JP6433286B2 - Auxiliary device for blood vessel puncture, and blood vessel puncture device using the same - Google Patents

Description

  The present invention relates to a blood vessel puncture auxiliary device used when puncturing a blood vessel, and a blood vessel puncture device for an extracorporeal circulation device using the same.

Conventionally, in percutaneous cardiopulmonary assistance (hereinafter referred to as “PCPS”), artificial dialysis, and the like, a technique for percutaneously inserting an indwelling needle, a puncture needle, and the like has been performed.
For example, PCPS performs cardiopulmonary assistance with a closed circuit cardiopulmonary apparatus (extracorporeal circulation apparatus) using a pump and an artificial lung, and includes a venous cannula inserted into the femoral vein and an artery inserted into the femoral artery. The heart-lung machine and the body are connected via the side cannula (see, for example, Patent Document 1).
Since these tubes called cannulas are inserted percutaneously, it is preferable to first puncture the patient's femoral arteriovenous vein under fluoroscopy, and the cannula can be inserted using the punctured indwelling needle. It is inserted into the femoral artery and vein. For PCPS and the like having such a technique, the key to success is how accurately and quickly the indwelling needle can be inserted into the blood vessel.

Japanese Patent Application Laid-Open No. 7-67954

By the way, for patients in an emergency scene, even if they want to perform a procedure under fluoroscopy, for example, they cannot use X-ray fluoroscopy outside the radiation control area in an emergency room or a doctor car, etc. The maneuver is forced.
Therefore, recently, it is desired to realize a technique for puncturing a blood vessel using an ultrasonic echo device. That is, a technique for puncturing a blood vessel while pressing an ultrasonic probe around a blood vessel to be punctured with an indwelling needle and the like and transmitting and receiving ultrasonic waves and viewing a tomographic image around the blood vessel is realized.
However, there is still a problem in reducing the difficulty level of the blood vessel puncture technique, such as an image resolution lower than that of an X-ray apparatus, and the ultrasonic echo apparatus is not standard.

  An object of the present invention is to provide a blood vessel puncture auxiliary device that can reduce the difficulty of a procedure using an image obtained by transmitting and receiving ultrasonic waves, and a blood vessel puncture device using the same.

An object of the present invention is to display an ultrasonic probe that transmits and receives ultrasonic waves to and from a blood vessel peripheral region of a subject to be punctured by a puncturing means, and an image related to the blood vessel peripheral region based on the transmission and reception of the ultrasonic probe. image forming means for, in a blood vessel puncture auxiliary device provided with the ultrasonic probe, said being positionable mounted to a subject's body, said in a state of being attached to the body has a contact portion in close contact with the body, said image forming means is disposed on the contact portion, the cross-sectional images a sectional image of the blood vessel peripheral region in a direction substantially perpendicular to the depth direction of the puncture This is achieved by a blood vessel puncture assisting device having first image forming means for displaying so as to guide a puncture direction that is a direction in which a blood vessel extends at least adjacent to the body.

According to the above configuration, the blood vessel puncture assisting device includes an ultrasonic probe that transmits and receives ultrasonic waves to and from a blood vessel peripheral region of a subject to be punctured by the puncturing means, and a blood vessel based on transmission and reception of the ultrasonic probes. Image forming means for displaying an image relating to the peripheral area. Therefore, puncturing means such as an indwelling needle can be punctured while viewing the image of the blood vessel peripheral region.
The ultrasonic probe can be positioned with respect to the body of the subject. Therefore, a stable image can be obtained by fixing the ultrasonic probe to the body. Moreover, when performing a procedure alone, the certainty of the procedure can be increased by using both hands freely. Further, even when two or more people perform the procedure, it is not necessary to make difficult communication between the person who handles the probe and the person who performs the puncture, and the procedure becomes easy.
Further, the image forming means cuts a cross-sectional image that is a cross-sectional image of the peripheral region of the blood vessel in a direction substantially orthogonal to the puncture depth direction (that is, the cross-sectional image of the blood vessel and the cross-sectional image around the blood vessel. Image) is displayed so as to guide the puncture direction at least adjacent to the body.
Then, since a cross-sectional image of the peripheral region of the blood vessel is displayed at least adjacent to the body, when puncturing, the operator can puncture while focusing on the hand while visually recognizing an image close to the hand. The difficulty level can be lowered. In addition, since the cross-sectional image, which is a cross-sectional image of the peripheral region of the blood vessel in a direction substantially orthogonal to the puncture depth direction, is displayed so as to guide the puncture direction, the operator can perform the puncture direction guided by the cross-sectional image. If the puncture is performed according to the above, the puncture means can be punctured accurately and quickly into the blood vessel.

Preferably, the image forming unit includes a second image forming unit that displays information different from the first image forming unit in a surplus area that is an area other than the area where the cross-sectional image is displayed. It is characterized by that. Therefore, the surplus regions of this other information (preferably, a depth direction of the tomographic image of piercing longitudinal layer image) that will contribute to ensure, rapidity of procedures, such as by displaying the accurate and rapid procedures The sex can be further increased.

  Preferably, the surplus region is not disposed on the ultrasonic probe, and is a long hole notch substantially corresponding to the position of the blood vessel in the cross-sectional image and the direction in which the blood vessel extends. A portion is formed. Therefore, the puncture direction and the direction of the notch portion in the surplus region generally correspond to each other, and if the operator pushes the puncture means along the notch portion, the puncture means can easily reach the blood vessel, The difficulty level can be further reduced.

  Preferably, the ultrasonic probe and the image forming unit are detachable. Therefore, even if blood that bleeds during puncture adheres to the image forming means, only the image forming means can be replaced.

  Preferably, the cutout portion is movable so as to match the position of the blood vessel in the cross-sectional image. For this reason, even when the position of the blood vessel in the cross-sectional image and the position of the cutout portion do not match, the cutout portion is moved without reattaching the entire apparatus to the body, and the blood vessel of the image forming means The position and the position of the notch can be matched. Therefore, the procedure can be completed quickly.

  Preferably, the image forming unit includes a projection device that projects the cross-sectional image onto a biocompatible sheet member punctured by the puncturing unit. Then, since the cross-sectional image is projected onto the sheet member by the projection device, as described above, if the operator performs puncturing according to the puncturing direction guided by the cross-sectional image on the sheet member, the puncturing means is used as a blood vessel. Can puncture accurately and quickly. The sheet member on which the cross-sectional image is projected can be punctured by the puncturing means and has biocompatibility. Therefore, even if the blood vessel is projected on any position on the sheet member, it can be punctured from above the sheet member in accordance with the position and direction of the projected blood vessel. At this time, even if a piece of the sheet member enters the body at the tip of the puncture means when a hole is made in the sheet member by this puncture, there is no problem because the sheet member has biocompatibility. Note that such a sheet member is preferably detachable from the ultrasonic probe, whereby the sheet member can be positioned and fixed with respect to the body, and the sheet member contaminated with blood or the like can be replaced.

In addition, the above-described problem includes the blood vessel puncture assisting device and an indwelling needle as the puncturing means for inserting the cannula of the extracorporeal circulation device, and the image forming means uses a color Doppler for the direction of blood flow. Information is displayed, and the indwelling needle is more preferably solved by a blood vessel puncture device having a marker portion indicating the puncture direction.
For this reason, when the indwelling needle for the extracorporeal circulation apparatus is punctured into the blood vessel, both the blood flow and the puncture direction of the indwelling needle can be grasped. Therefore, a blood removal side indwelling needle punctured in the direction of blood flow on the vein side of the subject and a blood feeding side indwelling needle punctured in the direction opposite to the blood flow on the artery side are mistaken. Without this, the indwelling needle can be properly punctured into the artery and vein. Further, since the puncture direction of the indwelling needle is known, it is easy to understand how the body is gradually punctured, and the procedure becomes easier.

  As described above, according to the present invention, there is provided a blood vessel puncture auxiliary device that can reduce the difficulty of a procedure using an image obtained by transmitting and receiving ultrasonic waves, and a blood vessel puncture device using the same. Can be provided.

Schematic which shows the main structures of the extracorporeal circulation apparatus and the blood vessel puncture apparatus which concerns on 1st Embodiment of this invention used for this. FIGS. 2A and 2B are diagrams in which a blood vessel puncture auxiliary device used in the blood vessel puncture device of FIG. 1 is attached to a subject, FIG. 2A is a front view thereof, and FIG. FIG. 3 is a partial front view of the blood vessel puncture assisting device of FIG. 2, in which FIG. 3 (A) is a partial front view thereof, and FIG. FIG. 3 is a diagram illustrating a usage state in which an image is displayed on the image forming unit of the blood vessel puncture assisting device in FIG. 2. The front view which concerns on the modification of a notch part. The figure which switched the image formation means of the auxiliary apparatus for blood vessel puncture of FIG. 4 to another mode. The schematic block diagram which shows the characteristic part of the auxiliary device for blood vessel puncture of FIG. FIG. 5 is a perspective view of a blood vessel puncture assisting device according to a first modification of the first embodiment of the present invention in a state where an ultrasonic probe and an image forming unit are separated. FIG. 9 is a schematic cross-sectional view when the ultrasonic probe of FIG. 8 and the image forming unit are connected and cut at the position of the AA line of FIG. 8. FIGS. 10A and 10B are diagrams for explaining a usage state of the blood vessel puncture assisting device in FIGS. 8 and 9, in which FIG. 10A shows a blood vessel on the image forming unit, and FIG. 10B shows the image of FIG. The figure which moved the image formation means after visually recognizing the formation means. The front view of the auxiliary device for blood vessel puncture which concerns on the 2nd modification of 1st Embodiment of this invention. BB sectional drawing which abbreviate | omitted the internal mechanism of FIG. The figure which attaches the auxiliary device for blood vessel puncture which concerns on 2nd Embodiment of this invention to a subject, and projects the image by an image formation means. FIG. 14 is a diagram illustrating a usage state in which an image is displayed on the sheet member of the blood vessel puncture assisting device of FIG. 13. FIG. 14 is a schematic block diagram of the blood vessel puncture assisting device of FIG. 13.

DESCRIPTION OF EMBODIMENTS Hereinafter, preferred embodiments of the present invention will be described in detail with reference to the accompanying drawings.
The embodiments described below are preferred specific examples of the present invention, and thus various technically preferable limitations are given. However, the scope of the present invention is particularly limited in the following description. Unless otherwise stated, the present invention is not limited to these embodiments. Moreover, in the following drawings, the parts denoted by the same reference numerals have the same configuration.

[First Embodiment]
FIG. 1 is a schematic diagram showing the main configuration of an extracorporeal circulation device 1 and a blood vessel puncture device 20 according to the first embodiment of the present invention used for this.
The extracorporeal circulation apparatus 1 shown in FIG. 1 is an apparatus that extracorporeally circulates blood of a patient P. This “extracorporeal circulation” includes “extracorporeal circulation operation” and “auxiliary circulation operation”.
The “extracorporeal circulation operation” is performed by the extracorporeal circulation device 1 when blood cannot be exchanged in the patient P because the blood does not circulate in the heart of the patient (subject) P to which the extracorporeal circulation device 1 is applied. A blood circulation operation and a gas exchange operation (oxygen addition and / or carbon dioxide removal) for the blood are performed.
The “auxiliary circulation operation” is a case where blood circulates in the heart of a patient (subject) P to which the extracorporeal circulation apparatus 1 is applied and gas exchange can be performed in the lungs of the patient P. Is also to assist blood circulation. Some devices have a function of performing a gas exchange operation on blood.

The extracorporeal circulation device 1 shown in the figure is an example of a device (hereinafter referred to as “PCPS”) used for percutaneous cardiopulmonary support, and this PCPS has an responsiveness that can be worn relatively quickly. Since it is provided, it can be suitably used in an emergency scene such as an emergency room in a hospital or a doctor car, or a scene where an auxiliary circulation operation is performed.
Specifically, PCPS draws venous blood outside the body with a venous cannula (bleeding side cannula) 5 inserted into a vein (femoral vein) and gasses with an oxygenator (preferably a hollow fiber membrane oxygenator) 2. The blood is exchanged and oxygenated blood is returned to the patient P by an arterial cannula (blood sending cannula) 6 inserted into an artery (femoral artery). Blood circulation in this circuit is performed by a pump (preferably a centrifugal pump) 3 upstream of the oxygenator 2, blood in the blood removal tube 11 flows in the V direction, and blood in the blood supply tube 12 flows. Flows in the W direction. The overall control of PCPS is performed by the controller 10.

In the PCPS, the blood removal side cannula 5 and the blood supply side cannula 6 described above are percutaneously inserted into the blood vessel of the patient, and the blood vessel puncture device 20 is used for this insertion.
The blood vessel puncture device 20 can also be called a blood vessel puncture set, and includes a blood vessel puncture auxiliary device 30 and indwelling needles 21 and 22 (an example of puncture means of the present invention).
The indwelling needles 21 and 22 are introduction needles for inserting the blood removal and blood feeding side cannulas 5 and 6 into the blood vessel. That is, the indwelling needles 21 and 22 are punctured and inserted into the blood vessel, and the inner needle 25 is extracted leaving the outer tubes 23 and 24, and then a guide wire (not shown) is passed through the outer tubes 23 and 24. Later, the outer tubes 23 and 24 are extracted, and then the blood removal and blood supply side cannulas 5 and 6 are inserted into the blood vessel along the guide wire. The indwelling needle 21 is a blood removal side indwelling needle 21 for inserting the blood removal side cannula 5, and the indwelling needle 22 is a blood feeding side indwelling needle 22 for inserting the blood supply side cannula 6.

Here, as shown in the figure, for example, a plurality of substantially circular markers M as marker portions are arranged on the outer tubes 23 and 24 of the blood removal side indwelling needle 21 and the blood sending side indwelling needle 22.
The blood removal side indwelling needle 21 has two markers M connected to (or continuous with) the proximal end side (gripping part 26 side) of the outer tube 23. Further, one marker M is arranged on the tip side with a predetermined interval from the two markers M.
On the other hand, in the blood-feeding indwelling needle 22, four markers M are arranged on the proximal end side (gripping part 27 side) of the outer tube 24 and connected. Further, one marker M is arranged on the tip side with a predetermined interval from these four markers M.
These markers M can be marked on a very shallow portion of the surface of the outer tube 23, 24, preferably with a laser, and compatibility with a living body is not impaired.

In this way, the markers M of the blood removal side indwelling needle 21 and the blood sending side indwelling needle 22 can be distinguished from each other in appearance, and the operator or the like can immediately use any indwelling needle at first glance from the appearance. It is configured to be able to judge whether there is. In the present embodiment, the appearance is distinguished by the number and arrangement of the markers M, but the present invention is not limited to this, and the markers M may have different shapes.
The marker M also serves as a marker that can immediately grasp the puncture direction. That is, in the case of the drawing, in the blood removal side indwelling needle 21, the direction from the two connected markers M toward one marker M arranged at a predetermined interval is the puncture direction. Moreover, in the blood-feeding indwelling needle 22, the direction from the four connected markers M toward one marker M arranged at a predetermined interval is the puncture direction.

  As described above, prior to blood removal and insertion of the blood sending side cannulas 5 and 6, the indwelling needles 21 and 22 are first inserted into the blood vessel, and the indwelling needles 21 and 22 are inserted accurately and quickly. There is a blood vessel puncture assisting device 30 as a device for insertion into the blood vessel. The blood vessel puncture assisting device 30 is a device for projecting the indwelling needles 21 and 22 while displaying an image of a blood vessel peripheral region (blood vessel and its peripheral region) by ultrasonic echo and visually recognizing the image. It can also be said to be a device, a blood vessel imaging device, or an ultrasonic imaging device.

Hereinafter, the blood vessel puncture assisting device 30 will be described with reference to FIGS.
FIG. 2 is a view in which the blood vessel puncture assisting device 30 is mounted on the thigh of the patient P, FIG. 2 (A) is a front view thereof, and FIG. 2 (B) is a side view thereof. 3 is a partial front view of the blood vessel puncture auxiliary device 30 of FIG. 2, FIG. 3 (A) is a partial front view thereof, and FIG. 3 (B) is a partial rear view thereof. FIG. 4 is a use state diagram in which an image is displayed on the image forming means 31 of the blood vessel puncture assisting device 30 of FIG. In FIG. 3, the belt 32 shown in FIG. 2B is omitted.

  As shown in FIG. 2, the blood vessel puncture assisting device 30 has a size that can be transported only by human hands and has a tablet shape as a whole, and a blood vessel peripheral region BB of a patient P to be punctured with an indwelling needle And an image forming means 40 for displaying an image related to the blood vessel peripheral region BB obtained by the ultrasonic probe 31.

The ultrasonic probe 31 is placed in the same housing 37 as a part such as a substrate on which a power supply unit and an integrated circuit (not shown) are mounted while a part 31d of the ultrasonic probe 31 is exposed on the back surface shown in FIG. Arranged and integrated with these components. In other words, it can be said that the component is housed in the ultrasonic probe 31. Therefore, unless otherwise specified, the ultrasonic probe 31 includes the above components and the housing 37.
The ultrasonic probe 31 of this embodiment is a probe for a three-dimensional (3D) image, and only n1 to nX piezoelectric transducers (not shown) that transmit and receive ultrasonic waves are shown in FIG. 3B. The plurality of piezoelectric vibrators are arranged in a line and are scanned in the width direction W1 in FIG. The three-dimensional imaging probe of the present invention is not limited to this, and piezoelectric vibrators may be arranged in the width direction W1 in FIG. 3 and scanned in the height direction H1. Alternatively, a known 2D array probe in which piezoelectric vibrators are arranged in a matrix may be used.
The ultrasonic wave transmitted from the piezoelectric vibrator is reflected by the blood vessel peripheral region BB to be punctured as shown in FIG. 2B (relatively reflected by the blood vessel wall), and the reflected wave is received and converted into an electric signal. Based on the converted data, a predetermined image relating to the blood vessel peripheral region BB is displayed on the image forming means 40. The ultrasonic probe 31 can be either a linear scanning type or a convex scanning type. However, in this embodiment, the ultrasonic probe 31 can be linearly transmitted to visually recognize the vicinity of the ground surface, and A linear probe having a substantially flat contact surface is used.

  Such an ultrasonic probe 31 can be positioned with respect to the body of the subject P. Specifically, the ultrasonic probe 31 can be attached to and detached from the body by the belt 32 shown in FIG. 2B inserted through the through hole 34 of FIG. 3B, and the belt 32 is attached using the buckle 33. Can be fastened to the body. Further, the position of the ultrasonic probe 31 to be fixed to the body can be adjusted by loosening the belt 32. The means for fixing the position of the ultrasonic probe 31 and adjusting the position in this way are not limited to the belt 32, and other positioning adjusting means such as an annular rubber can be used.

  The ultrasonic probe 31 has a stepped shape as shown in FIG. 2B. In the mounted state, the ultrasonic probe 31 is closely attached to the body on the back side, and the front side (in the case of FIG. 2B, the upper side). ) Surface portion 31b. As shown in FIG. 3, the contact portion 31a has a height dimension (a dimension in the longitudinal direction of the leg when mounted on the thigh) H1 larger than the height dimension H2 of the surface portion 31b. A step 31c is formed as shown in FIG. The area AR where the piezoelectric vibrator is arranged and transmits / receives ultrasonic waves is arranged toward the close contact portion 31a, and the area AR where the ultrasonic waves are transmitted is a part PR (in this embodiment) where puncture is started with an indwelling needle. It is preferable to be close to a notch 50) described later.

  The image forming unit 40 displays an image in real time based on image data obtained by scanning with the ultrasonic probe 31. The image forming unit 40 according to the present embodiment is generally plate-shaped as a whole, and can be disposed at least adjacent to the body of the patient P (may be in close contact). Specifically, as shown in FIGS. 2 and 4, the image forming means 40 is disposed adjacent to a site PR where puncturing with an indwelling needle begins. The image forming means 40 is preferably as thin as possible. For example, a liquid crystal display can be used, and an organic EL display that is curved substantially along the outer shape of the thigh may be used.

The image forming unit 40 is connected to the ultrasonic probe 31 and is preferably disposed at least on the ultrasonic probe 31.
In the case of the present embodiment, the image forming unit 40 is protruded from the first image forming unit 41 disposed on the close contact portion 31a and further from the ultrasonic probe 31 (mounted on the close contact portion 31a). Not) the second image forming means 42.
As shown in FIGS. 2 and 4, the first image forming unit 41 includes a cross-sectional image that is a cross-sectional image of the blood vessel peripheral region BB in a direction substantially perpendicular to the depth direction (Z direction in the figure) where the indwelling needle punctures. A plane image is displayed, and this cross-sectional image is displayed so as to guide the puncture direction (direction DR in which the blood vessel extends in FIG. 4). For example, in the state of FIG. 4 in which the indwelling needles 21 and 22 are to be inserted into the femoral arterial vein BV of the patient P lying on his back, the first image forming unit 41 is substantially horizontal in the region where the femoral arterial vein BV exists. A cross section (a cross section cut along the approximate XY plane in the figure) is displayed, and the displayed image of the femoral artery and vein BV is displayed along the actual position and direction of the femoral artery and vein BV. As a result, the operator punctures from the position PR corresponding to the position of the femoral artery and vein BV projected on the first image forming means 41 while being close to the edge 41a of the first image forming means 41 and displaying the image. The indwelling needles 21 and 22 are pushed forward in the direction DR in which the femoral arteriovenous BV is directed, so that the indwelling needles 21 and 22 can be punctured and inserted accurately and rapidly into the femoral arterial vein BV.

The second image forming means 42 is in a surplus area which is an area other than the area where the above-mentioned cross-sectional image is displayed, among the image forming means 40, and the first image forming means contributing to the reliability and speed of the procedure. Various information different from 41 is displayed. Preferably, as shown in FIG. 4, a longitudinal tomographic image which is a tomographic image of a blood vessel peripheral region in the depth direction Z to be punctured is displayed. Thereby, the operator can grasp the blood vessel position both in the depth direction in the puncture direction and in the direction orthogonal thereto, and the reliability of the procedure can be further increased.
Note that the first image forming unit 41 and the second image forming unit 42 in the figure are physically separated, but the present invention is not limited to this, and the same without being physically separated. You may comprise so that a screen may be divided | segmented in a display screen.

With respect to the image forming means 40, an excess area other than the area where the cross-sectional image is displayed substantially corresponds to the position of the blood vessel BV and the direction in which the blood vessel BV extends in the cross-sectional image. A notch 50 is formed. In the case of the present embodiment, a slot-like notch 50 is formed in the housing 45 of the image forming unit 40 so as to correspond to the position of the blood vessel BV displayed on the first image forming unit 41. A position PR at which puncturing is started is present in the notch 50. That is, in FIG. 4 in which the indwelling needles 21 and 22 are to be inserted into the femoral arterial vein, the housing 45 may have the femoral arterial vein under the first image forming means 41 from the foot side end 45a. Notched toward a highly probable neighborhood. Thus, if the operator pushes the indwelling needles 21 and 22 along the shape of the long hole of the notch 50, the indwelling needles 21 and 22 can easily reach the blood vessel. Thus, the image in the puncture direction (DR direction in FIG. 4) displayed on the first image forming means 41 is the first guide means for guiding the puncture, and the second guide in which the notch 50 guides the puncture. It can be said that it is a means.
In this regard, the notch 50 is located on the end 45a side as compared with the width W2 on the first image forming means 41 side disposed on the ultrasonic probe 31, as shown in FIG. It is preferable that the width W3 is wide, which can effectively prevent the hand from hitting the casing 45 and the second image forming means 42 when puncturing. Further, it is more preferable that the notch 50 has a width that increases from the first image forming unit 41 toward the end 45a, so that the puncture direction DR of the blood vessel and the extending direction Y of the notch 50 match. Even if it is not, it becomes easy to push the indwelling needle forward.

In the present embodiment in which a linear probe is used, it is preferable that the first image forming unit 41 has the same area and position as the area AR for transmitting ultrasonic waves in FIG.
In addition, when the first image forming unit 41 is attached to the thigh as in the present embodiment, it is preferable that the dimension W1 in the width direction is larger than the height dimension H3. As shown in FIG. 4, the position of the femoral artery and vein BV in the lateral direction (X direction in FIG. 4) can be easily understood.
Further, the second image forming means 42 for displaying the longitudinal tomographic image of the peripheral region of the blood vessel is disposed adjacent to the notch 50, and the blood vessel BV of the longitudinal tomographic image has a long hole notch. It is possible to display along a direction different from the longitudinal direction Y of 50, preferably along a direction X substantially orthogonal to the longitudinal direction Y. Thereby, even if the operator who advances puncturing along the longitudinal direction Y of the cutout portion 50 sees the second image forming means 42, the direction DR to be punctured is confused and is not mistaken. I am doing so.

  In the image forming unit 40, a surplus area other than the area where the cross-sectional image is displayed is touched to perform various operations on the opposite side of the second image forming unit 42 with the notch 50 interposed therebetween. A sensor type menu display area 46 is provided. In the case of the blood vessel puncture auxiliary device 30 of FIG. 4 used for emergency PCPS, the menu display area 46 is provided with screen switching buttons 47 to 49. The button 47 is for displaying a cross-sectional image and a longitudinal tomographic image of the blood vessel peripheral region in a so-called B mode. The button 48 is for switching to a mode in which an image acquired by the ultrasonic probe 31 for a three-dimensional (3D) image is displayed in three dimensions. The button 49 is for switching to a mode for displaying blood flow direction information by color Doppler.

  FIG. 6 is a diagram when the mode is switched to the mode for displaying the direction information of the blood flow. In this mode, the Doppler effect in which the frequency of the reflected ultrasonic waves changes is used to determine whether the blood flow is approaching or moving away from the ultrasonic probe. Color Doppler mode is used to color-change changes in flow velocity on the image. This “color coding” has, for example, a configuration in which a blood flow approaching the probe 31 is indicated by “red R” and a blood flow moving away from the probe 31 is indicated by “blue B”.

  Thereby, the operator can determine the direction of the blood flow to be punctured. Further, in this embodiment, the blood removal side indwelling needle 21 and the blood sending side indwelling needle 22 shown in FIG. have. Therefore, the blood removal side indwelling needle 21 to be punctured along the direction of blood flow on the venous side and the blood sending side indwelling needle 22 to be punctured along the direction opposite to the blood flow on the arterial side are appropriately made without mistakes. Indwelling needles can be punctured into arteries and veins. For example, in the case of FIG. 6, it can be seen that the blood flow is in the direction from red R to blue B. In addition, it can be seen that the indwelling needle has advanced in the direction of the arrow GS by a plurality of markers M connected to the gripping portion side and one marker M on the distal end side. I understand that Furthermore, the markers M of the blood removal side indwelling needle 21 and the blood sending side indwelling needle 22 shown in FIG. 1 are distinguished from each other in appearance. For this reason, for example, in FIG. It can be seen that the blood removal side indwelling needle 21. As described above, it is possible to grasp the three directions of the direction of blood flow, the direction in which the indwelling needle is punctured, and the type of the indwelling needle, and it is possible to puncture the indwelling needle appropriately and quickly even in an emergency.

Next, the system configuration of the blood vessel puncture auxiliary device 30 described with reference to FIGS. 2 to 6 will be described with reference to FIG. FIG. 7 is an example of a schematic block diagram showing a characteristic part of the blood vessel puncture assisting device 30.
The blood vessel puncture assisting device 30 of FIG. 7 includes an ultrasonic probe 31 and an image forming unit 40 that displays an image of a blood vessel peripheral region based on the processed image data.
The housing 37 of the ultrasonic probe 31 stores a known transmission / reception unit 50, controller 56, signal processing unit 51, and image generation unit 52.

The ultrasonic probe 31 is as described above, and the piezoelectric vibrators are arranged in a line shape or a matrix shape. The probe transmits three-dimensional ultrasonic waves by scanning and receives the reflected ultrasonic waves. A child.
The transmission / reception unit 50 includes a transmission unit that supplies a drive signal to the ultrasonic probe 31 to generate an ultrasonic wave, and a reception unit that receives a signal from the ultrasonic probe 31. Note that the transmission unit of the transmission / reception unit 50 includes a delay circuit for performing scanning. The reception unit of the transmission / reception unit 50 includes a preamplifier circuit that amplifies the signal output from the ultrasonic probe 31, an A / D conversion circuit that performs A / D conversion on the amplified signal, a reception delay, an addition circuit, and the like. ing.
The signal processing unit 51 is a circuit for performing signal processing on the reflected wave data input from the reception unit of the transmission / reception unit 50. In the case of the present embodiment, the signal processing unit 51 generates B mode data for expressing the signal intensity by luminance. A mode processing unit 53 and a Doppler processing unit 54 that performs FTF analysis necessary for color Doppler and processes a Doppler signal are provided.

  The image generation unit 52 is a circuit that generates image data. The image generation unit 52 reads the raw data output from the signal processing unit 51, converts the raw data into display data (scan conversion processing), and MPR (Multi Planar). Lettering processing such as (Reconstruction) is performed. Specifically, when data is received from the B mode processing unit 53 and scan conversion processing is performed, B mode tomographic image data is generated. Also, three-dimensional image data is generated by performing coordinate conversion on B-mode tomographic image data at a plurality of positions. Further, when scan conversion processing is performed by receiving data from the Doppler processing unit 54, Doppler data such as blood flow velocity information is generated. Further, the image generation unit 52 of the present embodiment specifies the position of the blood vessel wall from the three-dimensional image data. As a specific method, for example, since a strong reflected wave is acquired from the blood vessel wall, the B-mode tomographic image data has a brightness that is brighter than other parts, and the operator uses a mouse pad, etc. In this case, the position of the blood vessel wall is specified by performing a known contour tracking process or the like. Then, it is possible to generate B-mode tomographic image data relating to the specified cross-sectional image of the blood vessel wall.

  The transmission / reception unit 50, the signal processing unit 51, and the image generation unit 52 are entirely controlled by a controller 56. The transmission / reception unit 50, the signal processing unit 51, and the image generation unit 52 are configured by hardware such as an integrated circuit, but may be configured by software. That is, the processing of each of the units 50, 51, and 52 may be modularly performed by a computer program including a CPU (Central Processing Unit), a ROM (Read Only Memory), and a RAM (Random Access Memory).

  The image data processed by the image generation unit 52 in this way is output to the display control unit 55, and the display control unit 55 sorts and displays the images on the first image forming unit 41 and the second image forming unit 42. . Specifically, display according to each mode is performed by operating the operation unit (touch sensor) 46. For example, when the B-mode button 47 (see FIG. 4) is selected, a B-mode tomographic image is displayed. In this embodiment, as a preferred mode, a cross-sectional image of the peripheral region of the blood vessel is displayed on the first image forming unit 41. The second image forming unit 42 displays a longitudinal tomographic image of the peripheral region of the blood vessel. When the color Doppler mode button 49 (see FIG. 4) is selected, color Doppler data is displayed. When the three-dimensional mode button 48 (see FIG. 4) is selected, a three-dimensional image composed of three-dimensional image data is displayed.

The first embodiment of the present invention is configured as described above, and the ultrasonic probe 31 can be positioned on the body. Therefore, a stable image can be obtained, and both hands can be used freely. The certainty can be increased. Further, since the image forming means 40 is arranged adjacent to the position PR where the puncturing starts, the operator can visually recognize the image forming means close to the hand, and punctures while concentrating on the hand so that the difficulty of the technique is increased. Can be lowered. In addition, as shown in FIG. 4, the first image forming unit 41 on the ultrasonic probe 31 generates a cross-sectional image that is a cross-sectional image of the blood vessel peripheral region in the XY plane direction orthogonal to the puncture depth direction. Since the display guides the puncture direction, the operator can puncture the indwelling needle accurately and quickly if the puncture is performed according to the displayed position and extending direction of the blood vessel.
Since the ultrasonic probe 31 of the first embodiment is a linear probe that transmits ultrasonic waves linearly, as shown in FIG. Although the portion is disposed on the area AR of the ultrasonic probe 31, the present invention is not limited to such a mode. For example, when a convex probe that swings in an arc shape is used as the ultrasonic probe 31, the first image forming unit can be obtained by arranging the piezoelectric vibrators in the width direction W 1 in FIG. 3 and swinging in the height direction H 1. 41 may be connected so as to have a portion protruding from the top of the ultrasonic probe 31. Alternatively, in various ultrasonic probes 31, the first image forming unit 41 may not be disposed on the ultrasonic probe 31 at all depending on the transmission angle of the ultrasonic wave.

[First Modification of First Embodiment]
8 to 10 show a blood vessel puncture assisting device 60 according to a first modification of the first embodiment of the present invention. FIG. 8 is a perspective view of the ultrasonic probe 31 and the image forming means 40 separated from each other. 9 is a schematic cross-sectional view when the ultrasonic probe 31 and the image forming means 40 in FIG. 8 are connected and cut along the line AA in FIG. 8, and FIG. 10 (A) is the image forming means. FIG. 10B is a diagram in which the image forming unit 40 is moved after visually recognizing the image forming unit 40 of FIG. 10A. In these drawings, the belt shown in FIG. 2 is omitted. In FIG. 9, the internal mechanism is omitted.
In these drawings, the portions denoted by the same reference numerals as those of the blood vessel puncture assisting device 30 in FIGS. 1 to 7 have the same configuration, and therefore, overlapping description will be omitted, and hereinafter, differences will be mainly described.
The blood vessel puncture assisting device 60 according to the first modification differs from the above-described embodiment in the connection structure between the ultrasonic probe 31 and the image forming means 40.

That is, in the blood vessel puncture auxiliary device 60, as shown in FIGS. 8 and 9, the ultrasonic probe 31 and the image forming means 40 are detachable.
Specifically, on the stepped ultrasonic probe 31 side having the step portion 31c, a connector 62 protruding upward is provided on the close contact portion 31a that is in close contact with the body. On the other hand, on the image forming unit 40 side, a recess 64 is formed in the housing 45 on the back side of the first image forming unit 41, and a terminal (not shown) is disposed in the recess 64. Yes. Then, the connector 62 and the recess 64 are fitted together, and the ultrasonic probe 31 and the housing 45 are mechanically connected. Also, a pin (not shown) in the connector 62 and a terminal (not shown) in the recess 64. The image generation unit 52 and the display control unit 55 in FIG. 7 are connected. Accordingly, it is possible to replace only the image forming means 40 to which blood that has been bleeding easily adheres during puncturing.

  In this respect, the connector 62 is slidable in a direction X orthogonal to the direction Y in which the notch 50 extends. In the case of the figure, a groove 65 that is long in the X direction in the figure is formed in the upper part of the contact portion 31a, and the connector 62 is configured to slide in the X direction while engaging with the groove 65. The connector 62 can only be slid by an operation such as pressing the movable permission switch 67. Specifically, when the movable permission switch 67 is pressed, the pin 68 protruding above the close contact portion 31a that has been inserted so as to be fitted into the bottomed hole 59 of the housing 45 before the pressing is retracted, thereby forming an image. The means 40 can slide in the X direction.

  Thereby, the notch 50 formed in the surplus area other than the area where the cross-sectional image (the cross-sectional image of the XY plane of the patient's figure) is displayed is displayed in the cross-sectional image of the first image forming unit 41. It can move to match the position of the blood vessel BV. Therefore, for example, as shown in FIG. 10A, the center line CL of the blood vessel BV displayed on the first image forming unit 41 is not on the notch 50, and it is difficult to puncture. However, as shown in FIG. 10B, the position of the blood vessel BV and the position of the notch 50 can be matched by sliding the housing 45 including the notch 50. That is, the housing 45 may be slid in the X direction by a distance SL in which the notch 50 and the blood vessel center line CL are different in the X direction. The center line CL of the blood vessel BV is preferably displayed on the first image forming unit 41 because it is easy to grasp the distance to be slid. More preferably, as shown in FIG. 10 (B), when the housing 45 is slid, the blood vessel BV displayed on the first image forming means 41 corresponds to the distance SL by which the housing 45 is slid. It is preferable to move in the image of the first image forming means 41 to the opposite side to the moving direction (moving from the position of the alternate long and short dash line to the position of the solid line).

[Second Modification of First Embodiment]
11 and 12 show a blood vessel puncture assisting device 70 according to a second modification of the first embodiment of the present invention, FIG. 11 is a front view thereof, and FIG. 12 is a cross-sectional view of FIG. It is sectional drawing. In these drawings, the belt shown in FIG. 2 is omitted.
In these drawings, the portions denoted by the same reference numerals as those of the blood vessel puncture assisting devices 30 and 60 in FIGS. 1 to 10 have the same configuration, and therefore, redundant description will be omitted, and the following description will focus on differences. To do.
The blood vessel puncture assisting device 70 according to the second modification differs from the above-described embodiment and the blood vessel puncture assisting devices 30 and 60 according to the modification mainly in the structure of the housing 45.

That is, the housing 45 of the second modification includes a first housing 73 in which the first image forming means 41 is disposed and a second housing 74 in which the notch 50 is formed. The second housing 74 is slidable with respect to the first housing 73 in a direction X orthogonal to the direction Y in which the notch 50 extends. Specifically, as shown in FIG. 12, the second housing 74 has a groove 75 that is long in the X direction on the end surface on the first housing 73 side. The first casing 73 is provided with a rail 76 protruding in the X direction on the end surface on the second casing 74 side. A rail 76 is slidably engaged in the groove 75. As shown in FIG. 11, the display control unit 55 (see also FIG. 7) is accommodated in the second casing 74. The display control unit 55 and the first image forming means 41 are not shown in the figure. As described above, it is possible to establish an electrical connection via the cable 72 or to use a known wireless communication technique such as Wi-Fi Direct for wireless connection.
Thereby, the notch 50 can be moved so as to be aligned with the position of the blood vessel BV displayed on the first image forming means 41, and also displayed on the first image forming means 41 during the movement. There is no need to move the formed blood vessel BV imagewise.

[Second Embodiment]
13 to 15 show a blood vessel puncture assisting device 80 according to the second embodiment of the present invention. FIG. 13 shows a case where the blood vessel puncture assisting device 80 is attached to a patient (subject) P and attached to a sheet member 82. FIG. 14 is a diagram in which an image is projected, FIG. 14 is a use state diagram in which an image is displayed on the sheet member 82, and FIG. 15 is a schematic block diagram of the blood vessel puncture assisting device 80. In FIG. 13, legs for supporting the projection device 83 are omitted.
In these drawings, the portions denoted by the same reference numerals as those of the blood vessel puncture assisting devices 30, 60, and 70 in FIGS. 1 to 12 have the same configuration, and therefore, redundant description will be omitted. Explained.

The blood vessel puncture assisting device 80 according to the second embodiment is different from the blood vessel puncture assisting devices 30, 60, and 70 according to the above-described embodiments and modifications thereof mainly in the configuration of the image forming unit.
That is, the image forming unit includes a projection device 83 that directly projects an image onto a sheet member 82 that is adjacent to or in close contact with the body.
Specifically, as shown in FIG. 13 and FIG. 14, the ultrasonic probe 31 is not in a staircase shape but in a substantially rectangular panel shape. Then, the sheet member 82 and the like are attached to substantially the entire upper surface of the ultrasonic probe 31 with a detachable adhesive, and the ultrasonic probe 31 and the sheet member 82 are detachable.
The sheet member 82 is a thin sheet-like member, and a material on which the image of the projection device 83 is clearly projected is preferable.

The sheet member 82 can be punctured with the indwelling needle 21 as puncturing means, and is made of a material having biocompatibility. Biomedical degradable polymers can be used as biocompatible materials, such as natural polymers (cellulose, starch, etc.), synthetic polymers (polyglycolic acid or copolymers thereof, polylactic acid or A copolymer or the like).
As the projection device 83, a so-called projector can be used. At this time, the sheet member 82 is imaged by a camera (not shown) and taken as three-dimensional solid object data, and the blood vessel of the blood vessel is matched to the shape of the three-dimensional solid object data. You may perform the projection mapping which correct | amends image data. As a result, the shape of the blood vessel can be accurately projected even when the sheet member 82 is made of a flexible material and brought into close contact with the patient's body shape. In addition, for this projection mapping, a three-dimensional display can be performed using a plurality of projectors. In the case of the present embodiment, as shown in FIG. 15, the display control unit 55 is accommodated in the housing 37 of the ultrasonic probe 31, and the display control unit 55 and the projection device 83 are preferably connected via an interface (preferably Electrically connected by wireless communication). The operation unit 46 is also disposed on the ultrasonic probe 31 side.

  The second embodiment is configured as described above, and since the image is projected on the sheet member 82 by the projection device 83, the operator can use the blood vessel of the cross-sectional image of the sheet member 82 as in the first embodiment. If puncturing is performed according to the position of BV and the extending direction, indwelling needle 21 can be punctured accurately and quickly into blood vessel BV. Since the sheet member 82 is a member that can be punctured by the indwelling needle 21, no matter where the image of the blood vessel BV is projected on the sheet member 82, the position and direction of the projected blood vessel BV are the same. In addition, puncture can be performed from above the sheet member 82. Moreover, even if a piece of the sheet member 82 enters the body during this puncture, there is no problem because the sheet member 82 has biocompatibility.

The present invention is not limited to the above embodiment, and various modifications can be made without departing from the scope of the claims.
For example, in the above embodiment, the ultrasonic probe 31 is disposed in the same housing 37 as a component such as a substrate on which a power supply unit and an integrated circuit are mounted, and is integrated with these components. However, the present invention is not limited to this, and the ultrasonic probe 31 and other components may be separated.
In the above-described embodiment, the image forming unit 40 has a surplus area (such as the second image forming unit 42 in the above-described embodiment) that protrudes from the ultrasonic probe 31. However, in the present invention, the image forming unit 40. May be arranged only on the ultrasonic probe 31.
In addition, the image forming means (first image forming means 41 in the above embodiment) disposed on the ultrasonic probe 31 has a cross-sectional image (a cross section of the peripheral region of the blood vessel in a direction perpendicular to the puncture depth direction). Any other image may be displayed as long as the image can be displayed. For example, a cross-sectional image and a longitudinal tomographic image (a tomographic image of a blood vessel peripheral region in the depth direction to be punctured) can be arbitrarily selected by the operator. You may make it switch to.
In the second embodiment, the sheet member 82 is used as a medium on which an image is projected by the projection device 83 that is an image forming unit. However, the present embodiment is not limited to this, and the projection device 83 can perform projection. For example, a known projection mapping process may be performed, and the image may be directly projected on the leg of the subject without providing the sheet member 82.

DESCRIPTION OF SYMBOLS 1 ... Extracorporeal circulation apparatus, 20 ... Blood vessel puncture device, 21, 22 ... Puncture means (indwelling needle), 30, 60, 70, 80 ... Auxiliary device for blood vessel puncture, 31 ... Acoustic wave probe, 40, 83 ... image forming means, 41 ... first image forming means, 42 ... second image forming means (surplus area), 46 ... menu display area (surplus area) , 50 ... Notch

Claims (7)

An ultrasonic probe that transmits / receives ultrasonic waves to / from a blood vessel peripheral region of a subject to be punctured by a puncturing unit, and an image forming unit that displays an image related to the blood vessel peripheral region based on the transmission / reception of the ultrasonic probe A blood vessel puncture assisting device comprising:
The ultrasonic probe is mounted so as to be positionable with respect to the body of the subject, and has a close contact portion that is in close contact with the body in a state of being mounted on the body,
The image forming means is disposed on the contact portion, and a blood vessel is disposed at least adjacent to the body with a cross-sectional image that is a cross-sectional image of the peripheral region of the blood vessel in a direction substantially perpendicular to the depth direction of the puncture. A blood vessel puncture assisting device comprising first image forming means for displaying a puncture direction which is an extending direction . The image forming unit includes a second image forming unit that displays information different from the first image forming unit in a surplus area that is an area other than the area where the cross-sectional image is displayed. The blood vessel puncture assisting device according to claim 1. 3. The blood vessel puncture assisting device according to claim 2, wherein the second image forming unit displays a longitudinal tomographic image that is a tomographic image of the blood vessel peripheral region in the puncture depth direction. The surplus area, the not arranged on the ultrasonic probe, and, substantially in correspondence to the position and direction of the vessel extending the blood vessel of the cross-sectional image, long hole-like cutout portion is formed for venipuncture aid of claim 2 or 3, characterized in that it is. The notch is a vascular puncture aid of claim 4, wherein the movable so as to match the position of the blood vessel of the cross-sectional images. For venipuncture assisting device according to any one of claims 1 to 5, characterized in that said said image forming means and the ultrasonic probe is detachable. A blood vessel puncture auxiliary device according to any one of claims 1 to 6 ,
An indwelling needle as the puncture means for inserting the cannula of the extracorporeal circulation device;
Have
The image forming means is adapted to display blood flow direction information by color Doppler,
The indwelling needle has a marker that indicates the puncture direction. A blood vessel puncture device for an extracorporeal circulation device.

Images