JP4399712B2 - 麻酔時及び鎮静時の覚醒度、痛感度及びストレス度の評価システム及び方法 - Google Patents
麻酔時及び鎮静時の覚醒度、痛感度及びストレス度の評価システム及び方法 Download PDFInfo
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- JP4399712B2 JP4399712B2 JP2003581648A JP2003581648A JP4399712B2 JP 4399712 B2 JP4399712 B2 JP 4399712B2 JP 2003581648 A JP2003581648 A JP 2003581648A JP 2003581648 A JP2003581648 A JP 2003581648A JP 4399712 B2 JP4399712 B2 JP 4399712B2
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- 206010002091 Anaesthesia Diseases 0.000 title claims description 13
- 230000037005 anaesthesia Effects 0.000 title claims description 13
- 238000000034 method Methods 0.000 title claims description 9
- 230000037007 arousal Effects 0.000 title claims description 6
- 206010039897 Sedation Diseases 0.000 title claims description 5
- 230000008533 pain sensitivity Effects 0.000 title claims description 5
- 230000036280 sedation Effects 0.000 title claims description 5
- 238000011156 evaluation Methods 0.000 title 1
- 239000000523 sample Substances 0.000 claims description 12
- 230000003444 anaesthetic effect Effects 0.000 claims description 8
- 230000000202 analgesic effect Effects 0.000 claims description 7
- 238000001514 detection method Methods 0.000 claims description 5
- 230000000747 cardiac effect Effects 0.000 claims description 4
- 230000035882 stress Effects 0.000 claims description 3
- 238000012544 monitoring process Methods 0.000 claims description 2
- 238000001356 surgical procedure Methods 0.000 claims description 2
- 238000001914 filtration Methods 0.000 claims 1
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- 230000007423 decrease Effects 0.000 description 9
- 230000002567 autonomic effect Effects 0.000 description 5
- 238000004458 analytical method Methods 0.000 description 4
- 206010021118 Hypotonia Diseases 0.000 description 3
- 206010062519 Poor quality sleep Diseases 0.000 description 3
- 208000003443 Unconsciousness Diseases 0.000 description 3
- 230000036772 blood pressure Effects 0.000 description 3
- 230000003750 conditioning effect Effects 0.000 description 3
- 230000008602 contraction Effects 0.000 description 3
- 230000000147 hypnotic effect Effects 0.000 description 3
- 230000036640 muscle relaxation Effects 0.000 description 3
- 230000004044 response Effects 0.000 description 3
- 230000002889 sympathetic effect Effects 0.000 description 3
- 238000010586 diagram Methods 0.000 description 2
- 238000005259 measurement Methods 0.000 description 2
- 230000036407 pain Effects 0.000 description 2
- 230000001734 parasympathetic effect Effects 0.000 description 2
- 238000011084 recovery Methods 0.000 description 2
- 229960002078 sevoflurane Drugs 0.000 description 2
- DFEYYRMXOJXZRJ-UHFFFAOYSA-N sevoflurane Chemical compound FCOC(C(F)(F)F)C(F)(F)F DFEYYRMXOJXZRJ-UHFFFAOYSA-N 0.000 description 2
- 208000007536 Thrombosis Diseases 0.000 description 1
- 230000001154 acute effect Effects 0.000 description 1
- 230000036592 analgesia Effects 0.000 description 1
- 210000000709 aorta Anatomy 0.000 description 1
- 208000011775 arteriosclerosis disease Diseases 0.000 description 1
- 210000001367 artery Anatomy 0.000 description 1
- QVGXLLKOCUKJST-UHFFFAOYSA-N atomic oxygen Chemical compound [O] QVGXLLKOCUKJST-UHFFFAOYSA-N 0.000 description 1
- 210000003403 autonomic nervous system Anatomy 0.000 description 1
- 239000008280 blood Substances 0.000 description 1
- 210000004369 blood Anatomy 0.000 description 1
- 230000017531 blood circulation Effects 0.000 description 1
- 238000006243 chemical reaction Methods 0.000 description 1
- 230000002596 correlated effect Effects 0.000 description 1
- 230000003247 decreasing effect Effects 0.000 description 1
- 229940079593 drug Drugs 0.000 description 1
- 239000003814 drug Substances 0.000 description 1
- 238000000605 extraction Methods 0.000 description 1
- 230000006698 induction Effects 0.000 description 1
- 230000007935 neutral effect Effects 0.000 description 1
- 230000003040 nociceptive effect Effects 0.000 description 1
- 229910052760 oxygen Inorganic materials 0.000 description 1
- 239000001301 oxygen Substances 0.000 description 1
- 238000013186 photoplethysmography Methods 0.000 description 1
- 238000005293 physical law Methods 0.000 description 1
- 230000026416 response to pain Effects 0.000 description 1
- 230000003938 response to stress Effects 0.000 description 1
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- 238000002627 tracheal intubation Methods 0.000 description 1
- 230000002861 ventricular Effects 0.000 description 1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/48—Other medical applications
- A61B5/4821—Determining level or depth of anaesthesia
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
- A61B5/021—Measuring pressure in heart or blood vessels
- A61B5/02108—Measuring pressure in heart or blood vessels from analysis of pulse wave characteristics
- A61B5/02125—Measuring pressure in heart or blood vessels from analysis of pulse wave characteristics of pulse wave propagation time
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
- A61B5/026—Measuring blood flow
- A61B5/0285—Measuring or recording phase velocity of blood waves
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
- A61B5/316—Modalities, i.e. specific diagnostic methods
- A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
- A61B5/346—Analysis of electrocardiograms
- A61B5/349—Detecting specific parameters of the electrocardiograph cycle
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
- A61B5/024—Detecting, measuring or recording pulse rate or heart rate
- A61B5/02416—Detecting, measuring or recording pulse rate or heart rate using photoplethysmograph signals, e.g. generated by infrared radiation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/103—Detecting, measuring or recording devices for testing the shape, pattern, colour, size or movement of the body or parts thereof, for diagnostic purposes
- A61B5/11—Measuring movement of the entire body or parts thereof, e.g. head or hand tremor, mobility of a limb
- A61B5/1104—Measuring movement of the entire body or parts thereof, e.g. head or hand tremor, mobility of a limb induced by stimuli or drugs
- A61B5/1106—Measuring movement of the entire body or parts thereof, e.g. head or hand tremor, mobility of a limb induced by stimuli or drugs to assess neuromuscular blockade, e.g. to estimate depth of anaesthesia
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
- A61B5/316—Modalities, i.e. specific diagnostic methods
- A61B5/318—Heart-related electrical modalities, e.g. electrocardiography [ECG]
- A61B5/346—Analysis of electrocardiograms
- A61B5/349—Detecting specific parameters of the electrocardiograph cycle
- A61B5/352—Detecting R peaks, e.g. for synchronising diagnostic apparatus; Estimating R-R interval
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- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Cardiology (AREA)
- Molecular Biology (AREA)
- Animal Behavior & Ethology (AREA)
- Veterinary Medicine (AREA)
- Biophysics (AREA)
- Pathology (AREA)
- Engineering & Computer Science (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Medical Informatics (AREA)
- Public Health (AREA)
- Surgery (AREA)
- Physics & Mathematics (AREA)
- General Health & Medical Sciences (AREA)
- Hematology (AREA)
- Physiology (AREA)
- Vascular Medicine (AREA)
- Anesthesiology (AREA)
- Measuring Pulse, Heart Rate, Blood Pressure Or Blood Flow (AREA)
- Measurement Of The Respiration, Hearing Ability, Form, And Blood Characteristics Of Living Organisms (AREA)
- Measurement And Recording Of Electrical Phenomena And Electrical Characteristics Of The Living Body (AREA)
- Infusion, Injection, And Reservoir Apparatuses (AREA)
Description
本願は2002年4月1日出願の米国仮特許願60/369142の優先権を主張する。
Claims (14)
- 鎮静時あるいは麻酔時にストレス度、痛感度または覚醒度をモニターする装置であって、
少なくとも1つのECG信号を取得する手段と、
動脈パルス波形を取得する手段と、
前記ECG信号を処理してパルス開始基準点を特定する手段と、
前記動脈パルス波形を処理してパルス到達基準点を特定する手段と、
心臓サイクルの前記パルス開始基準点と前記パルス到達基準点との時間差を計算する手段と、
該時間差の結果から継時PTTを推定する手段と、
PTTの臨床解釈に基いて鎮痛剤あるいは麻酔剤の投与量を決定する手段と、
を含んで成る装置。 - 動脈パルス波形はフォトプレシスモグラフを利用して取得することを特徴とする請求項1記載の装置。
- 動脈パルス波形はトノメータ装置で取得することを特徴とする請求項1記載の装置。
- パルス開始基準点はQRS検出で決定されることを特徴とする請求項1記載の装置。
- パルス到達基準点はパルス検出で決定されることを特徴とする請求項1記載の装置。
- 心臓サイクルの前記パルス開始基準点と前記パルス到達基準点との時間差を計算する手段は、
パルス開始基準点に対しては、次の予め決定された時間間隔内でパルス到達基準点を特定する手段と、
ペアが特定されれば、開始基準点と到達基準点との時間差を計算する手段と、
ペアが特定されなければ、前記パルス開始基準点に関係するデータの処理を中止する手段と、
をさらに含んでいることを特徴とする請求項1記載の装置。 - 時間差の結果から継時PTTを推定する手段は最新値を利用する手段をさらに含んでいることを特徴とする請求項1記載の装置。
- 時間差の結果から継時PTTを推定する手段は最後のY秒は5秒から30秒の間であり、50%または75%であるX%のトリム平均値を利用する手段をさらに含んでいることを特徴とする請求項1記載の装置。
- 時間差の結果から継時PTTを推定する手段は最後のY秒は5秒から30秒のメジアンフィルタ処理を利用する手段をさらに含んでいることを特徴とする請求項1記載の装置。
- PTTの臨床解釈に基いて鎮痛剤あるいは麻酔剤の投与量を決定する手段は、
手術または処置刺激によってPTTが基準値以下に減少した場合、充分量の鎮痛剤あるいは麻酔剤を投与してPTTを基準値以上に増加させる手段をさらに含んでいることを特徴とする請求項1記載の装置。 - 予め決定された時間間隔は500m秒であることを特徴とする請求項6記載の装置。
- ストレス度、痛感度または覚醒度をモニターするシステムであって、
ECG信号を取得するために少なくとも1つのECGリードと、
パルス波形信号を取得するために接続されたプローブと、
前記ECGとPPG信号を分析し、対象のPTTの推定値を対象の心臓からPPGプローブが設置されている他の部位まで計算するためのプロセッサであって、鎮痛剤あるいは麻酔剤の投与量が前記PTTに基いて調整されるべきか否かを決定するプロセッサと、
を含んで構成されていることを特徴とするシステム。 - プローブはフォトプレシスモグラフであることを特徴とする請求項12記載のシステム。
- プローブはトノメータであることを特徴とする請求項12記載のシステム。
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US36914202P | 2002-04-01 | 2002-04-01 | |
PCT/US2003/009900 WO2003084396A1 (en) | 2002-04-01 | 2003-04-01 | System and method of assessment of arousal, pain and stress during anesthesia and sedation |
Publications (2)
Publication Number | Publication Date |
---|---|
JP2005521505A JP2005521505A (ja) | 2005-07-21 |
JP4399712B2 true JP4399712B2 (ja) | 2010-01-20 |
Family
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Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
JP2003581648A Expired - Fee Related JP4399712B2 (ja) | 2002-04-01 | 2003-04-01 | 麻酔時及び鎮静時の覚醒度、痛感度及びストレス度の評価システム及び方法 |
Country Status (8)
Country | Link |
---|---|
US (1) | US20040015091A1 (ja) |
EP (1) | EP1489964A1 (ja) |
JP (1) | JP4399712B2 (ja) |
AU (1) | AU2003226171B2 (ja) |
BR (1) | BR0308878A (ja) |
CA (1) | CA2479916C (ja) |
MX (1) | MXPA04009533A (ja) |
WO (1) | WO2003084396A1 (ja) |
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