JP4643247B2 - 心不全及びチェーン・ストークス型呼吸の治療のための換気補助 - Google Patents
心不全及びチェーン・ストークス型呼吸の治療のための換気補助 Download PDFInfo
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Description
本明細書において、呼吸性気流は肺を出入りする気体の瞬間的な流れの意味で使用される。「平均」という言葉は、低域通過フィルターの動作の中央化効果又はその結果(any measure of central tendency or the result of any low pass filtering operation)の意味に使用される。換気補助は呼吸筋と同様の効果を有する任意の手順、特にノーズマスク、フェースマスク、気管支内挿入管、気管カニューレなどを介して変化する陽圧で呼吸可能気体を気道に供給することを意味するが、陰圧換気、胸鎧、鉄の肺、外的な胸部圧迫又は揺動ベッド換気のような他の手順も含む。通常の用法に従い、換気は、「陽圧換気」と表現されるような手順か、又は、ある時間にわたる呼吸性気流の平均値(measure of average)を意味することがある。瞬間的な換気は、数秒未満の短時間に吸入される体積の意味に使われる。同様にこれは、かかる期間の間に排出される体積として計算することもでき、また両者の平均値とすることもできる。例えば、瞬間的な換気の測定量には、数秒程度に比べて短い時間にわたって計算された呼吸性気流の絶対値の平均値の半分、あるいは数秒程度に比べて短い時定数を持つ低域通過フィルターにかけられた呼吸性気流の絶対値の半分が含まれるであろう。後で説明する技術的な理由により、最適な実施例においては、瞬間的な呼吸性気流の絶対値の半分、すなわち任意の短い時間にわたって平均されたものを瞬間的な換気量とする。ただし本発明は、瞬間的な換気量をこの方法で計算することに限定されるものではない。
患者に換気補助を施すステップと、
瞬間換気の測定量を導くステップと、かつ、
前記瞬間換気の測定量の短期的な変化には対抗するが、前記瞬間換気の測定量の長期的な変化は許容するステップとからなる治療方法を開示する。
患者に制御可能な程度の換気補助を施す装置と、
患者の瞬間換気量を示す信号を導く手段と、及び、
前記瞬間換気の測定量の短期的な変化には対抗するが、前記瞬間換気の測定量の長期的な変化は許容するように、前記換気補助装置が供給する換気補助の程度を制御するように動作可能なサーボコントローラーとで構成される治療装置を開示する。
患者に換気補助を施すステップと、
患者の瞬間換気の測定量を導くステップと、かつ、
無治療のチェーン・ストークス型呼吸又は中枢型睡眠無呼吸症の増加・減少サイクルの周期と同程度の時間スケールにわたる前記瞬間換気の測定量の変化を軽減するが、前記増加・減少サイクルよりも大幅に長い時間スケールでの前記瞬間換気の測定量の変化は許容するように、換気補助の程度を調節するステップとからなる治療方法を開示する。
患者に換気補助を施すステップと、
患者の瞬間換気の測定量を導くステップと、
患者の長期的な平均換気の測定量を導くステップと、
サーボコントローラーの制御された変数を前記患者の瞬間換気の測定量の関数に設定するステップと、
前記サーボコントローラーの基準変数を前記患者の長期的な平均換気の測定量に設定するステップと、かつ、
前記サーボコントローラーの出力に従って前記換気補助の程度を調節するステップとからなる治療方法を開示する。
患者に換気補助を施すステップと、
患者の瞬間換気の測定量を導くステップと、
前記患者の瞬間換気の測定量を高域通過フィルターにかけるステップと、かつ、
前記換気補助の程度を、高域通過フィルターを通過した前記患者の瞬間換気の測定量と逆向きに調節するステップとからなる治療方法を開示する。
患者に制御可能な大きさと割合の陽圧換気補助を施すステップと、
患者の瞬間換気の測定量を導くステップと、
(a)前記瞬間換気の測定量を低域通過フィルターにかけて直近の平均換気の測定量を導くことと、
(b)前記直近の平均換気の測定量の一部分に等しい目標換気量を設定することと、
(c)換気補助の程度を調節することにより、前記瞬間換気の測定量を少なくとも目標換気量に等しくサーボ制御することにより、前記陽圧の大きさを調節するステップと、
(a)瞬間換気量が前記目標換気量と等しいかそれを超える場合は、呼吸性気流と同調して前記陽圧を変調することと、
(b)瞬間換気量が前記目標換気量よりも小さい場合は、前記陽圧を事前に設定された割合で変調することにより前記割合を連続的に調節するステップとからなる治療方法を開示する。
陽圧の呼吸可能な気体の制御可能な供給源と、
患者の気道に前記呼吸可能な気体を陽圧で供給する手段と、
患者の瞬間換気の測定量を導く手段と、及び、
無治療のチェーン・ストークス型呼吸又は中枢型睡眠無呼吸症の増加・減少サイクルの周期と同程度の時間スケールでの前記瞬間換気の測定量の変化を軽減するが、前記増加・減少サイクルよりも大幅に長い時間スケールでの前記瞬間換気の測定量の変化は許容するように、換気補助の程度を調節するためのサーボコントローラーとからなる治療装置を開示する。
呼吸可能な気体の陽圧での制御可能な供給源と、
患者の気道に前記呼吸可能な気体を陽圧で供給する手段と、
患者の瞬間換気の測定量を導く手段と、
患者の長期的な平均換気の測定量を導く手段と、
前記患者の長期的な平均換気の測定量の関数として目標換気量を導く手段と、
入力変数が前記患者の瞬間換気の測定量の関数であり、基準変数が前記目標換気量であるサーボコントローラーと、
サーボコントローラーの出力に従って前記換気補助の程度を調節する手段とからなる治療装置を開示する。
制御可能な大きさと割合の換気補助を供給するための換気手段と、
患者の瞬間換気量を示す信号を導くセンサー及び処理手段と、及び、
直近の平均換気の測定量を導くために前記瞬間換気量の信号を低域通過フィルターにかけることにより圧力補助の大きさを調節するように動作可能で、目標換気量を前記直近の平均換気の測定量の一部分に等しく設定し、前記瞬間換気の測定量を少なくとも目標換気量に等しくなるようにサーボ制御を行い、又更に瞬間換気量が前記目標換気量と等しいかそれを超える場合は呼吸性気流と同調して前記陽圧を変調し、瞬間換気量が前記目標換気量よりも小さい場合は前記陽圧を事前に設定された割合で変調することにより、前記割合を連続的に調節するように動作可能なサーボ制御手段とで構成される治療装置を開示する。
1. 気流がゼロであり急速に増加している場合は、位相は0回転である。
2. 気流が大きな正の値を持ち安定しているならば、位相は0.25回転である。
3. 気流がゼロであり急速に低下している場合は、位相は0.5回転である。
4. 気流がゼロであり大きな負の値であり安定している場合は、位相は0.75回転である。
5. 気流がゼロで安定しており、5秒の低域通過フィルターにかけられた呼吸性気流の絶対値が大きな値を持つ場合は、位相は0.9回転である。
6. 気流が正であり位相が呼気である場合は、位相は0回転である。
7. 気流が負であり位相が吸気である場合は、位相は0.5回転である。
8. 5秒の低域通過フィルターにかけられた呼吸性気流の絶対値が小さな値を持つ場合は、呼吸サイクルにおける位相は患者の予想される呼吸速度と等しい固定した割合で増加している。
9. 5秒の低域通過フィルターにかけられた呼吸性気流の絶対値が大きな値を持つ場合、呼吸サイクルにおける位相は、位相の現実の変化率に等しい安定した割合で増加しており、時定数20秒の低域通過フィルターにかけられる。
11 マスク
12 供給管
13 排気管
14 呼吸気流計
15 差圧トランスデューサ
16 マイクロコントローラー
17 ポート
18 圧力トランスデューサ
19 サーボ
20 モーター
21 シリアルポート
22 マスク流信号
24 圧力信号
26 瞬間マスク圧力要求信号
Claims (11)
- 心不全、チェーン・ストークス型呼吸又は中枢型睡眠無呼吸症の治療装置であって、
陽圧の呼吸可能な気体の制御可能な供給源(10)と、
患者の気道に前記呼吸可能な気体を陽圧で供給する手段(11,12)と、
患者の呼吸気流の測定量を導く手段(14,15,16)と、
入力変数と基準量とを受け取るサーボコントローラーであって、該入力変数の値を該基準量の値に近づけるために用いられる出力を与えるサーボコントローラー(16)と、を有する治療装置において、
(i)上記入力変数は、瞬間換気の測定量の関数であり、
(ii)上記基準量は、呼吸気流の測定量から得られた換気の長期的な測定量のフラクションであり、
上記フラクションは、プラスのフィードバックを生じる値よりは小さく、且つ、チェーン・ストークス型呼吸を許す値よりは大きく、
上記長期は、未治療のチェーン・ストークス型呼吸又は中枢型睡眠無呼吸症の増大・減少サイクルの周期の時間スケールよりも長い時間スケールであることを特徴とする、治療装置。 - 上記フラクションは95%である、請求項1記載の治療装置。
- 上記瞬間換気の上記測定量は、数秒未満の短時間に吸入される上記呼吸可能な気体の体積として計算される、請求項1記載の治療装置。
- 上記瞬間換気の上記測定量は、数秒未満の短時間に排出される上記呼吸可能な気体の体積として計算される、請求項1記載の治療装置。
- 上記瞬間換気の上記測定量は、数秒未満の短時間に吸入されたり排出されたりする上記呼吸可能な気体の体積の平均値として計算される、請求項1記載の治療装置。
- 上記瞬間換気の上記測定量は、数秒と比較して短い時間に亘る上記呼吸気流の絶対値の平均値の半分として計算される、請求項1記載の治療装置。
- 上記瞬間換気の上記測定量は、数秒と比較して短い時定数を有する低域通過フィルターにかけられた上記呼吸気流の絶対値の半分として計算される、請求項1記載の治療装置。
- 上記サーボコントローラーは、換気補助の程度が最小の補助の程度より小さくならないように、更に、上記患者の気道に供給される上記呼吸可能な気体によって提供される換気補助の程度をクリップするような動作が可能であり、
上記最小の補助の程度は、患者の呼吸作用を実行するのに十分な程度であるが、しかし、患者の全呼吸作用を実行する換気補助よりも小さい程度である、請求項1〜7のいずれかに記載の治療装置。 - 上記サーボコントローラーは、換気補助の程度が最大の補助の程度を超えないように、更に、上記患者の気道に供給される上記呼吸可能な気体によって提供される換気補助の程度をクリップするような動作が可能であり、
上記最大の補助の程度は、患者の呼吸作用のほとんど又は全部を実行するのに十分な程度であるが、しかし、危険ではない程度である、請求項1〜7のいずれかに記載の治療装置。 - 上記サーボコントローラーは、更に、患者が十分に呼吸している時には、患者の呼吸気流と同調させて患者の気道に供給される呼吸可能な気体を変調するような動作が可能であり、また、患者が十分に呼吸していない時には、事前に設定された割合で患者の気道に供給される呼吸可能な気体を変調するような動作が可能である、請求項1〜9のいずれかに記載の治療装置。
- 心不全、チェーン・ストークス型呼吸又は中枢型睡眠無呼吸症の治療装置が、患者の呼吸気流について得られた測定量に基づき、患者の気道に呼吸可能な気体を陽圧で供給することを制御するのに相応しい制御信号を計算する、装置の作動方法であって、入力変数と基準量とを受け取り該入力変数の値を該基準量の値に近づけるのに適切な出力として該制御信号を与えるサーボ制御手順を有する、装置の作動方法にして、
(i)上記入力変数は、患者の瞬間換気について得られた測定量であり、
(ii)上記基準量は、呼吸気流の測定量から得られた換気の長期的な測定量のフラクションであり、
上記フラクションは、プラスのフィードバックを生じる値よりは小さく、且つ、チェーン・ストークス型呼吸を許す値よりは大きく、
上記長期は、未治療のチェーン・ストークス型呼吸又は中枢型睡眠無呼吸症の増大・減少サイクルの周期の時間スケールよりも長い時間スケールであることを特徴とする、装置の作動方法。
Applications Claiming Priority (1)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
AUPP3663A AUPP366398A0 (en) | 1998-05-22 | 1998-05-22 | Ventilatory assistance for treatment of cardiac failure and cheyne-stokes breathing |
Related Parent Applications (1)
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JP2004365373A Expired - Lifetime JP4643247B2 (ja) | 1998-05-22 | 2004-12-17 | 心不全及びチェーン・ストークス型呼吸の治療のための換気補助 |
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EP (6) | EP2774645A1 (ja) |
JP (3) | JP3737698B2 (ja) |
AT (1) | ATE377437T1 (ja) |
AU (3) | AUPP366398A0 (ja) |
DE (1) | DE69937492T2 (ja) |
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