JP5437401B2 - Artificial respiration system - Google Patents

Description

  The present invention relates to an artificial respiration system including a plurality of connection points.

A typical artificial respiration system includes a main device and a breathing circuit assembly connected to the main device. The breathing circuit assembly has a breathing tube connected to the main device and an intubation tube inserted into a patient's trachea.
The main apparatus alternately performs a process of supplying air to the patient's lungs through the breathing circuit assembly (inhalation process) and a process of discharging air containing carbon dioxide from the patient's lungs (expiration process). And help the patient breathe.

  As shown in Patent Document 1, an artificial respiration system in which a sensor unit is interposed between the breathing tube and the intubation tube is known. This sensor unit is provided with a pressure sensor, a flow rate sensor, and a carbon dioxide sensor. Based on the detection information of these sensors, the respiratory state of the patient is diagnosed, and the respiratory assistance is adjusted.

  In the artificial respiration system of Patent Document 1, the breathing tube and the main device are detachably connected, and the sensor unit and the breathing tube are detachably connected directly or indirectly, and the sensor unit and the intubation tube are connected to each other. The space is detachably connected directly or indirectly. Further, the intubation tube is connected to the patient's trachea so that it can be inserted and removed.

  As described above, there are a plurality of connection points in the artificial respiration system. However, if there is a connection abnormality (disconnection) at any of the connection points, it becomes impossible to assist the patient's breathing. If it continues for a minute, it will cause serious damage to the patient. In order to avoid such an accident due to a connection abnormality, it is required to always monitor whether or not the connection is normal.

  In the artificial respiration system shown in Patent Document 2, a pressure sensor is provided in the sensor unit connected between the breathing tube and the intubation tube, and when the detected pressure of the pressure sensor falls below a predetermined level, a connection abnormality occurs. Is detected and an alarm is issued.

JP 2005-537068 A WO2009 / 119449

However, although the system of Patent Document 2 can detect a connection abnormality at any of a plurality of connection points of the breathing circuit assembly based on the detected pressure, more specifically where the connection abnormality occurs. It cannot be detected.
Therefore, even if a doctor or nurse who has received an alarm rushes, it may not be possible to immediately determine where in the respiratory circuit assembly the connection is abnormal, and reconnection work may not be performed quickly.

The present invention has been made to solve the above problems, and in an artificial respiration system including a main device and a breathing circuit assembly,
The main apparatus has an inhalation-side connection terminal and an exhalation-side connection terminal, and an inhalation process for supplying air through the inhalation-side connection terminal, and an exhalation process for discharging the patient's exhalation through the exhalation-side connection terminal Are executed alternately,
The breathing circuit assembly is
(A) An inhalation tube portion whose one end is detachably connected to the inhalation side connection terminal, an exhalation tube portion whose one end is detachably connected to the exhalation side connection terminal, and these inspiration tube portions And a breathing tube having a connection portion connected to the other end of the exhalation tube;
(B) an intubation tube inserted into the patient's trachea;
(C) Removably connected between the connection portion of the breathing tube and the proximal end portion of the intubation tube, and has an internal flow path, and detects the pressure, flow rate, and component of the air in the internal flow path, respectively. A sensor unit incorporating a pressure sensor, a flow rate sensor, and a component sensor,
(D) a monitor display for displaying an image of the breathing circuit assembly;
(E) a control means for controlling the monitor display;
The control means detects connection abnormality of the breathing circuit assembly based on the detection information of the pressure sensor, and further detects the connection from the sensor unit based on the detection information of at least one of the flow sensor and the component sensor. It is determined whether the connection is abnormal on the main device side or on the patient side from the sensor unit. Based on this determination, the monitor display is controlled to connect to the region or area of the connection abnormality in the image of the respiratory circuit assembly. An abnormality is displayed.

  According to the above configuration, when there is a connection failure in the artificial respiration system, the region of connection failure is specified, that is, the main device side or the patient side is specified from the sensor unit and displayed on the monitor display. Alternatively, the nurse can immediately determine where the connection is abnormal, can quickly perform reconnection work, and can further improve patient safety.

  In a specific aspect of the present invention, when the flow rate sensor does not detect the flow rate in the inspiratory process and the expiratory process, the control unit determines that the main unit side connection abnormality is detected from the sensor unit, and in the inspiratory process If the flow rate in the exhalation process is not detected, it is determined that there is a connection abnormality on the patient side from the sensor unit.

  In a specific aspect of the invention, the component sensor is a carbon dioxide sensor, and the control means detects the carbon dioxide gas lower than the carbon dioxide concentration during normal breathing and higher than the carbon dioxide concentration in the atmosphere by the carbon dioxide sensor. Determines that there is a connection abnormality on the main device side from the sensor unit, and if the carbon dioxide sensor does not detect carbon dioxide with a concentration higher than the carbon dioxide concentration in the atmosphere, the connection abnormality on the patient side from the sensor unit It is judged that.

Preferably, a cuff is provided on the outer periphery of the intubation tube, and air is supplied to the cuff via an air supply tube so as to swell, and further, the pressure of the cuff is supplied via the air supply tube. A cuff pressure sensor to detect, and when the control means detects an increase history of the cuff pressure from the cuff pressure sensor, it determines that a pulling force is applied to the intubation tube, and Based on the determination and the determination of the connection abnormality on the patient side from the sensor unit, the monitor display is controlled to display the connection abnormality in the region or region corresponding to the intubation tube in the image of the respiratory circuit assembly.
According to this, the reinsertion work (reconnection work) of the intubation tube to the patient trachea can be performed more quickly.

Preferably, the control means determines that there is a connection abnormality between the sensor unit and the intubation tube when there is no increase history of the cuff pressure when it is determined that there is a connection abnormality on the patient side from the sensor unit. Based on this determination, the monitor display is controlled to display a connection abnormality in a region or region between the intubation tube and the sensor unit in the image of the breathing circuit assembly.
According to this, the reconnection operation between the intubation tube and the sensor unit can be performed more rapidly.

Preferably, the control means controls the monitor display to detect a cuff pressure increase history from the cuff pressure sensor and control the monitor display even if there is no determination of a connection abnormality on the patient side from the sensor unit. An abnormal connection is displayed in a region or region corresponding to the intubation tube in the image of the assembly.
According to this, importance can be attached to the fact that the pulling force is applied to the intubation tube, and it is possible to prompt the doctor or nurse to confirm whether or not the intubation tube has been inserted into the trachea to a normal depth. As a result, when the intubation tube is not removed from the trachea but is displaced in the removal direction, it can be returned to the normal insertion depth.

Preferably, an inspiratory side connection sensor for detecting whether or not the inspiratory tube portion is connected to the inspiratory side connecting terminal, and an expiratory side connection for detecting whether or not the expiratory tube portion is connected to the expiratory side connecting terminal. And at least one of the two connection sensors determines that there is an abnormal connection between the main apparatus and the breathing tube, and based on this determination, the control means displays a monitor display. Control is performed to display a connection abnormality in a region or region between the main apparatus and the breathing tube in the image of the breathing circuit assembly.
According to this, the reconnection operation between the breathing tube and the main device can be performed more quickly.

Preferably, when the control unit determines that the connection to the main device side is more abnormal than the sensor unit, when the two connection sensors detect the connection of the inspiratory tube portion and the expiratory tube portion, the respiratory tube and the sensor unit Based on this determination, the monitor display is controlled, and the connection abnormality is displayed in the region or region between the respiratory tube and the sensor unit in the image of the respiratory circuit assembly.
According to this, the reconnection operation between the breathing tube and the sensor unit can be performed more quickly.

Preferably, different first and second colors are attached to the outer peripheries of the one end portions of the inhalation tube portion and the exhalation tube portion, and the two connection sensors have the first color and the second color. Each is a color sensor for detection.
According to this, when the inhalation tube part and the exhalation tube part are erroneously connected to the inhalation side connection terminal and the exhalation side connection terminal of the main apparatus, this misconnection can also be detected.

Preferably, the control means determines that the leakage is between the cuff and the patient's trachea when the flow rate in the exhalation process is smaller than the flow rate in the inspiration process based on the detection information from the flow sensor. On the display.
According to this, it is possible to prompt the doctor or nurse to promptly respond to the cuff leak display.

  The component sensor may include at least one of an oxygen sensor and a humidity sensor. These sensors work in the same way as carbon dioxide sensors.

Preferably, the control means causes the display to display a display of an elapsed time since the determination of an artificial respiratory system abnormality including the connection abnormality or a display corresponding to the elapsed time.
According to this, the doctor or nurse can confirm the elapsed time from the occurrence of the abnormality, can instantly determine the magnitude of damage caused by the connection abnormality to the patient, and can take necessary emergency measures.

  According to the present invention, since the part or region of the abnormal connection of the artificial respiration system is identified and displayed on the monitor display, the doctor or nurse can quickly perform the reconnection work and keep the patient safe. it can.

It is the schematic which decomposes | disassembles and shows the artificial respiration system concerning 1st Embodiment of this invention for every component. It is a perspective view which decomposes | disassembles and shows the inhalation | air_intake side connection terminal of the main apparatus in the same artificial respiration system, the edge part of the inhalation tube part of a respiration tube, and the color sensor corresponding to this. FIG. 3 is a perspective view showing a state in which the color sensor of FIG. 2 is attached to the intake side connection terminal and the end of the intake tube portion is connected to the intake side connection terminal. It is a perspective view which decomposes | disassembles and shows the exhalation side connection terminal of the main apparatus in the same artificial respiration system, the edge part of the exhalation tube part of a respiration tube, and the color sensor corresponding to this. The sensor unit in the said artificial respiration system is shown, (A) is a side view, (B) is a longitudinal cross-sectional view, (C) is a top view. It is a block diagram containing the signal circuit of the artificial respiration system. The monitor display of the artificial respiration system is shown. (A) shows an image when all the connection points of the breathing circuit assembly are normal, and (B) shows an image when a part of the breathing circuit assembly is abnormally connected. Show. It is a graph which shows a time-dependent change of the detection information of various sensors in the state in which the artificial respiration system is connected normally. It shows the change over time of the cuff pressure detected by the cuff pressure sensor of the artificial respiration system. (A) is working normally, (B) is coughing, (C) is intubated. The time-dependent change of the cuff pressure when the tube is pulled out is shown. It is a figure which shows the algorithm of the connection abnormality detection performed with the artificial respiration system. It is the schematic which abbreviate | omits and shows the respiration circuit assembly of the artificial respiration system concerning 2nd Embodiment of this invention. It is a graph which shows the time-dependent change of the humidity and oxygen concentration which can be detected with the said sensor unit when the artificial respiration system of 1st, 2nd embodiment exists in a normal connection state.

Hereinafter, an artificial respiration system according to a first embodiment of the present invention will be described with reference to FIGS.
As shown in FIG. 1, the artificial respiration system includes a breathing circuit assembly 1, a main device 10, a sub device 70, and a monitor display 80.

  The main apparatus 10 includes an inspiratory side connection terminal 11, an expiratory side connection terminal 12, a blender 13 for blending compressed air from a compressed air source (not shown) and oxygen from an oxygen source (not shown), oxygen A decompressor (not shown) for decompressing the compressed air blended with the pressure to a pressure slightly higher than the atmospheric pressure, an internal supply passage 14 that connects the decompressor and the inspiratory side connection terminal 11, and an internal space that communicates with the expiratory side connection terminal 12. A discharge passage 15, and these internal supply passage 14 and electromagnetic on-off valves 16 and 17 provided in the internal discharge passage 15 are provided.

Color sensors 18 and 19 (connection sensors) are provided in the vicinity of the connection terminals 11 and 12 of the main device 10. This will be described in detail below.
As shown in FIGS. 2 and 3, the intake-side connection terminal 11 of the main device 10 includes a fixed portion 11 a that is fixed to the housing of the main device 10 and a connection portion 11 b that protrudes outward from the housing. Yes. An annular engagement groove 11c is formed on the outer periphery of the base end portion of the connection portion 11b.

On the other hand, the color sensor 18 includes a base portion 18a and a mounting portion 18b having a C-shaped cross section that is integral with the base portion 18a. Engagement protrusions 18c are formed on the inner periphery of the edge of the mounting portion 18b on the main device 10 side. The color sensor 18 is attached to the intake-side connection terminal 11 by fitting the engagement protrusion 18c into the engagement groove 11c with the elastic deformation of the attachment portion 18b. In this mounted state, a gap is formed between the inner periphery of the mounting portion 18 b of the color sensor 18 and the outer periphery of the connecting portion 11 b of the connection terminal 11.
The inner surface of the base portion 18a of the color sensor 18 is provided with a sensor portion 18x that emits white light and detects a first color (for example, blue).

  Moreover, the expiration side connection terminal 12 of the main apparatus 10 has the fixing | fixed part 12a similar to the inhalation side connection terminal 11, and the connection part 12b with the engaging groove 12c, as shown in FIG. The color sensor 19 corresponding thereto has a base portion 19 a and a mounting portion 19 b with an engaging protrusion 19 c, and is attached to the connection terminal 12, similarly to the color sensor 18. The color sensor 19 has a sensor unit 19x for detecting a second color (for example, yellow).

Returning to FIG. 1, the breathing circuit assembly 1 includes five components in this embodiment, that is, a breathing tube 20 arranged in order from the main device 10 side to the patient side, an artificial nose 30, and a sensor unit 40. The extension tube 50 and the intubation tube 60 are detachably connected. Note that these components are connected by taper bonding (friction bonding).
Hereinafter, each component will be described.

  The breathing tube 20 has a common connector 23 and flexible inspiratory tube portions 21 and expiratory tube portions 22 fixed to the two crotch portions of the common connector 23, respectively. The common connector 23 has a connecting portion 23 a that communicates with both the inspiratory tube portion 21 and the expiratory tube portion 22.

  As best shown in FIGS. 2 to 4, the inhalation tube portion 21 and the exhalation tube portion 22 are respectively cylindrical end portions 21 a and 22 a that are detachably connected to the connection terminals 11 and 12 of the main device 10. have. The outer periphery of the end portion 21a of the inhalation tube portion 21 is given a first color (blue) over the entire circumference, and the outer periphery of the end portion 22a of the exhalation tube portion 22 is provided with a second color (over the entire circumference). Yellow).

  As shown in FIG. 3, the end 21 a of the intake tube portion 21 is inserted between the connection portion 11 b of the intake side connection terminal 11 and the mounting portion 18 b of the color sensor 18 to connect the intake side connection terminal 11. It is detachably connected to the outer periphery of the portion 11b. In this connected state, the end 21a is disposed inside the color sensor 18, and when the color sensor 18 detects the first color on the outer periphery of the end 21a, the intake tube portion 21 is normally connected to the connection terminal 11. It can be detected that it is connected to. This connection point is indicated by the symbol A in FIG.

  Similarly, the end portion 22a of the exhalation tube portion 22 is inserted between the connection portion 12b of the exhalation side connection terminal 12 and the mounting portion 19b of the color sensor 19, and the outer periphery of the connection portion 12b of the inspiration side connection terminal 12 Is detachably connected. When the color sensor 19 detects the second color of the end 22a, it can be detected that the exhalation tube 22 is normally connected to the connection terminal 12. This connection point is indicated by the symbol B in FIG.

  Next, the artificial nose 30, the sensor unit 40, the extension tube 50, and the intubation tube 60 will be described. In the following description, the main device 10 side is referred to as the upstream side, and the intubation tube 60 side (patient side) is referred to as the downstream side with reference to the air flow direction in the inhalation process.

  The artificial nose 30 is also known as an HME (heat and moisture exchanger) and is known. Briefly, the artificial nose 30 absorbs exhaled heat and moisture from the patient and applies the retained heat and moisture to the inhalation to the patient.

The inner periphery of the connection part 32 on the upstream side of the artificial nose 30 and the outer periphery of the connection part 23a of the connector 23 of the breathing tube 20 are detachably connected. This connection point is denoted by reference numeral C1 in FIG.
A resin holder 36 is detachably attached to the outer periphery of the connection portion 33 on the downstream side of the artificial nose 30. The holder 36 is supported by a support arm (not shown).

  As best shown in FIG. 5, the sensor unit 40 includes a cylindrical main body 41 having an internal channel 41x extending in the axial direction, a pressure sensor 42 provided in the main body 41, and a carbon dioxide gas sensor 43 (component sensor). Two ultrasonic flow sensors 44 and 45 and a temperature sensor 46 are provided. The pressure sensor 42, the carbon dioxide sensor 43, the flow rate sensors 44 and 45, and the temperature sensor 46 detect the pressure, carbon dioxide concentration (component; component concentration), flow rate per unit time, and temperature of the internal flow path 41x, respectively. is there.

  Both ends of the main body 41 are provided as cylindrical connection portions 41 a and 41 b, and one connection portion 41 a is detachably connected to the inner periphery of the connection portion 33 of the artificial nose 30. This connection point is denoted by reference numeral C2 in FIG.

The two flow sensors 44 and 45 are arranged side by side in the axial direction of the main body 41, and the axes of the flow sensors 44 and 45 are inclined in opposite directions with respect to the axis of the main body 41. Each of the flow sensors 44 and 45 includes a transmitter and a receiver. The ultrasonic signal transmitted from one flow sensor 44 is reflected by the wall on the opposite side of the flow sensors 44 and 45 in the main body 41 and received by the receiving portion of the other flow sensor 45, and the flow rate is reversed. The ultrasonic signal transmitted from the sensor 45 is received by the receiving unit of the flow sensor 44. The direction of air flow and the flow rate per unit time can be detected based on the physical quantity of the two received ultrasonic signals, for example, the propagation velocity.
In the present embodiment, the temperature detected by the temperature sensor 46 is used for temperature compensation of the flow rate.

Returning to FIG. 1, the extension tube 50 is configured by fixing connectors 52 and 53 (connection portions) to both ends of the flexible tube 51. The connection portion 41b of the sensor unit 40 is detachably connected to the inner periphery of the upstream connector 52. This connection point is denoted by reference numeral D1 in FIG.
A cylindrical heater 55 is attached to the outer periphery of the extension tube 50.

The intubation tube 60 is known and is inserted into a patient's trachea. Briefly, a connector 61 (connection portion) is fixed to the proximal end (upstream end) of the intubation tube 60, and the distal end is open.
The connector 61 is detachably connected to the connector 53 of the extension tube 50. This connection point is indicated by a symbol D2 in FIG.

  A cuff 65 made of an annular balloon is provided on the outer periphery of the intubation tube 60. The cuff 65 is inflated by compressed air and closely contacts the inner wall of the patient's trachea, thereby sealing the trachea and stably maintaining the intubation tube 60 inserted into the trachea.

As a connection point between the intubation tube 60 and the patient's trachea, reference numeral E is attached to the distal end of the intubation tube 60 in FIG. Further, in FIG. 1, the cuff 65 is denoted by a symbol F as a seal point between the cuff 65 and the patient's tracheal inner wall.
A tip of a thin air supply tube 66 is connected to the cuff 65. The air supply tube 66 extends to the auxiliary device 70.

The auxiliary device 70 is attached to a patient's bed or a rail fixed to the wall of a hospital room in the vicinity of the bed. The secondary device 70 may be on a dedicated frame.
As shown in FIG. 6, the auxiliary device 70 has a housing 71, a compressed air supply portion 72 that supplies compressed air to the cuff 65 via an air supply tube 66, and an internal pressure of the cuff 65 via the air supply tube 66. And a cuff pressure sensor 73 for detecting (cuff pressure). The compressed air supply unit 72 is a well-known one, and includes a small air pump, a pressure reducing valve, and a relief valve, and controls the air pump so that the detected cuff pressure from the cuff pressure sensor 73 is within an appropriate range. ing.

  Further, the auxiliary device 70 has a controller 75 (control means) comprising a circuit incorporating a CPU and a memory in a housing 71. The controller 75 detects the connection detection signals from the color sensors 18 and 19, the detection signals from the pressure sensor 42, the carbon dioxide sensor 43, the flow rate sensors 44 and 45, the temperature sensor 46 in the sensor unit 40, and the detection from the cuff pressure sensor 73. In response to the signal, it is determined whether or not there is an abnormality such as a connection abnormality in the system, and the monitor display 80 is controlled.

  The monitor display 80 receives a control signal from the controller 75, and schematically displays the main apparatus 10, the breathing circuit assembly 1, and a patient image as shown in FIG. In the image of this embodiment, the extension tube 50 and the cuff 65 of the breathing circuit assembly 1 are omitted. The artificial nose 30 may be omitted and displayed.

In the present embodiment, as indicated by an imaginary line in FIG. 7A, five connection abnormality marks M _A , M _B , M _C , M _D , and M _E can be displayed as necessary.
Mark M _A is for displaying the abnormal connection in the connection point A 1, has an area extending around the end of the intake tube 21.
Mark M _B is for displaying the abnormal connection in the connection point B 1, has a region extending around the end of the expiratory tube 22.
Mark M _C, is intended to display the connection failure at the connection point C1, C2 of FIG. 1, the downstream end of the breathing tube 20, a region including the upstream end and the artificial nose 30 of the sensor unit 40 Yes doing.
Mark M _D is for displaying the abnormal connection at the connection point D1, D2 of FIG. 1, has an area comprising the upstream end of the downstream end and the intubation tube 60 of the sensor unit 40 .
Mark M _E is for displaying errors on the connection between the intubation tube 60 and the patient's trachea (connection point of FIG. 1 E), and a region including the distal end of intubation tube 60.

  In the above-described configuration, the breathing circuit assembly 1 is assembled by connecting the breathing tube 20, artificial nose 30, sensor unit 40, extension tube 50, and intubation tube 60. Then, the inspiratory tube portion 21 and the expiratory tube portion 22 of the breathing tube 20 are connected to the connection terminals 11 and 12 of the main device 10 and the intubation tube 60 is inserted into the patient's trachea so that the patient's lungs are in the breathing circuit assembly 1. Is connected to the main apparatus 10 via

When the power switch of the main device 10 is turned on, the on-off valves 16 and 17 are alternately opened. When the on-off valve 17 is closed and the on-off valve 16 is opened, oxygen-blended air passes from the internal supply passage 14 and the intake tube portion 21 through the artificial nose 30, the sensor unit 40, the extension tube 50, and the intubation tube 60 to the patient. Sent to the lungs (inspiration process).
Next, when the on-off valve 16 is closed and the on-off valve 17 is opened, the air of the patient's lungs flows in the reverse direction and is released from the exhalation tube 22 to the atmosphere via the internal exhaust passage 15 (exhalation process).

  The controller 75 determines that the connection points A and B are in a normal connection state when the color sensors 18 and 19 detect the colors of the end portion 21a of the inhalation tube portion 21 and the end portion 22a of the exhalation tube portion 22, respectively. When the color is not detected, it is determined that the connection is abnormal.

  When the system is normally connected and operating normally, as shown in FIG. 8, the pressure detected by the pressure sensor 42 rises in the inspiratory process, decreases in the expiratory process, and returns to almost atmospheric pressure. In the controller 75, the inspiratory process and the expiratory process are set in advance for one or a plurality of respiration cycles, and a threshold pressure is set. This threshold pressure is sufficiently higher than atmospheric pressure and lower than the maximum pressure in the normal intake process. The controller 75 determines that the connection is normal when the detected pressure exceeds the threshold pressure within the set time, and determines that the connection is abnormal when the time when the detected pressure does not exceed the threshold pressure exceeds the set time. Note that only when all the connection points A, B, C1, C2, D1, D2, and E of the breathing tube assembly 1 are normal, the normal connection determination based on the detected pressure is made, and at least one of them is disconnected. In this case, a connection abnormality judgment is made.

  Since the detection information from the flow rate sensors 44 and 45 includes the flow rate per unit time and the air flow direction, the controller 75 can discriminate between the flow rate in the inhalation process and the flow rate in the expiration process. As shown in FIG. 8, the controller 75 integrates the flow rate per unit time toward the patient as positive and the flow rate per unit time in the reverse direction as negative. When all the connection points A, B, C1, C2, D1, D2, and E of the breathing tube assembly 1 are normal, the integrated flow rate increases in the inhalation process and decreases in the exhalation process as shown in FIG. It becomes zero at the end of one cycle. This is because the air supply amount (inhalation amount) to the lungs of the patient is equal to the discharge amount (expiration amount) from the lungs. The controller 75 can detect both inspiration and expiration from the increase and decrease in the integrated flow rate, and in this case, determines that all connection points are normally connected. In the present embodiment, the controller 75 clears the integrated flow rate to zero at the end of one cycle.

  When the disconnection occurs at any one of the connection points A, B, C1, and C2 on the upstream side of the sensor unit 40, the air from the main device 11 does not reach the sensor unit 40, so the integrated flow rate in the intake process Remains zero (no inspiratory flow is detected) and the integrated flow in the expiratory process also remains zero (no expiratory flow is detected). The controller 75 determines that there is a connection abnormality at the connection point on the upstream side of the sensor unit 40 when the state of zero flow rate accumulation continues for a time corresponding to one or more breathing cycles. Note that it is not possible to specify in more detail which of the upstream connection points A, B, C1, and C2 is abnormal in connection only with this integrated flow rate.

When a disconnection occurs at any one of the connection points D1, D2, and E on the downstream side of the sensor unit 40, the integrated flow rate increases because air reaches the sensor unit 40 in the intake process. However, since the flow rate of air returning from the patient in the exhalation process is zero, the integrated flow rate does not decrease. Based on this fact, the controller 75 determines that inspiration detection and expiration detection are not performed, and determines that there is a connection abnormality on the downstream side of the sensor unit 40. However, it is not possible to further specify which of the downstream connection points D1, D2, and E is abnormal in connection.

  The controller 75 detects and does not detect the inhalation in the inhalation process and detects and does not detect the exhalation in the expiration process based on the flow rate and direction per unit time instead of the integrated flow. You may identify whether the connection abnormality has occurred on the upstream side or the downstream side.

  In the present embodiment, the controller 75 can also determine whether or not the seal between the cuff 65 and the patient trachea (indicated by symbol F in FIG. 1) is normal from the integrated flow rate. That is, the integrated flow rate (exhalation amount) of the exhalation process is compared with the integrated flow rate (inspiration amount) of the inhalation process, and when the exhalation amount is equal to the inspiration amount, it is determined that the seal is normal, and the exhalation amount is the inspiration amount. When it is smaller, it is determined that the entire amount of air supplied to the patient's trachea during the inhalation process does not return to the main apparatus 10 and that part of the air leaks from between the cuff 65 and the patient's trachea. Judge as (cuff leakage).

  In the controller 75, two threshold values are set for the carbon dioxide gas concentration. The first threshold is higher than the carbon dioxide concentration in the atmosphere, and is lower than the concentration of carbon dioxide generated from weak spontaneous breathing of the patient described later. The second threshold is sufficiently higher than the carbon dioxide concentration resulting from the weak spontaneous breathing, and is sufficiently lower than the carbon dioxide concentration detected during normal artificial respiration.

When all the connection points A, B, C1, C2, D1, D2, and E of the breathing tube assembly 1 are normal, the carbon dioxide concentration from the carbon dioxide sensor 43 changes as shown in FIG. That is, it rises in the exhalation process due to carbon dioxide contained in exhaled air from the lungs of the patient, and rapidly decreases in the inspiratory process and becomes substantially zero (the concentration of carbon dioxide contained in the atmosphere is about 0.03%).
The controller 75 determines that all connection points are in a normal connection state when the carbon dioxide gas concentration exceeds the second threshold value.

When there is a connection abnormality at any of the connection points A, B, C1, and C2 upstream from the sensor unit 40, air is not supplied to the patient's lungs and normal ventilation is not performed. However, the sensor unit 40 is connected to the patient's lungs via the extension tube 50 and the intubation tube 60. Therefore, as long as the patient is alive, weak spontaneous breathing is performed, and a minute amount of carbon dioxide from the patient's lungs reaches the sensor unit 40. Therefore, the carbon dioxide sensor 43 detects this small amount of carbon dioxide.
When the carbon dioxide concentration exceeds the first threshold but does not exceed the second threshold in a time corresponding to one or a plurality of breathing cycles, the controller determines that the connection is abnormal at the upstream connection point.

  When there is a connection abnormality at any of the connection points D1, D2 and E downstream of the sensor unit 40, the communication between the sensor unit 40 and the patient's lung is blocked. The carbon dioxide sensor 43 is not reached. In the controller 75, when the carbon dioxide gas concentration does not reach the first threshold value during the above time, it is determined that the connection is abnormal at the downstream connection point.

  In a state where the intubation tube 60 is inserted into the patient trachea, the pressure of the cuff 65 is maintained in an appropriate range by the control of the compressed air supply unit 72. In this state, the cuff pressure sensor 73 detects a change in the cuff pressure accompanying respiration as shown in FIG. Even when the patient coughs, a change in cuff pressure is detected as shown in FIG. In the controller 75, a value sufficiently higher than the upper limit value of the fluctuation is set as the threshold value of the cuff pressure, and it is judged that the cuff pressure fluctuation is in a normal state.

  When the intubation tube 60 receives a force in the direction of being pulled out of the patient's trachea, the cuff 65 is deformed, and as shown in FIG. 9C, the detected cuff pressure of the cuff pressure sensor 73 is temporarily greatly increased. The controller 75 determines that a pulling force has acted on the intubation tube 60 when the cuff pressure exceeds the threshold value.

FIG. 10 shows the relationship between the connection abnormality determination at the connection point and detection information of various sensors. In the controller 75, based on the connection abnormality determination, and displays the connection abnormal marks _M A ~M _B on the display 80.

A case where the end 21a of the intake tube portion 21 is disengaged from the intake-side connection terminal 11 of the main apparatus 10, that is, a case where a connection abnormality at point A (out of point A) has occurred will be described. In this case, the controller 75 determines that there is a connection abnormality at any of the connection points A, B, C1, C2, D1, D2 and E of the breathing tube assembly 1 based on the detected pressure, and detects the detected flow rate and the detected carbon dioxide concentration. Based on the above, it is determined that the connection abnormality is upstream of the sensor unit 40. Further, the connection abnormality at the connection point A is specified based on the non-detection signal from the color sensor 18. Based on this determination, and displays the connection abnormal marks M _A on the monitor display 80 as shown in Figure 7 (B).

When the end 22a of the exhalation tube portion 22 is disconnected from the inspiratory side connection terminal 12, that is, when a connection abnormality occurs at the point B, the controller 75 connects the connection point of the breathing tube assembly 1 based on the detected pressure. A connection abnormality in any one of A, B, C1, C2, D1, D2, and E is determined, and a connection abnormality upstream of the sensor unit 40 is determined based on the detected flow rate and the detected carbon dioxide concentration. Further, the connection abnormality at the connection point B is specified based on the non-detection signal from the color sensor 19. Based on this determination, and displays the connection abnormal marks M _B on the monitor display 80.
Incidentally, in a case where both the intake tube 21 and expiratory tube 22 is not connected to the connection terminals 21 and 22, two connecting abnormal marks M _A on the display 80 _to display the M _B.
The controller 75 may prioritize connection abnormality based on information from the color sensors 18 and 19 over determination of connection state based on detection information from other sensors.

If the inhalation tube 21 is mistakenly connected to the exhalation side connection terminal 22 and the exhalation tube portion 22 is connected to the inhalation side connection terminal 21, the controller 75 detects a connection error from the detection information of pressure, flow rate, and carbon dioxide concentration. can not determine, for the color sensor 18 and 19 is not both detected ends 21a, a 22a, a, it is determined that the erroneous connection of the point B, the two connecting abnormal marks _M a on the display 80 to display the _{M B} .

  When one of the connection points C1 and C2 is disconnected, the controller 75 connects at one of the connection points A, B, C1, C2, D1, D2, and E of the breathing tube assembly 1 based on the detected pressure. Based on the detected flow rate and the detected carbon dioxide concentration, it is determined that the connection abnormality is upstream of the sensor unit 40. Further, based on the detection signals of the color sensors 18 and 19, it is determined that the connection points A and B are in a normal connection state. As a result, it is determined that there is a connection abnormality at one of the connection points C1 and C2, and the connection abnormality mark Mc is displayed on the display 80.

When the intubation tube 60 is removed from the patient's trachea (connection abnormality at the connection point E), the controller 75 performs connection points A, B, C1, C2, D1, and the like of the respiratory tube assembly 1 based on the detected pressure. It is determined that there is a connection abnormality in either D2 or E, and a connection abnormality at a connection point on the downstream side of the sensor unit 40 is determined based on the detected flow rate and the detected carbon dioxide concentration. The controller 75 further from the raised history of cuff pressure in identifying abnormal connection of the connection point E, and displays the connection abnormal marks M _E on the display 80.

When disconnection occurs at the connection points D1 and D2, it is determined that the connection is abnormal at the connection point on the downstream side of the sensor unit 40 from the detection information on the pressure, flow rate, and carbon dioxide concentration in the same manner as described above. However, since the controller 75 has no cuff pressure increase history, it is determined that the connection point E is normally connected. As a result, to identify abnormal connection at the connection point D1, D2, and displays the connection abnormal marks M _D on the display 80.

  In addition, since the rise of the cuff pressure occurs when a pulling force is applied to the intubation tube 60, it cannot be immediately determined whether or not the intubation tube 60 has actually been removed only by the cuff pressure increase history. The controller 75 determines that the intubation tube 60 is dropped (abnormality at the connection point E) based on the determination of the downstream connection abnormality from the detection information of the pressure, the flow rate, and the carbon dioxide gas concentration as described above and the cuff pressure increase history. To do.

The controller 75 may prioritize determination of connection abnormality based on the cuff pressure over determination of connection state based on detection information of pressure, flow rate, and carbon dioxide concentration. That is, when the cuff pressure increase history is detected, even if there is no downstream connection abnormality determination from the detection information of pressure, flow rate, and carbon dioxide concentration, it is determined that the connection point E is abnormal, and the display 80 is abnormally connected. mark M _E may be displayed. Emphasis is placed on the fact that the pulling force acts on the intubation tube 60, and it is confirmed whether the intubation tube 60 is inserted into the trachea to a normal depth (whether the cuff 65 is in an appropriate position in the trachea) or a nurse or nurse. This is to encourage the teacher. If the intubation tube 60 is coming off, the doctor or nurse can return it to the normal insertion depth.

  The controller 75 basically determines that there is an upstream or downstream connection abnormality based on all of the pressure detection information, the flow rate detection information, and the carbon dioxide concentration detection information. When a connection abnormality on the upstream side or the downstream side is determined based on one of them, priority may be given to determination of a connection state based on the other detection information or pressure detection information.

  The controller 75 performs notification to the nurse center and generation of an alarm sound simultaneously with the display control of the display 80. The doctor or nurse who rushed in response to this can immediately determine where the connection is abnormal by looking at the display 80, and can quickly perform reconnection work.

  In the present embodiment, the controller 75 can also detect cuff leaks and can display cuff leaks on the display 80. This display may be displayed by blinking the cuff 65 on the image of the display 80, may be displayed in characters, or may be warned by voice.

  In the present embodiment, the controller 75 may display on the display 80 that the test lung is connected. More specifically, the intubation tube 65 is connected to a test lung (rubber-like bag) before being inserted into the patient's trachea, and a drive test of the present apparatus 10 is performed. Thereafter, the intubation tube 65 is inserted into the patient's trachea. Sometimes. In this case, when forgetting to insert the intubation tube 65 into the patient's trachea and starting to drive the main apparatus 10 while connected to the test lung, the detection information of the sensors other than the carbon dioxide sensor 43 is in a normal connection state. This indicates that the carbon dioxide sensor 43 does not detect carbon dioxide. The controller 75 determines that the test lung is connected from the abnormality of the carbon dioxide concentration, and displays it on the display 80. For example, the test lung is displayed on the display 80 and blinked.

  Further, in the present embodiment, the controller 75 measures the elapsed time from the time when it is determined that the connection abnormality or the cuff leakage is abnormal, and displays the elapsed time on the screen area 80x of the display 80. From this display, the doctor or nurse who rushed can confirm the elapsed time from the occurrence of the abnormality, can instantly determine the magnitude of damage given to the patient, and can take necessary first aid measures.

  Instead of or in addition to the display of the elapsed time, the color of the screen such as the background area of the display 80 may be changed. For example, the color of the background area is changed from green to yellow and from yellow to red as the elapsed time after the occurrence of a connection abnormality or the like becomes longer.

In the above embodiment, the connection abnormality marks M _{A to} M _E may be displayed on the display 80 even in a normal state, and the corresponding connection abnormality mark may be blinked or the color may be changed in the case of a connection abnormality. . The connection abnormality may be displayed with an arrow or may be displayed with blinking characters.

In the above embodiment, the connection abnormality on the upstream side and downstream side of the sensor unit 40 is identified based on both the detection information of the flow sensor and the detection information of the carbon dioxide sensor, but may be identified by only one of the information. .
Detection information from the pressure sensor, flow sensor, carbon dioxide sensor, etc. can be used to check the condition of the patient.

  When the color sensors 18 and 19 and the cuff pressure sensor are not present, the controller 75 discriminates and determines the connection abnormality between the upstream side and the downstream side. In this case, the connection abnormality mark displays a wider area than the above embodiment.

Next, a second embodiment of the present invention will be described with reference to FIG. In this embodiment, components corresponding to those of the first embodiment are denoted by the same reference numerals and description thereof is omitted.
In the second embodiment, a first joint 210 is interposed between the artificial nose 30 and the sensor unit 40, and a second joint 220 is interposed between the sensor unit 50 and the extension tube 50.

The first joint 210 has a cylindrical shape, and has a connection part 210 a to the artificial nose 30 and a connection part 210 b to the sensor unit 40. These connection points C2 when the connection abnormality occurs in '', C1, C2 correspond to the connection point C2. Junction point C1 of the first embodiment '", the controller 75 displays a mark _{M C} on the display 80 ( (See FIG. 7).
A holder 211 is provided on the outer periphery of the first joint 210.

The second joint 220 has a cylindrical shape, and one end portion serves as a connection portion 220a to the sensor unit 40, and the other end portion serves as a connection portion 220b to the extension tube 50. These connection points D1 ', D1 "corresponds to the connection point D1 of the first embodiment. Connection points D1', D1" when the connection abnormality has occurred, the controller 75 displays a mark _{M D} on the display 80 ( (See FIG. 7).

  The sensor unit 40 may be provided with a humidity sensor and / or an oxygen sensor in place of the carbon dioxide sensor 43 or in addition to the carbon dioxide sensor 43. When the artificial respiration system is operating normally, the humidity and oxygen concentration of the internal flow path 41x of the sensor unit 40 change as shown in FIG.

Under normal conditions, the oxygen concentration varies inversely with the carbon dioxide concentration. That is, since the air blended with oxygen in the inhalation process flows through the sensor unit, the oxygen concentration increases. In the exhalation process, oxygen is taken into the patient's body and carbon dioxide is discharged, so the oxygen concentration decreases.
When there is a connection abnormality on the upstream side, the oxygen concentration does not increase in the intake process and is always equal to the atmosphere. When there is a connection abnormality on the downstream side, the oxygen concentration rises in the inhalation process and becomes the same level as the atmosphere in the exhalation process.
The controller 75 can discriminate between an upstream connection abnormality and a downstream connection abnormality from the oxygen concentration detection information.

  Since the humidity shows the same change as the carbon dioxide concentration, the controller 75 can detect a connection abnormality using this information. The temperature information of the temperature sensor 65 may be used for connection abnormality detection. This is because the temperature in the internal flow path 41x changes similarly to the humidity.

The present invention is not limited to the above-described embodiments, and various aspects can be adopted. For example, the air supplied from the main device may not contain oxygen.
In the above-described embodiment, the sub device is separated from the main device. However, the sub device may not be provided, and the entire internal structure may be incorporated in the main device. In this case, the support arm may be fixed to the main device.
Instead of the artificial nose, a warming humidifier may be provided in the middle of the intake tube portion. In this case, the erroneous connection detection of the connection points A and B in the above embodiment is very effective.
The extension tube may be omitted.
The controller may use a signal representing the inhalation / expiration process from the main device for detecting a connection abnormality.

  The present invention can be applied to an artificial respiration system that assists the patient in breathing.

DESCRIPTION OF SYMBOLS 1 Breathing circuit assembly 10 Main apparatus 11 Inhalation side connection terminal 12 Expiration side connection terminals 18, 19 Color sensor (connection sensor)
DESCRIPTION OF SYMBOLS 20 Breathing tube 21 Inhalation tube part 22 Exhalation tube part 21a, 22a End part 40 Sensor unit 42 Pressure sensor 43 Carbon dioxide sensor (component sensor)
44, 45 Flow sensor 60 Intubation tube 65 Cuff 73 Cuff pressure sensor 75 Controller (control means)
80 Monitor display M _{A to} M _E Connection error mark

Claims (12)

A main device and a breathing circuit assembly;
The main apparatus has an inhalation-side connection terminal and an exhalation-side connection terminal, and an inhalation process for supplying air through the inhalation-side connection terminal, and an exhalation process for discharging the patient's exhalation through the exhalation-side connection terminal Are executed alternately,
The breathing circuit assembly is
(A) An inhalation tube portion whose one end is detachably connected to the inhalation side connection terminal, an exhalation tube portion whose one end is detachably connected to the exhalation side connection terminal, and these inspiration tube portions a respiratory tube having a connecting portion communicating with the other end of the expiratory tube portion,
(B) an intubation tube inserted into the patient's trachea;
(C) having a body which is detachably connected between the connecting portion and the proximal end of the intubation tube of the breathing tube, the interior of the body, the flow passage and the intubation in the respiratory tube An internal flow path that is connected to the flow path in the tube is formed , a pressure sensor that detects the pressure of air in the internal flow path is incorporated in the main body, and a flow rate sensor that detects the flow rate of air in the internal flow path and / or Or a sensor unit in which a component sensor for detecting a component of the internal flow path is incorporated in the main body ;
(D) a monitor display for displaying an image of the breathing circuit assembly;
(E) a control means for controlling the monitor display;
The control means detects an abnormal connection of the breathing circuit assembly based on the detection information of the pressure sensor, and further on the main apparatus side from the sensor unit based on the detection information of the flow sensor and / or component sensor. Whether the connection is abnormal on the patient side or on the patient side from the sensor unit, and the monitor display is controlled based on this determination, and the connection abnormality is displayed in the region or area of the connection abnormality in the image of the respiratory circuit assembly. An artificial respiration system characterized by letting A main device and a breathing circuit assembly;
The main apparatus has an inhalation-side connection terminal and an exhalation-side connection terminal, and an inhalation process for supplying air through the inhalation-side connection terminal, and an exhalation process for discharging the patient's exhalation through the exhalation-side connection terminal Are executed alternately,
The breathing circuit assembly is
(A) An inhalation tube portion whose one end is detachably connected to the inhalation side connection terminal, an exhalation tube portion whose one end is detachably connected to the exhalation side connection terminal, and these inspiration tube portions And a breathing tube having a connection portion connected to the other end of the breathing tube portion,
(B) an intubation tube inserted into the patient's trachea;
(C) Removably connected between the connection portion of the breathing tube and the proximal end portion of the intubation tube and having an internal flow path, and the air pressure, flow rate, and components of the internal flow path are respectively A sensor unit incorporating a pressure sensor, a flow sensor, and a component sensor to detect;
(D) a monitor display for displaying an image of the breathing circuit assembly;
(E) a control means for controlling the monitor display;
The control means detects connection abnormality of the breathing circuit assembly based on the detection information of the pressure sensor, and further detects the connection from the sensor unit based on the detection information of at least one of the flow sensor and the component sensor. It is determined whether the connection is abnormal on the main device side or on the patient side from the sensor unit. Based on this determination, the monitor display is controlled to connect to the region or area of the connection abnormality in the image of the respiratory circuit assembly. If the flow rate sensor does not detect the flow rate in the inspiratory process and the expiratory process, the control means determines that there is a connection abnormality on the main device side from the sensor unit, and the flow rate in the inspiratory process is displayed. Is detected but the flow rate in the exhalation process is not detected, the connection from the sensor unit to the patient is abnormal Ventilation system, characterized in that to determine. The component sensor is a carbon dioxide sensor,
When the carbon dioxide sensor detects carbon dioxide that is lower than the carbon dioxide concentration during normal breathing and higher than the carbon dioxide concentration in the atmosphere, the control means determines that there is a connection abnormality on the main device side from the sensor unit. 3. When the carbon dioxide sensor does not detect carbon dioxide having a concentration higher than the carbon dioxide concentration in the atmosphere, it is determined from the sensor unit that there is a connection abnormality on the patient side. Artificial respiration system. A cuff is provided on the outer periphery of the intubation tube, and air is supplied to the cuff via an air supply tube so as to swell,
And a cuff pressure sensor for detecting the cuff pressure through the air supply tube.
When the control means detects the rising history of the cuff pressure from the cuff pressure sensor, the control means determines that a pulling force has been applied to the intubation tube, and determines whether the pulling force is applied, 4. The connection abnormality is displayed in a region or a region corresponding to the intubation tube in the image of the respiratory circuit assembly by controlling the monitor display based on the determination of the connection abnormality. The described artificial respiration system.   When it is determined that there is a connection abnormality on the patient side from the sensor unit, the control means determines that there is a connection history between the sensor unit and the intubation tube when there is no increase in the cuff pressure. 5. The artificial respiration system according to claim 4, wherein a monitor display is controlled based on the determination to display a connection abnormality in a region or region between the intubation tube and the sensor unit in the image of the breathing circuit assembly. .   When the control means detects an increase in the cuff pressure from the cuff pressure sensor, the control means controls the monitor display even if there is no determination of a connection abnormality on the patient side from the sensor unit. The artificial respiration system according to claim 4, wherein a connection abnormality is displayed in a region or region corresponding to the intubation tube. Furthermore, an inspiratory side connection sensor that detects whether or not the inspiratory tube portion is connected to the inspiratory side connection terminal, and an expiratory side connection sensor that detects whether or not the expiratory tube portion is connected to the expiratory side connection terminal. Prepared,
When at least one of the two connection sensors does not detect connection, the control means determines that the connection is abnormal between the main apparatus and the respiratory tube, and controls the monitor display based on this determination, The artificial respiration system according to any one of claims 1 to 6, wherein a connection abnormality is displayed in a region or a region between the main apparatus and the breathing tube in an image of a breathing circuit assembly.   When the control unit determines that the connection to the main apparatus side is more abnormal than the sensor unit, and the two connection sensors detect the connection between the inspiratory tube portion and the expiratory tube portion, the control means And determining a connection abnormality based on the determination to display a connection abnormality in a region or region between the respiratory tube and the sensor unit in the image of the respiratory circuit assembly. Item 8. The artificial respiration system according to Item 7. Different first and second colors are attached to the outer peripheries of the one end of the inhalation tube part and the exhalation tube part,
The artificial respiration system according to claim 7 or 8, wherein the two connection sensors are color sensors for detecting the first color and the second color, respectively.   Based on the detection information from the flow sensor, the control means determines that the leakage is between the cuff and the patient's trachea when the flow rate in the expiration process is less than the flow rate in the inspiration process. It displays on a display, The artificial respiration system in any one of Claims 1-9 characterized by the above-mentioned.   The artificial respiration system according to claim 1, wherein the component sensor includes at least one of an oxygen sensor and a humidity sensor.   The said control means makes a display perform the display of the elapsed time after judging the artificial respiration system abnormality including the said connection abnormality, or the display corresponding to this elapsed time. The artificial respiration system in any one.

Images