JP2011056287A - 除細動器 - Google Patents
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Abstract
【解決手段】患者の体内を横断して少なくとも2本の電気的経路を確立するために患者の体外に装着される3個以上の電極を備える。体内を横断するインピーダンス分布を表すインピーダンス情報が決定され、少なくとも2本の電気的経路の各々を横断する電磁波形が発生し、その波形の少なくとも1つのパラメータが、体内の1箇所または複数箇所の位置において選択された電流密度分布を発生するようにインピーダンス情報を用いて選択される。
【選択図】図1
Description
本発明のこの態様の好ましい実施形態は、以下の1または複数を組み入れていてよい。すなわち、本発明はさらに、患者の電気的パラメータ、心電図パラメータ、生理学的パラメータまたは解剖学的パラメータを測定することと、少なくとも幾つかの状況下では異なる電気的経路毎に異なっていてよい除細動波形を発生することと、を備え、各々の波形の少なくとも1つのパラメータは測定されたパラメータに依存している。測定する際には、経胸腔インピーダンス分布を決定してもよい。波形が生成されるときに通過する電極の各々の面積は、心臓の投影面積の60%未満であってよい。波形が生成されるときに通過する電極の各々の面積は、心臓の投影面積の50%未満であってもよい。胸腔の同じ側の電極の面積和は心臓の投影面積の90%よりも大きくてよい。胸腔の同じ側の電極の面積和は心臓の投影面積100%よりも大きくてよい。電極は、電気的経路が患者の胸郭の体前部と体後部との間に延在するように体前部位置および体後部位置に配置されていてよい。電極は、電気的経路が患者の胸郭の左側と右側との間に延在するように体側位置に配置されていてもよい。波形は多相であってよい。波形は単相であってもよい。電極の少なくとも2個を組み合わせて、1つのユニットとして患者に装着されかつ患者から取り外される1個の単一体電極パッドとしてもよい。電極が支持されているパッドの区域の間に継目線が存在していて、継目線が、電極が支持されている区域に皺を形成せずにパッドを折り畳み得るように構成されていてよい。多数の電極が単一体電極パッド上に配置されていてもよい。多数の電極は充填密度を高めるように配置されていてよい。電極は、多角形充填形(テセレーション、tessellation)の形態で配置されていてよい。充填形は、平面を対称にタイリング(敷き詰め)する正多面体からなる正充填形であってよい。多面体は、三角形、正方形または六角形のいずれか1つであってよい。
多数の電極を、単一のパッドとして一体化した複数の電極作用域として具現化してもよく、この場合には胸郭の各々の側に1枚ずつパッドを装着し、これにより2部パッド式の使い易い系を達成する。一体型パッドは、胸骨、胸骨上端または乳頭の正確な配置図のような解剖学的標認点を含んで、患者に電極をさらに正確に配置する能力を医師に提供し得る。電極は、超音波撮像、インピーダンス、パルス酸素測定法、呼気終末二酸化炭素、血圧、速度検知、加速センサのようなセンサを含んでいてよい。
本発明のその他の特徴および利点は、添付図面、詳細な説明および特許請求の範囲から明らかとなろう。
∇・ρ-1∇V=I
によって支配されており、式中、Vは電圧であり、ρは抵抗率分布であり、Iは被検領域内での印加電流源分布であり、境界条件はV0およびJ0である。EITの場合には、高周波で低振幅の信号、例えばそれぞれ60kHzで約1マイクロアンペアが用いられる。この周波数の電流源は体内には存在しないのでρ=0となり、ポアソンの式はラプラスの式となる。
EITの分野では幾つかの形式の問題が研究されている。
1.「順問題」。ρ、V0およびJ0が与えられており、目標は電圧分布Vおよび電流分布Jを決定することにある。
2.「逆問題」。VおよびJが与えられており、目標はρを決定することにある。
3.「境界値」問題。V0およびJ0が与えられており、目標はρ、VおよびJを決定することにある。
Φ(ρ)=(1/2)(Ve(ρ)−V0)T(Ve(ρ)−V0)
当業者に公知の方法を用いて、分布を最初に推定し、次いで所与の電流入力に対する理論的な電圧応答を有限要素法を用いて算出するアルゴリズムを用いる。推定された電圧を測定された電圧から減算して目的関数を求める。目的関数が誤差閾値よりも小さい場合には、推定された分布は許容可能な推定値になったと見做される。そうでない場合には、以下の方程式を用いて抵抗率分布を更新する。
Δρk=−[Ve’(ρk)TVe’(ρk)]-1{Ve’(ρk)T[Ve’(ρk)−V0]}
この系列を許容可能な推定値が達成されるまで繰り返す。
多数の電極を密に充填することにより、電流発生(およびインピーダンス測定)を改善し得る。電極の多くの構成が可能である。好ましい実施形態では、電極の構成は充填形の理論を援用して決定される。多角形(2次元の場合)、多面体(3次元の場合)またはポリトープ(polytope)(n次元の場合)による規則的なタイリングを充填形と呼ぶ。充填形は、シュレーフリ(Schlaefli)の記号を用いて指定することが可能である。自己交差型多角形を単純な多角形に分解することも充填形と呼ばれ、またはさらに適切には多角形充填形と呼ばれる。図10に示すように、平面を対称にタイリングする正多面体で構成される丁度3種の正充填形が存在する。2種以上の凸正多角形による平面の充填形であって同じ多角形が同じ状態で各々の多角形の頂点を包囲しているような充填形は半正充填形と呼ばれ、またはアルキメデス型充填形とも呼ばれる。図11に示すように、平面においては8種のかかる充填形が存在する。また、3種の正充填形と8種の半正充填形との規則的な混成体である14種の部分的正(demi−regular)(または多形)充填形が存在する。これらの多面体を図12に示す。他の部分的正充填形はペンローズ・タイリングである。3次元では、空間を充填することが可能な多面体を空間充填型多面体と呼ぶ。例としては、立方体、菱形十二面体および切隅八面体がある。また、16面の空間充填体、および空間を非周期的にのみ充填するシュミット−コンウェイ(Schmitt−Conway)多面体として知られる凸多面体もある。空間充填形多面体を用いると、電極を人体の胸郭の3次元性にさらによく適合させることが可能である。好ましい実施形態では、電極充填形・パターンは立方体または六角形の正充填形である。
Claims (39)
- 患者の体内を横断して少なくとも2本の電気的経路を確立するために該患者の体外に装着される3個以上の電極を備え、
該体内を横断するインピーダンス分布を表すインピーダンス情報を決定し、該少なくとも2本の電気的経路の各々を横断する電磁波形を発生し、該波形の少なくとも1つのパラメータが、該体内の1箇所または複数箇所の位置において選択された電流密度分布を発生するように該インピーダンス情報を用いて選択される、体内への体外からの電磁的刺激を行うための除細動器。 - 前記電磁的刺激は心臓の除細動(デフィブリレーションまたはカーディオバージョン)のためのものであり、前記インピーダンス分布は胸郭を横断するものであり、前記電流密度分布は該心臓でのものである、請求項1に記載の除細動器。
- 前記インピーダンス情報を決定する際には、電気インピーダンス法(EIT)が用いられる請求項1または請求項2に記載の除細動器。
- 前記インピーダンス情報を決定する際には、組織部位の位置を決定するために身体を撮像し、該組織部位の位置および該組織の抵抗率から経胸腔インピーダンス分布が算出される請求項1または請求項2に記載の除細動器。
- 前記撮像は超音波撮像からなる、請求項4に記載の除細動器。
- 患者の胸腔を横断して心臓を通る複数の電気的経路を確立するために該患者の胸郭に装着される3個以上の電極を備え、
該電気的経路の少なくとも2本の各々を横断して除細動波形を発生させ、該波形が発生するときに通過する該電極の各々の面積は該心臓の投影面積の70%未満であり、該胸腔の同じ側の該電極の面積和は該心臓の投影面積の80%よりも大きい、除細動器。 - 前記患者の電気的パラメータ、心電図パラメータ、生理学的パラメータまたは解剖学的パラメータを測定し、少なくとも幾つかの状況下では異なる電気的経路毎に異なっている除細動波形を発生し、各々の波形の少なくとも1つのパラメータは該測定されたパラメータに依存している、請求項6に記載の除細動器。
- 前記患者の電気的パラメータ、心電図パラメータ、生理学的パラメータまたは解剖学的パラメータの測定により、経胸腔インピーダンス分布が決定される請求項7に記載の除細動器。
- 前記波形が発生するときに通過する前記電極の各々の面積は、前記心臓の投影面積の60%未満である、請求項6に記載の除細動器。
- 前記波形が発生するときに通る前記電極の各々の前記面積は、前記心臓の投影面積の50%未満である、請求項6に記載の除細動器。
- 前記胸腔の同じ側の前記電極の面積和は、前記心臓の投影面積の90%よりも大きい、請求項6に記載の除細動器。
- 前記胸腔の同じ側の前記電極の面積和は、前記心臓の投影面積の100%よりも大きい、請求項6に記載の除細動器。
- 前記電極は、前記電気的経路が前記患者の胸郭の体前部と体後部との間に延在するように、体前部位置および体後部位置に配置されている、請求項6に記載の除細動器。
- 前記電極は、前記電気的経路が前記患者の胸郭の左側と右側との間に延在するように体側位置に配置されている、請求項6に記載の除細動器。
- 前記波形は多相である、請求項6に記載の除細動器。
- 前記波形は単相である、請求項6に記載の除細動器。
- 前記電極の少なくとも2個を組み合わせて、1つのユニットとして患者に装着されかつ該患者から取り外される1個の単一体電極パッドとする、請求項6に記載の除細動器。
- 前記電極が支持されている前記パッドの区域の間に継目線が存在していて、該継目線が、前記電極が支持されている該区域に皺を形成せずに前記パッドを折り畳み得るように構成されている、請求項17に記載の除細動器。
- 多数の電極が前記単一体電極パッド上に配置されている、請求項17に記載の除細動器。
- 前記多数の電極は充填密度を高めるように配置されている、請求項19に記載の除細動器。
- 前記電極は多角形充填形の形態で配置されている、請求項20に記載の除細動器。
- 前記充填形は、平面を対称にタイリングする正多面体からなる正充填形である、請求項21に記載の除細動器。
- 前記多面体は三角形、正方形または六角形のいずれか1つである、請求項22に記載の除細動器。
- 患者の胸腔を横断して心臓を通る少なくとも2本の電気的経路を確立するために該患者の胸郭に装着される3個以上の電極を備え、該少なくとも2本の電気的経路の各々を横断して二相または多相の除細動波形を発生し、少なくとも幾つかの状況下では、該発生する多相波形は該少なくとも2本の電気的経路毎に異なっている除細動器。
- 前記少なくとも2本の電気的経路を横断する経胸腔インピーダンス分布を決定し、各々の多相波形の少なくとも1つのパラメータが該経胸腔インピーダンス分布に依存している前記二相または多相の除細動波形を発生する請求項24に記載の除細動器。
- 2対の電極が存在しており、各々の対の一方の電極が、前記胸郭の全体的に対向する両面に配置されている、請求項24に記載の除細動器。
- 各々の対の一方の電極が、前記胸郭の体前部面および体後部面に位置している、請求項25に記載の除細動器。
- 1つのブリッジ回路が前記二相または多相の除細動波形の各々を発生する1対のブリッジ回路を更に備える請求項24に記載の除細動器。
- 前記二相または多相の除細動波形は時間的に重なるように発生する、請求項24に記載の除細動器。
- 前記二相または多相の除細動波形は同時である、請求項29に記載の除細動器。
- 前記二相または多相の除細動波形は逐次的である、請求項24に記載の除細動器。
- 電極へまたは電極から除細動パルスを伝達する第1の電気的ワイヤと、
電気ケーブルに接続されている金属層と、
該金属層から皮膚へ前記パルスを伝達する伝導性皮膚接触層と、
超音波センサと、
該超音波センサを超音波撮像回路に接続する第2の電気的ワイヤと
からなる除細動電極。 - 患者の胸腔を横断して心臓を通る複数の電気的経路を確立するために該患者の胸郭に装着される3個以上の電極と、
少なくとも2種の全体的に異なる除細動波形を発生する少なくとも2個の異なる除細動回路と
を備え、該少なくとも2本の電気的経路の各々を横断して該少なくとも2種の異なる除細動波形の一方ずつを発生し、該少なくとも2個の異なる除細動回路の間の通信により該少なくとも2種の除細動波形の発生を同期させる経胸腔式の除細動器。 - 前記除細動回路は各々、プロセッサと、エネルギー発生回路と、切換回路とからなる、請求項33に記載の除細動器。
- 前記各除細動回路は別個の外被に収容されており、前記通信は該外被の間で生ずる、請求項34に記載の除細動器。
- 前記切換回路は、二相除細動波形または多相除細動波形を発生することが可能である、請求項34に記載の除細動器。
- 前記発生を同期させるため、前記除細動回路同士の間のアナログ通信を含んでいる、請求項33に記載の除細動器。
- 前記発生を同期させるため、前記除細動回路同士の間のディジタル通信を含んでいる、請求項33に記載の除細動器。
- 前記各除細動回路は別個の外被に収容されている、請求項33に記載の除細動器。
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US10/960,311 US9174061B2 (en) | 2003-11-13 | 2004-10-06 | Multi-path transthoracic defibrillation and cardioversion |
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US11097118B2 (en) | 2021-08-24 |
JP2013116356A (ja) | 2013-06-13 |
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US9174061B2 (en) | 2015-11-03 |
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US20160193473A1 (en) | 2016-07-07 |
JP5427209B2 (ja) | 2014-02-26 |
DE602004023044D1 (de) | 2009-10-22 |
US20050107834A1 (en) | 2005-05-19 |
JP2011177590A (ja) | 2011-09-15 |
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