JP2020202980A - Puncture stress detection device - Google Patents
Puncture stress detection device Download PDFInfo
- Publication number
- JP2020202980A JP2020202980A JP2019112592A JP2019112592A JP2020202980A JP 2020202980 A JP2020202980 A JP 2020202980A JP 2019112592 A JP2019112592 A JP 2019112592A JP 2019112592 A JP2019112592 A JP 2019112592A JP 2020202980 A JP2020202980 A JP 2020202980A
- Authority
- JP
- Japan
- Prior art keywords
- stress
- puncture needle
- puncture
- pericardiocentesis
- heart
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Granted
Links
- 238000001514 detection method Methods 0.000 title abstract description 8
- 210000002216 heart Anatomy 0.000 claims abstract description 47
- 210000003516 pericardium Anatomy 0.000 claims abstract description 30
- 208000005228 Pericardial Effusion Diseases 0.000 claims abstract description 19
- 238000011156 evaluation Methods 0.000 claims abstract description 17
- 230000002123 temporal effect Effects 0.000 claims abstract description 10
- 230000007704 transition Effects 0.000 claims abstract description 10
- 238000006243 chemical reaction Methods 0.000 claims abstract description 7
- 210000000779 thoracic wall Anatomy 0.000 claims description 23
- 210000004165 myocardium Anatomy 0.000 claims description 20
- 210000004912 pericardial fluid Anatomy 0.000 claims description 18
- 210000005242 cardiac chamber Anatomy 0.000 claims description 2
- 238000005259 measurement Methods 0.000 abstract description 7
- 230000010349 pulsation Effects 0.000 abstract description 5
- 238000011282 treatment Methods 0.000 description 15
- 208000006017 Cardiac Tamponade Diseases 0.000 description 11
- 238000000034 method Methods 0.000 description 8
- 239000008280 blood Substances 0.000 description 5
- 210000004369 blood Anatomy 0.000 description 5
- 230000007423 decrease Effects 0.000 description 5
- 238000010586 diagram Methods 0.000 description 5
- 210000004072 lung Anatomy 0.000 description 5
- 210000000038 chest Anatomy 0.000 description 4
- 238000012360 testing method Methods 0.000 description 4
- 210000001124 body fluid Anatomy 0.000 description 3
- 239000010839 body fluid Substances 0.000 description 3
- 230000000747 cardiac effect Effects 0.000 description 3
- 238000003780 insertion Methods 0.000 description 3
- 230000037431 insertion Effects 0.000 description 3
- 230000035939 shock Effects 0.000 description 3
- 210000001519 tissue Anatomy 0.000 description 3
- APWRZPQBPCAXFP-UHFFFAOYSA-N 1-(1-oxo-2H-isoquinolin-5-yl)-5-(trifluoromethyl)-N-[2-(trifluoromethyl)pyridin-4-yl]pyrazole-4-carboxamide Chemical compound O=C1NC=CC2=C(C=CC=C12)N1N=CC(=C1C(F)(F)F)C(=O)NC1=CC(=NC=C1)C(F)(F)F APWRZPQBPCAXFP-UHFFFAOYSA-N 0.000 description 2
- 230000017531 blood circulation Effects 0.000 description 2
- 230000036772 blood pressure Effects 0.000 description 2
- 239000012530 fluid Substances 0.000 description 2
- 230000006870 function Effects 0.000 description 2
- 239000000463 material Substances 0.000 description 2
- 210000004379 membrane Anatomy 0.000 description 2
- 239000012528 membrane Substances 0.000 description 2
- 210000003205 muscle Anatomy 0.000 description 2
- 238000009825 accumulation Methods 0.000 description 1
- QVGXLLKOCUKJST-UHFFFAOYSA-N atomic oxygen Chemical compound [O] QVGXLLKOCUKJST-UHFFFAOYSA-N 0.000 description 1
- 238000010009 beating Methods 0.000 description 1
- 238000005452 bending Methods 0.000 description 1
- 230000000740 bleeding effect Effects 0.000 description 1
- 210000000988 bone and bone Anatomy 0.000 description 1
- 206010007625 cardiogenic shock Diseases 0.000 description 1
- 210000004351 coronary vessel Anatomy 0.000 description 1
- 201000010099 disease Diseases 0.000 description 1
- 208000037265 diseases, disorders, signs and symptoms Diseases 0.000 description 1
- 230000000004 hemodynamic effect Effects 0.000 description 1
- 239000000314 lubricant Substances 0.000 description 1
- 229910052760 oxygen Inorganic materials 0.000 description 1
- 239000001301 oxygen Substances 0.000 description 1
- 201000003144 pneumothorax Diseases 0.000 description 1
- 229920002635 polyurethane Polymers 0.000 description 1
- 239000004814 polyurethane Substances 0.000 description 1
- 238000012545 processing Methods 0.000 description 1
- 230000000541 pulsatile effect Effects 0.000 description 1
- 230000035485 pulse pressure Effects 0.000 description 1
- 230000035807 sensation Effects 0.000 description 1
- 238000001356 surgical procedure Methods 0.000 description 1
- 238000012549 training Methods 0.000 description 1
- 230000002861 ventricular Effects 0.000 description 1
Landscapes
- Surgical Instruments (AREA)
Abstract
Description
本発明は、穿刺応力検出装置に係り、詳しくは心嚢穿刺応力検出装置に関する。 The present invention relates to a puncture stress detector, and more particularly to a pericardiocentesis stress detector.
心臓は全身へ血液を送り出すポンプとしての働きを担っているが、通常は心膜という２枚の薄い膜に包み込まれている。この２枚の膜の間のスペースは心嚢（しんのう）と呼ばれ、その中には心嚢液という液体で充填されている。心嚢液には心臓が摩擦なくスムーズに収縮と拡張を繰り返すことができるよう潤滑油としての役割がある。 The heart acts as a pump that pumps blood throughout the body, but is usually wrapped in two thin membranes called the pericardium. The space between these two membranes is called the pericardial sac, which is filled with a fluid called pericardial fluid. Pericardial fluid serves as a lubricant so that the heart can smoothly contract and expand without friction.
何らかの原因で心嚢液が大量に、あるいは急速に増加して貯留してしまったために、心嚢内圧が上昇して心臓が十分に拡張することができない状態となり、これを心タンポナーデという。その結果、心臓はポンプとして機能できなくなり、急速にショック状態となる心タンポナーデは、緊急を要する疾患であり、進行すると急速に死に至ることになる。救命のためには、緊急入院の上、まずはショック状態からの離脱を図ることが先決となる。この処置としては、心嚢液が貯留しているスペースに向かって胸壁から針を刺す心嚢穿刺術を行い、心嚢液の排液と心嚢の減圧を行う。詳しくは、一時的に柔らかいチューブを挿入する治療（心嚢穿刺、心嚢ドレナージ）を行うことで、患者をショック状態から救うことができる。 For some reason, a large amount of pericardial fluid or a rapidly increasing amount of pericardial fluid accumulates, causing the intracardiac pressure to rise and the heart to become unable to expand sufficiently. This is called cardiac tamponade. As a result, the heart can no longer function as a pump and is rapidly in shock. Cardiac tamponade is an urgent disease that can lead to rapid death as it progresses. In order to save lives, the first step is to get out of shock after being hospitalized urgently. As this procedure, pericardiocentesis is performed by piercing the chest wall with a needle toward the space where the pericardial fluid is stored, and the pericardial fluid is drained and the pericardial fluid is decompressed. Specifically, treatment by temporarily inserting a soft tube (pericardiocentesis, pericardiocentesis) can save the patient from shock.
係る心嚢穿刺術治療の安全性を高めるために、現在は、エコーで心臓や心嚢液の貯留部位を確認しながら、またはカテーテル検査室でレントゲン装置を使用しながら手技を行っている。しかしながら、これらの装置・器具を用いて慎重に行ったとしても、心嚢穿刺（心嚢ドレナージ含む）はリスクの高い処置・治療となる。すなわち、この処置・治療は、動いている心臓に向かって針を進めることから、穿刺しすぎると心臓を傷つけ大出血を起こしたり、気胸（肺に傷をつける）を合併したりする可能性がある。また、心タンポナーデの患者は、すでに循環動態（血圧、心拍数、心臓の収縮力など）が非常に不安定であり、常に急変する可能性は高い状態となっている。そのため、心嚢穿刺を行ったとしても残念ながら救命できないケースもあり、心タンポナーデ治療は、難易度の高い術式となっている。 In order to increase the safety of such pericardiocentesis treatment, we are currently performing the procedure while confirming the accumulation site of the heart and pericardial fluid by echo or using an roentgen device in a catheter laboratory. However, even if carefully performed using these devices / instruments, pericardiocentesis (including chest tube drainage) is a high-risk treatment / treatment. In other words, since this procedure / treatment advances the needle toward the moving heart, excessive puncture may damage the heart and cause major bleeding, or may cause pneumothorax (damage to the lungs). .. In addition, patients with cardiac tamponade are already in a state where their hemodynamics (blood pressure, heart rate, cardiac contractility, etc.) are extremely unstable and are likely to change suddenly at all times. Therefore, unfortunately, there are cases in which life cannot be saved even if pericardiocentesis is performed, and cardiac tamponade treatment is a highly difficult procedure.
この難易度の高い心タンポナーデ治療のような治療において、穿刺の際の状況把握を支援するため、荷重センサや圧力計により、穿刺針部の負荷量を計測して、針部の動作状態を検出して、針部が生体組織の組織境界部に対応する位置にある旨の判定を行う技術が開示されている（特許文献１，２参照）。 In a treatment such as this highly difficult cardiac tamponade treatment, in order to support grasping the situation at the time of puncture, the load amount of the puncture needle is measured by a load sensor or a pressure gauge to detect the operating state of the needle. Then, a technique for determining that the needle portion is at a position corresponding to the tissue boundary portion of the living tissue is disclosed (see Patent Documents 1 and 2).
しかしながら、特許文献１、２にて開示された穿刺装置の技術は、心嚢を対象とした場合に心臓の拍動による外乱の影響で正確な負荷量を計測することが困難な場合が生じた。また、どの部位まで針部が到達したかを判定する指標が開示されておらず、穿刺状況の視覚化を行う技術は開示されていなかった。そのため、術者の熟練に依存する部分が多く存在し、特に緊急性を有する心タンポナーデ治療において穿刺術の困難性を緩和することが求められていた。 However, in the technique of the puncture device disclosed in Patent Documents 1 and 2, when the heart sac is targeted, it may be difficult to accurately measure the load amount due to the influence of disturbance due to the beating of the heart. .. Further, the index for determining to which part the needle portion has reached has not been disclosed, and the technique for visualizing the puncture status has not been disclosed. Therefore, there are many parts that depend on the skill of the operator, and it has been required to alleviate the difficulty of puncture in the treatment of cardiac tamponade, which is particularly urgent.
本発明は、前記背景におけるこれらの実情に鑑みてなされたものであり、難易度の高い心嚢穿刺術において、エコーやレントゲンのみに依存せず、かつ穿刺しすぎて心臓や肺に傷つけることのない安全な穿刺術を支援するために、穿刺応力検出装置を提供することをその目的とする。 The present invention has been made in view of these circumstances in the above background, and in a highly difficult pericardiocentesis, it does not depend only on echo or roentgen, and punctures too much to damage the heart or lungs. Its purpose is to provide a puncture stress detector to support no safe puncture.
本発明は、心嚢に穿刺して心嚢液を吸入する術具を有する心嚢穿刺応力検出装置である。本発明の一態様は、穿刺針と、該穿刺針の穿刺方向の抵抗を電気信号として取得する計測手段と、該計測手段の信号から、施術する対象の心臓の拍動に応じた周波数成分を除去する周波数成分除去手段と、該周波数成分除去手段によって処理された信号を応力に変換する応力変換手段と、該応力の時間的な推移に応じて穿刺状態を判定する判断評価手段と、を備える構成としている。 The present invention is a pericardiocentesis stress detecting device having a surgical tool for puncturing a pericardial sac and inhaling pericardial fluid. In one aspect of the present invention, a puncture needle, a measuring means for acquiring the resistance of the puncturing needle in the puncturing direction as an electric signal, and a frequency component corresponding to the beat of the heart to be treated are obtained from the signal of the measuring means. It includes a frequency component removing means for removing, a stress converting means for converting a signal processed by the frequency component removing means into stress, and a judgment evaluation means for determining a puncture state according to the temporal transition of the stress. It has a structure.
本構成は、ロードセルや歪みゲージ等の穿刺方向の抵抗を測定できる計測手段と、心臓の拍動に応じた周波数成分を除去するであるフィルター等の周波数成分除去手段備えることで、計測手段で取得した抵抗から外乱を除去して、正確な穿刺時の応力を計測することができる。この構成によれば、穿刺しすぎて心臓や肺に傷つけることのない安全な心嚢穿刺術を支援することができる。 This configuration is acquired by the measuring means by providing a measuring means such as a load cell or a strain gauge that can measure the resistance in the puncture direction and a frequency component removing means such as a filter that removes the frequency component according to the heartbeat. It is possible to remove the disturbance from the resistance and accurately measure the stress at the time of puncture. This configuration can support safe pericardiocentesis without over-puncturing and damaging the heart or lungs.
前記態様の心嚢穿刺応力検出装置において、前記判断評価手段は、心臓の部位に応じた応力の範囲を予め格納した記憶手段と、該応力の時間的推移を記録する記録手段と、選択した前記心臓の部位に対応する応力範囲に前記応力が到達したときに報知する報知手段と、を備える構成とすることができる。 In the pericardiocentesis stress detecting device of the above-described embodiment, the determination and evaluation means are selected as a storage means for pre-storing the range of stress according to the site of the heart and a recording means for recording the temporal transition of the stress. The configuration may include a notification means for notifying when the stress reaches the stress range corresponding to the part of the heart.
この構成によれば、心臓の部位に応じた応力の範囲を予め格納したクライテリアテーブル等を備えた記憶手段で、穿刺の到達部位を取得した応力によって把握できることから、エコーやレントゲンに依存せずに穿刺を行うことができる。 According to this configuration, a storage means equipped with a criteria table or the like that stores the stress range according to the heart part in advance can grasp the arrival part of the puncture by the acquired stress, so that it does not depend on echo or roentgen. Can perform puncture.
前記態様の心嚢穿刺応力検出装置において、前記周波数成分除去手段は、心電図から取得した前記周波数成分に応じてカットオフ周波数帯を設定し、前記カットオフ周波数帯を除去するバンドパスフィルタである構成とすることができる。 In the pericardiocentesis stress detecting device of the above aspect, the frequency component removing means is a bandpass filter that sets a cutoff frequency band according to the frequency component acquired from an electrocardiogram and removes the cutoff frequency band. Can be.
この構成によれば、施術の際に患者の心電図から心臓の拍動を取得できるため、確実に拍動による外乱を除去でき、より正確な穿刺時の応力を計測することできる。 According to this configuration, since the heartbeat can be obtained from the patient's electrocardiogram during the treatment, the disturbance due to the heartbeat can be reliably removed, and the stress at the time of puncture can be measured more accurately.
前記態様の心嚢穿刺応力検出装置において、前記記憶手段には、前記穿刺針の先端が、心膜、心筋のそれぞれに到達したときのそれぞれの応力範囲が格納されており、前記報知手段は、前記心膜、前記心筋の順で、それぞれの前記応力範囲に前記応力が到達したときに報知する構成とすることができる。 In the pericardiocentesis stress detecting device of the above aspect, the storage means stores the respective stress ranges when the tip of the puncture needle reaches the pericardium and the myocardium, respectively. In this order, the pericardium and the myocardium can be configured to notify when the stress reaches the respective stress ranges.
この構成によれば、穿刺針が到達する心膜、心筋の順序を明確にすることで、応力範囲が幅を有するときにでも、穿刺針の到達状況を正確に把握することができる。また、心膜による抵抗が減少したときが心嚢に穿刺したものと見なすことができるため、心筋を傷つけることなく穿刺を行うことを可能とし、さらに心筋に到達したと見なされたときには、警告を発生させる等の処理をすることで心臓への損傷を軽減させることができる。 According to this configuration, by clarifying the order of the pericardium and the myocardium that the puncture needle reaches, the arrival status of the puncture needle can be accurately grasped even when the stress range has a width. In addition, when the resistance due to the pericardium decreases, it can be considered that the heart muscle has been punctured, so that the puncture can be performed without damaging the heart muscle, and when it is considered that the heart muscle has been reached, a warning is given. Damage to the heart can be reduced by performing treatments such as generating.
前記態様の心嚢穿刺応力検出装置において、前記記憶手段には、前記穿刺針の先端が、胸壁に到達したときの応力範囲がさらに格納されており、前記報知手段は、前記胸壁の前記応力範囲に前記応力が到達したときに報知する構成とすることができる。 In the pericardiocentesis stress detecting device of the above aspect, the storage means further stores the stress range when the tip of the puncture needle reaches the chest wall, and the notification means is the stress range of the chest wall. It can be configured to notify when the stress reaches.
この構成によれば、心臓部位の切開手術を行わず、胸壁から直接穿刺する場合であっても、穿刺針が到達する胸壁を応力的に明確にすることで、応力範囲が幅を有するときにでも、穿刺針の到達状況を正確に把握することができる。なお、胸壁とは肋骨、横隔膜などを含む心臓より外側の構造全体をさすが、心嚢穿刺の際には、肋骨等の骨を回避して穿刺している。したがって、ここでは、皮膚および皮膚と心膜の間の筋肉を対象としている。 According to this configuration, even when puncturing directly from the chest wall without performing incision surgery on the heart site, the stress range is wide by clarifying the stress on the chest wall to which the puncture needle reaches. However, the arrival status of the puncture needle can be accurately grasped. The chest wall refers to the entire structure outside the heart, including the ribs and diaphragm, but when pericardiocentesis is performed, the ribs and other bones are avoided for puncture. Therefore, the subject here is the skin and the muscles between the skin and the pericardium.
前記態様の心嚢穿刺応力検出装置において、前記穿刺針は、大径の第１穿刺針と、該第１穿刺針の針管何に挿抜自在に備えられた小径の第２穿刺針と、からなり、該第１穿刺針は前記心膜まで到達したときに留置され、該第２穿刺針が挿入される構成とすることができる。 In the pericardiocentesis stress detecting device of the above aspect, the puncture needle comprises a large-diameter first puncture needle and a small-diameter second puncture needle provided in the needle tube of the first puncture needle so as to be freely inserted and removed. The first puncture needle is placed when it reaches the pericardium, and the second puncture needle can be inserted.
市販されている心膜および胸腔穿刺用胸部ドレナージ用カテーテルは、通常１８Ｇ（１８ゲージ例：外径１．２５ｍｍ±０．０２、内径０．８２ｍｍ±０．０３）が使われ、この穿刺針を使用して胸壁から心膜まで穿刺している。係る構成の場合には、胸壁における抵抗力が大きく、測定される応力値が、計測システムに対して過大となって、計測できない可能性がある。 Commercially available catheters for chest drainage for pericardial and thoracentesis usually use 18 G (18 gauge example: outer diameter 1.25 mm ± 0.02, inner diameter 0.82 mm ± 0.03), and this puncture needle is used. It is used to puncture from the chest wall to the pericardium. In the case of such a configuration, the resistance force on the chest wall is large, and the measured stress value becomes excessive with respect to the measurement system, and there is a possibility that the measurement cannot be performed.
この構成によれば、胸壁による抵抗力は第１穿刺針が負担し、胸壁の影響を受けない第２穿刺針によって、心膜、心嚢液が存在する心嚢、心筋の穿刺応力を計測することができる。 According to this configuration, the resistance force by the chest wall is borne by the first puncture needle, and the puncture stress of the pericardium, the pericardial sac where the pericardial fluid is present, and the myocardium is measured by the second puncture needle which is not affected by the chest wall. Can be done.
また、従来技術では、大径の穿刺針を使って心嚢穿刺を行っており、患者の負担が大きくなるおそれがあった。この構成によれば、胸壁から心膜に到達するまでは太い穿刺針を用い、到達したときその太い穿刺針を留置して、その後の心嚢穿刺については、患者の負担が少ない細い穿刺針とすることができる。 Further, in the prior art, pericardiocentesis is performed using a large-diameter puncture needle, which may increase the burden on the patient. According to this configuration, a thick puncture needle is used until it reaches the pericardium from the chest wall, and when it reaches, the thick puncture needle is placed, and for subsequent pericardiocentesis, a thin puncture needle that places less burden on the patient is used. can do.
本発明は、難易度の高い心嚢穿刺術において、エコーやレントゲンのみに依存せず、かつ穿刺しすぎて心臓や肺に傷つけることのない安全な穿刺術を支援するために、穿刺応力検出装置を提供する提供することができる。 The present invention is a puncture stress detection device in order to support a safe pericardiocentesis in which the pericardiocentesis is difficult and does not depend only on echo or roentgen and does not cause excessive puncture to damage the heart or lungs. Can be provided.
以下、図面を参照しながら、本発明の心嚢穿刺応力検出装置に係る好適な実施の形態について説明する。以下の説明において、異なる図面においても同じ符号を付した構成は同様のものであるとして、その説明を省略する場合がある。 Hereinafter, a preferred embodiment of the pericardiocentesis stress detecting apparatus of the present invention will be described with reference to the drawings. In the following description, it may be assumed that the configurations with the same reference numerals in different drawings are the same, and the description thereof may be omitted.
本発明に係る一実施態様は、心嚢に穿刺して心嚢液を吸入する術具を有する心嚢穿刺応力検出装置であって、穿刺針と、該穿刺針の穿刺方向の抵抗を電気信号として取得する計測手段と、該計測手段の信号から、施術する対象の心臓の拍動に応じた周波数成分を除去する周波数成分除去手段と、該周波数成分除去手段によって処理された信号を応力に変換する応力変換手段と、該応力の時間的な推移に応じて穿刺状態を判定する判断評価手段と、を備える構成であれば、その具体的態様はいかなるものであっても構わない。 One embodiment of the present invention is a pericardiocentesis stress detecting device having a surgical tool for puncturing the pericardiocentesis and sucking the pericardiocentesis fluid, and uses the puncture needle and the resistance of the puncture needle in the puncture direction as an electric signal. The measurement means to be acquired, the frequency component removing means for removing the frequency component corresponding to the beat of the heart to be treated, and the signal processed by the frequency component removing means are converted into stress from the signal of the measuring means. Any specific embodiment may be used as long as it includes a stress conversion means and a determination and evaluation means for determining the puncture state according to the temporal transition of the stress.
はじめに本発明の第１実施形態に係る全体構成について図１の全体構成図に基づいて説明する。 First, the overall configuration according to the first embodiment of the present invention will be described with reference to the overall configuration diagram of FIG.
心タンポナーデとは、心臓１０を取り囲む袋状となった心膜１２，１３の間の心嚢１４に心嚢液２０である体液などの血液が貯留して、心臓１０の内部である心筋１６、心腔１８を圧迫するものである。このため、心臓１０は完全に拡張することができず、血圧の低下、心拍数の上昇、脈圧の狭小化、冠動脈の血流減少等を引き起こす。その結果として体内の組織への血流や酸素供給が低下して、心原性ショックを生じさせる。そのため、心タンポナーデと診断されると、早急に心嚢に貯留した体液などの血液を吸入・排出する必要がある。 Cardiac tamponade means that blood such as body fluid, which is pericardial fluid 20, is stored in the heart chamber 14 between the pericardiums 12 and 13 in the shape of a bag surrounding the heart 10, and the myocardium 16 and the heart, which are inside the heart 10. It presses on the cavity 18. For this reason, the heart 10 cannot be completely dilated, causing a decrease in blood pressure, an increase in heart rate, a narrowing of pulse pressure, a decrease in blood flow in coronary arteries, and the like. As a result, blood flow and oxygen supply to tissues in the body decrease, causing cardiogenic shock. Therefore, when a person is diagnosed with cardiac tamponade, it is necessary to immediately inhale and expel blood such as body fluid stored in the cardiac sac.
現状は心嚢１４に穿刺して心嚢液２０を吸入する術具（穿刺針１１０等）のみによって、心嚢１４に貯留した心嚢液２０である体液などの血液を吸入・排出している。しかし、穿刺針１１０が心嚢１４に到達したか否かは、術者の感覚とエコーやレントゲンを併用することで判断していたが、緊急度が高い治療であること、術者には高い熟練度が要求されること、等から困難性が高い手術であった。 At present, blood such as body fluid, which is the pericardial fluid 20 stored in the pericardial fluid 14, is inhaled and discharged only by a surgical tool (puncture needle 110 or the like) that punctures the pericardial fluid 14 and inhales the pericardial fluid 20. However, whether or not the puncture needle 110 reached the heart sac 14 was determined by using the surgeon's sensation in combination with echo and roentgen, but it is a highly urgent treatment and is high for the surgeon. It was a highly difficult operation due to the need for skill.
図１を参照すると、図の左上には上述した心タンポナーデとなった心臓１０の模式図を、そして四角い枠で囲った心嚢穿刺応力検出装置１００の構成を表すブロック図を含む模式図を示している。 Referring to FIG. 1, the upper left of the figure shows a schematic diagram of the heart 10 as the cardiac tamponade described above, and a schematic diagram including a block diagram showing the configuration of the pericardiocentesis stress detection device 100 surrounded by a square frame. ing.
心嚢穿刺応力検出装置１００は、心臓１０に穿刺する穿刺針１１０と、この穿刺針１１０の抵抗を計測する計測手段１２０と、計測手段１２０からの信号を受信して心臓１０の拍動成分を除去する周波数成分除去手段１３０と、拍動成分を同定するための心電計１７０と、拍動成分が除去された信号を応力に変換する応力変換手段１４０と、応力変換手段１４０によって変換された応力によって穿刺状態を判断する判断評価手段１５０と、判断評価手段１５０の判断結果を報知する報知手段１６０と、から構成されている。 The pericardiocentesis stress detection device 100 receives signals from the puncture needle 110 that punctures the heart 10, the measuring means 120 that measures the resistance of the puncturing needle 110, and the measuring means 120, and detects the pulsatile component of the heart 10. It was converted by the frequency component removing means 130 to be removed, the electrocardiograph 170 for identifying the pulsating component, the stress converting means 140 for converting the signal from which the pulsating component was removed into stress, and the stress converting means 140. It is composed of a judgment evaluation means 150 for judging the puncture state by stress and a notification means 160 for notifying the judgment result of the judgment evaluation means 150.
穿刺針１１０は、鋭利に尖った先端とこの先端を生体内に挿入するための把持部１１５を備えている。穿刺針１１０としては、市販されている心膜および胸腔穿刺用胸部ドレナージ用カテーテル等を適用することができる。 The puncture needle 110 includes a sharply pointed tip and a grip portion 115 for inserting the tip into the living body. As the puncture needle 110, a commercially available pericardial and chest drainage catheter for thoracentesis can be applied.
手順の一例としては、内套を備えた穿刺針１１０の先端を心嚢１４内に刺入し、穿刺針の内套を取り除き、ガイドワイヤーを穿刺針１１０に挿入し、心嚢内へ進める。ガイドワイヤーはそのまま残して穿刺針１１０を抜去する。ドレナージカテーテル、もしくはドレナージカテーテルと挿入用カニューラが一体になったものをガイドワイヤーに被せて挿入し、ドレナージカテーテルの先端が心膜１２の後方に来るまで進める。ドレナージカテーテルとガイドワイヤーを保持したまま、挿入用カニューラを回転させながら取り除く。ドレナージカテーテルを心嚢１４内に進める。ガイドワイヤーを取り除く。接続チューブ等をドレナージカテーテルに取り付けて貯留した血液の吸引を行う。なお、ドレナージ用カテーテルのサイズは、例えばポリウレタン製で外径１．６７〜２．８３ｍｍ、長さ１５〜４０ｃｍである。 As an example of the procedure, the tip of the puncture needle 110 provided with the pelvic needle is inserted into the heart sac 14, the puncture needle inner cloak is removed, the guide wire is inserted into the puncture needle 110, and the needle is advanced into the heart sac. The puncture needle 110 is removed while leaving the guide wire as it is. A drainage catheter or a combination of a drainage catheter and an insertion cannula is inserted over a guide wire, and the drainage catheter is advanced until the tip of the drainage catheter is behind the pericardium 12. While holding the drainage catheter and guide wire, rotate the insertion cannula to remove it. Advance the drainage catheter into the heart sac 14. Remove the guide wire. A connecting tube or the like is attached to the drainage catheter to suck the stored blood. The size of the drainage catheter is, for example, made of polyurethane and has an outer diameter of 1.67 to 2.83 mm and a length of 15 to 40 cm.
計測手段１２０は、穿刺針１１０の先端の抵抗力を計測するものであり、例えば、ロードセルを適用することができる。ロードセルは、力の大きさを電気信号に変える変換器であり、力に比例して変形する起歪体とその変形量であるひずみを測定するひずみゲージから構成される。ひずみの検出方法は特に限定されないが、ベンディング型、コラム型、シェア型などから選択することができる。計測手段１２０は、抵抗力を表すひずみに比例した電気信号を周波数成分除去手段１３０へ送出する。 The measuring means 120 measures the resistance force of the tip of the puncture needle 110, and for example, a load cell can be applied. A load cell is a converter that converts the magnitude of force into an electric signal, and is composed of a strain-causing body that deforms in proportion to the force and a strain gauge that measures the strain that is the amount of deformation. The strain detection method is not particularly limited, but can be selected from bending type, column type, share type and the like. The measuring means 120 sends an electric signal proportional to the strain representing the resistance force to the frequency component removing means 130.
周波数成分除去手段１３０は、心電計１７０の心電図から取得した拍動の周波数成分に応じてカットオフ周波数帯を設定し、カットオフ周波数帯を除去するバンドパスフィルタを適用することができる。バンドパスフィルタは、必要な周波数である抵抗力に係る電気信号のみを通し、他の周波数である拍動に係る信号を通さない、もしくは、減衰させるものである。心タンポナーデを発症した患者の心拍数は心臓への圧迫によって上昇するが、患者個々の状態によって心拍数の乱れ等が生ずることから、心電計１７０の心電図から拍動周波数を取得することが望ましい。 The frequency component removing means 130 can set a cutoff frequency band according to the frequency component of the pulsation acquired from the electrocardiogram of the electrocardiograph 170, and can apply a bandpass filter that removes the cutoff frequency band. The bandpass filter passes only the electric signal related to the resistance force, which is a necessary frequency, and does not pass the signal related to the beat, which is another frequency, or attenuates it. The heart rate of a patient who develops cardiac tamponade rises due to pressure on the heart, but it is desirable to obtain the pulsation frequency from the electrocardiogram of the electrocardiograph 170 because the heart rate may be disturbed depending on the individual condition of the patient. ..
ここで本実施形態に係る周波数成分除去の一実施例を表した図２を参照する。図２は縦軸に穿刺応力、横軸に時間をとった応力の時間的推移を表している。ここで、実線のＯｒｉｇｉｎａｌは、計測手段１２０によって取得された力の大きさを表す電気信号である。一点鎖線のＮｏｉｓｅ ｃｏｍｐｏｎｅｎｔは、心電計１７０から取得した心拍数によるノイズである。破線のＳｈｅａｒ Ｓｔｒｅｓｓは、心電計１７０の心電図から取得した拍動の周波数成分に応じてカットオフ周波数帯を設定し、カットオフ周波数帯を除去するバンドパスフィルタを適用した応力となる。このように周波数成分除去手段１３０は、施術の際に患者の心電図から心臓の拍動を取得できるため、確実に拍動による外乱を除去でき、より正確な穿刺時の応力を計測することできる。 Here, reference is made to FIG. 2 showing an embodiment of frequency component removal according to the present embodiment. In FIG. 2, the vertical axis represents the puncture stress, and the horizontal axis represents the temporal transition of the stress over time. Here, the solid line Original is an electric signal representing the magnitude of the force acquired by the measuring means 120. The dashed line noise component is the noise due to the heart rate obtained from the electrocardiograph 170. The broken line Shear Stress is the stress obtained by setting the cutoff frequency band according to the frequency component of the pulsation acquired from the electrocardiogram of the electrocardiograph 170 and applying a bandpass filter for removing the cutoff frequency band. As described above, since the frequency component removing means 130 can acquire the heartbeat from the patient's electrocardiogram at the time of the treatment, the disturbance due to the heartbeat can be surely removed, and the stress at the time of puncture can be measured more accurately.
応力変換手段１４０は、拍動による周波数成分が除去された計測手段１２０の電気信号を要すれば増幅させて、穿刺針１１０の先端の抵抗力を穿刺応力として出力する。計測手段１２０をロードセルとしたときには、ひずみゲージの校正、信号の増幅を行うロードセル用アンプを適用することができる。応力変換手段１４０が出力した穿刺応力の電気信号は、判断評価手段１５０へ送出される。 The stress conversion means 140 amplifies the electric signal of the measuring means 120 from which the frequency component due to the pulsation has been removed, if necessary, and outputs the resistance force at the tip of the puncture needle 110 as the puncture stress. When the measuring means 120 is a load cell, a load cell amplifier that calibrates the strain gauge and amplifies the signal can be applied. The electric signal of the puncture stress output by the stress conversion means 140 is sent to the judgment evaluation means 150.
判断評価手段１５０は、マイクロコンピュータで構成されており、演算を行うプロセッサＣＰＵ、制御プログラムおよび各種データのリスト、テーブル、マップを格納するＲＯＭ、およびＣＰＵによる演算結果などを一時記憶するＲＡＭを有する。判断評価手段１５０は、不揮発性のメモリを備えており、必要なデータなどをこの不揮発性メモリに保存する。不揮発性メモリは、書き換え可能なＲＯＭであるＥＥＰＲＯＭ、または電源がオフにされていても保持電流が供給されて記憶を保持するバックアップ機能付きのＲＡＭで構成することができる。 The determination evaluation means 150 is composed of a microcomputer, and has a processor CPU that performs calculations, a control program and a list of various data, a table, a ROM that stores maps, and a RAM that temporarily stores calculation results by the CPU. The judgment evaluation means 150 includes a non-volatile memory, and stores necessary data and the like in the non-volatile memory. The non-volatile memory can be composed of EEPROM, which is a rewritable ROM, or RAM with a backup function, which is supplied with a holding current even when the power is turned off to hold the memory.
判断評価手段１５０は、心膜１２，１３、心筋１６の応力範囲が格納されたクライテリアテーブル１５４を備える記憶手段１５２および応力変換手段１４０から送出された穿刺応力を蓄積して穿刺応力の応力時間的推移１５７を記録する記録手段１５５を備えている。 The judgment evaluation means 150 accumulates the puncture stress sent from the storage means 152 and the stress conversion means 140 including the criterion table 154 in which the stress ranges of the pericardium 12, 13 and the myocardium 16 are stored, and the stress temporal of the puncture stress. The recording means 155 for recording the transition 157 is provided.
判断評価手段１５０は、応力時間的推移１５７の応力をクライテリアテーブル１５４に照合して、測定値が心膜の応力範囲か、心筋の応力範囲か、もしくはいずれの応力範囲にも含まれていない小さい値かを判定する。これを図式的に表すと、判定例１５８に示すようになるが、実際はディジタル値を不等式によって判定している。 The judgment evaluation means 150 collates the stress of the stress temporal transition 157 with the criterion table 154, and the measured value is the stress range of the pericardium, the stress range of the myocardium, or is not included in any of the stress ranges. Determine if it is a value. This is represented graphically as shown in Judgment Example 158, but in reality, the digital value is determined by an inequality.
本実施形態に基づき、試作機を製作して、豚の心臓を用いて応力データを取得する試験を実施した。この試験内容について説明する。試作機では、最大測定応力１０Ｎのロードセルを作製し、硬膜外穿刺用の同軸針挿入補助器具に取り付け、動ひずみ計測機とブリッジボックスを接続し測定システムを構成した。穿刺評価対象としては豚の摘出心臓から切り分けた心膜と心室筋を３７℃に保温したものを用い、素材固定冶具に固定した。固定された素材に対し、心膜，心筋に１８Ｇの穿刺針を穿刺し，穿刺応力電圧と穿刺距離を測定している。 Based on this embodiment, a prototype was manufactured and a test for acquiring stress data was conducted using a pig heart. The contents of this test will be described. In the prototype, a load cell with a maximum measured stress of 10 N was prepared, attached to a coaxial needle insertion assisting device for epidural puncture, and a dynamic strain measuring machine and a bridge box were connected to form a measuring system. As the puncture evaluation target, the pericardium and the ventricular muscle carved from the excised heart of the pig were kept at 37 ° C. and fixed to the material fixing jig. An 18G puncture needle is punctured into the pericardium and myocardium of the fixed material, and the puncture stress voltage and the puncture distance are measured.
試験結果を元にした判定に使う応力範囲の一例を以下に示す。
判定範囲に示すように、心筋の応力範囲と心膜の応力範囲とは重複しておらず、これらの判定基準をクライテリアテーブル１５４に格納することで、判定例１５８のように穿刺部位を把握することを可能としている。 As shown in the judgment range, the stress range of the myocardium and the stress range of the pericardium do not overlap, and by storing these judgment criteria in the criterion table 154, the puncture site can be grasped as in the judgment example 158. It is possible.
報知手段１６０は、判断評価手段１５０の判定結果に応じて、表示や音などを用いて報知する。例えば、心膜１２に到達したときには青色のランプを点灯させ、そこから急激な応力の上昇が見られ、穿刺針１１０の先端が心筋１６に達したと判断評価手段１５０が判断すると、赤色のランプを点灯させるとともに警戒音を発する等の報知を行う形態とすることができる。 The notification means 160 notifies by using a display, a sound, or the like according to the judgment result of the judgment evaluation means 150. For example, when the pericardium 12 is reached, the blue lamp is turned on, and a rapid increase in stress is observed from the lamp. When the evaluation means 150 determines that the tip of the puncture needle 110 has reached the myocardium 16, the red lamp is used. It is possible to make a notification such as emitting a warning sound while turning on the light.
このように、本実施形態によれば、穿刺針１１０が到達する心膜１２、心筋１６の順序を明確にすることで、クライテリアテーブル１５４にて応力範囲を設定し、穿刺針の到達状況を正確に把握することができる。また、心膜１２による抵抗が減少したときが心嚢１４に穿刺したものと見なすことができるため、心筋１６を傷つけることなく穿刺を行うことを可能とし、さらに心筋１６に到達したと見なされたときには、報知手段１６０によって警告を発生させる等の処理をすることで心臓への損傷を軽減させることができる。 As described above, according to the present embodiment, by clarifying the order of the pericardium 12 and the myocardium 16 that the puncture needle 110 reaches, the stress range is set on the criterion table 154 and the arrival status of the puncture needle is accurate. Can be grasped. Further, when the resistance by the pericardium 12 is reduced, it can be considered that the heart sac 14 has been punctured. Therefore, it is possible to perform the puncture without damaging the myocardium 16, and it is considered that the myocardium 16 has been reached. Occasionally, damage to the heart can be reduced by performing processing such as generating a warning by the notification means 160.
次に図３を参照して本発明の一実施形態に係る穿刺針の変形例を説明する。図３（ａ）は穿刺前、（ｂ）は穿刺後の状態を表している。なお、図３では人体に合わせて、胸壁３０と心膜１２に間に空隙を設けている。 Next, a modified example of the puncture needle according to the embodiment of the present invention will be described with reference to FIG. FIG. 3A shows the state before puncture and FIG. 3B shows the state after puncture. In FIG. 3, a gap is provided between the chest wall 30 and the pericardium 12 according to the human body.
市販されている心膜および胸腔穿刺用胸部ドレナージ用カテーテルは、通常１８Ｇ（１８ゲージ例：外径１．２５ｍｍ±０．０２、内径０．８２ｍｍ±０．０３）が使われ、この穿刺針を使用して胸壁から心膜まで穿刺している。 Commercially available catheters for chest drainage for pericardial and thoracentesis usually use 18 G (18 gauge example: outer diameter 1.25 mm ± 0.02, inner diameter 0.82 mm ± 0.03), and this puncture needle is used. It is used to puncture from the chest wall to the pericardium.
係る構成の場合には、胸壁における抵抗力が大きく、測定される応力値が、計測システムに対して過大となって、計測できない可能性がある。 In the case of such a configuration, the resistance force on the chest wall is large, and the measured stress value becomes excessive with respect to the measurement system, and there is a possibility that the measurement cannot be performed.
図３（ａ）を参照すると、本変形例は、断面視２重管状の穿刺針であって、外筒側が第１穿刺針１１１と、内筒側が第２穿刺針１１２と、から構成されている。胸壁３０に穿刺する前は、第１穿刺針１１１と第２穿刺針１１２とは先端を一にさせている。 Referring to FIG. 3A, this modified example is a double tubular puncture needle in cross-sectional view, which is composed of a first puncture needle 111 on the outer cylinder side and a second puncture needle 112 on the inner cylinder side. There is. Before puncturing the chest wall 30, the tips of the first puncture needle 111 and the second puncture needle 112 are aligned.
次に、図３（ｂ）に示すように、第１穿刺針１１１が胸壁３０に接触して穿刺を行い、先端の鋭角部分が胸壁を越えて心膜１２まで到達すると、胸壁３０の抵抗力が減少する。ここで第１穿刺針１１１は留置させる。 Next, as shown in FIG. 3B, when the first puncture needle 111 contacts the chest wall 30 to perform puncture and the acute-angled portion of the tip reaches the pericardium 12 beyond the chest wall, the resistance force of the chest wall 30 Decreases. Here, the first puncture needle 111 is indwelled.
次に第１穿刺針１１１を留置させた状態で、内筒側の第２穿刺針１１２を穿刺方向に進める。このように構成することで、胸壁による抵抗力は第１穿刺針１１１が負担し、胸壁の影響を受けない第２穿刺針１１２によって、心膜、心嚢液、心筋の穿刺応力を計測することができる。 Next, with the first puncture needle 111 indwelled, the second puncture needle 112 on the inner cylinder side is advanced in the puncture direction. With this configuration, the resistance force of the chest wall is borne by the first puncture needle 111, and the puncture stress of the pericardium, pericardial fluid, and myocardium can be measured by the second puncture needle 112, which is not affected by the chest wall. it can.
以上説明したように、難易度の高い心嚢穿刺術において、エコーやレントゲンだけに依存せず、かつ穿刺しすぎて心臓や肺に傷つけることのない安全な穿刺術を支援するために、穿刺応力検出装置を提供する提供することができる。なお、具体的な判定基準となるクライテリアテーブルは、人間以外の生体を用いた試験結果の積み重ねとともに、実際の施術時のデータ蓄積を行うことで、より精度を向上させることが好ましい。また、本装置を心タンポナーデ施術のトレーニング装置として利用することもできる。 As explained above, in the difficult pericardiocentesis, puncture stress is used to support safe puncture that does not depend only on echo or roentgen and does not puncture too much and damage the heart or lungs. Providing a detection device can be provided. It is preferable that the accuracy of the criteria table, which is a specific criterion, is further improved by accumulating test results using living organisms other than humans and accumulating data at the time of actual treatment. In addition, this device can also be used as a training device for cardiac tamponade treatment.
１０・・・心臓
１２，１３・・・心膜
１４・・・心嚢
１６・・・心筋
１８・・・心腔
２０・・・心嚢液
３０・・・胸壁
１００・・・心嚢穿刺応力検出装置
１１０，１１１，１１２・・・穿刺針
１１５・・・把持部
１２０・・・計測手段
１３０・・・周波数成分除去手段
１４０・・・応力変換手段
１５０・・・判断評価手段
１５２・・・記憶手段
１５４・・・クライテリアテーブル
１５５・・・記録手段
１５７・・・応力時間的推移
１６０・・・報知手段
10 ... Heart 12, 13 ... Pericardium 14 ... Cardiac muscle 16 ... Myocardium 18 ... Cardiac cavity 20 ... Pericardial fluid 30 ... Chest wall 100 ... Pericardiocentesis stress detection Devices 110, 111, 112 ... Puncture needle 115 ... Grip part 120 ... Measuring means 130 ... Frequency component removing means 140 ... Stress conversion means 150 ... Judgment evaluation means 152 ... Memory Means 154 ... Criteria table 155 ... Recording means 157 ... Stress temporal transition 160 ... Notifying means
Claims (6)
穿刺針と、
該穿刺針の穿刺方向の抵抗を電気信号として取得する計測手段と、
該計測手段の信号から、施術する対象の心臓の拍動に応じた周波数成分を除去する周波数成分除去手段と、
該周波数成分除去手段によって処理された信号を応力に変換する応力変換手段と、
該応力の時間的な推移に応じて穿刺状態を判定する判断評価手段と、を備えることを特徴とする心嚢穿刺応力検出装置。 A pericardiocentesis stress detector having a surgical tool for puncturing the pericardial sac and inhaling pericardial fluid.
With a puncture needle,
A measuring means for acquiring the resistance of the puncture needle in the puncture direction as an electric signal,
A frequency component removing means for removing a frequency component corresponding to the heartbeat of the target to be treated from the signal of the measuring means,
A stress conversion means for converting a signal processed by the frequency component removing means into stress,
A pericardiocentesis stress detecting device comprising: a determination evaluation means for determining a puncture state according to a temporal transition of the stress.
心臓の部位に応じた応力の範囲を予め格納した記憶手段と、
該応力の時間的推移を記録する記録手段と、
選択した前記心臓の部位に対応する応力範囲に前記応力が到達したときに報知する報知手段と、を備えることを特徴とする請求項１に記載の心嚢穿刺応力検出装置。 The judgment evaluation means is
A storage means that stores the range of stress according to the part of the heart in advance,
A recording means for recording the temporal transition of the stress and
The pericardiocentesis stress detecting apparatus according to claim 1, further comprising a notification means for notifying when the stress reaches a stress range corresponding to the selected heart region.
心電図から取得した前記周波数成分に応じてカットオフ周波数帯を設定し、
前記カットオフ周波数帯を除去するバンドパスフィルタであることを特徴とする請求項１または２のいずれか１項に記載の心嚢穿刺応力検出装置。 The frequency component removing means is
The cutoff frequency band is set according to the frequency component obtained from the electrocardiogram, and the cutoff frequency band is set.
The pericardiocentesis stress detecting apparatus according to any one of claims 1 or 2, wherein the bandpass filter removes the cutoff frequency band.
前記報知手段は、前記心膜、前記心腔の順で、それぞれの前記応力範囲に前記応力が到達したときに報知することを特徴とする請求項１から３のいずれか１項に記載の心嚢穿刺応力検出装置。 The storage means stores the respective stress ranges when the tip of the puncture needle reaches each of the pericardium and the myocardium.
The heart according to any one of claims 1 to 3, wherein the notification means notifies when the stress reaches the respective stress ranges in the order of the pericardium and the heart chamber. Pericardiocentesis stress detector.
前記報知手段は、前記胸壁の前記応力範囲に前記応力が到達したときに報知することを特徴とする請求項４に記載の心嚢穿刺応力検出装置。 The storage means further stores the respective stress ranges when the tip of the puncture needle reaches the chest wall.
The pericardiocentesis stress detecting device according to claim 4, wherein the notification means notifies when the stress reaches the stress range of the chest wall.
大径の第１穿刺針と、
該第１穿刺針の針管何に挿抜自在に備えられた小径の第２穿刺針と、からなり、
該第１穿刺針は前記心膜まで到達したときに留置され、該第２穿刺針が挿入されることを特徴とする請求項５に記載の心嚢穿刺応力検出装置。
The puncture needle
Large diameter first puncture needle and
The needle tube of the first puncture needle is composed of a small-diameter second puncture needle that is freely inserted and removed.
The pericardiocentesis stress detecting device according to claim 5, wherein the first puncture needle is placed when it reaches the pericardium, and the second puncture needle is inserted.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| JP2019112592A JP7340841B2 (en) | 2019-06-18 | 2019-06-18 | Puncture stress detection device. |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| JP2019112592A JP7340841B2 (en) | 2019-06-18 | 2019-06-18 | Puncture stress detection device. |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| JP2020202980A true JP2020202980A (en) | 2020-12-24 |
| JP7340841B2 JP7340841B2 (en) | 2023-09-08 |
Family
ID=73837661
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| JP2019112592A Active JP7340841B2 (en) | 2019-06-18 | 2019-06-18 | Puncture stress detection device. |
Country Status (1)
| Country | Link |
|---|---|
| JP (1) | JP7340841B2 (en) |
Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN112649130A (en) * | 2020-12-29 | 2021-04-13 | 上海海事大学 | Medical puncture biopsy needle interface interaction mechanical property integrated test and method |
Citations (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| JP2004081852A (en) * | 2002-08-07 | 2004-03-18 | National Institute Of Advanced Industrial & Technology | Puncturing apparatus and detection method for working condition of needle of puncturing apparatus |
| US20120310052A1 (en) * | 2009-09-11 | 2012-12-06 | University Of Virginia Patent Foundation | Systems and methods for determining location of an access needle in a subject |
-
2019
- 2019-06-18 JP JP2019112592A patent/JP7340841B2/en active Active
Patent Citations (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| JP2004081852A (en) * | 2002-08-07 | 2004-03-18 | National Institute Of Advanced Industrial & Technology | Puncturing apparatus and detection method for working condition of needle of puncturing apparatus |
| US20120310052A1 (en) * | 2009-09-11 | 2012-12-06 | University Of Virginia Patent Foundation | Systems and methods for determining location of an access needle in a subject |
Cited By (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN112649130A (en) * | 2020-12-29 | 2021-04-13 | 上海海事大学 | Medical puncture biopsy needle interface interaction mechanical property integrated test and method |
| CN112649130B (en) * | 2020-12-29 | 2022-03-08 | 上海海事大学 | Integrated testing method for interaction mechanical property of medical puncture biopsy needle interface |
Also Published As
| Publication number | Publication date |
|---|---|
| JP7340841B2 (en) | 2023-09-08 |
Similar Documents
| Publication | Publication Date | Title |
|---|---|---|
| US11083381B2 (en) | Systems and methods for determining pressure frequency changes in a subject | |
| EP2326241B1 (en) | Monitoring the blood pressure of a patient | |
| US4821735A (en) | Method and apparatus for detecting myocardial ischemia | |
| KR101727367B1 (en) | System and method for monitoring phonocardiogram | |
| JP2001520902A (en) | Device for detecting pericardial effusion | |
| US10194885B2 (en) | Automatic monitoring for and detection of tissue pop | |
| JP2022544625A (en) | Systems and methods for portable ultrasound-guided cannulation | |
| JP2010284532A (en) | Device for deciding patient's physiological parameter, and method for the same | |
| US7353057B2 (en) | Apparatus and method for detecting atrial fibrillation | |
| US20170143225A1 (en) | Device for measurement and evaluation of cardiac function on the basis of thoracic impedance | |
| JP6558881B2 (en) | Perfusion cannula with integrated sensor technology | |
| KR20030069035A (en) | Autonomic-nerve-function evaluating apparatus | |
| JP2020202980A (en) | Puncture stress detection device | |
| KR101879634B1 (en) | Monitoring system for cardiopulmonary vessel | |
| JP2007510493A (en) | Method and apparatus for determining the presence of an ischemic region of a human or animal heart | |
| JP3694438B2 (en) | Blood vessel tension measuring device | |
| CN108618783B (en) | Method and device for judging position of catheter and monitoring equipment | |
| JP4227519B2 (en) | Method for measurement of posterior arteriole pressure | |
| EP3960106A1 (en) | Electrode catheter system | |
| JP2019037686A5 (en) | ||
| Badran et al. | Blood pressure measurement | |
| RU185916U1 (en) | TONOMETER | |
| EP3509486B1 (en) | Medical apparatus for the introduction of catheters into the human body | |
| CN105310672B (en) | Biological information measuring apparatus and biological information measuring method | |
| JP6596228B2 (en) | Cardiac catheter testing device and method of operating cardiac catheter testing device |
Legal Events
| Date | Code | Title | Description |
|---|---|---|---|
| A621 | Written request for application examination |
Free format text: JAPANESE INTERMEDIATE CODE: A621 Effective date: 20220616 |
|
| A977 | Report on retrieval |
Free format text: JAPANESE INTERMEDIATE CODE: A971007 Effective date: 20230315 |
|
| A131 | Notification of reasons for refusal |
Free format text: JAPANESE INTERMEDIATE CODE: A131 Effective date: 20230320 |
|
| A521 | Request for written amendment filed |
Free format text: JAPANESE INTERMEDIATE CODE: A523 Effective date: 20230508 |
|
| A131 | Notification of reasons for refusal |
Free format text: JAPANESE INTERMEDIATE CODE: A131 Effective date: 20230530 |
|
| A521 | Request for written amendment filed |
Free format text: JAPANESE INTERMEDIATE CODE: A523 Effective date: 20230719 |
|
| TRDD | Decision of grant or rejection written | ||
| A01 | Written decision to grant a patent or to grant a registration (utility model) |
Free format text: JAPANESE INTERMEDIATE CODE: A01 Effective date: 20230808 |
|
| A61 | First payment of annual fees (during grant procedure) |
Free format text: JAPANESE INTERMEDIATE CODE: A61 Effective date: 20230822 |
|
| R150 | Certificate of patent or registration of utility model |
Ref document number: 7340841 Country of ref document: JP Free format text: JAPANESE INTERMEDIATE CODE: R150 |