RU2118545C1 - Heart electric stimulation method - Google Patents

Abstract

FIELD: medicine. SUBSTANCE: intracavitary electrode is introduced into heart. Heart is stimulated by electric pulses of rectangular form with amplitude of 20-60 V, at frequency of 60-80 pulses per minute. Novelty of given method is in that thin long acupuncture needle is used instead of intracavitary electrode. This needle punctures skin and front thoracic wall in fourth intercostal zone on the left. Needle is introduced into muscle of left ventricle of heart. EFFECT: enhanced recovery of heart activity. 2 cl, 1 ex

Description

 The proposed technical solution relates to medicine and is intended for pacemaking mainly in the conditions of the prehospital stage and intensive care unit.

 The time factor is of great importance in the treatment of myocardial infarction, cardiac arrhythmias, acute heart failure, especially with sudden cardiac arrest, when the possibility of a return to life is limited by a critical 4-5 minutes of clinical death.

 The most rational way to reduce the time from the onset of the disease to the beginning of active treatment in a hospital is to conduct clinical methods of effective treatment to the maximum extent possible at the prehospital stage.

 One of these methods is intracardiac injection or cardiac puncture, in which drugs are injected into the heart cavity with a needle and syringe. After injection of the drug, an immediate post-injection massage is performed, which transfers the drug from the ventricular cavity to the coronary arteries for distribution in the myocardium [1].

 However, the known method has several disadvantages. Firstly, it is not always effective, secondly, it is fraught with the danger of introducing the drug into the muscle of the heart, which can cause hemorrhage and damage to the myocardium, and thirdly, there is a risk of tissue clogging of the needle. When using special needles that have a standard mandrin, the doctor has to spend time on removing the mandrin and attaching the syringe.

Known electrical pulse defibrillator therapy. With this method, the chest defibrillator electrode is placed on the front surface of the patient’s chest in the region of the middle third of the sternum, closer to the right subclavian region. The doctor presses the electrode to the patient’s chest with a force of 10 kg and a defibrillator discharge is given. The minimum allowable charge during defibrillation is 4500 V. [2]
However, the known method is very laborious. He requires a special team of four people, each of whom must know the circle of his duties. Complex equipment is required, requiring preparation for work. In one session, up to four categories of defibrillator are allowed, which is not enough to resume heart function. Sometimes, when using the known method, one has to resort to short-term direct massage of the heart and mechanical ventilation. In addition, the danger of electric shock to the operating personnel and the patient is not excluded. The patient’s skin, as a rule, gets burned at the place of contact with the chest electrode of the defibrillator and requires anti-burn lubrication.

 The closest technical solution (prototype) is a method in which an electrode is introduced into the heart and the heart is stimulated with electric pulses [3].

 According to the known method, the patient is punctured with the right subclavian vein using a needle and an intracavitary electrode is inserted through the lumen of the needle. The electrode along the vein is sent to the superior vena cava and then to the cavity of the right atrium. Then the non-insulated end of the intracavitary electrode is connected to the cathode electrode of the pacemaker, after which cardiac stimulation is started for 0.5 - 1 min with a frequency 20-50% higher than the frequency of the heart’s own rhythm.

 The disadvantage of this method is the probability of the electrode entering the internal jugular vein. After vein puncture, it is necessary to conduct the electrode as quickly as possible along the lumen of the puncture needle, which requires the skill and experience of a doctor.

 During the entire manipulation, according to the indications, indirect cardiac massage and mechanical ventilation should be continuously performed.

 However, conducting closed cardiac massage during pacing is difficult and, as experience shows, pacing using known electrodes is ineffective.

 The applicant proposes to eliminate shortcomings as an intracavitary electrode, use an acupuncture thin long needle, pierce the skin and the anterior chest wall in the fourth intercostal space on the left, insert the needle into the muscles of the left ventricle, and act on the heart with rectangular impulses.

 A comparative analysis of the claimed technical solution in this technical field showed that it is unknown from the prior art at the filing date of the application, and this gives the applicant reason to say that the claimed technical solution meets the criterion of "novelty."

 Comparison of the claimed technical solution not only with analogues, but also with the prototype did not allow to reveal in it the signs that match the signs of the claimed technical solution and for the specialist does not explicitly follow from the prior art. Thus, the applicant believes that the proposed technical solution meets the criterion of "inventive step".

 In addition, the proposed technical solution can be used in health care for emergency and short-term electrical stimulation of the heart in cases of sudden cardiac arrest, therefore, the proposal is "industrially applicable".

 The proposed method can be implemented as follows. A cotton swab dipped in alcohol disinfects the skin of the anterior chest wall in the fourth intercostal space on the left and, piercing it, an intracavitary electrode is introduced, which is an acupuncture thin long needle. Acupuncture needles of this group are mass-produced, have a length of 10 - 12 cm and are made of steel.

 As practice has shown, it is enough to introduce the needle by gradually screwing it to 8 cm in adults and 5 cm in children. The depth of the needle can vary both up and down depending on the size of the chest and the size of the patient.

 At the chosen injection site, the needle enters the muscle of the left ventricle. The choice of the injection site of the needle (left ventricular muscle) is determined by the fact that this muscle has a greater ability to conduct excitation that occurs at any point to other parts of the heart muscle [4].

 When the activity of the left ventricle is restored, the activity of the whole heart is restored and a large circle of blood circulation is included in the work. The depth of penetration of the needle into the muscle of the left ventricle does not affect the final result. The penetration of the needle is allowed both over the entire thickness of the muscle of the left ventricle, and further into the cavity of the ventricle. The diameter of the needle is so small that it does not cause bleeding.

 After insertion of the intracavitary electrode, an indifferent electrode is introduced under the skin above the apex of the heart, which also uses an acupuncture needle.

 After the introduction of acupuncture needles, their handles are connected to the terminals of the pulse current generator. The needle, which is an intracavitary electrode, is connected to the cathode of the generator, and the needle, which is an indifferent electrode, is connected to the anode of the generator. After connecting the generator, stimulation of the heart begins with pulses, delivering 60-80 cpm / min. The most acceptable shape of the pulses for stimulation of the heart is rectangular, since it is similar in shape to the natural pulse generated by the heart, and the frequency is 60 pulses / min.

 As a generator, a pulse current generator designed for rhythmic pulse current with rectangular pulses, developed by the Acupuncture Department of the Institute of Oriental Medicine, can be used. According to the scheme, it is a self-oscillator based on a low-power transistor, producing rectangular pulses.

 With a resistance of 10 kΩ, the voltage of the main pulse is 20 V, and the voltage of the DC component is 50 V. The maximum frequency of the output pulse is 100 Hz / s, the minimum is 0.1 Hz / s. The duration of the main pulse is 0.7 ms [5].

 During the period of stimulation of the heart, the pulsation of the radial or carotid arteries is controlled. When the pulse appears and normalizes in these arteries, pacing is stopped.

 An example of clinical application. A patient with a diagnosis of post-infarction cardiosclerosis, coronary heart disease, sudden cardiac arrest, clinical death. After unsuccessful attempts to restore cardiac activity using a defibrillator, as well as intracardiac administration of adrenaline, against the background of artificial ventilation of the lungs from the mouth into the mouth and indirect heart massage, intracardiac electrical stimulation was performed using the proposed method.

 An acupuncture thin long needle was inserted into the fourth intercostal space on the left lateral of the edge of the sternum 1.5-2 cm to a depth of 9 cm. The second indifferent electrode in the form of a short acupuncture needle was inserted to a depth of 1.5 cm one intercostal space above. After connecting the clamps with wires from the pulse current generator with rectangular pulses to the needles and turning on the generator, the voltage on the electrodes gradually increased, starting from 20 V. At a voltage of 30 V, heartbeats and pulses appeared on the carotid and radial arteries. After a minute of work at a frequency of 60 cpm, the apparatus was turned off, and cardiac activity was restored. The needles were removed, further resuscitation measures were carried out.

 Using the proposed method will allow for emergency and short-term pacemaking in camp and outpatient settings that do not require special preparation and bulky equipment. Acupuncture needles are kept sterile in a test tube with 96% alcohol, and the weight of the pulse current generator developed by the Acupuncture Department of the Institute of Oriental Medicine is 200 g.

 Sources of information.

 1. Directory of emergency physician, ed. 3, corrected and supplemented. Kiev. The head publishing house of the Vishka Shkola Publishing Association, 1979, p. 459 - 460.

 2. Bunyatyan A.A. Handbook of Anesthesiology and Intensive Care. M .: Medicine, 1982, p. 81-82.

 3. USSR A.S. N 810212, class A 61 N 1/36, 1981.

 4. Murashko V.V. and others. Electrocardiography. M .: Medicine, 1987, p. 11-15.

 5. Acupuncture. / Under the general ed. Hoang Bao Tiao, La Quang Niep. - M.: Medicine, 1988, p. 452-453.

Claims (2)

 1. A method of electrical stimulation of the heart against the background of circulatory arrest, including conducting an electrical pulse, characterized in that an acupuncture thin long needle is inserted into the muscle of the left ventricle of the heart through the chest in the fourth intercostal space on the left, and rectangular electric pulses are used to stimulate the heart. pulses with a voltage of 20 - 50 V.  2. The method according to claim 1, characterized in that the stimulation of the heart is carried out with a frequency of 60 to 80 pulses in 1 min, a pulse duration of 0.7 ms with 1 second intervals between pulses.