RU2732218C1 - Apparatus for treating wounds and stopping bleeding using low-temperature atmospheric pressure plasma - Google Patents

Abstract

FIELD: medical equipment.

SUBSTANCE: invention relates to a device for wound treatment and haemorrhage stopping using low-temperature atmospheric pressure plasma. Proposed device comprises high-voltage source, gas feed system and set of bipolar and unipolar arresters. Process of formation of flow of low-temperature plasma of atmospheric pressure on treated surface is carried out with simultaneous use of bipolar, and unipolar discharges in two stages. At the first stage the initial ionisation of the supplied gas in bipolar dischargers inside the device is performed with further supply of ionized gas to the processed surface. At the second stage, the low-temperature plasma flow of atmospheric pressure is finally formed in the wound surface treatment area by high-voltage discharges between the monopolar electrodes and the treated body surface of the patient.

EFFECT: technical result is higher reliability and simplified design of device, reduced weight and overall characteristics, as compared to known analogues while maintaining wound coagulation efficiency, as well as providing mobile design of device for use in field conditions, outside rooms and stationary electric network.

10 cl, 11 dwg

Description

The invention relates to plasma technology, namely to devices for plasma treatment of wounds and can be used in the complex treatment of chronic, infected and acute wounds, which are traumatic and purulent-necrotic lesions of soft and bone tissues of various etiologies, as well as for stopping bleeding, including number in the field.

A wide variety of devices for plasma treatment of wounds and stopping bleeding are known from the prior art, which can be divided into "bipolar" and "monopolar" (Fig. 1)

Bipolar devices include devices in which plasma (ionized gas) is produced by electromagnetic discharges between electrodes inside the device or working tool (tip). Monopolar devices are devices in which one of the electrodes that create a discharge in a gas environment is the patient's body.

Bipolar devices, in turn, can be conditionally divided into thermal (in which the ion temperature in the ionization zone is 500 K or more) and non-thermal (with an ion temperature of about 300 K)

For example, a bipolar device for plasma treatment of wounds is known, comprising a hollow cylindrical body, a conical tip in the form of a nozzle with a central hole and a cooling circuit, and an axial electrode mounted in the body by means of a coaxial insulating cartridge with longitudinal channels (see patent RU 2183946, class A61B 18/04, publ. 27.06.2002,). In the known device, the channels are flats made on the outer surface of the cartridge and forming channels for supplying coolant. In this case, the axial electrode is fixed in the cartridge only in the rear part of the device, and the working gas is supplied through a channel made inside the axial electrode. Many additional parts are used to center the electrode.

It is also known a device for plasma treatment of wounds using a bipolar plasma source containing a hollow cylindrical body, a conical tip in the form of a nozzle with a central hole and a cooling circuit and an axial electrode installed in the body by means of a coaxial insulating cartridge with longitudinal channels, equipped with an end sleeve, in which the end part of the axial electrode is fixed and longitudinal channels are made, assembled to coincide with the channels of the cartridge, and the coupling and the cartridge are equipped with a working gas supply channel communicating with the central hole of the nozzle, channels for supplying and removing coolant communicating with the nozzle cooling circuit, and a power supply channel, in which there is an electrical wire supplying voltage to the conical tip (see International application PCT / RU2017 / 0003 11 patent classification: A 5IB 18/04 (2006.01) A61B I5 / 12 (2006.01) 05/16/2017 Priority data: 2016120637, May 26 2016 (26.05.2016) RU). The channels in the sleeve and the cartridge are preferably made in the form of through holes. The axial electrode is preferably secured within the sleeve and chuck by a collet chuck.

Known similar bipolar devices for stopping bleeding (including intraoperative) and treatment of the wound surface (see patent RU 2473318 C2 class A61B 18/04 H05H 1/36, publ. 2013.01.27, patent RU 188887 U1 class H05H 1 / 24, publ. 2019.04.29, patent RU 62009 U1 class A61B 18/18, publ. 2007.03.27, patent RU 167392 U1 class A61B 18/04 H05H 1/34, publ. 2017.01.10, application PCT / RU2017 / 000311, class А61В 18/04 А61В 18/12, publ. 2017.11.30, patent RU 2654504 C1, class Н05Н 1/00, publ. 2018.05.21).

There are also known many devices using a monopolar method of producing "cold" plasma, used mainly intraoperatively to stop bleeding and disinfect wound surfaces. The principle of their action on the tissue cells of the treated surface consists in an electromagnetic discharge in a gaseous medium (air, argon, krypton or a mixture of gases) between the high-voltage electrode and the patient's body with a neutral electrode connected to it (see, for example, patent RU 2016118137 A, cl . А61В 18/042, publ. 2017.11.15, patent RU 2517052 C1, class А61В 18/00 А61В 18/04 A61N 1/44, publ. 2014.05.27,)

Known methods for stopping bleeding and disinfecting the wound surface of this type with monopolar devices, such as "FOTEK" series 140, 142 in the "Spray" and "Fulgur" mode using argon gas (see patent UA 73500 U, class A61B 17/42 , publ. 2012.09.25, patent UA 73501 U, class A61B 17/42, publ. 2012.09.25, patent RU 2009111095A, class A61B 17/42, publ. 2010.12.20)

Argon plasma coagulation (APC) is usually used to ensure hemostasis of dissected tissues and to treat tissues superficially damaged by the disease, in order to stimulate natural processes of their replacement with healthy tissues, as well as in operations on parenchymal organs (see RU 2339334 C1, 27.11.2008), in oncology (RU 2255697 C1, 10.07.2005), in gynecology (RU 2406458 C1, 20.12.2010).

In general, all devices contain a power source and at least one working part, which is a two-electrode system, which is powered by the supplied voltage from the power source.

The known method of hemostasis, carried out using the apparatus "Plazon", generating plasma, developed at the Moscow State Technical University. NOT. Bauman in 1998. The disadvantage of this method is that the apparatus produces high-temperature plasma in a bipolar discharge, and then in a special cooling chamber, its temperature decreases, leading to a loss of active elements, which leads to a decrease in the effectiveness of hemostasis. The monopolar method for generating low-temperature atmospheric pressure plasma is free from this drawback.

Coagulation of the wound surface using low-temperature atmospheric pressure plasma, in particular argon plasma coagulation (APC), is one of the most common non-contact methods in clinical practice. Electrical impulses are used to create a spark discharge in a jet of inert gas. Energy transfer is carried out by ions of an excited inert gas, without direct contact of the instrument with the tissue. Under the influence of plasma, local heating and coagulation of tissues occurs. In the process of tissue drying and the formation of a scab, their electrical resistance increases, and argon plasma discharges are deflected to the peripheral tissue areas with lower resistance. As a result, there is a uniform coagulation of the entire exposure zone with a depth of 0.5 to 3.0 mm, depending on the duration of exposure, type of tissue (Maisterenko N.A. et al., 2004; Timerbulatov V.M. et al., 2007 ; Golubev A.A. et al., 2013). One of the main advantages of APC is the uniform distribution of energy, limitation of the zone and depth of coagulation depending on the installed power of the generator, the rate of argon supply, the duration of exposure, the distance to the organ surface, and the physical characteristics of the tissues of a particular organ. (Mashkin A.M. et al., 2011).

An important role in coagulation processes using low-temperature atmospheric pressure plasma is also played by the non-thermal effects of the interaction of active particles and compounds of low-temperature atmospheric pressure plasma with the cells of the treated tissues.

Non-contact argon plasma monopolar coagulation is the most common method of intraoperative stopping bleeding, in which a high-frequency (usually above 400 kHz) alternating voltage is applied from an electrosurgical generator to the active electrode in the handle of the surgeon's instrument, causing ionization discharges between the high-voltage active electrode and the wound surface (in an inert argon).

This method has the following advantages:

- effective and fast stopping of extensive bleeding;

- low cost of argon as a plasma-forming gas;

- avoidance of unwanted oxidation and carbonization of living tissue;

- ease of processing and easy visual control of the result;

- accelerated healing of the wound surface;

- reducing the likelihood of pyoinflammatory complications;

- accelerated benign regeneration of the patient's tissue cells.

The objective of the present invention was to create a device for treating the wound surface and stopping extensive bleeding by exposure to low-temperature gas plasma at atmospheric pressure, suitable for use in the field, outdoors and in the absence of a stationary electrical network.

The technical result was an increase in the reliability and simplification of the design of the device, a decrease in its mass-dimensional characteristics, in comparison with known analogues, while maintaining the efficiency of coagulation of the wound surface using low-temperature plasma of atmospheric pressure, as well as ensuring the possibility of a mobile version of the device for its use in the field, outside premises and stationary electrical network.

The specified technical result is achieved by the fact that, compared to existing devices for treating wounds and stopping bleeding, the claimed device simultaneously uses two types of arresters and two stages of ionization to obtain low-temperature atmospheric pressure plasma, bipolar and monopolar arresters.

At the same time, in the process of forming an ionized gas mixture for treating the wound surface, in the claimed device, each component of low-temperature atmospheric pressure plasma is produced by the most effective and least energy-consuming method for it (in terms of voltage, frequency and other characteristics of discharges). The final formation of low-temperature atmospheric pressure plasma occurs under conditions of monopolar discharges between the high-voltage electrode (s) and the treated wound surface in an environment of pre-ionized gas of a given plasma-chemical composition.

In addition, the claimed device provides the ability to supply to the treated surface a mixture of gases of a plasma-chemical composition, the components of which are obtained in incompatible conditions (temperature, current frequency, voltage between the spark gap electrodes, etc.). For example, the simultaneous supply of nitrogen oxide (NO) to the wound surface and surface treatment in an ionized argon (Ar) environment. That is, the simultaneous implementation of NO-therapy and APC (argon plasma coagulation).

In fig. 2 shows a diagram of a DEVICE FOR TREATING WOUNDS AND STOPPING BLEEDING WITH THE APPLICATION OF LOW-TEMPERATURE PLASMA ATMOSPHERIC PRESSURE and bipolar and monopolar discharges in two stages:

a. initial ionization of the supplied gas in bipolar arresters inside the device, followed by the supply of ionized gas to the treated surface,

b. final formation of the flow of low-temperature plasma of atmospheric pressure in the area of treatment of the wound surface with high-voltage discharges between the monopolar electrodes and the treated surface of the patient's body.

In fig. 3 shows a diagram of a DEVICE that differs from that shown in fig. 2 by the fact that a high voltage generator of high frequency (over 3 kV, over 15 kHz) with an output to a voltage multiplier (with a factor of more than 4) and a set of bipolar and monopolar arresters, consisting of one or more bipolar arresters connected to one or more oscillating circuits, the inductances of which are simultaneously the primary windings of one or more high-frequency resonant transformers (with a resonance frequency of more than 400 kHz), as well as one or more output resonant circuits consisting of inductances, which in turn are secondary windings of one or more resonant transformers (more than 400 kHz), and capacities, which also include capacities between one or more monopolar electrodes and the patient's body in the area of the treated surface.

In fig. 4 shows a diagram of a DEVICE that differs from that shown in fig. 3 by the fact that gas of different chemical composition is supplied to different bipolar arresters through parallel gas pipelines.

In fig. 5 shows a diagram of a DEVICE that differs from that shown in fig. 3 by the fact that a gas of different chemical composition is sequentially added to different bipolar arresters located in series to each next bipolar arrester, mixing with the ionization products in the previous (their) arrester (s).

In fig. 6 shows a diagram of a DEVICE that differs from that shown in fig. 3 by the fact that the ionization products of reptiles of different chemical composition at the exit from different bipolar dischargers are supplied to the treated surface separately, each to its own monopolar electrode (discharger).

In fig. 7 shows a diagram of a DEVICE that differs from that shown in fig. 6 by the fact that the ionization products of reptiles of different chemical composition at the exit from some bipolar arresters are supplied to the treated surface separately directly, bypassing the monopolar electrode (arrester).

In fig. 8 shows a diagram of a DEVICE that differs from that shown in fig. 3 by the fact that one or more bipolar arresters are powered from a high-frequency circuit (from the secondary windings of resonant transformers).

In fig. 9 shows a diagram of a DEVICE that differs from that shown in fig. 8 by the fact that one or more bipolar arresters powered from a high-frequency circuit (from the secondary windings of resonant transformers) have common high-voltage electrodes with corresponding monopolar arresters.

In fig. 10 shows a diagram of a DEVICE that differs from that shown in fig. 9 by the fact that, in addition, gas (mixture of gases) is supplied directly to the treatment area of the wound surface, bypassing all dischargers.

In fig. 11 shows a diagram of a DEVICE that differs from that shown in fig. 9 in that one pair or several pairs of monopolar and bipolar arresters work alternately depending on the value of bioimpedance between the monopolar electrodes and the surface to be treated.

Claims (12)

1. A device for treating wounds and stopping bleeding using low-temperature atmospheric pressure plasma, containing a high-voltage source, a gas supply system and a set of bipolar and monopolar arresters, characterized in that the process of forming a flow of low-temperature atmospheric pressure plasma onto the treated surface is carried out with the simultaneous use and bipolar and monopolar discharges in two stages: a. initial ionization of the supplied gas in bipolar arresters inside the device, followed by the supply of ionized gas to the treated surface, b. final formation of the flow of low-temperature plasma of atmospheric pressure in the area of treatment of the wound surface with high-voltage discharges between the monopolar electrodes and the treated surface of the patient's body. 2. The device according to claim 1, characterized in that a generator over 3,000 V and a frequency of over 15,000 Hz is used as a high voltage source with an output to a voltage multiplier with a factor of more than 4 and a set of bipolar and monopolar arresters. 3. A device according to claim 1, characterized in that gas of different chemical composition is supplied to different bipolar arresters through parallel gas pipelines. 4. The device according to claim. 1, characterized in that a gas of different chemical composition is sequentially added to different bipolar arresters located in series to each next bipolar arrester, mixing with the ionization products in the previous arrester. 5. The device according to claim 1, characterized in that the products of ionization of gases of different chemical composition at the exit from different bipolar arresters are supplied to the treated surface separately, each to its own monopolar electrode, which is a discharger. 6. The device according to claim 5, characterized in that the products of ionization of gases of different chemical composition at the output of the bipolar arresters are supplied to the treated surface separately directly, bypassing the monopolar electrode, which is the arrester. 7. A device according to claim 2, characterized in that the bipolar arresters are powered from the secondary windings of the resonant transformers. 8. The device according to claim 7, characterized in that the bipolar arresters powered from the secondary windings of the resonant transformers have common high-voltage electrodes with corresponding monopolar arresters. 9. The device according to claim. 8, characterized in that, in addition, gas is supplied directly to the treatment area of the wound surface, bypassing all dischargers. 10. The device according to claim 9, characterized in that the pairs of monopolar and bipolar arresters operate alternately depending on the magnitude of the bioimpedance between the monopolar electrodes and the surface to be treated.

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