JP2010214024A - Respiratory exercise support device - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a new respiratory exercise support device for supporting the respiratory exercise of a patient with a lung problem through the use of a percutaneous method. <P>SOLUTION: The respiratory exercise support device includes: a nasal cavity pressure detecting part 20 for measuring pressure close to a nasal cavity with the use of a pressure sensor 22 connected to a nasal cannula 21; an electrode part 30 to be percutaneously mounted on accessory muscles of respiration; and a stimulation control part 40 for performing control to give an electric stimulation to the accessory muscles of respiration from the electrode part 30 when an inspiration state start period is detected based on the measured nasal pressure and also to stop the electric stimulation when an inspiration state end period is detected. <P>COPYRIGHT: (C)2010,JPO&INPIT

Description

  The present invention relates to a respiratory motion support device that supports spontaneous respiratory motion of a patient with lung disease.

  In general, a healthy person breathes by expansion and contraction of the diaphragm, which is the main respiratory muscle. In contrast, patients with chronic obstructive pulmonary disease (COPD), etc., have an excessively expanded lung and are unable to expect normal breathing exercise by the diaphragm. In addition, forced breathing must be performed with respiratory assistance muscles such as the sternocleidomastoid muscle and the oblique muscles, resulting in a state of difficulty in breathing. For such patients, nasal mask ventilation (NIP), diaphragm pacing, extrathoracic negative pressure ventilation (RTX), and the like have been supported.

  In addition to these support methods, a method of introducing a seal balloon between the respiratory airway and the respiratory circuit by mouth, nose, or tracheotomy and performing air seal control with the seal balloon is disclosed in order to support patient lung ventilation. (See Patent Document 1). According to this document, as a method for controlling an air seal, a method for detecting a myoelectric signal of a breathing-related muscle such as a diaphragm and changing a seal state in accordance with the myoelectric signal is disclosed. Specifically, it is described that an electromyogram (EMG) of a diaphragm is measured by an electromyographic sensor attached to an esophageal catheter. Further, in addition to the diaphragm, it is disclosed that the myoelectric signal is detected by an electrode directly embedded in the parasternal intercostal muscle, the sternocleidomastoid muscle, the oblique angle muscle, and the nasal wing muscle. Based on the myoelectric signal detected from the diaphragm and other respiratory-related muscles, control for changing the seal state of the seal balloon is performed.

JP 2004-522505 A

Conventional respiratory support methods such as nasal mask ventilation (NIP), diaphragm pacing, and extrathoracic negative pressure ventilation (RTX) require expensive equipment, and in principle, patients It is necessary to use these devices in a resting state.
Also, the air seal control method using the seal balloon described in Patent Document 1 is also used in a resting state, and an esophageal catheter with a myoelectric sensor attached to the patient's esophagus must be inserted. It is necessary to embed an electrode for detecting an electromyogram in the muscle.

  As described above, all the conventional respiratory support methods for patients with pulmonary diseases are used in a resting state, and in use, a catheter or an electrode is attached to the body by a non-percutaneous method. There was a heavy burden on the patient.

Accordingly, the present invention aims to provide a new respiratory motion support device that can support the respiratory motion of a patient such as chronic obstructive pulmonary disease (COPD) by a transcutaneous method without imposing a heavy burden. And
Another object of the present invention is to provide a respiratory motion support device having a compact structure that can be used even when the patient is not in a resting state.
It is another object of the present invention to provide a respiratory motion support device that can support respiratory motion in synchronization with the breathing pattern of the patient's spontaneous breathing.

The respiratory movement support device of the present invention made to solve the above-mentioned problems is percutaneously attached to a nasal cavity pressure detection unit that measures the pressure in the vicinity of the nasal cavity with a pressure sensor connected to the nasal cannula, and a respiratory assist muscle. Based on the measured electrode and the measured nasal pressure, the electrode provides electrical stimulation to the respiratory assist muscle when the inhalation state is detected, and is electrically activated when the end of the inspiration state is detected. A stimulus control unit that performs control to stop the stimulus.
According to the present invention, the tube opening of the nasal cannula is attached to the patient's nasal cavity, and the end of the nasal cannula on the device connection side is attached to the pressure sensor (pressure-sensitive head). As a result, when the nasal cavity is slightly inhaled due to a small spontaneous breathing of the patient, the inside of the nasal cannula is decompressed to a negative pressure state. Also, when the end of the inhalation state is reached, the inside of the nasal cannula is almost at atmospheric pressure. Further, when the patient exhales, the nasal cannula is in a positive pressure state. By detecting this pressure change with a pressure sensor, it is possible to distinguish between an inspiration state and an expiration state. Then, when the stimulation control unit detects the start period of the inhalation state from the pressure measurement result by the nasal cannula, it sends a current stimulation signal to the respiratory assistance muscle through the electrode unit. As a result, the respiratory assistance muscles are forcibly contracted, and a forced inspiration operation is added in synchronization with the inspiration operation by spontaneous breathing. Therefore, it is possible to support breathing by performing forced inspiration exercise in conjunction with spontaneous breathing. Subsequently, when the end stage of the inhalation state is detected, the current stimulation signal is stopped. As a result, the respiratory assistance muscle expands and the forced inhalation operation is canceled. By repeating the above operation, spontaneous breathing by the patient can be supported by forced exercise of the respiratory assistance muscle.

In the above invention, the nasal cavity pressure detection unit may determine the inhalation start period and the inhalation end period by comparing the nasal cavity pressure value at each time point with a preset threshold pressure.
By determining the inspiratory start period and inspiratory end period by comparing with the set pressure threshold, the determination of the inspiratory start period and inspiratory end period can be set to a threshold pressure suitable for each patient. The influence of the difference can be eliminated.

In the above invention, the stimulus control unit may apply an electrical stimulus that gently rises with a predetermined time constant when the start period of the inhalation state is detected.
Thereby, when a patient produces a pain and discomfort when the forced inhalation operation | movement by a respiratory assistance muscle is caused, these can be reduced.

  In the above invention, the respiratory assistance muscle to which the electrode unit is attached may include any of the parasternal intercostal muscle, the sternocleidomastoid muscle, and the oblique muscle. By applying electrical stimulation to any of these respiratory assist muscles, it is possible to support the respiratory movement safely and effectively.

It is a figure which shows the structure of the respiratory movement assistance apparatus which is one Embodiment of this invention. It is a figure which shows a respiratory muscle. It is a figure which shows a sternocleidomastoid muscle. It is a time chart of the electrical stimulation given to a respiratory assistance muscle. It is a time chart of the electrical stimulation given to a respiratory assistance muscle.

  Hereinafter, an embodiment of the respiratory motion support device of the present invention will be described with reference to the drawings. Note that the present invention is not necessarily limited to the following embodiments, and can be appropriately modified and changed without departing from the spirit of the present invention.

  FIG. 1 is a diagram showing a configuration of a respiratory motion support device according to the present invention. The respiratory motion support device 10 mainly includes a nasal cavity pressure detection unit 20, an electrode unit 30, and a stimulation control unit 40. These are designed to be carried in bags.

The nasal cavity pressure detection unit 20 includes a nasal cannula 21, a pressure sensor 22, and a sensor controller 23.
The nasal cannula 21 is a commercially available product used in oxygen therapy, the open end 21a of the nasal cannula 21 is attached to the front of the patient's nasal cavity, and the end on the device connection side is connected to the sensor head 22a of the pressure sensor 22. Is done. When the pressure in the nasal cavity changes due to the patient's spontaneous inspiration or exhalation, and the air flow fluctuations occur in front of the nostrils, the pressure in the nasal cannula 21 becomes negative pressure or positive pressure due to the change. Is transmitted to the sensor head 22a.

The pressure sensor 22 measures the pressure near the nasal cavity transmitted through the nasal cannula 21. The sensor controller 23 operates the pressure sensor 22 and generates a contact signal by detecting the intake start period and the intake end period from the measured value. That is, the sensor controller 23 can set a threshold pressure for determining the inhalation start period and the inhalation end period, and compares the set threshold value with the measured pressure to determine the inhalation start period and the inhalation end period. A contact signal for determination is output. The current atmospheric pressure may be used as the threshold pressure, but the negative pressure value is set so that it is detected that the intake state has started after being slightly on the negative pressure side so that malfunction does not occur. Is preferred. The generated contact signal is sent to a stimulus control unit 40 described later.
In order for the patient to be able to use the patient while not resting and operating, a small and highly portable device is used for the pressure sensor 22 and the sensor controller 23. Specifically, for example, a pressure sensor AP-C40 and a control unit CU-21TA manufactured by Keyence Corporation can be used.

  The electrode part 30 is composed of a pair of metal electrodes 31 and a signal line 32 that can be attached to the skin with a space therebetween, so that electric current can be applied to the muscles by applying an electric current. It is. The electrode 31 is attached to a respiratory assistance muscle that can be stimulated percutaneously. FIG. 2 is a diagram showing respiratory muscles including the diaphragm. Of these respiratory muscles, the present invention can be implemented by attaching the electrode 31 to any one of the respiratory assist muscles other than the diaphragm, but it is preferable to avoid muscles close to the heart such as intercostal muscles from the viewpoint of safety. Specifically, it is easy and most preferable to attach the electrode 31 to the sternocleidomastoid muscle M shown in FIG. When stimulating the sternocleidomastoid muscle M, two pairs of electrodes 31 are used in order to simultaneously stimulate the left and right sternocleidomastoid muscles. The number of electrodes may be further increased to simultaneously stimulate the oblique angle muscle and parasternal intercostal muscle. Each electrode 31 gives electrical stimulation to muscles by a current signal from a stimulation control unit 40 described later.

  The stimulation control unit 40 includes a control computer and a power supply, and outputs a current signal for electrical stimulation to the electrode unit 30 based on the contact signal output from the sensor controller 23. The output current signal is a pulse signal, and the pulse is continuously oscillated during the period when the contact signal is in the ON state. The amplitude of the current signal can be set by the control computer of the stimulus control unit 40.

  Next, the support operation by the respiratory exercise support device 10 will be described. FIG. 4 is a time chart showing electrical stimulation given to the respiratory assistance muscle. 4A shows a patient's spontaneous breathing cycle (inhalation state and expiration state), FIG. 4B shows a contact signal of the pressure sensor 22 that changes in response to the spontaneous breathing, and FIG. 4 (c) shows an output signal from the stimulus controller 40 generated based on the contact signal.

  Inspiration and expiration are repeated by small spontaneous breathing by the patient's respiratory assist muscle. When the inhalation operation starts, an air flow is generated near the nasal cavity, the nasal cannula 21 is in a negative pressure state, the negative pressure state is transmitted to the pressure sensor 22, and an ON signal is output from the sensor controller 23. As a result, the stimulation control unit 40 causes a current to flow through the electrode 31, and as a result of contraction of the muscle, a forced inspiration operation is added to the spontaneous inspiration operation, thereby supporting breathing.

  Thereafter, at the end stage of the inhalation operation, the airflow change due to the inspiration disappears, and the negative pressure state of the nasal cannula 21 returns to the atmospheric pressure. When the pressure in the nasal cannula 21 reaches the set threshold pressure, the output from the pressure sensor 22 becomes an OFF signal, the current signal flowing through the electrode 31 is stopped, the muscle is in an expanded state, and is in an expired state. Transition. Thereafter, the same inhalation operation and exhalation operation are repeated.

  FIG. 5 is a time chart showing another embodiment of electrical stimulation. In the figure, FIGS. 5 (a), 5 (b), and 5 (c) correspond to FIGS. 4 (a), 4 (b), and 4 (c), respectively. Here, a time constant is added to the electrical stimulation signal applied to the respiratory assistance muscle so that the stimulation is gradually started. The time constant can be set by the control computer of the stimulus control unit 40. According to this embodiment, when the change in the electrical stimulation signal is too rapid and the patient feels pain or discomfort, the pain can be relieved by slowly changing the current stimulation signal with a predetermined time constant.

  INDUSTRIAL APPLICABILITY The present invention can be used as a respiratory motion support device that supports respiratory motion of respiratory assist muscles of patients with lung diseases.

DESCRIPTION OF SYMBOLS 10 Respiratory motion support apparatus 20 Nasal cavity pressure detection part 21 Nasal cannula 22 Pressure sensor 23 Sensor controller 30 Electrode part 31 Electrode 40 Stimulation control part

Claims (4)

A nasal pressure detector that measures the pressure in the vicinity of the nasal cavity with a pressure sensor connected to the nasal cannula;
An electrode that is percutaneously attached to a respiratory assist muscle;
Based on the measured nasal pressure, the electrical stimulation is applied from the electrode part to the respiratory assist muscle when the inhalation state is detected, and the electrical stimulation is stopped when the end state of the inspiration is detected A respiratory motion support device, comprising: a stimulus control unit that performs the operation.   The respiratory movement support device according to claim 1, wherein the nasal cavity pressure detection unit determines an inhalation start period and an inhalation end period by comparing a nasal cavity pressure value at each time point with a preset pressure threshold value.   The respiratory exercise support device according to claim 1, wherein the stimulus control unit applies an electrical stimulus that gently rises with a predetermined time constant when the start period of the inspiration state is detected. The respiratory support device according to claim 1, wherein the respiratory assistance muscle to which the electrode unit is attached includes any of the parasternal intercostal muscle, the sternocleidomastoid muscle, and the oblique muscle.