettepressure cuff
- 1212
- Druckkammerpressure chamber
- 1313
- Abdichtungsmanschettesealing collar
- 1515
- Drucksegmentpressure segment
- 2121
- DruckerhöhungsmittelPressure increasing means
- 2222
- DruckerniedrigungsmittelPressure depressants
- 2525
- Leitungmanagement
- 2727
- Klimatisierungseinrichtungair conditioning unit
- 2828
- FeuchtekonditioniermittelFeuchtekonditioniermittel
- 2929
- Temperiermitteltemperature control
- 3030
- Steuereinrichtungcontrol device
- 3535
- Sensorsensor
- 4040
- Regelungseinrichtungcontrol device
- 5050
- Patientpatient
- 5353
- Körper des PatientenBody of the patient
- 5555
- Extremität des Patienten 50Limb of the patient 50
Claims (10)
- Apparatus (1) for diagnosis, implementing and/or regulating physiological functions, in particular in an anaesthetized patient comprising:- a pressure sleeve (10) configured to be placed on at least one arm and/or on at least one leg of a patient such that it encompasses the hand of the at least one arm or the foot of the at least one leg, wherein the length of the pressure sleeve (10) is selected such that the pressure sleeve (10) extends at least 20 cm in direction of the heart,- pressure increasing means (21) and pressure reducing means (22) allocated to the pressure sleeve (10) for applying an external compression on the at least one arm and/or the at least one leg,- at least one sensor (35) for detecting of a blood pressure of the patient, and- a control device (30) configured to receive signals from the at least one sensor (35) and to control continuously the pressure increasing means (21) and the pressure reducing means (22) depending on the signal values of the at least one sensor (35) and/or values derived therefrom, such that an pressure on the at least one arm and/or on the at least one leg is applied which is between the arterial pressure and the venous pressure of the patient.
- Apparatus according to claim 1, wherein the pressure sleeve (10) includes more than one pressure segment (15).
- Apparatus according to one of the proceeding claims, wherein the pressure increasing means (21) comprises a fluid or gas which is able to be supplied to the pressure sleeve (10) and/or the pressure reducing means (22) comprises a fluid or gas which is able to be drawn from the pressure sleeve (10).
- Apparatus according to one of the preceding claims, wherein the pressure sleeve (10) is pneumatically and/or climatically controllable.
- Apparatus according to one of the preceding claims, wherein the skin temperature, core temperature, conductivity and/or moisture is additionally detectable via the at least one sensor (35).
- Apparatus according to one of the preceding claims, wherein the control device (30) is set up to be able to process venous return-flow and/or pre-load of the heart and/or beat volume of the heart such that these values can be considered for setting of the pressure by the control device.
- Apparatus, according to one of the preceding claims, wherein the control device (30) is set up to adjust the temperature in the pressure sleeve (10) according to the signal values of the sensors (35) and/or values derived therefrom.
- Apparatus, according to one of the preceding claims, wherein the control device (30) is set up to regulate the pressure and/or the temperature in the pressure sleeve (30) according to the pressure or temperature pattern which varying over time.
- Apparatus according to one of the preceding claims wherein the control device (30) is coupled with a monitor (39).
- Apparatus according to one of the preceding claims, wherein the pressure sleeve (10) includes at least one sealing collar (13), wherein the at least one sealing collar includes the at least one sensor (35).
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
DE102008019647A DE102008019647A1 (en) | 2008-04-18 | 2008-04-18 | Device for the diagnosis, execution and / or regulation of physiological functions, in particular in an anesthetized patient |
PCT/EP2009/002837 WO2009127427A1 (en) | 2008-04-18 | 2009-04-17 | Appliance for diagnosis, performance and/or regulation of physiological functions, in particular in an anaesthetized patient |
Publications (2)
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EP2265239A1 EP2265239A1 (en) | 2010-12-29 |
EP2265239B1 true EP2265239B1 (en) | 2016-10-12 |
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EP09732481.8A Active EP2265239B1 (en) | 2008-04-18 | 2009-04-17 | Appliance for diagnosis, performance and/or regulation of physiological functions, in particular in an anaesthetized patient |
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US (2) | US20110098741A1 (en) |
EP (1) | EP2265239B1 (en) |
JP (1) | JP5497004B2 (en) |
CN (1) | CN102006849B (en) |
DE (1) | DE102008019647A1 (en) |
WO (1) | WO2009127427A1 (en) |
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EP2401984A1 (en) * | 2010-07-02 | 2012-01-04 | MyoPowers Medical Technologies SA | Medical device comprising an artificial contractile structure |
DE102010048519B4 (en) * | 2010-10-14 | 2016-12-22 | Charité-Universitätsmedizin Berlin | Apparatus for the treatment of peripheral circulatory disorders in the lower extremities |
DE102011107813A1 (en) | 2011-07-13 | 2013-01-17 | Otto-Von-Guericke-Universität Magdeburg | Multifunctional system for use in e.g. space suit for astronaut, for providing treatment of e.g. skin lesions of human, has two pumps supplying fluids and continuously controlled by computer-aided system over sensor unit |
EP2594244A1 (en) * | 2011-11-15 | 2013-05-22 | Barrett Reed Mitchell | Medical vest for high frequency chest wall oscillation (HFCWO) system |
US9375586B2 (en) * | 2013-03-15 | 2016-06-28 | Pavel V. Efremkin | Apparatus and method for treatment of foot and nail diseases |
JP6775280B2 (en) * | 2015-03-30 | 2020-10-28 | 国立大学法人高知大学 | Compression system |
US20200268601A1 (en) * | 2015-09-25 | 2020-08-27 | Delta Dynamics Llc | System and methods for pulmonary expansion therapy (pxt) |
CN106038201A (en) * | 2016-07-11 | 2016-10-26 | 广州彩磁信息技术有限公司 | Bionic rhythmical diastole and systole type wearable device capable of promoting lymph and vein circulation |
WO2019059332A1 (en) * | 2017-09-21 | 2019-03-28 | 日本電信電話株式会社 | G tolerance improvement device and control method |
FR3081704B1 (en) * | 2018-05-31 | 2023-11-17 | Neuraltide | PRESSURE APPLICATION CLOTHING |
US10646233B1 (en) * | 2018-11-28 | 2020-05-12 | Jay Dean Everett | Device, system and method for intermittent displacement of blood to mitigate peripheral nerve neuropathy |
EP3897505A4 (en) * | 2018-12-17 | 2022-09-21 | The Trustees of The University of Pennsylvania | Improvements on ambulatory respiratory assist device |
US20230023355A1 (en) * | 2019-12-04 | 2023-01-26 | Colin Felton | Conformal vest ventilator |
WO2022245785A1 (en) * | 2021-05-18 | 2022-11-24 | Inova Labs, Inc. | Systems and methods for determining physical shape properties of a limb during therapy and fit of a compression garment |
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- 2008-04-18 DE DE102008019647A patent/DE102008019647A1/en not_active Withdrawn
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2009
- 2009-04-17 EP EP09732481.8A patent/EP2265239B1/en active Active
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- 2009-04-17 JP JP2011504382A patent/JP5497004B2/en active Active
- 2009-04-17 CN CN200980113721.0A patent/CN102006849B/en active Active
- 2009-04-17 WO PCT/EP2009/002837 patent/WO2009127427A1/en active Application Filing
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2017
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None * |
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US20170367922A1 (en) | 2017-12-28 |
CN102006849A (en) | 2011-04-06 |
WO2009127427A1 (en) | 2009-10-22 |
CN102006849B (en) | 2017-05-10 |
US20110098741A1 (en) | 2011-04-28 |
JP2011516223A (en) | 2011-05-26 |
DE102008019647A1 (en) | 2009-11-05 |
EP2265239A1 (en) | 2010-12-29 |
JP5497004B2 (en) | 2014-05-21 |
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