JP7000744B2 - Air leak cause determination device and method - Google Patents

Description

The present invention relates to an air leak generation cause determination device and method, and more particularly to an air leak generation cause determination device and method for determining an air leak generation cause.

Pneumothorax is a disease in which air leaks from the lungs, causing the lungs to contract and make breathing difficult. During the treatment of pneumothorax, air leaks into the patient's chest cavity. Here, the leakage of air into the patient's thoracic cavity is generally referred to as an air leak. For pneumothorax surgery, chest tube drainage is performed to remove air and fluid from the chest cavity. The drain system used for chest drainage drains the air in the chest cavity and uses a water valve to prevent backflow of air. In the treatment process of pneumothorax, it is required to quantitatively observe the amount of air leak.

Patent Document 1 discloses a technique for detecting an air leak by estimating the generation of bubbles based on the pressure fluctuation in the suction circuit in the drain system. Further, Patent Document 1 also discloses a technique for automatically controlling the pressure of the aspirator based on the measured pressure.

Further, Patent Document 2 discloses a technique relating to an air leak monitoring device for providing information useful for grasping a patient's air leak state to a medical professional. The air leak monitoring device according to Patent Document 2 measures the pressure in the suction circuit and calculates the minimum value of the negative pressure or the like based on the measured pressure. Then, the presence or absence of air leak and the tendency of occurrence are determined based on the minimum value of negative pressure and the like.

Japanese Unexamined Patent Publication No. 2014-136104 Japanese Unexamined Patent Publication No. 2016-93227

However, Patent Documents 1 and 2 have a problem that it is difficult to determine the cause of the air leak. First, according to the technique according to Patent Document 1, the pressure of the aspirator is automatically controlled based on the pressure measured quantitatively, but there is a possibility that abnormal air leak (re-collapse) may be induced from the hole of the lung by continuous low pressure suction. There is. Here, the re-collapse of the lungs makes it difficult for the patient to breathe because the air taken in by breathing leaks into the thoracic cavity. Further, in the technique according to Patent Document 2, although the air leak itself can be detected, the cause of the air leak cannot be determined. The causes of air leaks include physical causes such as air leaks due to loose drain circuits and re-collapse of the lungs. And if the cause is re-collapse of the lungs, surgery by a doctor may be required. However, in order to determine the cause of the air leak, it is necessary for the medical staff to judge the condition of the patient, which is difficult.

The present invention has been made to solve such a problem, and an object of the present invention is to provide an air leak generation cause determination device and a method for assisting the determination of an air leak generation cause.

The device for determining the cause of an air leak according to the first aspect of the present invention is
A detector that detects that the measured value of the pressure between the water-sealed chamber and the suction source in the chest tube connected to the patient's chest continues below the first threshold for a predetermined time or longer.
A cause-determining unit for determining the cause of air leak based on at least one of the biometric information acquired from the patient or the respiratory state of the patient when the detection is detected.
To prepare for.

The method for determining the cause of an air leak according to the second aspect of the present invention is as follows.
The pressure between the water-sealed chamber and the suction source in a chest tube connected within the patient's chest was measured and
It is detected that the measured pressure falls below the first threshold value for a predetermined time or longer.
When the detection is made, the cause of the air leak is determined based on at least one of the biometric information obtained from the patient or the respiratory condition of the patient.

INDUSTRIAL APPLICABILITY According to the present invention, it is possible to provide an air leak generation cause determination device and a method for assisting the determination of an air leak generation cause.

It is a block diagram which shows the structure of the air leak occurrence cause determination apparatus which concerns on Embodiment 1 of this invention. It is a flowchart which shows the flow of the air leak occurrence cause determination method which concerns on Embodiment 1 of this invention. It is a block diagram which shows the whole structure of the chest tube drain system which concerns on Embodiment 2 of this invention. It is a figure which shows the example of the case where the air leak occurs intermittently by the normal treatment process of pneumothorax. It is a figure which shows the example of the case where an abnormal air leak occurs. It is a figure which shows the example of the case where the cause of the air leak is the re-collapse of the lung. It is a figure which shows the example of the case where the cause of the air leak is the air leak of the chest tube drain device. It is a flowchart which shows the flow of the air leak occurrence cause determination method which concerns on Embodiment 2 of this invention.

Hereinafter, specific embodiments to which the present invention is applied will be described in detail with reference to the drawings. In each drawing, the same elements are designated by the same reference numerals, and duplicate explanations will be omitted as necessary for the sake of clarity of explanation.

<Embodiment 1>
FIG. 1 is a block diagram showing a configuration of an air leak generation cause determination device 100 according to the first embodiment of the present invention. The air leak occurrence cause determination device 100 is an information processing device connected to a chest tube drain device (not shown) connected in the chest cavity of a patient (not shown) such as pneumothorax. The air leak occurrence cause determination device 100 includes a detection unit 110 and an occurrence cause determination unit 120. The detection unit 110 detects that the measured value of the pressure between the water sealing chamber and the suction source in the chest tube drain device continues to be below the first threshold value for a predetermined time or longer. The occurrence cause determination unit 120 determines the occurrence cause of the air leak based on at least one of the biological information acquired from the patient or the respiratory state of the patient when detected by the detection unit 110. Here, the occurrence cause determination unit 120 determines whether the cause of the air leak is, for example, the re-collapse of the lungs or the air leak of the chest tube drain device.

FIG. 2 is a flowchart showing the flow of the method for determining the cause of air leak according to the first embodiment of the present invention. First, the air leak cause determination device 100 measures the pressure between the water sealing chamber and the suction source in the chest tube drain device (S101). Next, the detection unit 110 determines whether or not the measured value is below the first threshold value (S102). If the measured value does not fall below the first threshold value, the process returns to step S101.

On the other hand, when it is determined that the measured value is below the first threshold value, the detection unit 110 determines whether or not the measured value is below the first threshold value for a predetermined time or longer (S103). If it has not continued for a predetermined time or more, the process returns to step S101. On the other hand, if it is determined that the continuation is continued for a predetermined time or more, the process proceeds to step S104. That is, the detection unit 110 detects through steps S101 to S103 that the measured value falls below the first threshold value continues for a predetermined time or longer.

After that, the occurrence cause determination unit 120 determines the occurrence cause of the air leak based on at least one of the biological information acquired from the patient and the respiratory state of the patient (S104). For example, the occurrence cause determination unit 120 determines whether the cause of the air leak is due to the re-collapse of the lungs or the air leak of the chest tube drain device. This can help determine the cause of the air leak.

<Embodiment 2>
The second embodiment is an embodiment of the first embodiment described above.
FIG. 3 is a block diagram showing the overall configuration of the chest tube drain system 1000 according to the second embodiment of the present invention. The chest drain system 1000 includes a connecting pipe 1, a drainage chamber 2, a connecting pipe 3, an air leak cause determination device 4, and a pressure control unit 5. The chest drain system 1000 utilizes the negative pressure generated by the pressure control unit 5 to drain body fluids such as blood accumulated in a patient (not shown) chest cavity such as pneumothorax and to remove air leaked into the chest cavity. It is a medical system for performing qi through the water sealing chamber 22. The chest tube drain device shall include at least a connecting pipe 1, a drainage chamber 2, a connecting pipe 3, and an air leak cause determination device 4.

The connection pipe 1 is connected into the patient's thoracic cavity and is connected to the drainage chamber 2. The drainage chamber 2 includes a drainage section 21 and a water sealing chamber 22. The drainage unit 21 is a region for collecting body fluid discharged from the thoracic cavity via the connecting pipe 1. The water sealing chamber 22 contains a liquid such as water and prevents the backflow of outside air to the thoracic cavity side. The connection pipe 3 connects the water sealing chamber 22 and the pressure control unit 5. The pressure control unit 5 is an example of a supply source and generates a negative pressure. The negative pressure generated by the pressure control unit 5 traps the body fluid in the patient's chest cavity in the drainage unit 21 as shown by the solid arrow, and the gas leaked into the patient's chest cavity is indicated by the broken line arrow. Is guided to the pressure control unit 5 via the water sealing chamber 22. Therefore, when an air leak occurs in the patient's thoracic cavity, air passes through the water sealing chamber 22, and air bubbles are generated in the water sealing chamber 22.

The air leak occurrence cause determination device 4 is connected to a pipe branched from the connection pipe 3. The air leak occurrence cause determination device 4 includes a pressure sensor 41, a calculation processing unit 42, a display device 43, and a SpO2 sensor 45. The pressure sensor 41 measures the pressure between the water sealing chamber 22 and the pressure control unit 5, and outputs the measured value to the arithmetic processing unit 42. The SpO2 sensor 45 measures the oxygen saturation in the blood acquired from the patient as biological information, and outputs the oxygen saturation value to the arithmetic processing unit 42.

Here, the air leak occurrence cause determination device 4 is further provided with a storage unit for storing a first threshold value, a predetermined time, and a second threshold value as a configuration (not shown). The first threshold is the threshold of the measured value of the pressure for detecting the occurrence of the air leak. The predetermined time is a time indicating a threshold value of the duration during which the air leak continues to occur. The second threshold is the threshold at which the patient's blood oxygen saturation indicates re-collapse of the lungs.

The arithmetic processing unit 42 detects the generation of air bubbles in the water sealing chamber 22, that is, the generation of air leaks, based on the fluctuation of the measured value of the pressure. Specifically, the arithmetic processing unit 42 detects that an air leak has occurred when the measured value of the pressure is lower than the first threshold value.

Here, in the normal treatment process of pneumothorax, air leaks occur intermittently, and the amount of air leaks gradually decreases. Therefore, if air leaks continue to occur and the amount of air leaks does not decrease, it can be said to be an abnormal air leak. Therefore, when an abnormal air leak occurs, it is necessary to determine the cause of the air leak and take appropriate measures. FIG. 4 is a diagram showing an example in which an air leak occurs intermittently due to a normal treatment process of pneumothorax. Further, FIG. 5 is a diagram showing an example when an abnormal air leak occurs.

Therefore, the arithmetic processing unit 42 determines whether or not the occurrence of the detected air leak continues for a predetermined time or longer. That is, the arithmetic processing unit 42 detects that the generation of the air leak continues for a predetermined time or longer by using the measured value of the pressure and the history of the occurrence of the air leak.

When it is determined that the occurrence of the air leak continues for a predetermined time or longer, the arithmetic processing unit 42 determines the cause of the air leak based on the oxygen saturation in the blood output from the SpO2 sensor 45.

Here, a typical chest tube system is fitted with a valve that releases positive pressure in the chest cavity. In this case, suction is performed only when the pressure in the thoracic cavity is higher than the pressure set in the drain. In the re-collapse of the lung, the oxygen saturation in the blood decreases because the lung itself re-contracts due to air leakage from the lung. On the other hand, in the air leakage of the chest tube drain device, since air is not taken into the chest cavity by the one-sided valve, the lungs do not contract and the oxygen saturation in the blood does not decrease. Therefore, if the oxygen saturation in the blood is low when air leaks are continuously detected, there is a high possibility of lung recollapse. FIG. 6 is a diagram showing an example when the cause of the air leak is re-collapse of the lung. FIG. 7 is a diagram showing an example in the case where the cause of the air leak is the air leak of the chest tube drain device.

Therefore, the arithmetic processing unit 42 determines that the air leak is due to the re-collapse of the lung when the oxygen saturation is lower than the second threshold value. On the other hand, when the oxygen saturation does not fall below the second threshold value, the arithmetic processing unit 42 determines that the air leak is due to the air leak of the chest tube drain device. Then, the arithmetic processing unit 42 outputs the determination result of the cause of the air leak to the display device 43. The display device 43 is an example of an output unit that outputs to the outside according to the discrimination result. For example, when the discrimination result is due to the re-collapse of the lung, the display device 43 displays the warning degree higher than the case where the discrimination result is due to the air leakage of the chest tube drain device.

FIG. 8 is a flowchart showing the flow of the method for determining the cause of air leakage according to the second embodiment of the present invention. First, the pressure sensor 41 measures the pressure in the chest tube drain device, that is, the pressure of the connecting pipe 3, and records it in the storage unit. Further, the SpO2 sensor 45 measures the oxygen saturation (SpO ₂ ) from the blood obtained from the patient and records it in the storage unit (S11). Next, the arithmetic processing unit 42 determines whether or not the measured value of the pressure is below the first threshold value (S12). If the measured pressure value is equal to or greater than the first threshold value, the process returns to step S11. When the measured pressure value is less than the first threshold value, it means that an air leak has been detected. The arithmetic processing unit 42 sets a threshold value (second threshold value) of SpO ₂ in the storage unit (S13). Note that step S13 may be executed in advance before step S11.

The arithmetic processing unit 42 determines whether or not the pressure below the first threshold value continues for a predetermined time or longer (S14). If it is less than the predetermined time, air leaks occur intermittently, and it can be said that the treatment process is normal. Therefore, the process returns to step S11. On the other hand, when the continuation is continued for a predetermined time or more, the arithmetic processing unit 42 determines whether or not the measured SpO ₂ is below the second threshold value (S15). When SpO ₂ is equal to or greater than the second threshold value, the arithmetic processing unit 42 outputs to the display device 43 that the cause of the air leak is the air leak of the chest tube drain device (S16). On the other hand, when SpO ₂ is less than the second threshold value, the arithmetic processing unit 42 outputs to the display device 43 that the cause of the air leak is the re-collapse of the lung (S17). After that, the display device 43 displays according to the output (discrimination result) from the arithmetic processing unit 42.

As described above, according to the present embodiment, the medical staff can easily grasp the cause of the air leak by the display device 43.

<Embodiment 3>
The third embodiment is another embodiment of the first embodiment described above. In the third embodiment, the cause of the air leak is determined based on the timing of breathing when the air leak occurs.

Here, the timing of exhalation and inspiration can be detected by the pressure sensor 41. The timing of the patient's breathing can be grasped by the movement (fluctation) of water in the water sealing chamber 22. Fruction is caused by changes in pressure in the chest cavity due to breathing. That is, fluctation occurs when the pressure of the drainage portion 21 is high in the exhaled air and low in the inspiratory air. Therefore, for example, the detection unit according to the third embodiment can discriminate between exhalation and inspiration based on the change in pressure measured by the pressure sensor 41, and can detect the timing of respiration.

When the cause of the air leak is the air leak of the chest tube drain device, the air leak occurs regardless of the timing of breathing. On the other hand, when the cause of the air leak is re-collapse of the lung, the air leak occurs at the same timing as the breathing. Therefore, the occurrence cause determination unit according to the third embodiment determines the occurrence cause of the air leak by comparing the breathing timing of the patient with the occurrence timing of the air leak.

That is, the detection unit further detects the breathing timing of the patient as the respiratory state based on the fluctuation timing of the measured value of the pressure at the time of the detection, and the occurrence cause determination unit further detects the breathing timing of the patient. And, the cause of the air leak may be determined based on the degree of coincidence with the timing of the occurrence of the air leak.

<Embodiment 4>
The fourth embodiment is another embodiment of the first embodiment described above. In the fourth embodiment, the patient is asked to temporarily stop breathing, and the cause of the air leak is determined based on the presence or absence of an air leak at the time of the respiratory stop.

Here, if the occurrence of an air leak is detected even during respiratory arrest, it can be determined that the cause of the air leak is the air leak of the chest tube drain device. On the other hand, if no air leak occurs during respiratory arrest, it can be determined that the cause of the air leak is re-collapse of the lungs.

That is, the occurrence cause determination unit may determine the occurrence cause of the air leak based on whether or not the air leak has occurred when the patient's breathing is stopped.

<Other embodiments>
The air leak cause determination device 4 may further include a warning sound output unit, and may output a warning sound when the occurrence of an abnormal air leak is detected. At that time, the types of warning sounds shall be classified according to the determination result of the cause of the air leak. This makes it easier to understand the cause of the air leak.

The present invention is not limited to the above embodiment, and can be appropriately modified without departing from the spirit.

Further, in the above-described embodiment, the present invention has been described as a hardware configuration, but the present invention is not limited thereto. The present invention can also realize arbitrary processing by causing a CPU (Central Processing Unit) to execute a computer program.

In the above example, the program can be stored and supplied to the computer using various types of non-transitory computer readable medium. Non-temporary computer-readable media include various types of tangible storage media. Examples of non-temporary computer-readable media include magnetic recording media (eg, flexible discs, magnetic tapes, hard disk drives), magneto-optical recording media (eg, magneto-optical discs), CD-ROMs (Read Only Memory), CD-Rs. CD-R / W, DVD (Digital Versatile Disc), BD (Blu-ray (registered trademark) Disc), semiconductor memory (for example, mask ROM, PROM (Programmable ROM), EPROM (Erasable PROM), flash ROM, RAM (for example) Random Access Memory)) is included. The program may also be supplied to the computer by various types of transient computer readable medium. Examples of temporary computer readable media include electrical, optical, and electromagnetic waves. The temporary computer-readable medium can supply the program to the computer via a wired communication path such as an electric wire and an optical fiber, or a wireless communication path.

100 Air leak cause determination device 110 Detection unit 120 Occurrence cause determination unit 1000 Chest cavity drain system 1 Connection pipe 2 Drainage chamber 21 Drainage unit 22 Water seal chamber 3 Connection pipe 4 Air leak occurrence cause determination device 41 Pressure sensor 42 Calculation processing unit 43 Display device 45 SpO2 sensor 5 Pressure control unit

Claims (5)

It is detected that the measured value of the pressure between the water-sealed chamber and the suction source in the chest tube device connected to the patient's chest cavity falls below the first threshold value continues for a predetermined time or longer, and the above- mentioned at the time of the detection. A detector that further detects the breathing timing of the patient as a breathing state based on the fluctuation timing of the measured pressure value, and
When the detection is made, a cause determining unit for determining the cause of the air leak based on the degree of coincidence between the breathing timing of the patient and the occurrence timing of the air leak.
A device for determining the cause of an air leak. The air leak occurrence cause determining device according to claim 1, wherein the occurrence cause determining unit determines whether the air leak is caused by the re-collapse of the lungs or the air leak of the chest tube drain device as the cause of the air leak. The device for determining the cause of an air leak according to claim 1 or 2 , wherein the cause determination unit determines the cause of the air leak based on whether or not the air leak has occurred when the patient has stopped breathing. The air leak occurrence cause determination device according to any one of claims 1 to 3 , further comprising an output unit that outputs to the outside according to the determination result by the occurrence cause determination unit. An air leak cause determination device connected to a chest drain device connected to the patient's chest cavity
The pressure between the water seal chamber and the suction source in the chest tube drain device was measured and measured.
It is detected that the measured pressure falls below the first threshold value for a predetermined time or longer.
The timing of the patient's respiration is further detected as a respiratory state based on the fluctuation timing of the measured value of the pressure at the time of the detection.
A method for determining the cause of an air leak, which determines the cause of the air leak based on the degree of coincidence between the timing of the patient's breathing and the timing of the occurrence of the air leak when the respiratory state is detected.

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