JP2004261592A - External counter pulsation apparatus - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an external counter pulsation apparatus whose cuff used for a pressurizing site is improved to reduce a volume of use of air to stabilize pressure applied on a patient. <P>SOLUTION: The cuff structure part of an external counter pulsation apparatus is changed to a double chamber system. That is, the structure of the cuff can usually pressurize a pressurizing objective site in a state of surrounding the pressurizing objective site and another part pressurizable as required is carried in a part within the surrounded pressurizing objective site. <P>COPYRIGHT: (C)2004,JPO&NCIPI

Description

  The present invention relates to an improvement in a cuff (pressing portion) used for an external counterpulsation.

Conventionally, for the treatment of severe heart disease, ventricular artificial hearts and complete artificial hearts have been actively studied, and the ventricular artificial hearts have already been commercialized. However, the application of these techniques requires thoracotomy in earnest and under careful preparation, and is almost ineffective for rescue of emergency patients such as acute myocardial infarction. In order to rescue these emergency patients, the blood assisted circulation method has been used as a method of temporarily assisting and substituting the pumping action of the heart mechanically to restore the function of the heart. This blood assisted circulation method includes a counterpulsation method.In the systole of the cardiac cycle, the aortic pressure is reduced to reduce the load, and blood from the ventricle is helped, while in the diastole, the aortic pressure is increased. By increasing coronary blood flow, it assists dysfunctional ventricles and improves systemic circulation. As this counterpulsation, the intraaortic balloon pumping method (IABP) performed by inserting a balloon catheter into the aorta is most commonly performed. In 1964, an external counterpulsation device was developed, discussing the significance of blood being pumped out sequentially from the upper and lower arteriovenous vascular beds. In 1995, Vasomedical developed a device that uses air as a medium to apply pressure from the outside and can reduce the impact of pressure applied to the patient and reduce patient discomfort, and it has already been used in multiple facilities. Has been established (Non-Patent Document 1). Because this device can be treated non-invasively, it is already being used in the United States as an option for stable angina patients who are less likely to undergo CA bypass surgery and PTCA catheter treatment.
Journal of the American College of Cardiology Vol.33,1833-40 (1999)

1. In prior art devices, the cuff procedure exerted extra force on the patient, resulting in unstable pressurization of the patient and severe compression.
2. The prior art cuffs use a lot of air and require a corresponding horsepower air compressor.

  The present inventor has conducted various studies in consideration of the above circumstances, and found that the external counterpulsation apparatus has a cuff structure changed to a double chamber type in the external counterpulsation apparatus. By stabilizing the pressurization and reducing the amount of air used, it was confirmed that the use of an air compressor with lower horsepower could be achieved, and the present invention was completed.

In other words, the present invention
"1. An external counterpulsation device of a double chamber type in which a pressurizing unit (cuff) surrounding a treatment unit of a patient of the external counterpulsation device is constituted by a main chamber and a preload chamber.
2. The structure of the preceding item 1, wherein the structure of the cuff is always pressurizable in a state surrounding the pressure treatment target portion, and a part of the enclosed pressure treatment target portion carries another optional pressurizable portion. External counter pulsation device.
3. The apparatus according to the above item 1 or 2, wherein the constant pressurization is performed by a preload chamber.
4. An apparatus in which the constantly pressurized air of the above item 3 is supplied to the precompression chamber at a pressure of 8 to 12 KPa by a hose having an inner diameter of 2 to 5 mm.
5. The main chamber is pressurized as needed, and the compressed air is sent to expand the main chamber. As a result, the preload chamber containing the main chamber is pressed and compressed to increase the internal pressure of the preload chamber. The device according to any one of the preceding items 1 to 4, wherein the pressure-treatment target site is pressed by the device.
6. A device in which compressed air of 30 to 40 KPa is alternately sent to the main chamber by a hose having an inner diameter of 6 to 12 mm, which is optionally pressurized as described in 5 above.
7. When the main chamber is optionally pressurized, a part of the air volume in the preload chamber is exhausted from the air inlet, but the pressure in the preload chamber is sufficiently maintained by controlling the exhaust volume. An apparatus according to claim 1.
8. A device in which the exhaust gas amount control of the preceding paragraph 7 adjusts the exhaust gas amount to the air inlet of the preload chamber by the flow resistance due to the inner diameter of the hose.
9. The compressed air in the main chamber is exhausted, the main chamber contracts, the preload chamber returns to its original state, and the pressurization treatment target site can be released from compression. Equipment.
10. The apparatus according to any one of items 1 to 9, wherein the pressure (P3) of the preload chamber when the main chamber is pressurized is represented by the following equation.
P3 = P2 x [V2 / (V2-V1)]
(Where P2 is the pressure constantly applied by the preload chamber, V2 is the preload chamber volume, and V1 is the main chamber volume)
11. The device according to any one of items 1 to 10, wherein the cuff is divided into a calf, a thigh, a waist, and a foot including a sole.
12, the cuff of the main chamber in the preceding item 11 is a total of 200 to 300 cc for the cuff volume for the calf and the sole including the sole, a total of 500 to 700 cc for the cuff volume for the thigh, and a total of 200 to 300 cm for the waist cuff volume. Equipment that is 500cc.
13. The apparatus according to any one of the above items 1 to 12, wherein even when the main chamber is pressurized, the pressure on the pressurized treatment target site can be controlled to be constant.
14. An external counterpulsation treatment method using the device according to any one of the above items 1 to 13. "
Consists of

1. The cuff according to the invention stabilizes the pressure on the patient and eliminates the occurrence of severe compression.
2. By reducing the amount of air used in the cuff according to the present invention, a lower horsepower air compressor can be used, and a smaller air compressor can be used.

  The cuff according to the present invention refers to a pressurizing unit that surrounds a treatment unit of a patient in an external counterpulsation device. As shown in FIGS. 8 to 12, the cuff is of a double-chamber system including a main chamber and a preload chamber. As shown in FIGS. 8 and 9, the double-chamber structure of the cuff is such that one can always be pressurized in a state surrounding the pressure treatment target portion, and the other is in the enclosed pressure treatment target portion. A part that can be pressurized as needed. The constant pressurization is performed by a preload chamber. For example, as one example, the pressure is adjusted by constantly sending compressed air (about 8 to 12 KPa) by a thin hose having an inner diameter of about 2 to 5 mm (FIG. 8). FIG. 8 shows that the preload chamber portion of the cuff is wrapped around the lower limb to pressurize the lower limb with the volume P2 and the pressure P2, and that compressed air is constantly being sent from the preload port shown at the bottom of the figure.

  Pressurization is performed as needed by the main chamber. For example, as one example, compressed air (about 30 to 40 KPa) as a main pressure P1 shown in FIG. 9 is rapidly sent through a thick hose having an inner diameter of about 6 to 12 mm. The main chamber expands rapidly, and as a result, the preload chamber containing the main chamber is pressed and compressed, and the internal pressure of the preload chamber rises, so that the pressure treatment target site (the lower limb in FIG. 9) is pressed.

  During the occasional pressurization by the main chamber, a part of the air volume in the preload chamber is exhausted from the air inlet, but the exhaust volume is controlled by the inner diameter of the hose, for example, in one embodiment, and the pressure in the preload chamber is sufficiently increased. Will be retained. When the compressed air in the main chamber is exhausted, the main chamber contracts, the preload chamber returns to its original state, and the pressure treatment target site (the lower limb in FIGS. 8 and 9) is released from the compression.

The pressure relationship in the double chamber system configured as described above is as follows: The pressure (P3) of the preload chamber when the main chamber is pressurized is expressed by the following equation:
P3 = P2 x [V2 / (V2-V1)]
(Where P2 is the pressure constantly applied by the preload chamber, V2 is the preload chamber volume, and V1 is the main chamber volume)

  10 to 12 show shapes of the cuff at the time of pressurization according to the treatment site. FIG. 10 shows a calf cuff, one for each of the left and right main chambers (two in total), and a main chamber for optional pressurization is installed in a pre-compression chamber inside each calf. For example, in one embodiment, the thickness is preferably about 30 mm, but may be about 20-40 mm. The length is not particularly limited, but is shown as 200 mm in the figure. Approximately 150 to 250 mm is suitable for use. The volume of the cuff in FIG. 10 is calculated to be 282.6 cc in total using the formula of “(1.5 × 1.5 × 3.14 × 20) × 2”. This numerical value is not limited, and for example, can be applied in a range of about 200 to 300 cc.

  FIG. 11 shows a pair of left and right main chambers (two in total) with two cuffs for the thigh, and main chambers (two in total inside and outside the thigh) for pressurization are placed in the preload chamber at any time. is set up. For example, in one embodiment, the thickness is preferably about 30 mm, but may be about 20-40 mm. The length is not particularly limited, but is shown as 200 mm in the figure. Approximately 150 to 250 mm is suitable for use. The volume of the cuff in FIG. 11 is calculated by a formula of “(1.5 × 1.5 × 3.14 × 20) × 4 pieces” to be 565.2 cc in total. This numerical value is not limited, and can be applied in the range of about 500 to 700 cc, for example.

  FIG. 12 shows one main chamber (two in total) on the left and right sides of the waist with a cuff for the waist, and a main chamber (two in total inside and outside the thigh) for pressurization at any time in the preload chamber. It is installed in. For example, in one embodiment, the thickness is preferably about 30 mm, but may be about 20-40 mm. The length is not particularly limited, but is shown as 200 mm in the figure. Approximately 150 to 250 mm is suitable for use. The volume of the cuff in FIG. 12 is calculated by a formula of “(1.5 × 1.5 × 3.14 × 20) × 2 pieces” to be 565.2 cc in total. This numerical value is not limited, and for example, can be applied in a range of about 200 to 500 cc.

  FIG. 10 also shows a left and right main cuff (two in total) with a foot cuff including a sole, and a main chamber for optional pressurization is provided inside a preload chamber inside each foot including the sole. It is installed in. For example, in one embodiment, the thickness is preferably about 30 mm, but may be about 20-40 mm. The length is not particularly limited, but is shown as 200 mm in the figure. Approximately 150 to 250 mm is suitable for use. The volume of the foot cuff including the sole is calculated by a formula of “(1.5 × 1.5 × 3.14 × 20) × 2 pieces” to be 282.6 cc in total. This numerical value is not limited, and can be applied in the range of about 200 to 300 cc, for example.

  The total cuff volume of the main chamber at the above four locations, namely the calf, thigh, waist, and foot cuff, including the sole, is 1.6956 liters. Assuming that the number of uses is 100 times / minute, the air usage is 169.56 liters / minute.

According to the present invention, after the cuff is attached, compressed air is first sent to the precompression chamber to constantly pressurize. Thereafter, the compressed air is alternately sent to the main chamber only, and is repeatedly pressurized and expanded. That is, the compressed air is not simultaneously sent to the main chamber and the preload chamber. In the prior art apparatus, compressed air is alternately sent to a precompression chamber to repeatedly inflate and contract, and pressurization is performed as needed.
Comparing the air usage of the cuff according to the present invention with the prior art device, the air usage of the cuff according to the present invention was about 51% of the air usage of the prior art device.

  By reducing the air consumption of the cuff according to the present invention, it becomes possible to use even a lower horsepower air compressor, and even if a smaller air compressor is used, the same performance as the prior art device can be secured. , It is possible to have the same counter-pulsation effect.

  FIG. 13 shows the state of pressurizing the human body in the case of the cuff of the present invention. FIG. 14 shows a conventional cuff. FIG. 13 shows a state in which the cuff is set on the lower limb on the bed, the left side shows a time when the compressed air is not sent to the main chamber, and the right side shows a time when the compressed air is sent to the main chamber. On the left, the main chamber is deflated and a weak pressurization is applied to the lower limb from the preload chamber. On the right side, the main chamber installed on one side of the lower limb is expanded by sending compressed air, and as a result, the pressure in the preload chamber rises as a whole, and compression can be achieved uniformly on the lower limb . On the other hand, FIG. 14 shows a conventional method, but when the left side is depressurized, there is no pressure on the lower limb, so that it is in contact with the bed surface. When compressed air is sent to the cuff and pressurized, the lower limb receives uneven pressure from below with the force of W in the figure. This indicates that the conventional treatment with the cuff exerts extra force on the human body.

The force applied to the lower limb in the conventional cuff is “lower limb pressure area” × “air pressure”. In the case of the waist, for example, the waist area is “40 cm × 20 cm” and the air pressure is “0.3 Kg / cm ² ”, so that W is a tremendous force of “240 Kg”.

  1 to 3 are overall views of an external counterpulsation device. The upper part of FIG. 1 shows a view from the lower part of the device main body, and each solenoid valve [a calf solenoid valve (a foot solenoid valve including a sole). (4), thigh solenoid valve (5), waist solenoid valve (6), rapid preload solenoid valve (7), pressure regulating solenoid valve (8)], preload chamber (3) and exhaust fan (28) Is arranged. The lower figure shows the inside of the apparatus main body, and shows a view in which the air compressor (1) and the main chamber (2) are arranged. Note that the foot solenoid valve including the sole is the same as the calf solenoid valve, and is not shown. Also, illustration is omitted in FIGS. The upper diagram of FIG. 2 is a diagram of the device viewed from above, and the lower diagram is a diagram of the device viewed from the side. The preload pressure gauge (9), the preload air regulator (10), and the liquid crystal monitor (12) related to the personal computer. , A keyboard (13), a mouse (14), and a flexible disk drive (15). The upper part of FIG. 3 is a view of the upper part of the apparatus main body. The personal computer main body (11), analog lamp (16), personal computer output converter (17), sequencer (18), air compressor CP (19), outlet CP (20), operating circuit CP (21), main pressure switch (22), preload pressure switch (23), terminal block (24), and outlet (25). The lower figure is a view from the rear, in which the primary power connector (26) and the air connection port (27) are arranged.

  FIGS. 4 and 5 are electrical diagrams of the external type counter pulsation device, in which a compressor and an exhaust fan are controlled by a personal computer, and a main pressure pressure switch and a pre-pressure pressure switch for controlling the delivery of compressed air to the main chamber are controlled by a sequencer. Are linked.

  6 and 7 are air system diagrams of the external counterpulsation device. FIG. 7 shows the flow of compressed air from above to the waist, thigh, and calf, and FIG. 6 shows the compressed air produced by the compressor. Shows a system diagram in which each is sent to the main chamber and the preload chamber under each control.

1. The cuff according to the invention stabilizes the pressure on the patient and eliminates the occurrence of severe compression.
2. By reducing the amount of air used in the cuff according to the present invention, a lower horsepower air compressor can be used, and a smaller air compressor can be used.

The lower part (upper part in the figure) and the inside of the main part (lower part in the figure) of the external counterpulsation device are shown. The figure which looked at the external type counterpulsation apparatus from the top (upper in the figure) and the figure seen from the side (lower in the figure) are shown. The upper part (upper part in the figure) and the rear part (lower part in the figure) of the main body of the external counterpulsation device are shown. 1 shows an electrical diagram of an external type counterpulsation device. Fig. 2 shows an electrical system diagram 2 of the external type counterpulsation device. FIG. 1 shows an air system diagram No. 1 of an external counterpulsation apparatus. FIG. 2 shows an air system diagram No. 2 of the external counterpulsation apparatus. Fig. 4 shows a state where the main chamber of the external counterpulsation device is contracted. 3 shows the main chamber of the external counterpulsation device when it is inflated. Figure 3 shows a cuff for the calf and sole including the sole of the external counterpulsation device. 3 shows a thigh cuff of an external counterpulsation device. 3 shows a waist cuff of an external counterpulsation device. The left side of the lower leg cuff of the external counterpulsation device of the present invention pressed against the lower limb cuff shows a reduced pressure, and the right shows a pressurized state. The left side of the lower extremity cuff pressing state on the lower extremity cuff of the conventional external counterpulsation device shows a time of pressure reduction, and the right side shows a time of pressurization.

Explanation of reference numerals

1: Air compressor 2: Main chamber 3: Preload chamber 4: Solenoid valve for calf (solenoid valve for foot including sole)
5: Thigh solenoid valve 6: Waist solenoid valve 7: Rapid preload solenoid valve 8: Pressure regulating solenoid valve 9: Preload pressure gauge 10: Preload air regulator 11: PC body 12: LCD monitor 13: Keyboard 14: Mouse 15 : Flexible disk drive 16: Analog lamp 17: PC output converter 18: Sequencer 19: CP for air compressor
20: CP for outlet
21: Operation circuit CP
22: Main pressure pressure switch 23: Preload pressure switch 24: Terminal block 25: Outlet 26: Primary power connector 27: Air connection port 28: Exhaust fan

Claims (14)

An external counter-pulsation device of a double-chamber type in which a pressurizing section (cuff) surrounding a treatment section of a patient of the external counter-pulsation device is constituted by a main chamber and a preload chamber. 2. The external structure according to claim 1, wherein the cuff structure is capable of constantly applying pressure in a state surrounding the pressure treatment target portion, and carries another optional pressurizable portion in a part of the enclosed pressure treatment target portion. Type counter pulsation device. 3. The device according to claim 1, wherein the constant pressurization is performed by a preload chamber. 4. The apparatus according to claim 3, wherein the constantly compressed air of 8 to 12 KPa is sent to the preload chamber by a hose having an inner diameter of 2 to 5 mm. Pressurization is performed as needed by the main chamber, and the compressed air is sent to expand the main chamber. As a result, the preload chamber containing the main chamber is pressed to be compressed, and the internal pressure of the preload chamber is increased. The apparatus according to any one of claims 1 to 4, wherein the pressure treatment target site is compressed. 6. The apparatus according to claim 5, wherein compressed air of 30 to 40 KPa is alternately sent to the main chamber by a hose having an inner diameter of 6 to 12 mm. A part of the amount of air in the preload chamber is exhausted from the air inlet when the main chamber is optionally pressurized, but the pressure in the preload chamber is sufficiently maintained by controlling the exhaust amount. An apparatus according to claim 1. 8. The apparatus according to claim 7, wherein the exhaust amount to the air inlet of the preload chamber is adjusted by the flow resistance due to the hose inner diameter. The compressed air of the main chamber is exhausted, the main chamber contracts, the precompression chamber returns to the original state, and the pressurization treatment target site can be released from the compression. apparatus. The apparatus according to any one of claims 1 to 9, wherein the pressure (P3) of the preload chamber when the main chamber is pressurized is represented by the following equation.
P3 = P2 x [V2 / (V2-V1)]
(Where P2 is the pressure constantly applied by the preload chamber, V2 is the preload chamber volume, and V1 is the main chamber volume) 11. The device according to any one of claims 1 to 10, wherein the cuff is divided into a calf, a thigh, a waist, and a foot including a sole. The cuff of the main chamber according to claim 11, wherein the cuff volume for the calf and the sole including the sole is 200 to 300 cc in total for the left and right, the cuff volume for the thigh is 500 to 700 cc for the left and right, and the left and right total is 200 to 500 cc for the waist cuff. Device. The apparatus according to any one of claims 1 to 12, wherein even when the main chamber is pressurized, pressure on the pressurized treatment target site can be controlled to be constant. An external counterpulsation treatment method using the device according to any one of claims 1 to 13.

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