JP7233069B2 - Myocardial infarction treatment control device and myocardial infarction treatment control method - Google Patents

Description

Some aspects of the present invention relate to a myocardial infarction treatment control device and a myocardial infarction treatment control method.

For the treatment of myocardial infarction, reperfusion therapy, which reopens occluded blood vessels, is widespread. As a result, in recent years, the mortality rate due to myocardial infarction has tended to slightly decrease over the long term. However, even if blood flow resumes, necrosis of the myocardium remains, and the rate of heart failure and death in the long term is extremely high. For example, there is a survey that the 5-year survival rate of chronic heart failure patients is only about 40%.

As one of the treatments for acute heart failure, a method of inserting an electrode into a blood vessel is known (see Patent Document 1, for example). US Pat. No. 5,300,000 discloses a neuromodulation system for treating Acute Heart Failure Syndrome, using an intravenously positioned electrode array to target the parasympathetic and/or parasympathetic nerves. Alternatively, applying electrical pulse stimulation to sympathetic cardiac nerves is described.

U.S. Patent Application Publication No. 2014/0142590

However, although the method described in Patent Document 1 refers to the treatment of heart failure, it does not consider the treatment of myocardial infarction. As described above, the prevalence of heart failure is extremely high after the onset of myocardial infarction, so it is thought that appropriate treatment at the time of myocardial infarction will eventually lead to a reduction in the mortality rate from heart failure.

SUMMARY OF THE INVENTION Several aspects of the present invention have been made in view of the above problems, and provide a myocardial infarction treatment control device and a myocardial infarction treatment control method capable of suitably performing treatment for myocardial infarction. is one of the purposes.

A control device for treating myocardial infarction according to one aspect of the present invention reduces myocardial work with stimulation electrodes inserted into blood vessels running near the vagus nerve in order to stimulate the vagus nerve of a patient. a stimulus control unit that outputs a stimulus signal for causing a stimulus, a detection unit that detects the first biological information and the second biological information of the patient, and threshold information that determines the normal range of the first biological information and the second biological information and a determination unit that determines whether the values of the detected first biological information and the second biological information are within the normal range defined by the threshold information, The stimulation control unit controls the value of the first biological information and the value of the second biological information to be within the normal range, and the value of the second biological information to decrease by a predetermined ratio or more compared to before the stimulation. Adjust the strength of the stimulation signal.

A control method for treating myocardial infarction according to one aspect of the present invention reduces the work of the myocardium with respect to a stimulating electrode inserted into a blood vessel running near the vagus nerve in order to stimulate the vagus nerve of a patient. a stimulus control step of outputting a stimulus signal for causing a stimulus signal to cause a stimulus to occur; a step of detecting first biological information and second biological information of the patient; and threshold information defining a normal range of the first biological information and the second biological information. setting; determining whether or not the detected values of the first biological information and the second biological information are within the normal range defined by the threshold information; and the first biological information and adjusting the intensity of the stimulation signal so that the value of the second biological information is within the normal range and the value of the second biological information is lower than before the stimulation by a predetermined ratio or more. The infarct control device does.

In the present invention, "part", "means", "apparatus" and "system" do not simply mean physical means. This includes the case where the function of "" is realized by software. In addition, even if the function of one "part", "means", "apparatus", or "system" is realized by two or more physical means or devices, two or more "part", "means", "device", or "system" The functions of "apparatus" and "system" may be realized by one physical means or device.

FIG. 4 is a diagram for explaining a specific example of a vagus nerve stimulation method according to the embodiment; 1 is a diagram showing a functional configuration of a myocardial infarction treatment control device according to an embodiment; FIG. 3 is a flow chart showing a flow of processing for determining a combination of stimulation electrodes used for stimulation of the vagus nerve by the myocardial infarction treatment control device shown in FIG. 2; 3 is a flow chart showing the flow of processing for the control device for myocardial infarction treatment shown in FIG. 2 to perform treatment for myocardial infarction; 3 is a diagram showing a specific example of the myocardial infarction treatment control device shown in FIG. 2; FIG.

Embodiments of the present invention will be described below with reference to the drawings. However, the embodiments described below are merely examples, and are not intended to exclude various modifications and application of techniques not explicitly described below. In other words, the present invention can be modified in various ways without departing from the scope of the invention. In addition, in the description of the drawings below, the same or similar parts are denoted by the same or similar reference numerals. The drawings are schematic and do not necessarily correspond to actual dimensions, proportions, and the like. Even between the drawings, there are cases where portions with different dimensional relationships and ratios are included.

[1. overview]
Myocardial infarction is a symptom in which blood cannot sufficiently flow to the heart muscle due to the formation of blood clots in blood vessels. When the blood does not flow sufficiently to the myocardium, the supply of oxygen to the myocardium does not meet the oxygen demand of the myocardium, resulting in ischemia. Therefore, as a treatment for myocardial infarction, reperfusion therapy for reopening blocked blood vessels is commonly used.

However, since myocardial ischemia continues after the onset of myocardial infarction until the blood vessels are opened by reperfusion therapy, a certain proportion of the myocardium undergoes necrosis during that time. Due to such necrosis, many patients die from heart failure caused by myocardial necrosis during myocardial infarction after a certain period of time, even if they have recovered from the onset of myocardial infarction.
Therefore, if myocardial necrosis can be suppressed at the time of onset of myocardial infarction, it is believed that it will also lead to suppression of the subsequent onset of heart failure.

Here, myocardial ischemia is caused because the supply of oxygen to the myocardium falls short of the oxygen demand of the myocardium. Although the aforementioned reperfusion therapy increases the supply of oxygen to the myocardium, myocardial necrosis can be suppressed by also performing a treatment to suppress the oxygen demand of the myocardium.

The myocardial infarction treatment control device according to the present embodiment reduces the heart rate, that is, reduces the workload of the myocardium by applying electrical stimulation to the vagus nerve. As a result, oxygen demand in the myocardium is reduced, so that when used in combination with the reperfusion therapy described above, the occurrence of ischemic conditions can be suppressed, and as a result, the rate of myocardial necrosis can be kept low. .

On the other hand, if the vagus nerve is stimulated unnecessarily, side effects such as coughing, vomiting reflex, and deterioration of hemodynamics associated with bradycardia may lead to a serious situation such as the patient being unable to recover. Although it is conceivable that a doctor manually adjusts the amount of stimulation, the burden of continuing such adjustment for a long time is heavy. If it takes time to adjust the appropriate amount of stimulation of the vagus nerve, the physician cannot adequately respond to reperfusion therapy, which may result in the expansion of myocardial necrosis.

Moreover, when it is necessary to select a suitable combination of electrodes for vagus nerve stimulation from a large number of electrodes for vagus nerve stimulation when applying electrical stimulation, a doctor may manually select this combination. Then, since it takes time to select suitable electrodes, necrosis of the myocardium may spread during that time.

Therefore, the myocardial infarction treatment control device according to the present embodiment can be used without the need for a doctor to manually select electrodes for vagus nerve stimulation or adjust the amount of stimulation as long as the vagus nerve stimulation catheter is properly inserted. , it is possible to suitably stimulate the vagus nerve according to the patient's condition.

A specific example of the method of applying electrical stimulation to the vagus nerve will be described below with reference to FIG. FIG. 1 is a diagram for explaining a method of applying electrical stimulation to the vagus nerve 10 for treatment of myocardial infarction.

The vagus nerve 10 is a trunk parasympathetic nerve that runs from the brain through the neck to the chest. The vagus nerve 10 runs along the superior vena cava 20 . Therefore, for example, if the vagus nerve stimulation catheter 200 is inserted into the superior vena cava 20 from the jugular vein, the stimulating electrode 223 of the vagus nerve stimulation catheter 200 is applied to the vagus nerve via the vessel wall of the superior vena cava 20. 10 can be electrically stimulated.

As described above, since the vagus nerve 10 is a parasympathetic nerve, excitation of the parasympathetic nerve obtained by electrical stimulation causes a decrease in heart rate, a decrease in blood pressure, and the like. Therefore, if the vagus nerve 10 is stimulated within a suitable range, the activity of the heart 30 is reduced, thereby reducing oxygen consumption in the myocardium that constitutes the heart 30 . As a result, the expansion of myocardial necrosis is suppressed even under vascular occlusion.

The configuration of the vagus nerve stimulation catheter 200 inserted into the superior vena cava 20 to stimulate the vagus nerve 10 will be briefly described below. The vagus nerve stimulation catheter 200 is roughly divided into a tube portion 210 and a basket portion 220 .

The tube portion 210 is a tubular portion that connects the basket portion 220 and the myocardial infarction treatment control device. Transmission of electrical signals to the stimulating electrodes 223 of the basket part 220 and the like are performed via the tube part 210 .

The basket portion 220 is a portion provided at the distal end of the vagus nerve stimulation catheter 200 and includes a plurality of frame portions 221 and a plurality of stimulation electrodes 223 attached to each frame portion 221 .

A plurality of frame portions 221 serving as a frame of the basket portion 220 are connected to each other at a connection portion with the pipe portion 210 and at the tip portion on the opposite side thereof, and are provided so as to be openable and closable. That is, the thickness of the basket portion 220 in the cross-sectional direction changes depending on whether the frame portion 221 is opened or closed. When inserting the vagus nerve stimulation catheter 200 into the superior vena cava 20, the doctor can easily insert the vagus nerve stimulation catheter 200 to a suitable position by keeping the basket portion 220 in a closed state, that is, in a thin state. On the other hand, when the basket part 220 of the vagus nerve stimulation catheter 200 is inserted to a suitable position, for example, near the third rib in the superior vena cava, the doctor opens each frame part 221 to bring it into close contact with the inner wall of the blood vessel. , the position of the basket portion 220 is fixed. In addition, as a result, the distance between the vagus nerve 10 and the stimulating electrode 223 closest to the vagus nerve 10 is shortened, and the distance remains constant. After the treatment is completed, the doctor can easily remove the vagus nerve stimulation catheter 200 by closing the basket part 220 again.

A plurality of stimulation electrodes 223 are arranged on each of the plurality of frame portions 221 . The myocardial infarction treatment control device applies electrical stimulation to the vagus nerve 10 from, for example, a combination of stimulation electrodes 223 and observes the biological reaction caused thereby. For example, electrical stimulation is applied from two stimulation electrodes 223 arranged on the first frame portion 221, then electrical stimulation is applied from two stimulation electrodes 223 arranged on the second frame portion 221, and then Then, electrical stimulation is applied from the two stimulation electrodes 223 arranged on the third frame part 221, and the biological reaction (for example, heart rate) obtained as a result of applying each stimulation is recorded. Among them, the frame part 221 in which the combination of the stimulation electrodes 223 that gave the greatest response to stimulation (for example, the decrease in heart rate was large) is arranged is considered to be the closest to the vagus nerve 10. The control device uses the stimulation electrodes 223 arranged on the frame portion 221 to stimulate the vagus nerve 10 .

In the example described above, among the combinations of the two stimulation electrodes 223 arranged on each frame portion 221, the optimum combination of the two stimulation electrodes 223 arranged on one frame portion 221 is selected. Although the method of selecting the stimulation electrodes 223 has been described, the method of selecting the stimulation electrodes 223 is not limited to this. For example, a combination of one stimulating electrode 223 of one frame portion 221 and one stimulating electrode 223 of the adjacent frame portion 221 may be used to stimulate the vagus nerve 10 . In this case, after sequentially applying stimulation to the vagus nerve 10 using each of the possible combinations of the stimulation electrodes 223, the combination that gives the greatest response to stimulation is selected. good.

[2. Functional configuration]
Hereinafter, the functional configuration of the myocardial infarction treatment control device 100 will be described with reference to FIG. As shown in FIG. 2, the myocardial infarction treatment control device 100 includes a biological information detection unit 110, a biological information determination unit 120, a threshold setting unit 130, a threshold information 131, an electrode control unit 140, an auxiliary device control unit 150, and an output A portion 160 may be included.

The biometric information detection unit 110 detects various biometric information such as heart rate, heartbeat amplitude, blood pressure, and respiration from the human body. In FIG. 2, the biological information detection unit 110 includes a blood pressure measurement unit 111 that measures blood pressure and a heartbeat measurement unit 113 that detects heartbeats.

In the search process for determining the combination of the stimulation electrodes 223 used to stimulate the vagus nerve 10, the stimulation electrode search unit 141, which will be described later, sequentially stimulates the vagus nerve 10 using the combinations of the stimulation electrodes 223. At this time, the biological information determination unit 120 determines the magnitude of the biological reaction caused by the stimulus (for example, the decrease in heart rate). As a result, the stimulation electrode search unit 141 can select the combination of the stimulation electrodes 223 with the greatest change in the biological information to be used for stimulation of the vagus nerve 10 .

Further, after the combination of the stimulation electrodes 223 used for stimulating the vagus nerve 10 for reducing the work of the myocardium is determined, the biological information determination unit 120 determines that the value of the biological information detected by the biological information detection unit 110 is , whether or not it falls within an appropriate range set by the threshold information 131 . For example, the biological information determination unit 120 may determine whether or not the heart rate, heartbeat amplitude, blood pressure, respiration, etc., which are biological information, are equal to or higher than the lower limit values set by the threshold information 131 . The biological information determination section 120 outputs the determination result to the stimulation intensity control section 143 of the electrode control section 140 .

The threshold setting unit 130 sets, as threshold information 131, a range of values of biological information to be maintained (for example, lower limits of blood pressure and heart rate) when stimulating the vagus nerve 10 with the vagus nerve stimulation catheter 200. FIG. As a method for setting the threshold information 131, for example, a doctor inputs a threshold from an input interface such as a keyboard or a touch panel according to the patient's daily blood pressure, chronic disease, etc., and the threshold setting unit 130 sets the threshold according to the input. It is conceivable to store the information 131 in any storage medium.

The electrode control unit 140 performs various controls on the vagus nerve stimulation catheter 200 having a plurality of stimulation electrodes 223 . For example, the electrode control unit 140 searches for a combination of the stimulation electrodes 223 used to stimulate the vagus nerve 10 and adjusts the strength of the stimulation signal used to stimulate the vagus nerve 10 . Therefore, the electrode control section 140 has a stimulation electrode search section 141 and a stimulation intensity control section 143 .

The stimulation electrode search unit 141 performs search processing to determine which combination of stimulation electrodes 223 to use among the plurality of stimulation electrodes 223 of the vagus nerve stimulation catheter 200 to stimulate the vagus nerve 10 . More specifically, the stimulation electrode search unit 141 sequentially applies stimulation signals of a predetermined intensity to a combination of stimulation electrodes 223 selected from the plurality of stimulation electrodes 223 . As a result, the vagus nerve 10 is stimulated, and the biological information determination unit 120 determines changes in biological information that occur in response to the stimulation. As a result, the stimulation electrode search unit 141 determines the stimulation electrode 223 with the largest change in the value of the biological information to be used for stimulation of the vagus nerve 10 .

The stimulation intensity control section 143 adjusts the intensity of the stimulation signal for stimulating the vagus nerve 10 . More specifically, the stimulation intensity control unit 143 first stimulates the vagus nerve 10 by applying a stimulation signal of a predetermined intensity to the combination of the stimulation electrodes 223 of the vagus nerve stimulation catheter 200 . The biological information determination unit 120 determines changes in the biological information obtained in response to the stimulation. For example, when determining a decrease in heart rate as a reflex of stimulation to the vagus nerve 10, if the rate of decrease in heart rate obtained by stimulation is higher than a predetermined rate (for example, several percent to ten and several percent) If it is small and the obtained heart rate is higher than the heart rate lower limit value given by the threshold information 131, the stimulation intensity control section 143 may increase the intensity of the stimulation signal. On the other hand, when the obtained heart rate is lower than the lower limit value of the heart rate given by the threshold information 131, the stimulation intensity control section 143 may reduce the intensity of the stimulation signal. Through such control, the myocardial infarction treatment control device 100 reduces the activity of the heart 30 within a range that does not affect life support (for example, within a range in which the heart rate does not fall below the lower limit). At this time, the stimulation intensity control unit 143 also determines the blood pressure. For example, when the blood pressure value is lower than the lower limit given by the threshold information 131, output of the stimulation signal may be stopped.

The auxiliary device control unit 150 controls the left ventricular auxiliary device 300 . Here, the left ventricular assist device 300 is a pump that is inserted into the left ventricle of the heart 30 as a catheter from the patient's thigh or the like to assist blood circulation. When the left ventricular assist device 300 assists blood circulation, it suppresses bradycardia due to vagal nerve stimulation and a decrease in blood pressure due to pump failure of the heart 30, while reducing myocardial work. consumption is reduced, resulting in further suppression of myocardial necrotic expansion. The assisting device control unit 150 controls the operation of the left ventricular assisting device 300, for example, the strength of blood delivery assistance by a pump, according to the determination result of the biometric information determining unit 120 as to whether or not the value of the biometric information is properly maintained. etc. may be controlled.

The output unit 160 notifies the doctor and the patient of the biological information and the determination results thereof. As a notification method, for example, display on a display device, voice output, or the like can be considered.

[3. Process flow]
The processing flow of the myocardial infarction treatment control device 100 will be described below with reference to FIGS. 3 and 4. FIG. 3 and 4 are flowcharts showing the flow of processing of the myocardial infarction treatment control device 100. FIG.

Each processing step to be described later can be executed in any desired order or in parallel as long as there is no contradiction in the processing content. good. Further, steps described as one step for convenience can be divided into a plurality of steps and executed, and steps described as a plurality of steps for convenience can also be executed as one step.

[3.1 Determination process of stimulation electrode 223 used for stimulation of vagus nerve 10]
First, referring to FIG. 3, after the doctor inserts the vagus nerve stimulation catheter 200 into the superior vena cava 20 and expands the basket portion 220, the myocardial infarction treatment control device 100 stimulates the vagus nerve 10. The flow of processing for determining the stimulation electrodes 223 to be used will be described. FIG. 3 is a flow chart showing a specific example of the flow of the process of determining the stimulation electrode 223 to be used for stimulating the vagus nerve 10. As shown in FIG.

When the vagus nerve stimulation catheter 200 is inserted into the superior vena cava 20 and the basket portion 220 of the vagus nerve stimulation catheter 200 expands and each frame portion 221 is pressed against the inner wall of the blood vessel, the stimulation electrode searching portion 141 The vagus nerve 10 is stimulated by transmitting a stimulation signal to an arbitrary combination of stimulation electrodes 223 out of many stimulation electrodes 223 (S301). The biological information detection unit 110 measures and records changes in biological information obtained after stimulation of the vagus nerve 10, such as changes in blood pressure, electrocardiogram, pulse wave, and the like (S303). At this time, the biometric information determining unit 120 determines whether or not the value of the biometric information, such as blood pressure, has decreased beyond a preset range (S305). If the blood pressure or the like has decreased beyond the preset value (Yes in S305), the myocardial infarction treatment control device 100 terminates the process. The condition for terminating the process is not limited to a drop in blood pressure. 100 can end the process.

The stimulation electrode searching unit 141 sequentially gives stimulation signals to the combinations of the stimulation electrodes 223 until changes in the biological information for all the combinations of the stimulation electrodes 223 are obtained (No in S307) (S301), and obtains the biological information. Measure (S303).

The biological information determination unit 120 determines the change in the biological information that has the greatest change (for example, a decrease in heart rate) from among the changes in the obtained biological information, and selects a stimulation stimulus corresponding to the largest change in the biological information. A combination of electrodes 223 is determined as appropriate for use in stimulating the vagus nerve 10 (S309).

[3.2 Method for Adjusting Stimulation Intensity of Vagus Nerve 10]
Next, with reference to FIG. 4, a method for adjusting the stimulation intensity when stimulating the vagus nerve 10 with the vagus nerve stimulation catheter 200 will be described with reference to FIG. In the example of FIG. 4, the heart rate and blood pressure are used as the biological information to be observed, but any biological information such as respiration can be used as long as it is information that can determine the presence or absence of a hindrance to life support. It is possible.

First, the biological information determination unit 120 reads the threshold information 131 preset by the threshold setting unit 130 (S401). Threshold information 131 may include, for example, lower heart rate and blood pressure limits to be maintained. The biological information detection unit 110 also starts measuring biological information including heart rate and blood pressure (S403). In addition, the auxiliary device control unit 150 starts the operation of the left ventricular auxiliary device 300 (S405), and the electrode control unit 140 controls the vagus nerve 10 using the combination of the stimulation electrodes 223 determined in the processing of 3.1 above. to start stimulation (S407).

The biological information determination unit 120 determines whether or not the blood pressure value, which is the biological information detected by the biological information detection unit 110, falls within the range set by the threshold information 131 (S409). If the blood pressure value is below the lower limit value set by the threshold information 131 (No in S409), the electrode control unit 140 stops outputting the stimulation signal for stimulating the vagus nerve 10 ( S411).

On the other hand, if the measured blood pressure is within the range set by the threshold information 131 (Yes in S409), the biological information determination unit 120 detects the heart rate, which is the biological information detected by the biological information detection unit 110. Determine the value of More specifically, first, the biological information determination unit 120 determines whether the heart rate value has decreased by a predetermined percentage (for example, several percent to ten-odd percent) or more compared to before the stimulus was applied (S413). As a result, when it is determined that the heart rate has not sufficiently decreased (No in S413), the stimulation intensity control unit 143 increases the intensity of the stimulation applied to the vagus nerve 10, that is, the intensity of the stimulation signal (S415). ). At this time, the assist device control unit 150 may also increase the output of the pump by the left ventricular assist device 300 .

As a result of the determination in S413, if it is determined that the heart rate value has decreased by a predetermined rate or more (Yes in S413), the biological information determination unit 120 determines that the measured heart rate value is the threshold information value. 131 (for example, whether it is equal to or higher than the lower limit) (S417). If the heart rate is within the normal range, the stimulation intensity control unit 143 and the left ventricular assist device 300 do not change the intensity of the stimulation signal and the output of the pump (S419).

On the other hand, if the measured heart rate is outside the range set by the threshold information 131 (No in S417), it is determined that life support may be hindered. adjusts the stimulation intensity, for example by reducing the intensity of the stimulation signal (S421). The processing of S409 to S421 is repeated until the treatment for myocardial infarction is completed (No in S423).

At this time, if the threshold setting unit 130 has corrected the threshold information 131 according to the doctor's operation or the like (Yes in S425), the biological information determination unit 120 reads the corrected threshold information 131 (S427). ), and the processing of S409 to S421 may be performed.

[4 Hardware configuration]
A hardware configuration that can implement the myocardial infarction treatment control device 100 will be described below with reference to FIG. Myocardial infarction treatment control device 100 includes a control unit 501, a communication I/F unit 505, a storage unit 507, a display unit 511, and an input unit 513, each of which is connected via a bus line 515. .

The control unit 501 includes a CPU (Central Processing Unit, not shown), a ROM (Read Only Memory, not shown), a RAM (Random Access Memory) 503, and the like. By executing a control program 509 stored in a storage unit 507, the control unit 501 is configured to be able to execute processing related to each configuration shown in FIG. For example, the biological information detection unit 110, the biological information determination unit 120, the threshold value setting unit 130, the electrode control unit 140, the auxiliary device control unit 150, and the output unit 160 are temporarily stored in the RAM 503 and operate on the CPU. It can be implemented as a control program 509 .

In addition, the RAM 503 temporarily stores the codes included in the control program 509 as well as some or all of the biometric information that is input or output, the threshold information 131, and the like. Furthermore, the RAM 503 is also used as a work area when the CPU executes various processes.

The communication I/F unit 505 is a device for communicating with external devices such as the vagus nerve stimulation catheter 200 and the left ventricular assist device 300 . For example, the output of the stimulation signal to the vagus nerve stimulation catheter 200, the output of the control signal to the left ventricular assist device 300, and the like may be performed via the communication I/F section 505. FIG.

The storage unit 507 is a non-volatile storage medium such as an HDD (Hard Disk Drive) or flash memory. A storage unit 507 stores an operating system (OS) and a control program 509 for realizing functions as a general computer, and data necessary for executing them, such as biological information and threshold information 131 .

The display unit 511 is a display device for presenting various kinds of information to a doctor or the like who handles the myocardial infarction treatment control device 100 . Specific examples of the display unit 511 include a liquid crystal display and an organic EL (electro-luminescence) display. For example, the display unit 511 may display the biometric information measured by the biometric information detection unit 110, the determination result of the biometric information determination unit 120 for the biometric information, and the like.

The input unit 513 is a device for receiving various input operations from a doctor or the like who operates the myocardial infarction treatment control device 100 . Specific examples of the input unit 513 include a keyboard, mouse, touch panel, and the like. For example, the threshold information 131 can be input from the input unit 513 and set by the threshold setting unit 130 based on the input.

[5 Effect of this embodiment]
As described above, the myocardial infarction treatment control device 100 according to the present embodiment uses the vagus nerve stimulation catheter 200 to stimulate the vagus nerve 10, and uses the left ventricular assist device 300 as necessary. Promotes a decrease in myocardial work. As a result, the amount of oxygen consumed by the myocardium is reduced, and by opening blood vessels with reperfusion therapy in conjunction with this, necrosis of the myocardium in myocardial infarction can be greatly reduced. This is also expected to reduce the incidence of heart failure after recovery from myocardial infarction.

Stimulation of the vagus nerve also causes bradycardia, which weakens blood circulation. Therefore, the auxiliary control device 150 uses the left ventricular auxiliary device 300 to assist blood circulation, thereby suppressing bradycardia due to vagus nerve stimulation and a drop in blood pressure due to pump malfunction of the heart 30 while suppressing myocardial growth. Due to the reduced work load, myocardial consumption of oxygen is reduced, resulting in further suppression of myocardial necrotic spread.

Furthermore, if the intensity of stimulation to the vagus nerve 10 is too strong, it may cause a drop in blood pressure or the like, which may interfere with life support. Therefore, in the myocardial infarction treatment control device 100, the biological information is monitored by the biological information detection unit 110, and the stimulation intensity to the vagus nerve 10, The operation of the left ventricular assist device 300 is automatically adjusted. As a result, the stimulation to the vagus nerve 10 can be suitably adjusted without depending on the doctor's ability or the like and without the doctor performing treatment for a long period of time.

[6 Supplementary note]
The embodiments described above are for facilitating understanding of the present invention, and are not intended to limit and interpret the present invention. Each element included in the embodiment and its arrangement, materials, conditions, shape, size, etc. are not limited to those illustrated and can be changed as appropriate. Also, it is possible to partially replace or combine the configurations shown in different embodiments.

DESCRIPTION OF SYMBOLS 100... Control apparatus for myocardial infarction treatment, 110... Biological information detection part, 111... Blood pressure measurement part, 113... Heart rate measurement part, 120... Biological information determination part, 130... Threshold setting part, 131... Threshold information, 140... Electrode control Section 141 Stimulation electrode search section 143 Stimulation intensity control section 150 Auxiliary device control section 160 Output section 200 Vagus nerve stimulation catheter 210 Tube section 220 Basket section 221 Frame section , 223... electrode for stimulation, 300... left ventricular auxiliary device, 501... control unit, 503... RAM, 505... communication interface (I/F) unit, 507... storage unit, 509... control program, 511... display unit, 513 ... input section, 515 ... bus line

Claims (4)

stimulating electrodes on a first catheter inserted into the vena cava running near the vagus nerve to stimulate the patient's vagus nerve ;
a stimulation control unit that outputs a stimulation signal to the stimulation electrode for reducing work of the myocardium;
a detector that detects the patient's blood pressure and heart rate ;
a setting unit that sets threshold information that defines the normal range of the blood pressure and the heart rate ;
a determination unit that determines whether the detected blood pressure and heart rate values are within the normal range defined by the threshold information;
An auxiliary device that assists in reducing the work of the myocardium by supporting the activity of the patient's left ventricle, the pump being inserted as a second catheter into the left ventricle through the patient's artery. an auxiliary device comprising ;
an auxiliary device control unit for increasing the output of the auxiliary device when the determining unit determines that the heart rate has not decreased by a predetermined rate or more compared to before the vagus nerve is stimulated by the stimulating electrode ; prepared,
The stimulation control unit adjusts the intensity of the stimulation signal such that the blood pressure and the heart rate are within the normal range and the heart rate is lower than before the stimulation by a predetermined percentage or more. ,
Control device for myocardial infarction treatment. The stimulation control unit stops outputting the stimulation signal when the blood pressure value deviates from the normal range.
2. The control device for treating myocardial infarction according to claim 1. Further comprising an electrode search unit for determining a combination of the stimulation electrodes to be used for reducing the workload of the myocardium among the plurality of stimulation electrodes,
The electrode search unit sequentially outputs the stimulation signal to a partial combination of the plurality of stimulation electrodes,
Among the changes in the heart rate when output to each combination of the plurality of stimulation electrodes, the combination of the stimulation electrodes with the largest change in the heart rate is used to reduce the work of the myocardium. A combination of the stimulation electrodes,
3. The myocardial infarction treatment control device according to claim 1 or claim 2. The auxiliary device control unit controls the auxiliary device such that the blood pressure value is within the normal range.
2. The control device for treating myocardial infarction according to claim 1.

Images