JP2019041780A - Air leak cause discrimination device and method - Google Patents

Abstract

To support discrimination of an air leak cause.SOLUTION: An air leak cause discrimination device includes a pressure measuring part for measuring the pressure between a water seal chamber and a suction source in a thoracic drain device connected to the thoracic cavity of a patient, a detection part for detecting that the measured pressure value continues to be below a first threshold for a predetermined time or more, and a cause discrimination part for discriminating the air leak cause based on at least either biological information acquired from the patient or a respiratory state of the patient.SELECTED DRAWING: Figure 1

Description

  The present invention relates to an air leak occurrence cause determining apparatus and method, and more particularly to an air leak occurrence cause determining apparatus and method for determining an air leak occurrence cause.

  Pneumothorax is a disease in which air leaks from the lungs and the lungs contract and breathing becomes difficult. During treatment of pneumothorax, air leaks into the patient's chest cavity. Here, leakage of air into the patient's chest cavity is generally referred to as air leak. Then, for pneumothorax surgery, chest drainage is performed to remove air and fluid in the thoracic cavity. The drain system used for chest drainage drains the air in the thoracic cavity and uses a water valve to prevent air backflow. In the pneumothorax treatment process, it is required to quantitatively observe the amount of air leak.

  Patent Document 1 discloses a technique for detecting an air leak by estimating the generation of air bubbles based on pressure fluctuation in a suction circuit in a drain system. Patent Document 1 also discloses a technique for automatically controlling the pressure of the aspirator based on the measured pressure.

  Patent Document 2 discloses a technique relating to an air leak monitoring apparatus for providing medical staff with information useful for grasping a state of air leak of a patient. The air leak monitoring device concerning patent document 2 measures the pressure in a suction circuit, and calculates the minimum value etc. of negative pressure based on the measured pressure. Then, the presence or absence of air leak and the tendency of occurrence are determined based on the minimum value of negative pressure and the like.

JP 2014-136104 A JP, 2016-93227, A

  However, Patent Documents 1 and 2 have a problem that it is difficult to determine the cause of the air leak. First, although the technology according to Patent Document 1 automatically controls the pressure of the aspirator based on the pressure measured quantitatively, there is a fear that an abnormal air leak (re-collapse) may be induced from the hole of the lung by the low pressure sustained aspiration. There is. Here, re-collapsing of the lungs makes it difficult for the patient to breathe because the air taken in leaks into the chest cavity. Further, with the technology according to Patent Document 2, although the air leak itself can be detected, the cause of the air leak can not be determined. The causes of air leak include physical causes such as air leak due to loose drain circuit and cause of lung re-collapse. And, if the cause is re-collapse of the lung, surgery by a doctor may be necessary. However, in order to determine the cause of the air leak, it is necessary for the medical staff to judge the condition of the patient, and the degree of difficulty is high.

  The present invention has been made to solve such problems, and it is an object of the present invention to provide an air leak occurrence cause determination apparatus and method for assisting in determining the cause of air leak occurrence.

According to a first aspect of the present invention, there is provided an air leak occurrence cause determination apparatus comprising:
A detection unit that detects that the measurement of the pressure between the water ring and the suction source in the chest drain device connected in the patient's thoracic cavity continues below a first threshold for a predetermined time or longer;
An occurrence cause determination unit that determines an air leak occurrence cause based on at least one of biological information acquired from the patient or the respiratory state of the patient when the detection is performed;
Equipped with

According to a second aspect of the present invention, there is provided an air leak occurrence cause determining method comprising
Measuring the pressure between the water ring and the suction source in a chest drain device connected in the patient's thoracic cavity;
Detecting that the measured pressure falls below a first threshold for a predetermined time or more;
If it is detected, the cause of the air leak is determined based on the biological information acquired from the patient or at least one of the respiratory state of the patient.

  According to the present invention, it is possible to provide an air leak occurrence cause determination apparatus and method for assisting determination of an air leak occurrence cause.

It is a block diagram which shows the structure of the air leak generation cause determination apparatus concerning Embodiment 1 of this invention. It is a flowchart which shows the flow of the air leak generation cause determination method concerning Embodiment 1 of this invention. It is a block diagram which shows the whole structure of the chest cavity drain system concerning Embodiment 2 of this invention. It is a figure which shows the example in case an air leak generate | occur | produces intermittently by the normal treatment process of pneumothorax. It is a figure which shows the example when abnormal air leak generate | occur | produces. It is a figure which shows the example in the case in which the generation | occurrence | production cause of an air leak is re-collapse of a lung. It is a figure which shows the example in the case in which the generation | occurrence | production cause of an air leak is an air leak of a chest cavity drain apparatus. It is a flowchart which shows the flow of the air leak generation cause determination method concerning Embodiment 2 of this invention.

  Hereinafter, specific embodiments to which the present invention is applied will be described in detail with reference to the drawings. In the drawings, the same components are denoted by the same reference symbols, and redundant description will be omitted as appropriate for the sake of clarity.

Embodiment 1
FIG. 1 is a block diagram showing the configuration of an air leak occurrence cause determination apparatus 100 according to a first embodiment of the present invention. The air leak occurrence cause determination device 100 is an information processing device connected to a chest drain device (not shown) connected to the chest cavity of a patient (not shown) such as pneumothorax. The air leak occurrence cause determination device 100 includes a detection unit 110 and a occurrence cause determination unit 120. The detection unit 110 detects that the measured value of the pressure between the water ring and the suction source in the chest drain device continues to fall below a first threshold for a predetermined time or more. The occurrence cause determination unit 120 determines the cause of the air leak based on at least one of the biological information acquired from the patient or the patient's respiratory state when detected by the detection unit 110. Here, as the cause of the air leak, the occurrence cause determination unit 120 determines, for example, whether the air leak is due to re-collapse of the lung or due to the air leak of the chest drainage device.

  FIG. 2 is a flowchart showing the flow of the method for determining the cause of air leak according to the first embodiment of the present invention. First, the air leak occurrence cause determination device 100 measures the pressure between the water ring chamber and the suction source in the chest drainage device (S101). Next, the detection unit 110 determines whether the measured value is below the first threshold (S102). If the measured value does not fall below the first threshold, the process returns to step S101.

  On the other hand, when it is determined that the measured value is less than the first threshold, the detection unit 110 determines whether or not the measured value continues to be less than the first threshold for a predetermined time or more (S103). If it has not continued for a predetermined time or more, the process returns to step S101. On the other hand, if it is determined that the processing continues for a predetermined time or more, the process proceeds to step S104. That is, through steps S101 to S103, the detection unit 110 detects that the measured value continues to fall below the first threshold for a predetermined time or more.

  After that, the occurrence cause determination unit 120 determines the cause of the air leak based on at least one of the biological information acquired from the patient or the respiratory state of the patient (S104). For example, as the cause of the air leak, the occurrence cause determination unit 120 determines whether the air leak is due to re-collapse of the lung or due to the air leak of the chest drainage device. This can assist in determining the cause of the air leak.

Second Embodiment
The second embodiment is an example of the first embodiment described above.
FIG. 3 is a block diagram showing an overall configuration of a chest cavity drain system 1000 according to a second embodiment of the present invention. The chest cavity drain system 1000 includes a connection pipe 1, a drainage chamber 2, a connection pipe 3, an air leak occurrence cause determination device 4, and a pressure control unit 5. The chest drain system 1000 uses the negative pressure generated by the pressure control unit 5 to drain fluid such as blood accumulated in the patient's (not shown) chest cavity such as pneumothorax and remove air leaking into the chest cavity. It is a medical system for performing the care through the water ring 22. The chest drainage device is provided with at least the connection pipe 1, the drainage chamber 2, the connection pipe 3, and the air leak occurrence cause determination device 4.

  The connection pipe 1 is connected to the patient's thoracic cavity and connected to the drainage chamber 2. The drainage chamber 2 includes a drainage unit 21 and a water sealing chamber 22. The drainage portion 21 is a region for collecting the body fluid drained from the thoracic cavity via the connection pipe 1. The water seal chamber 22 is filled with a liquid such as water, and prevents backflow of external air to the chest cavity side. The connection pipe 3 connects the water seal chamber 22 and the pressure control unit 5. The pressure control unit 5 is an example of a supply source and generates a negative pressure. The negative pressure generated by the pressure control unit 5 causes the fluid in the patient's thoracic cavity to be trapped in the drainage 21 as indicated by the solid arrows, and the gas leaking into the patient's thoracic cavity to be indicated by the broken arrows. Is led to the pressure control unit 5 via the water seal chamber 22. Therefore, when an air leak occurs in the patient's thoracic cavity, air passes through the water seal chamber 22 so that air bubbles are generated in the water seal chamber 22.

  The air leak occurrence cause determination device 4 is connected to a pipe branched from the connection pipe 3. The air leak occurrence cause determination device 4 includes a pressure sensor 41, an arithmetic processing unit 42, a display device 43, and an SpO2 sensor 45. The pressure sensor 41 measures the pressure between the water seal chamber 22 and the pressure control unit 5, and outputs the measured value to the arithmetic processing unit 42. The SpO2 sensor 45 measures the oxygen saturation in the blood acquired as biological information from the patient, and outputs the value of the oxygen saturation to the arithmetic processing unit 42.

  Here, the air leak occurrence cause determination device 4 further includes a storage unit (not shown) that stores a first threshold, a predetermined time, and a second threshold. The first threshold is a threshold of the measurement value of pressure for detecting the occurrence of air leak. The predetermined time is a time that indicates a threshold value of the duration during which the air leak continues to occur continuously. The second threshold is a threshold at which the patient's blood oxygen saturation indicates pulmonary re-collapse.

  The arithmetic processing unit 42 detects the generation of air bubbles in the water sealing chamber 22, that is, the generation of air leak, based on the fluctuation of the measured value of pressure. Specifically, the arithmetic processing unit 42 detects that the air leak has occurred, when the measured value of the pressure falls below the first threshold.

  Here, in the normal treatment process of pneumothorax, air leaks occur intermittently, and the amount of air leak gradually decreases. Therefore, when the air leak continues to occur continuously and the amount of air leak does not decrease, it can be said that the air leak is abnormal. Therefore, if an abnormal air leak occurs, it is necessary to determine the cause of the air leak and take appropriate measures. FIG. 4 is a diagram showing an example where air leaks occur intermittently due to a normal treatment process of pneumothorax. Moreover, FIG. 5 is a figure which shows the example when abnormal air leak generate | occur | produces.

  Therefore, the arithmetic processing unit 42 determines whether or not the occurrence of the detected air leak continues for a predetermined time or more. That is, the arithmetic processing unit 42 detects that the occurrence of the air leak continues for a predetermined time or more using the measured value of the pressure and the occurrence history of the air leak.

  If it is determined that the occurrence of air leak continues for a predetermined time or more, the arithmetic processing unit 42 determines the cause of the air leak based on the oxygen saturation in blood output from the SpO 2 sensor 45.

  Here, a common chest drain system is fitted with a one-way valve that relieves positive pressure in the thoracic cavity. In this case, suction is performed only when the pressure in the thoracic cavity is higher than the pressure set at the drain. In the re-collapse of the lung, air leakage from the lung causes the lung itself to re-contract, thereby reducing the oxygen saturation in the blood. On the other hand, air leakage from the chest drain device does not cause contraction of the lungs because air is not taken into the thoracic cavity by a one-way valve, and oxygen saturation in blood does not decrease. Therefore, when the air leak is continuously detected, if the oxygen saturation in the blood is lowered, the possibility of re-collapse of the lung is high. FIG. 6 is a diagram showing an example in which the cause of air leak is re-collapse of the lung. FIG. 7 is a view showing an example in which the air leak is caused by an air leak in the chest drain device.

  Therefore, the arithmetic processing unit 42 determines that the air leak is due to re-collapse of the lung when the oxygen saturation level is lower than the second threshold. On the other hand, when the oxygen saturation level does not fall below the second threshold value, the arithmetic processing unit 42 determines that the air leak is due to the air leak of the chest drainage device. Then, the arithmetic processing unit 42 outputs the determination result of the cause of the air leak to the display device 43. The display device 43 is an example of an output unit that performs output to the outside according to the determination result. For example, when the determination result is a re-collision of the lungs, the display device 43 displays the degree of warning higher than in the case of an air leak in the chest drain device.

FIG. 8 is a flowchart showing the flow of the method for determining the cause of air leakage according to the second embodiment of the present invention. First, the pressure sensor 41 measures the pressure in the chest drainage device, that is, the pressure of the connection pipe 3 and records it in the storage unit. Further, the SpO 2 sensor 45 measures the oxygen saturation (SpO ₂ ) from the blood obtained from the patient, and records it in the storage unit (S 11). Next, the arithmetic processing unit 42 determines whether the measured value of pressure falls below a first threshold (S12). If the measured pressure value is equal to or greater than the first threshold value, the process returns to step S11. If the pressure measurement value is less than the first threshold value, it means that an air leak has been detected. The arithmetic processing unit 42 sets a threshold (second threshold) of SpO _{2 in} the storage unit (S13). Step S13 may be performed in advance before step S11.

The arithmetic processing unit 42 determines whether the pressure less than the first threshold continues for a predetermined time or more (S14). If it is less than the predetermined time, air leaks occur intermittently and it can be said that the treatment process is normal, so the process returns to step S11. On the other hand, when continuing for a predetermined time or more, the arithmetic processing unit 42 determines whether or not the measured SpO ₂ falls below the second threshold (S15). If SpO ₂ is greater than or equal to the second threshold, the processing unit 42 outputs the occurrence of air leak to the display device 43 as the cause of air leak due to air leak in the chest drain device (S16). On the other hand, when SpO ₂ is less than the second threshold, the arithmetic processing unit 42 outputs the cause of the air leak to the display device 43 as the cause of the relapse of the lungs (S17). Thereafter, the display device 43 performs display in accordance with the output (determination result) from the arithmetic processing unit 42.

  As described above, according to the present embodiment, the medical staff can easily grasp the cause of the air leak by the display device 43.

Embodiment 3
The third embodiment is another example of the first embodiment described above. In the third embodiment, the cause of the air leak is determined based on the timing of breathing when the air leak occurs.

  Here, the timing of exhalation and inhalation can be detected by the pressure sensor 41. The timing of breathing of the patient can be grasped by movement of water in the water ring 22 (fructation). Fluctuation occurs due to pressure changes in the chest cavity due to breathing. That is, the fructation occurs because the pressure in the drainage part 21 becomes high in exhalation and becomes low in inhalation. Therefore, for example, the detection unit according to the third embodiment can distinguish between exhalation and inspiration based on a change in pressure measured by the pressure sensor 41, and can detect the timing of respiration.

  When the air leak is caused by the air leak in the chest drain device, the air leak occurs regardless of the timing of breathing. On the other hand, when the cause of the air leak is due to re-collapse of the lung, the air leak occurs in synchronization with the timing of breathing. Therefore, the occurrence cause determination unit according to the third embodiment determines the cause of the air leak by comparing the breathing timing of the patient with the occurrence timing of the air leak.

  That is, the detection unit further detects the respiration timing of the patient as the respiration state based on the fluctuation timing of the measurement value of the pressure at the time of the detection, and the occurrence cause discrimination unit determines the respiration timing of the patient The cause of the air leak may be determined based on the degree of coincidence between the air leak occurrence timing and the air leak occurrence timing.

Fourth Preferred Embodiment
The fourth embodiment is another example of the first embodiment described above. In the fourth embodiment, the patient is caused to temporarily stop breathing, and the cause of the air leak is determined based on the presence or absence of the air leak at the time of the breath stop.

  Here, when the occurrence of the air leak is detected even at the time of breathing stop, it can be determined that the cause of the air leak is the air leak of the chest drain device. On the other hand, when air leak does not occur at the time of breathing stop, it can be determined that the cause of air leak is due to re-collapse of the lung.

  That is, the occurrence cause determination unit may determine the occurrence cause of the air leak based on whether or not the air leak has occurred when the patient has stopped breathing.

<Other Embodiments>
The air leak occurrence cause determination device 4 may further include a warning sound output unit, and a warning sound may be output when occurrence of an abnormal air leak is detected. At that time, the types of warning sounds are divided according to the determination result of the cause of the air leak. Thereby, the cause of the air leak can be grasped more easily.

  The present invention is not limited to the above embodiment, and can be appropriately modified without departing from the scope of the present invention.

  Further, although the present invention has been described as the hardware configuration in the above embodiment, the present invention is not limited to this. The present invention can also realize arbitrary processing by causing a central processing unit (CPU) to execute a computer program.

  In the above-mentioned example, the program can be stored using various types of non-transitory computer readable media and supplied to a computer. Non-transitory computer readable media include tangible storage media of various types. Examples of non-transitory computer readable media are magnetic recording media (eg flexible disk, magnetic tape, hard disk drive), magneto-optical recording media (eg magneto-optical disk), CD-ROM (Read Only Memory), CD-R, CD-R / W, DVD (Digital Versatile Disc), BD (Blu-ray (registered trademark) Disc), semiconductor memory (for example, mask ROM, PROM (Programmable ROM), EPROM (Erasable PROM), flash ROM, RAM (RAM) Random Access Memory)). Also, the programs may be supplied to the computer by various types of transitory computer readable media. Examples of temporary computer readable media include electrical signals, light signals, and electromagnetic waves. The temporary computer readable medium can provide the program to the computer via a wired communication path such as electric wire and optical fiber, or a wireless communication path.

100 air leak occurrence cause determination device 110 detection unit 120 occurrence cause determination unit 1000 chest drain system 1 connection pipe 2 drainage chamber 21 drainage unit 22 water seal chamber 3 connection pipe 4 air leak occurrence cause determination device 41 pressure sensor 42 arithmetic processing unit 43 Display unit 45 SpO2 sensor 5 pressure control unit

Claims (8)

A detection unit that detects that the measurement of the pressure between the water ring and the suction source in the chest drain device connected in the patient's thoracic cavity continues below a first threshold for a predetermined time or longer;
An occurrence cause determination unit that determines an air leak occurrence cause based on at least one of biological information acquired from the patient or the respiratory state of the patient when the detection is performed;
An air leak occurrence cause determination device comprising: The air leak occurrence cause determining apparatus according to claim 1, wherein the occurrence cause determination unit determines whether the air leak is due to re-collapse of a lung or due to an air leak of the chest drainage device as a cause of the air leak. The air leak occurrence cause determination according to claim 1 or 2, wherein the occurrence cause determination unit determines the cause of the air leak occurrence based on the oxygen saturation in the blood acquired from the patient as the biological information at the time of the detection. apparatus. The air leak occurrence cause determining apparatus according to claim 3, wherein the occurrence cause determination unit determines that the air leak is due to re-collapse of the lung when the oxygen saturation level is lower than a second threshold. The detection unit further detects, as the respiratory state, the timing of breathing of the patient based on the fluctuation timing of the measurement value of the pressure at the time of detection.
The air leak occurrence cause determining apparatus according to claim 1 or 2, wherein the occurrence cause determination unit determines a cause of the air leak occurrence based on a degree of coincidence between the patient's breathing timing and the air leak occurrence timing. The air leak occurrence cause determining apparatus according to claim 1, wherein the occurrence cause determination unit determines a cause of the air leak occurrence based on whether the air leak has occurred when the patient has stopped breathing. The air leak occurrence cause determination apparatus according to any one of claims 1 to 6, further comprising an output unit that outputs an output according to a determination result by the occurrence cause determination unit. Measuring the pressure between the water ring and the suction source in a chest drain device connected in the patient's thoracic cavity;
Detecting that the measured pressure falls below a first threshold for a predetermined time or more;
A method for determining the cause of an air leak, which determines the cause of the air leak based on the biological information acquired from the patient or at least one of the respiratory state of the patient, when detected.

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