JP4848505B2 - Autonomic nerve treatment device by cervical pressure load - Google Patents

Autonomic nerve treatment device by cervical pressure load Download PDF

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JP4848505B2
JP4848505B2 JP2007500388A JP2007500388A JP4848505B2 JP 4848505 B2 JP4848505 B2 JP 4848505B2 JP 2007500388 A JP2007500388 A JP 2007500388A JP 2007500388 A JP2007500388 A JP 2007500388A JP 4848505 B2 JP4848505 B2 JP 4848505B2
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nerve activity
activity value
pressure load
means
value
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JPWO2006080075A1 (en
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徹 川田
勝 杉町
賢二 砂川
厚範 神谷
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財団法人ヒューマンサイエンス振興財団
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61HPHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H7/00Devices for suction-kneading massage; Devices for massaging the skin by rubbing or brushing not otherwise provided for
    • A61H7/001Devices for suction-kneading massage; Devices for massaging the skin by rubbing or brushing not otherwise provided for without substantial movement between the skin and the device
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61HPHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2201/00Characteristics of apparatus not provided for in the preceding codes
    • A61H2201/16Physical interface with patient
    • A61H2201/1602Physical interface with patient kind of interface, e.g. head rest, knee support or lumbar support
    • A61H2201/165Wearable interfaces
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61HPHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2205/00Devices for specific parts of the body
    • A61H2205/04Devices for specific parts of the body neck

Description

  The present invention relates to an autonomic nerve treatment apparatus using a cervical pressure load, and more specifically, a pressure load means is attached to a patient's cervix, and suction (negative pressure) or pressure (positive pressure) is applied to the cervix by the pressure load means. The vagus nerve activity is increased or decreased, and the sympathetic nerve activity is decreased or increased, and the sympathetic nerve activity value and / or the vagus nerve activity value is controlled to the target value, thereby favoring the patient's autonomic nerve activity. The present invention relates to an autonomic nerve treatment device using a cervical pressure load, which improves to a simple state.

In recent years, causes of diseases in various fields, treatment methods and therapeutic drugs have been created with the advance of medicine. However, it is also true that there are many problems that cannot be solved even in medical progress.
In recent years, in developed countries, myocardial infarction that robs the active labor force has frequently occurred and has become a very important problem. Severe myocardial infarction is a major cause of chronic heart failure, and active research is being conducted to find the cause, treatment method and therapeutic agent for heart failure. However, despite progress in various treatment methods and drugs, the survival rate for chronic heart failure remains low.

  Autonomic abnormalities are involved in the exacerbation of many diseases for which effective medical treatment has not been established. Some of these diseases can be treated by improving this autonomic nerve activity to a suitable state.

In particular, chronic heart failure has a reduced heart pump function, and sympathetic nerves are abnormally increased as one of the abnormalities of the autonomic nerve, resulting in a very heavy load on the heart with reduced pump function and death. It has become clear as a result of research.
For this reason, as a treatment for chronic heart failure, a medical treatment method has been created to reduce the load on the heart by suppressing the enhanced sympathetic nerve activity, which is one of the abnormalities of the autonomic nerve.
For example, in Non-Patent Document 1, a nerve signal from the sympathetic nervous system (generally accompanied by the release of noradrenaline) is urged to activate the heart's pump function (enhancement of cardiac contractility, increase in heart rate) And the like, and a therapeutic method and therapeutic agent for chronic heart failure using a blocking agent for suppressing the action of the sympathetic nerve have been studied.
It is also known that nerve signals (generally accompanied by the release of acetylcholine) from the vagus nervous system (parasympathetic nervous system) promote the suppression of the heart's pump function (inhibitory action on the function of the heart). (For example, refer nonpatent literature 2).
For this reason, Non-Patent Document 3 discloses chronic heart failure treatment aimed at reducing the burden by activating the vagus nerve activity and suppressing the heart pump function by electrically stimulating the vagus nerve. Has been disclosed, and research in this field has been actively conducted.

However, the above-described treatment for adjusting the sympathetic nervous system or vagus nervous system activity to improve the patient's autonomic nervous activity or to improve the autonomic abnormality has the following problems. ing.
Among treatments that improve sympathetic nerve activity among autonomic nerve activities, sympathetic nerve activity cannot be quantitatively determined, sympathetic nerve activity cannot be controlled to a desired target value, sympathetic nerve blockers and sympathomimetic drugs as described above May have side effects, and sympathetic nerve-suppressing surgical treatments such as sympathectomy and sympathetic block are invasive.
In addition, in the treatment of improving vagus nerve activity among autonomic nerve activities, treatment that reliably increases vagus nerve activity has not been established, vagus nerve activity cannot be controlled to a desired target value, and vagus nerve activity is adjusted Surgical treatment for doing so has problems such as being invasive.
In view of these problems, there is currently no minimally invasive treatment apparatus capable of performing treatment by controlling the activities of the sympathetic nervous system and the vagus nervous system to target values.

On the other hand, conventionally, direct measurement of human sympathetic nerve activity is limited to several hours, and it has been difficult to directly measure vagus nerve activity. However, research has found that these sympathetic nerve activity and vagus nerve activity can be estimated by measuring biological signals such as body blood pressure, heart rate, electrocardiogram and pulse wave (for example, Non-Patent Document 4).
However, the present situation is that no device has been created for treatment by estimating the activities of the sympathetic nerve and the vagus nerve from body blood pressure, heart rate, and the like.

In addition, as a physiological experiment apparatus that is currently used, an apparatus that is worn on a human neck and examines a baroreflex function such as a blood pressure-sympathetic nerve activity relationship or a blood pressure-heart rate relationship is used. Such a device is used to examine how the baroreflex function changes in various physiological conditions such as exercise, standing up, aging, etc. of the person wearing this device, and in various diseases. It is used (for example, refer nonpatent literature 5).
However, even though such a device can be mounted on a human neck and measure baroreflex function, conventionally only invasive surgical treatment is known to regulate sympathetic nerve activity or vagus nerve activity. Because it was not available, it could not be used as a device to treat the patient's autonomic nerve.

Kazunari Komuro, "Heart Failure Frontier-Possibility of Elucidation of Origin to Regenerative Medicine-", Medical Review, Inc., April 15, 2003, p. 207-215 Toshinori Hongo and four others, "Standard Physiology (4th edition)", Medical School, Inc., October 1, 1996, p. 366-370 Meihua Li et, al "Vagal Nerve Stimulation Markedly Improves Long-Term Survival After Chronic Heart Failure in Rats" Circulation. 2004; 109: 120-124 Editor of the Japan MEE Association, "Cardiac Mechanics and Energetics", Corona Inc., November 10, 2000, p. 132-139 Ichinose M, Saito M, Kitano A, Hayashi K, Kondo N, Nishiyasu T "Modulation of arterial baroreflex dynamic response during mild orthostatic stress in humans" J Physiol. 2004 May 15; 557 (Pt 1): 321-30. Epub 2004 Mar 05

  The present invention has been made in view of such circumstances, and by attaching a pressure load means to a patient's neck and applying a suction (negative pressure) or a pressure (positive pressure) to the neck by the pressure load means. Cervical pressure, which increases or decreases vagus nerve activity and reduces or increases sympathetic nerve activity to improve autonomic nerve abnormalities by controlling sympathetic nerve activity value and / or vagus nerve activity value to a target value The present invention relates to an autonomic nerve treatment device by load.

The invention according to claim 1 is a treatment device for improving a patient's autonomic nerve activity to a suitable state, and is attached to the neck of the patient and extends the blood vessel wall in the neck. Pressure loading means 21 for aspirating the cervical surface and / or pressing the cervical surface in order to compress the blood vessel wall in the cervical body , a nerve activity value indicating sympathetic or vagus nerve activity of the patient, Control that compares the input means 22 for inputting an activity target value with the nerve activity value and the nerve activity target value input at the input means 22 and controls the operation of the pressure load means 21 according to the comparison result. Means 23, and the control means 23 further compares the current neural activity value with the past neural activity value, and the pressure value is set so that the neural activity value approaches the neural activity target value according to the comparison result. Load hand Providing autonomic treatment device according cervical pressure load and controls the pressing or suction operation 21.

The present invention in a second claim of claim, the input means 22, and sympathetic activity value indicating the patient's sympathetic activity, an input means 22 for inputting the target nerve activity value, the control means 23 compares the sympathetic activity value and the target nerve activity value is inputted at the input unit 22, a control unit 23 for controlling the operation of the pressure load section 21 in accordance with the comparison result, said control means 23 further compares the current sympathetic nerve activity value with the past sympathetic nerve activity value, and the pressure load means 21 presses the sympathetic nerve activity value closer to the target sympathetic nerve activity value according to the comparison result. Alternatively, an autonomic nerve treatment apparatus using a cervical pressure load according to claim 1 is provided, wherein suction operation is controlled .
The invention according to claim 3 is characterized in that the control means uses any one of PID control, PI control, and proportional control. Autonomic nerve treatment by cervical pressure load according to claim 2 Providing equipment.

Invention range from 4 claim of claim, the input means 22, the vagal activity value indicating the patient's vagus nerve activity, an input means 22 for inputting a target vagal activity value, the control means 23 compares the vagal activity value and the target vagal activity value is inputted at the input unit 22, a control unit 23 for controlling the operation of the pressure load section 21 in accordance with the comparison result, said control means 23 further compares the current vagus nerve activity value with the past vagus nerve activity value, and presses the pressure load means 21 so as to bring the vagus nerve activity value closer to the target vagus nerve activity value according to the comparison result. Alternatively, an autonomic nerve treatment apparatus using a cervical pressure load according to claim 1 is provided, wherein suction operation is controlled .
The invention according to claim 5 is characterized in that the control means uses any one of PID control, PI control, and proportional control, and autonomic nerve treatment by cervical pressure load according to claim 4 Providing equipment.
By providing these inventions, the above problems can be solved.

According to the first aspect of the present invention, the pressure load means can suck the cervical surface to extend the blood vessel wall in the patient's cervical body, and / or the pressure load means can press the cervical surface to press the cervical body. An autonomic nerve treatment device using a cervical pressure load capable of compressing a carotid artery blood vessel wall can be provided.
By using this autonomic nerve treatment device with cervical pressure load, the blood vessel wall in the patient's cervical body is stretched, so the cervical baroreflex receptor that senses blood pressure in the carotid artery wall has high blood pressure Is transmitted to the brain. This will encourage the patient's brain to suppress sympathetic activity and increase vagal activity, so patients with abnormally high sympathetic activity or patients with abnormally low vagal activity. Can treat autonomic abnormalities.
Furthermore, by using the autonomic nerve treatment device with this cervical pressure load, the carotid artery blood vessel wall in the patient's cervical body is compressed, so that the cervical baroreflex receptor present in the carotid artery wall and senses blood pressure has blood pressure. Receives dummy information that is low and transmits it to the brain. As a result, the patient's brain increases sympathetic nerve activity and suppresses vagus nerve activity, so that it can treat autonomic nerve abnormalities in patients with abnormally low sympathetic nerve activity and patients with abnormally high vagus nerve activity. .
As described above, by using the autonomic nerve treatment device with the cervical pressure load of the present invention, it is possible to treat an autonomic nerve abnormality in a minimally invasive manner.
Furthermore, since the abnormality of the autonomic nerve can be treated by using this treatment apparatus, the disease relating to the autonomic nerve abnormality can be improved or treated. In addition, unlike conventional invasive surgical treatment, extremely invasive treatment can be provided.

According to the invention described in claim 2, the target sympathetic nerve activity value, which is the target value, is compared with the sympathetic nerve activity value of the patient, and the operation of the pressure load means is controlled in accordance with the comparison result, and the sympathetic nerve activity Can be controlled quantitatively, and an autonomic nerve treatment device by cervical pressure load can be provided. In addition, with the target sympathetic nerve activity value as a threshold value, the suction and pressing operations of the pressure load means are controlled according to the patient's sympathetic nerve activity value, and depending on the patient's sympathetic nerve activity abnormality, the neck pressure load can be appropriately treated An autonomic nerve treatment device can be provided.
According to the invention of claim 3 , the control means is controlled to reach the target sympathetic nerve activity value by using any one of PID control, PI control and proportional control. It is possible to provide an autonomic nerve treatment apparatus using a cervical pressure load capable of controlling the operation of the cervical pressure load with extremely high efficiency, as well as controlling the pressure and suction operations of the pressure load means.

According to the invention described in claim 4 , the target vagus nerve activity value, which is the target value, is compared with the patient's vagus nerve activity value, and the operation of the pressure load means is controlled according to the comparison result, and the vagus nerve activity is controlled. It is possible to provide an autonomic nerve treatment apparatus using a cervical pressure load that can quantitatively control the value. In addition, since the operation of the suction and pressing of the pressure load means is controlled according to the vagus nerve activity value of the patient with the vagus nerve activity value as a threshold, appropriate treatment is performed according to the abnormality of the patient's vagus nerve activity. It is possible to provide an autonomic nerve treatment device that can be performed with a cervical pressure load.
According to the invention described in claim 5 , since the control means is controlled to reach the target vagus nerve activity value by using any one of PID control, PI control, and proportional control, It is possible to provide an autonomic nerve treatment apparatus using a cervical pressure load capable of controlling the operation of the cervical pressure load with extremely high efficiency, as well as controlling the pressure and suction operations of the pressure load means.

The best mode for carrying out the present invention will be described.
The autonomic nerve treatment device by cervical pressure load according to the present invention is a treatment device for improving (and treating) autonomic nerve abnormalities, and in particular, by appropriately controlling sympathetic nerve activity and vagus nerve activity, Can lead to the desired state.
The baroreceptor reflex function is used as the physiological basic principle utilized by the present invention.
This baroreceptor reflex function is a response by a baroreflex (baroreflex system) by a blood pressure sensor (cervical baroreflex receptor) in a blood vessel (carotid artery) in the cervical body of a mammal. It shows a function of sensing the pressure of blood flowing through a blood vessel and promoting a response of sympathetic nerve activity and vagus nerve activity according to the sensing result (see FIG. 1). FIG. 1 (a) is an image diagram showing how the cervical baroreflex receptor increases sympathetic nerve activity and suppresses vagus nerve activity when it senses that blood pressure is low, and (b) shows cervical pressure. When a reflex receptor senses that blood pressure is high, it is an image figure which shows a mode that a vagus nerve activity is increased and a sympathetic nerve activity is suppressed.
The specific function of this baroreceptor reflex function is, for example, that when the blood pressure applied to this blood vessel increases, the cervical baroreflex receptor transmits to the brain that the blood pressure has increased. At this time, in order to lower the blood pressure, the brain increases the vagus nerve activity, suppresses (decreases) the sympathetic nerve activity, decreases the heart pump function, and decreases the peripheral vascular resistance. To lower blood pressure.
On the other hand, when the blood pressure applied to the blood vessel decreases, the cervical baroreflex receptor transmits to the brain that the blood pressure has decreased. At this time, in order to increase blood pressure, the brain increases sympathetic nerve activity, suppresses (decreases) vagus nerve activity, improves heart pump function, and increases peripheral vascular resistance. To increase blood pressure.
That is, the brain controls sympathetic nerve and vagus nerve activity according to the sensing information sensed by the cervical baroreflex receptor.

The autonomic nerve treatment device (1) with cervical pressure load according to the present invention has pressure load means (11) attached to a patient's cervix (A). FIG. 2 is an embodiment showing a state in which the neck contact portion of the pressure load means according to the present invention is attached to the patient's neck, and FIG. 3 is a block diagram showing the configuration of the pressure load means.
The neck contact portion (111) of the pressure load means (11) is attached to the patient's neck (A). The pressure load means (11) can reduce the diameter of the blood vessel (blood vessel diameter) by compressing the blood vessel wall, while the diameter of the blood vessel can be increased by extending the blood vessel wall. The neck contact portion (111) of the pressure load means (11) shown in FIG. 2 is attached so as to cover the periphery of the patient's neck (A), but is not particularly limited. What is necessary is just to attach to the position which can promote compression and / or extension with respect to the blood-vessel wall in a cervical part (A) body.
Moreover, if the neck contact part (111) of the pressure load means (11) can urge the blood vessel wall in the patient's neck (A) to press and / or extend, as shown in FIG. It does not have to be a ring shape that covers the periphery of the neck. As a specific example in this case, the entire periphery of the neck (A) is not covered, but only the surface of the neck (A) near the neck baroreflex receptor (S) in the neck (A) is contacted. You may set so that the designed small thing may be mounted | worn one by one on either side.

As shown in FIG. 3, the pressure load means (11) has a neck contact portion (111), an adjustment portion (112), a pump (113), and a valve mechanism (114). The neck contact portion (111) and the adjustment portion (112), the pump (113) and the valve mechanism (114) may be arranged as different parts and connected by a tube, or the neck contact portion (111). ), The adjusting unit (112), the pump (113), and the valve mechanism (114) may be integrated.
The neck contact portion (111) is attached in direct contact with the patient's neck (A). The neck contact portion (111) can press and / or suck the surface of the patient's neck (A).
The method of pressing and / or sucking the surface of the neck (A) of the patient by the neck contact portion (111) is based on the surface of the neck (A) contacting the neck contact portion (111) and the neck contact portion ( 111) is formed as a peripheral surface, and this sealed space is expanded and / or contracted to press and / or suck the surface portion of the neck (A).
By discharging the air in the sealed space (decreasing the air pressure in the sealed space), the sealed space contracts and the surface portion of the neck (A) can be sucked.
Further, by sending air into the sealed space (increasing the air pressure in the sealed space), the sealed space expands and the surface portion of the neck (A) can be pressed.
In addition, this neck contact part (111) can be formed of a chamber.

The adjustment unit (112) can adjust the flow rate and pressure of air from the pump (113) described later. By this adjustment part (112), the inflow and outflow of air from a pump (113) can be adjusted reliably.
This adjustment part (112) can pressurize (positive pressure) the sealed space formed by the neck contact part (111) by using an electropneumatic regulator for pressurization when pressing the neck (A). When the neck (A) is sucked, it is most preferable that the sealed space formed by the neck contact portion (111) can be decompressed (negative pressure) by employing a negative pressure electropneumatic regulator.
The adjusting section (112) is preferably connected to a control means (not shown) such as a control measurement personal computer (personal computer) and the operation thereof is controlled.

The pump (113) can supply air to the sealed space formed by the neck contact portion (111) and exhaust air from the sealed space formed by the neck contact portion (111). With this pump (113), the air amount in the sealed space formed by the neck contact portion (111) can be adjusted, and the air pressure can be adjusted to a desired value.
The pump (113) can employ a vacuum pump when sucking the neck (A) and a positive pressure pump (air source) when pressing the neck (A). It is preferable to employ a pump having a function capable of both suction and pressing.
The pump (113) is preferably connected to a control means (not shown) so that the operation of the pump (113) can be controlled.

In FIG. 3, a valve mechanism (114) is further provided. By providing this valve mechanism (114), the inflow and / or outflow operation of air into the sealed space by the pump (113) can be accurately controlled. The valve mechanism (114) can employ an electromagnetic valve, and the operation of the valve mechanism (114) can be controlled very accurately and stably by employing the electromagnetic valve.
The valve mechanism (114) is also preferably connected to a control means (not shown) so that the operation of the valve mechanism (114) can be controlled.

  The pressure load means (11) described above uses the force of air to press and / or suck the surface of the patient's neck (A) by the expansion and contraction of the neck contact portion (111). Although it does, it will not specifically limit if it has a mechanism which can press and attract | suck a neck (A), It can also be set as the structure which utilizes a liquid etc.

Operation | movement of the autonomic-nerve treatment apparatus (1) by the neck pressure load based on this invention is demonstrated.
The neck contact portion (111) of the pressure load means (11) of the treatment device (1) is attached to the patient's neck (A).
In addition, although the case where a neck contact part (111) is provided in the periphery of a neck (A) as shown in FIG. 2 is shown, the blood vessel wall (carotid artery wall) in the neck (A) body is compressed and extended. It can also be provided in contact with a place where it can be performed.

The treatment by this treatment apparatus (1) will be described. FIG. 4 is a flowchart showing the use of the treatment device according to the present invention.
First, a case where a patient who needs to increase vagus nerve activity is targeted will be described.
The neck contact portion (111) of the pressure load means (11) of the treatment device (1) is attached to the patient's neck (A) as shown in FIG. 2 (S1).
Since the target patient needs to increase the vagus nerve activity (S2), the sealing part formed by the neck contact part (111) using the adjustment part (112), the pump (113) and the valve mechanism (114) is formed. Air is discharged from the space, the air pressure in the sealed space is reduced, and the surface of the neck (A) is sucked (S3).
At this time, since the surface of the neck (A) is sucked, the blood vessel wall in the neck (A) body is extended (S4).
When the blood vessel wall in the cervical region (A) is extended, the cervical baroreflex receptor (S) transmits dummy information “high blood pressure” to the brain. When the brain receives dummy information “high blood pressure”, the brain increases vagus nerve activity (S5). As a result, the target patient can be effectively treated.

Next, a case where a patient who needs to reduce (suppress) vagus nerve activity is described.
The neck contact portion (111) of the pressure load means (11) of the treatment device (1) is attached to the patient's neck (A) as shown in FIG. 2 (S1).
Since the target patient needs to suppress the vagus nerve activity (S6), the sealing part formed by the neck contact part (111) using the adjustment part (112), the pump (113) and the valve mechanism (114) is used. Air is supplied into the space, the air pressure in the sealed space is increased, and the surface of the neck (A) is pressed (S7).
At this time, since the surface of the neck (A) is pressed, the blood vessel wall in the body of the neck (A) is compressed (S8).
When the blood vessel wall in the cervical (A) body is compressed, the cervical baroreflex receptor (S) transmits dummy information “low blood pressure” to the brain. When the brain receives dummy information “low blood pressure”, the brain suppresses vagus nerve activity (S9). As a result, the target patient can be effectively treated.

Next, a case where a patient who needs to increase sympathetic nerve activity is targeted will be described.
The neck contact portion (111) of the pressure load means (11) of the treatment device (1) is attached to the patient's neck (A) as shown in FIG. 2 (S1).
Since the target patient needs to increase sympathetic nerve activity (S10), the sealing part formed by the cervical contact part (111) using the adjustment part (112), the pump (113) and the valve mechanism (114) is formed. Air is supplied into the space, the air pressure in the sealed space is increased, and the surface of the neck (A) is pressed (S11).
At this time, since the surface of the neck (A) is pressed, the blood vessel wall in the body of the neck (A) is compressed (S12).
When the blood vessel wall in the cervical (A) body is compressed, the cervical baroreflex receptor (S) transmits dummy information “low blood pressure” to the brain. When the brain receives dummy information “low blood pressure”, the brain increases sympathetic nerve activity (S13). As a result, the target patient can be effectively treated.

Next, a case where a patient who needs to reduce (suppress) sympathetic nerve activity will be described.
The neck contact portion (111) of the pressure load means (11) of the treatment device (1) is attached to the patient's neck (A) as shown in FIG. 2 (S1).
Since the target patient needs to suppress the sympathetic nerve activity (S14), the sealing part formed by the neck contact part (111) using the adjustment part (112), the pump (113) and the valve mechanism (114) is formed. Air is discharged from the space, the air pressure in the sealed space is lowered, and the surface of the neck (A) is sucked (S15).
At this time, since the surface of the neck (A) is sucked, the blood vessel wall in the body of the neck (A) is extended (S16).
When the blood vessel wall in the cervical region (A) is extended, the cervical baroreflex receptor (S) transmits dummy information “high blood pressure” to the brain. When the brain receives dummy information “high blood pressure”, the brain suppresses sympathetic nerve activity (S17). As a result, the target patient can be effectively treated.

Thus, by using the autonomic nerve treatment device (1) with cervical pressure load according to the present invention, the autonomic nerve activity can be changed in a minimally invasive manner. The abnormality of the autonomic nerve can be treated by appropriately adjusting the autonomic nerve activity according to the abnormality of the nerve activity of the increase or decrease of the nerve activity.
For example, a patient with chronic heart failure has abnormally increased sympathetic nerve activity, so that the sympathetic nerve activity is reduced (suppressed) by aspirating the neck (A) using the treatment apparatus (1), and This patient can be treated by increasing vagal activity.
In particular, existing therapies (drug treatments, etc.) cannot increase vagus nerve activity, but the present treatment apparatus (1) can increase vagus nerve activity, so that it is possible to perform treatment with extremely high utility value.

Next, the autonomic nerve treatment device (2) using another cervical pressure load according to the present invention will be described. FIG. 5 is an image diagram in the case of using another autonomic nerve treatment device with cervical pressure load according to the present invention, and (a) is a diagram showing a state in which sympathetic nerve activity increases and vagus nerve activity decreases. Yes, (b) shows a state in which the state of (a) is improved, the sympathetic nerve activity is reduced, and the vagus nerve activity is increased by the treatment of this treatment apparatus.
The other autonomic nerve treatment device (2) with cervical pressure load inputs the nerve activity value obtained by quantifying the sympathetic nerve activity or the vagus nerve activity of the patient and the nerve activity target value to the treatment device (2). It has the basic principle that the neural activity of the patient is closed-loop controlled so that the neural activity value is equal to or close to the target value.
Specifically, as shown in FIG. 5, if the patient's sympathetic nerve activity value is larger or smaller than the target sympathetic nerve activity value, the sympathetic nerve activity is decreased or increased so as to reach the target value. Appropriate blood pressure dummy information is transmitted to the brain by adjusting the pressure load applied to the neck (A). As a result, sympathetic nerve activity changes, but by adjusting the pressure load on the neck (A) again so that the new sympathetic nerve activity value reaches the target value, patients with autonomic nerve abnormalities Can be treated.
On the other hand, as shown in FIG. 5, when the patient's vagus nerve activity value is larger or smaller than the target vagus nerve activity value, the cervical region is set so that the vagus nerve activity is decreased or increased to reach the target value. The pressure load applied to (A) is adjusted to transmit appropriate blood pressure dummy information to the brain. As a result, the vagus nerve activity changes. By adjusting the pressure load applied to the neck (A) again so that the new vagus nerve activity value reaches the target value, patients with autonomic nerve abnormalities are treated. Can be treated.
Thus, using the sympathetic nerve activity value or the vagus nerve activity value from the patient that is measured or estimated as appropriate, control can be performed in comparison with the preset target sympathetic nerve activity value or the target vagus nerve activity value. Each time a sympathetic nerve activity value or a vagus nerve activity value is input, the pressure load applied to the neck (A) can be adjusted, and a patient with an autonomic nerve abnormality can be treated.

Another cervical pressure load autonomic nerve treatment device (2) has a pressure load means (21), an input means (22), and a control means (23) as shown in FIG.
The pressure load means (21) has a neck contact portion (not shown), an adjustment portion (not shown), a pump (not shown) and a valve mechanism (not shown). It has substantially the same configuration as the pressure load means (11) of the autonomic nerve treatment device (1) by pressure load.
The difference between the configuration of the pressure load means (21) of the autonomic nerve treatment device (2) with other cervical pressure load is different from the configuration of the pressure load means (11) described above. The input means (22) and the control means (23 ) And the pressure load means (21) are connected to each other, and the nerve activity value and the nerve activity target value input to the input means (22) are received. A control signal that is matched or approximated is conveniently determined, and the pressure load means (21) is controlled by the control signal to continuously and automatically control the pressing and / or suction of the neck (A) surface. It is a point.
By having such a configuration, the pressing and / or suction operation of the pressure load means (21) is automatically controlled by the control means (23) under a closed loop.
In addition, since the other structure and operation | movement (pressing and suction operation | movement) which a pressure load means (21) has are the same as that of a pressure load means (11), it abbreviate | omits.

The input means (22) sends the control means (23) described later to a sympathetic nerve activity value and / or vagus nerve activity value possessed by the patient, and a target value (target sympathetic nerve activity value and Enter the target vagus nerve activity value.
The input means (22) is not particularly limited as long as the numerical data as described above can be input to the control means (23). A keyboard, mouse, or the like can be used to input the target nerve activity value (target value). It is desirable to input a measured value or an estimated value automatically for inputting a nerve activity value of a patient.
For the target sympathetic nerve activity value and the target vagus nerve activity value input from the input means (22), a nerve activity value suitable for the patient is appropriately selected and set in advance by the user.

Further, the sympathetic nerve activity value and the vagus nerve activity value of the patient input by the input means (22) may use a sympathetic nerve activity value or a vagus nerve activity value measured from the patient, or the living body of the patient. A sympathetic nerve activity value or a vagus nerve activity value estimated from dynamics may be used.
The method for measuring the sympathetic nerve activity value is not particularly limited. For example, a method of measuring a sympathetic nerve activity value using a microneurography method can be employed. Moreover, the estimation method of a sympathetic nerve activity value is not specifically limited. For example, a method that estimates from plasma noradrenaline concentration, a method that estimates from heart rate and blood pressure (estimates from the power of the self-spectrum of heart rate variability and blood pressure variability), and a transfer function from blood pressure to sympathetic nerve activity values (baroreflex central system) It is possible to adopt a method of estimating using a transfer function from the sympathetic nerve activity value to the blood pressure (baroreflex peripheral system transfer function).

The method for measuring the vagus nerve activity value is not particularly limited, but the existing measurement method is not suitable because it is invasive to humans. For this reason, in order to obtain a vagus nerve activity value, it is preferable to employ an estimation method rather than a measurement method.
The method for estimating the vagus nerve activity value is not particularly limited. For example, a method of estimating from the heart rate and blood pressure (estimating from the power of the self-spectrum of heart rate variability and blood pressure variability), and a vagus nerve activity value from the sympathetic activity value and heart rate estimated from the blood pressure (sympathetic activity The estimated heart rate is estimated from the value using the sympathetic heart rate regulation system transfer function, and the estimated heart rate is compared with the measured heart rate to estimate the heart rate change caused by vagus nerve activity. The vagus nerve activity value is estimated from the change in number using the transfer function of the vagus heart rate regulation system).
FIG. 7 is a diagram showing an embodiment for estimating the sympathetic nerve activity value and the vagus nerve activity value described above, and a method for estimating the sympathetic nerve and vagus nerve activity values from body blood pressure and heart rate. It is an image figure shown.

The control means (23) compares the sympathetic nerve activity value input from the input means (22) with the target sympathetic nerve activity value, and controls the operation of the pressure load means (21) according to the comparison result. The control means (23) compares the vagus nerve activity value input by the input means (22) with the target vagus nerve activity value, and controls the operation of the pressure load means (21) according to the comparison result. .
The target sympathetic nerve activity value and the target vagus nerve activity value input to the control means (23) are appropriately set by the user in advance before using the treatment apparatus (2), and input by the input means (22). It is preferable that

In the control means (23), the previously set target sympathetic nerve activity value and target vagus nerve activity value are compared with the sympathetic nerve activity value and vagus nerve activity value input by the input means (22), respectively. The
When the input sympathetic nerve activity value and the target sympathetic nerve activity value are different, the control means (23) presses the pressure load means (21) and makes the sympathetic nerve activity value approach the target sympathetic nerve activity value. A signal for controlling the suction operation is transmitted.
Similarly, the control means (23) is configured so that, when the input vagus nerve activity value and the target vagus nerve activity value are different, the pressure load means (21) so that the vagus nerve activity value approaches the target vagus nerve activity value. ) To control the operation of pressing and suction.

The control method performed by the control means (23) is to control the pressing and suction operations performed by the pressure load means (21) so that each autonomic nerve activity value approaches (approximates) each target nerve activity value. If possible, there is no particular limitation.
As a control method performed by the control means (23), a closed loop control method using an input value and an output value can be adopted. As the input value at this time, a current input value and / or a past input value may be used.
The nerve activity of the patient changes according to the output value, and a new nerve activity value (sympathetic nerve activity value or vagus nerve activity value) is measured or estimated, and a new input value (sympathetic nerve activity value or vagus nerve activity value) is obtained. Arise. By taking this new input value into the control means (23) by the input means (22), closed loop control can be performed. This closed loop control is repeatedly performed so that the sympathetic nerve activity value or the vagus nerve activity value input from the input means (22) is the same value or the approximate value with the target sympathetic nerve activity value or the target vagus nerve activity value, respectively. .

As a specific example of the control method performed by the control means (23), two types of output values (the pressure signal of the pressure load means (21) and the pressure signal means the sympathetic activity value or the vagus nerve activity value) A closed loop control method that outputs a suction signal) can be adopted. By adopting this control, it is possible to control whether the pressure load means (21) performs pressing or suction.
As an example of this, when the input sympathetic nerve activity value is larger than the target sympathetic nerve activity value, a signal (suction signal) that prompts the pressure load means (21) to suck the neck (A) is used as the pressure load means. When the sympathetic nerve activity value transmitted to (21) and inputted is smaller than the target sympathetic nerve activity value, a signal (pressing signal) for urging the pressure load means (21) to press the neck (A) is issued. A closed loop control method in which transmission to the pressure load means (21) is repeated can be exemplified.
As another example, when the input vagus nerve activity value is larger than the target vagus nerve activity value, a signal (press signal) that prompts the pressure load means (21) to press the neck (A) is issued. A signal (suction) that is transmitted to the pressure load means (21) and prompts the pressure load means (21) to suck the neck (A) when the input vagus nerve activity value is smaller than the target vagus nerve activity value. Signal) is repeatedly transmitted to the pressure load means (21).

As another specific example of the control method performed by the control means (23), a closed loop control method using current and past input values can be adopted. By adopting this control, the pressure and suction performed by the pressure load means (21) and the strength of the pressure and suction can be controlled together.
This control method is, for example, a plurality of values including current and past neural activity values (history of neural activity values), a value obtained by integrating a difference between a neural activity value and a target value from the present to the past, neural activity By using a value obtained by differentiating the difference between the value and the target value alone or in combination, a method of determining the strength of pressing and suction performed by the pressure load means (21) can be adopted. Specific examples include proportional control, PI control, and PID control.
By using this proportional control, PI control, or PID control, the pressure and suction strength of the neck (A) performed by the pressure load means (21) can be finely adjusted, and the pressure and suction strength can be controlled. It has the advantage that it can be targeted and can be controlled very well.
On the other hand, adaptive control may be employed in order to deal with individual differences in autonomic nerve activity change with respect to the pressure load means (21) and time variation.

As described above, the autonomic nerve treatment device (2) by cervical pressure load compares the sympathetic nerve activity value with the target sympathetic nerve activity value or the vagus nerve activity value with the target vagus nerve activity value by adopting the closed loop control as described above. Then, the pressure load means (21) is repeatedly pressed and / or sucked so that each nerve activity value approximates the respective target nerve activity value.
FIG. 8 exemplifies closed loop control, and shows a method of controlling sympathetic nerve activity by cervical suction, which is an embodiment when using the treatment apparatus of the present invention.
The above is description of the autonomic-nerve-treatment apparatus (2) by the other neck pressure load concerning this invention.

Next, the operation of the autonomic nerve treatment device (2) with another cervical pressure load according to the present invention will be described. FIG. 9 is a flowchart showing an embodiment of a treatment method using an autonomic nerve treatment device with other cervical pressure load means.
First, a case where a patient having an abnormality in sympathetic nerve activity is treated will be described.
In each case described later, the target sympathetic nerve activity value and the target vagus nerve activity value are set in advance (normal) values suitable for the patient to the user, and the control means (23) adopts PID control. Yes. Further, as described above, the pressure load means (21) reduces the sympathetic nerve activity by sucking the patient's neck (A), and increases the sympathetic nerve activity by pressing the patient's neck (A). Let

The neck contact portion of the pressure load means (21) is attached to the patient's neck (A) (S21).
When the neck contact portion of the pressure load means (21) is attached, the current sympathetic nerve activity value estimated or measured from the patient by the input means (22) is input (S22).
At this time, the sympathetic nerve activity value input by the input means (22) is sent to the control means (23).

When receiving the sympathetic activity value of the patient, the control means (23) compares the sympathetic activity value with the target sympathetic activity value (S23).
The control means (23) controls the pressure load means (21) to decrease or increase the sympathetic nerve activity value so that the sympathetic nerve activity value of the patient approximates the target sympathetic nerve activity value. (S24).
Since the control means (23) has a PID control law, the control signal has information for prompting the pressure load means (21) to be pressed or sucked and information on the intensity of the pressure or suction action.

When the pressure load means (21) receives the control signal, the pressure load means (21) performs the operation of pressing or sucking the neck (A) with the intensity urged by the control signal (S25).
Since the pressure loading means (21) presses or sucks the neck (A) with this strength, the sympathetic nerve activity value of the patient changes (S26).
At this time, the new sympathetic nerve activity value of the patient is again input to the control means (23) by the input means (22) (S27).
Then, the operation from step (S22) described above is repeated, the new sympathetic nerve activity value and the target sympathetic nerve activity value are compared (S28), and the control means (23) generates a new control signal to generate the pressure load means. It transmits to (21) (S29).
Thus, even when the patient's sympathetic nerve activity value is different from the target sympathetic nerve activity value, the patient can quantitatively determine the patient's sympathetic nerve activity value by using the present treatment device (2). The disease can be treated by controlling the target sympathetic nerve activity value desired by the user.

FIG. 10 is a flowchart showing another embodiment of a treatment method using an autonomic nerve treatment device with other cervical pressure load means.
Next, a case where a patient having an abnormality in vagus nerve activity is treated will be described.
As described above, the pressure load means (21) increases the vagus nerve activity by sucking the patient's neck (A), and decreases the vagus nerve activity by pressing the patient's neck (A).

The neck contact portion of the pressure load means (21) is attached to the patient's neck (A) (S41).
When the neck contact portion of the pressure load means (21) is attached, the current vagus nerve activity value estimated or measured from the patient by the input means (22) is input (S42).
At this time, the vagus nerve activity value input by the input means (22) is sent to the control means (23).

Upon receiving the patient's vagus nerve activity value, the control means (23) compares this vagus nerve activity value with the target vagus nerve activity value (S43).
The control means (23) controls the pressure load means (21) to decrease or increase the vagus nerve activity value so that the patient's vagus nerve activity value approximates the target vagus nerve activity value. (S44).
Since the control means (23) has a PID control law, the control signal has information for prompting the pressure load means (21) to be pressed or sucked and information on the intensity of the pressure or suction action.

When the pressure load means (21) receives the control signal, the pressure load means (21) performs the operation of pressing or sucking the neck (A) with the intensity urged by the control signal (S45).
Since the pressure load means (21) presses or sucks the neck (A) with this strength, the vagus nerve activity value of the patient changes (S46).
At this time, the new vagus nerve activity value of the patient is again input to the control means (23) by the input means (22) (S47).
Then, the operation from the above step (S42) is repeated, the new vagus nerve activity value and the target vagus nerve activity value are compared (S48), and the control means (23) generates a new control signal to generate the pressure load means. It transmits to (21) (S49).
Thus, even if the patient's vagus nerve activity value is different from the target vagus nerve activity value, the patient can quantitatively determine the patient's vagus nerve activity value by using this treatment device (2). The disease can be treated by controlling the target vagus nerve activity value desired by the user.

(Test example)
Next, test examples when the present invention is used will be described.
The neck contact portion (111) of the pressure load means (11) of the autonomic nerve treatment device (1) with the neck pressure load according to the present invention is attached to the neck of the dog, and accompanying the pressure change by the pressure load means (11) Changes in body blood pressure and sympathetic nerve activity were observed.
FIG. 11 is a graph showing the state of sympathetic nerve control of a dog when using the autonomic nerve treatment apparatus with cervical pressure load according to the present invention. The sealed space formed by the cervical contact portion (111) of the pressure load means (11) is represented as a cervical chamber, and the sympathetic nerve activity is represented as cardiac sympathetic nerve activity.
From FIG. 11, changes in body blood pressure and cardiac sympathetic nerve activity occur as the pressure in the space changes due to the pressure loading means (11). FIG. 11 shows that the cardiac sympathetic nerve activity of the dog was suppressed to 50%.

  The present invention can improve or treat abnormalities in autonomic nerves by quantitatively controlling sympathetic nerve activity and vagus nerve activity. Furthermore, all diseases caused by autonomic nerve abnormalities can be improved or treated.

It is an image figure which shows the baroreceptor reflex function which is the physiological fundamental principle which this invention utilizes. (A) shows that the cervical baroreflex receptor increases the sympathetic nerve activity and suppresses the vagus nerve activity when the cervical baroreflex receptor senses that the blood pressure is low. When it is detected that the vagus is high, the vagus nerve activity is increased and the sympathetic nerve activity is suppressed. It is one Example which shows the state which attached the neck contact part of the pressure load means based on this invention to the patient's neck. It is a block diagram which shows the structure of the neck pressure load means which concerns on this invention. It is a flowchart which shows utilization of the treatment apparatus which concerns on this invention. It is an image figure in the case of utilizing the autonomic nerve treatment apparatus by the other neck pressure load which concerns on this invention. (A) shows a state in which the sympathetic nerve activity is increased and the vagus nerve activity is reduced, and (b) is a state in which the state of (a) is improved by the treatment of this treatment apparatus, and the sympathetic nerve activity is reduced and the vagus nerve is reduced. Indicates increased activity. It is a block diagram which shows schematic structure of the autonomic-nerve treatment apparatus by the other neck pressure load which concerns on this invention. It is an image figure which shows the method of estimating a sympathetic nerve and a vagus nerve activity value from body blood pressure and heart rate. The method of controlling the sympathetic nerve activity by neck suction which is one Example at the time of utilizing the autonomic-nerve treatment apparatus by the other neck pressure load based on this invention is shown. It is a flowchart which shows one Example of the treatment method using the autonomic-nerve treatment apparatus by the other neck pressure load means based on this invention. It is a flowchart which shows another Example of the treatment method using the autonomic-nerve treatment apparatus by the other neck pressure load means based on this invention. It is a graph which shows the mode of the sympathetic nerve control of the dog at the time of utilizing the autonomic nerve treatment apparatus by the neck pressure load concerning this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 ... Autonomic nerve treatment apparatus 11 by cervical pressure load 11 ... Pressure load means 2 ... Autonomic nerve treatment apparatus 21 by other cervical pressure load ... Pressure load means 22 ... Input means 23- ..Control means

Claims (5)

  1. A therapeutic device for improving a patient's autonomic nerve activity to a suitable state,
    Attached to the patient's neck,
    Pressure loading means 21 for aspirating the cervical surface to stretch the vascular wall in the cervical body and / or pressing the cervical surface to compress the vascular wall in the cervical body;
    An input means 22 for inputting a nerve activity value indicating a patient's sympathetic nerve activity or vagus nerve activity and a nerve activity target value;
    Comparing neural activity values and neural activity target value inputted at the input unit 22, have a control unit 23 for controlling the operation of the pressure load section 21 in accordance with the comparison result,
    The control means 23 further compares the current neural activity value with the past neural activity value, and according to the comparison result, the pressure load means 21 presses or closes so that the neural activity value approaches the neural activity target value. An autonomic nerve treatment device using cervical pressure load, characterized by controlling suction operation .
  2. The input means 22 is an input means 22 for inputting a sympathetic nerve activity value indicating a patient's sympathetic nerve activity and a target sympathetic nerve activity value,
    The control means 23 compares the sympathetic nerve activity value and the target sympathetic nerve activity value input at the input means 22 and controls the operation of the pressure load means 21 according to the comparison result. Oh it is,
    The control means 23 further compares the current sympathetic nerve activity value with the past sympathetic nerve activity value, and the pressure load means so as to bring the sympathetic nerve activity value closer to the target sympathetic nerve activity value according to the comparison result. 21 autonomic treatment device according neck pressure loading ranging first claim of claim, it characterized that you control the pressing or suction operation.
  3. The autonomic nerve treatment apparatus according to claim 2 , wherein the control means uses any one of PID control, PI control, and proportional control.
  4. The input means 22 is an input means 22 for inputting a vagus nerve activity value indicating a patient's vagus nerve activity and a target vagus nerve activity value,
    The control means 23 compares the vagus nerve activity value and the target vagus nerve activity value input at the input means 22 and controls the operation of the pressure load means 21 according to the comparison result. Oh it is,
    The control means 23 further compares the current vagus nerve activity value with the past vagus nerve activity value, and the pressure load means so as to bring the vagus nerve activity value closer to the target vagus nerve activity value according to the comparison result. 21 autonomic treatment device according neck pressure loading ranging first claim of claim, it characterized that you control the pressing or suction operation.
  5. 5. The autonomic nerve treatment apparatus with cervical pressure load according to claim 4 , wherein the control means uses any one of PID control, PI control, and proportional control.
JP2007500388A 2005-01-27 2005-01-27 Autonomic nerve treatment device by cervical pressure load Active JP4848505B2 (en)

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JP2006102265A (en) * 2004-10-06 2006-04-20 Nippon Telegr & Teleph Corp <Ntt> Evaluating device and evaluating method for autonomic nerve function

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JP2004526471A (en) * 2000-09-27 2004-09-02 シーブイアールエックス, インコーポレイテッド Apparatus and method for cardiovascular reflex control
JP2003235817A (en) * 2002-02-19 2003-08-26 Nippon Colin Co Ltd Autonomic nerve function evaluating instrument
JP2006102265A (en) * 2004-10-06 2006-04-20 Nippon Telegr & Teleph Corp <Ntt> Evaluating device and evaluating method for autonomic nerve function

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