RU2760470C1 - Method for electrostimulation of diaphragmatic breathing - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to medical technology, and can be used for electrical myostimulation of diaphragmatic breathing. The generator generates pulse packets with a modulated pulse repetition rate in a packet, amplifies them in a power amplifier and feeds them through electrodes connected to the patient. The electrodes are fixed on the patient’s body in the projection of the diaphragm. In this case, the front two active electrodes are located in the projection of the attachment of the diaphragm to the chest, and the rear two passive electrodes are on the back opposite the front electrodes. The insulated wires of the electrodes are connected to a switched-off device with a pre-set zero value of the voltage amplitude of the stimulating pulses. The device is switched on and packets of pulses are fed to the electrodes having a frequency varying according to a linear-step law of frequency increase close to the exponential law of physiological inspiration. In this case, the increase in the pulse frequency in the packet from the initial (f_in) to the final (f_fin) pulse repetition frequency in the packet (Hz) is carried out during a time of 2/3 τ_pack with a higher rate of increase in the pulse frequency in the packet in the initial section from f_in to (f_fin - f_in)/2, where τ_pack is the duration of the pulse packet (ms).

EFFECT: method provides effective breathing training while ensuring a comfortable procedure for the patient due to the optimal selection and adjustment of the parameters of the output signal of the device.

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Description

Appointment

The invention relates to medical equipment, namely to a method of electromyostimulation of diaphragmatic breathing, providing training and restoration of breathing in various diseases, as well as prevention and strengthening of the respiratory system.

State of the art

Exposure to electric current changes the state of tissues and tissue fluid and affects almost all processes occurring in them. The acid-base state, osmotic state, redox and enzymatic processes change, blood and lymph circulation is enhanced, metabolic processes are stimulated, regeneration (renewal) of nervous, bone and connective tissues is accelerated.

All muscles in the body need regular muscle strengthening training, because in the absence of training, the blood supply to neighboring organs deteriorates and dysfunctions and congestion develop. This especially applies to the area of the body "diaphragm - small pelvis", where the most important organs of the body's life are located. Unlike traditional drug therapy, non-drug therapy allows providing a qualitatively new level of treatment that does not cause harmful side effects from the use of (often incorrect) expensive drugs.

It should be noted that in a decrepit body, not all muscle fibers contract. Due to a variety of reasons, not every myoneuron associated with a muscle fiber conducts an impulse from the central nervous system. But when exposed to an external source of a pulsed electric field, all myoneurons in the electric field will literally "pull" their muscle fibers. The entire muscle will begin to contract, blood flow also changes, and fat and protein deposits are crowded out of the mobile muscles. Tetanic muscle contractions caused by electrical impulses and subsequent relaxation increase blood and lymph circulation in them, promote the delivery of nutrients to the muscle, ensure the release of under-oxidized products, and contribute to the accumulation of calcium, sodium and iron ions in the muscle (see Kolesnikov GF. Electrical stimulation of the neuromuscular apparatus . Kiev: Health. 1977, 244 s). In this case, muscle contraction occurs practically without the release of lactic acid, which poisons the muscles (lactic acid released during normal physical training must be removed from the muscles). Electrical myostimulation makes muscle fibers stronger, more elastic, more susceptible to subsequent stress.

Due to the sedentary lifestyle of a large part of the population (as well as people with physical injuries or, for example, astronauts during a long stay in space, etc.), diseases spread in people (with a tendency for their further growth) associated with weakening of the muscles organism, the task of the treatment of which is not only social, but also economic. The economic effect of the use of treatment by the method of training and restoring the functional muscles of the body consists of a decrease in the patients' need for expensive medicines, a reduction in the length of hospital stay and temporary disability, partial and sometimes complete rehabilitation of patients with a disability group.

So, for example, as the coronavirus (COVID-19) pandemic has shown, the problem of treating the respiratory system is especially acute, including the long-term rehabilitation process while eliminating the consequences of lung damage.

The use of traditional (mechanical) mechanical ventilation devices in intensive care has an obvious drawback in that the respiratory mixture is supplied mainly to the upper sections of the "affected" lungs under positive pressure (gas injection into the airways), which can adversely affect the treatment process (with this, due to the lack of ventilation in the lower lobes of the lungs, the development of "stagnant" phenomena in them is possible).

It should be noted that if the ventilator is connected for a long time (for example, more than 3 days), the patient "gets used" to the ventilator, and when it is turned off, he cannot always switch to spontaneous breathing.

Forced (forced) breathing of the patient is possible by conducting electromyostimulation of the diaphragm, the contraction of which under the influence of an electrical signal will provide a "physiological" flow of air into the lungs (inhalation), and exhalation is carried out in the absence of an electrostimulating signal due to relaxation of the muscles of the diaphragm, which takes its initial position in view of its elasticity , differential pressure and pressure of organs located in the abdominal cavity.

The diaphragm is a muscle-tendon septum that separates the chest cavity from the abdominal cavity and serves as the main respiratory muscle.

As a result of the movements, the diaphragm carries out the main volume of ventilation of the lower lobes of the lungs and 40-50% of the ventilation of the upper lobes, which is provided mainly by the costal-sternum mechanism.

Therefore, the most important and basic purpose of electromyostimulation of diaphragmatic breathing is:

• training and restoration of breathing for various diseases;

• rehabilitation while eliminating the consequences of lung damage;

• prevention and strengthening of the respiratory system;

• strengthening of the muscle fibers of the diaphragm, which become stronger, more elastic, more susceptible to stress during breathing.

During inhalation, the diaphragm reduces intrapleural pressure, helping to fill the right heart with venous blood, and by pressing on the liver, spleen and abdominal organs, it promotes the outflow of venous blood from them, acting like a pump. For example, it should be noted that as a result of electrical stimulation of respiration, an improvement in liver hemodynamics is observed, due to increased blood flow in the hepatic vein system, an increase in blood flow to the heart through the inferior vena cava, as well as a decrease in the total peripheral vascular resistance (see patent, RF No. 2232609 ).

The effect of the diaphragm on the digestive organs consists in a massaging effect on the stomach and intestines; with a decreased tone of the diaphragm, the amount of air in the stomach and intestines increases.

Effective electromyostimulation of the diaphragm leads to an improvement in the parameters of the respiratory system, ensuring the consumption of oxygen by the body and the release of carbon dioxide, and compensation of respiratory failure.

As an electrical stimulating signal (see, for example, A.S. SU No. 1503812), providing the patient's inhalation, packs of electrical pulses are used, therefore, it is necessary to optimally select the adjustable parameters in the pack (duration and amplitude of pulses in the pack, the law of change in the frequency of pulses in pack, the duration of the pack and the frequency of their repetition) that will ensure high efficiency of electromyostimulation are:

• formation of full-fledged inspiration and long-term continuous electromyostimulation without diaphragm fatigue;

• effective contraction of the diaphragm under the influence of a stimulating signal, the correspondence of the stimulated contractions of the diaphragm to the modulation of the signal (no unexpected sharp efforts or weakening during the deployment of muscle contraction);

• modeling of the electromyostimulation breathing process as close as possible to natural;

• comfort of the electrostimulation process (no pain).

As a prototype for the proposed method is taken the method of electromyostimulation of the diaphragm, carried out in the "Electrostimulator of respiration" (and.with. SU No. 1766421).

In this prototype, the pulse train generator generates pulse trains, the amplitude of which is set in the power driver and is fed through the electrodes to the patient for muscle contraction.

The disadvantage of the prototype is the lack of the presence of rational solutions to improve the efficiency of electromyostimulation, optimization and ease of control, the algorithm and sequence of work during operation, as well as achieving the comfort of the procedure for the patient.

The purpose of the proposed method of electromyostimulation of diaphragmatic breathing is to increase the efficiency of breathing training while ensuring the comfort of the procedure for the patient.

Disclosure of invention

The proposed method of electromyostimulation of diaphragmatic respiration consists in generating by the shaper packs of pulses with modulated pulse repetition rate in the pack, amplifying them in a power amplifier and supplying them through electrodes connected to the patient for muscle contraction.

The essence of the invention lies in the fact that the electrodes are fixed on the patient's body in the projection of the diaphragm, while the front two active electrodes should be in the projection of the attachment of the diaphragm to the chest, and the back two passive electrodes - on the back, approximately opposite the front electrodes, connect the isolated electrode wires to turned off the device with a preset zero value of the amplitude of the voltage of stimulating pulses, the selected frequency of breathing and the ratio of inhalation to exhalation, then turn on the device and supply to the electrodes a pack of pulses having a given pulse duration and a linear-step law of increasing the frequency of pulses close to the exponential law of physiological inspiration, set the value of the amplitude of the voltage of stimulating impulses for effective contraction of the diaphragm in the absence of pain in the patient and the requirements during the procedure change the respiratory rate and the ratio of inhalation to exhalation.

Graphic illustrations

The invention is illustrated in the figures of FIG. 1, fig. 2 and FIG. 3.

In the illustrated graphical figure, FIG. 1 shows an example of execution in the form of a structural diagram for the implementation of the proposed method of electromyostimulation of diaphragmatic respiration, containing the components indicated by the positions:

• EMC apparatus (electromyostimulator apparatus) - 1;

• FVP (generator of time parameters) - 2;

• FCHMP (shaper of frequency-modulated packets) - 3;

• PDI (pulse duration generator) - 4;

• EFV (inhalation / exhalation shaper) - 5;

• FCHSP (pulse train repetition frequency shaper) - 6;

• FM (pulse power shaper) - 7;

• RN (pulse voltage regulator) - 8;

• FAI (pulse amplitude shaper) - 9;

• electrodes - 10;

• elastic belt for fastening electrodes - 11;

• patient (front and back views) - 12;

• power supply 13.

FIG. 2 shows an example of the execution of electrodes 9.

In the graphical FIG. 3 shows an example of the law of variation of the frequency of pulses in a burst.

Description of an example of execution

Consider the method of electromyostimulation of diaphragmatic breathing (see Fig. 1).

Pre-elastic band 11 is inserted into the "ears" of four identical electrodes 10, made, for example, on the basis of silicone rubber with a metallized surface, which should be applied to the body of the patient 12 (an example of the implementation of electrodes 10 is shown in Fig. 2). To securely fix the electrodes 10 on the patient's body 12, the width of the belt 11 should approximately correspond to the size of the width of the "ears" of the electrodes 10.

As an elastic belt 11, you can use, for example, the Esmarch harness of the Company LLC "Global-Medtech", Moscow.

To ensure reliable contact with the body, a thin layer of conductive electrode paste is applied to the conductive surface of the electrodes 10 or gauze wipes moistened with isotonic sodium chloride solution are applied (ordinary water can be used), and then the elastic belt 11 with electrodes 10 is fixed on the patient's body 12 (the patient can fix it yourself) in the projection of the diaphragm (see Fig. 1). In this case, the front two electrodes 10 should be in the projection of the attachment of the diaphragm to the chest (approximately in the area of the seventh intercostal space outward from the mid-clavicular line symmetrically on both sides), and the back two electrodes 10 should be on the back approximately opposite the front electrodes 10 (area projections of the X-XI thoracic vertebrae). For convenience, the fastening of the elastic belt 11 with the electrodes 10 can be carried out in a sitting or standing position of the patient (it is also possible to fasten the electrodes 10 on the patient's body, for example, using a plaster).

Then connect the insulated wires of the electrodes 10 to the switched off EMC device 1, in which there is no signal at its output (for example, the power supply 13 is turned off). In this case, for electromyostimulation of the left and right domes of the diaphragm, two active front electrodes 10 are connected to the "phase" connectors, and two passive electrodes 10 located on the back are connected to the "zero" connectors (during electromyostimulation, negative pulse signals are applied to the "phase" connectors relative to zero potential at the "zero" connectors). It has been established that at the moment of closing the electrical circuit, the greatest irritating effect occurs at the negative electrode (cathode), and the smallest - at the positive (anode), therefore, during electrical stimulation with pulsed currents, the cathode is used as an active electrode (see site: https: // megapredmet. su / 1-65113.html).

Electromyostimulation of diaphragmatic breathing is performed in the patient's supine position (on an empty stomach or approximately more than 1.5 hours after eating) by turning on the EMC apparatus 1 (by turning on the power supply 13) and then adjusting the electromyostimulating signal.

Consider an example of the formation of an electrical signal at the output of the EMC apparatus 1 (see Fig. 1) for effective electromyostimulation of diaphragmatic respiration and the sequence of the electromyostimulation session. The electrical signal at the output of the EMC apparatus 1 is a sequence of pulse trains, which are characterized by the repetition rate and duration of the pulses in the packet, the duration of the pulse trains and the ratio of the duration of the packet to the pause between the packs, as well as the amplitude of the pulses in the packet. The pulse repetition rate in the burst lies within certain limits. At a high pulse repetition rate, i.e. the interval between stimuli is shorter than the relaxation phase, the muscle (diaphragm) does not have time to relax and at the moment of the next impulse it remains contracted, as a result of which there is a continuous shortening of it - tetanus. Under these conditions, the muscle can contract 3-4 times more. Those. for a more "strong" contraction of the diaphragm, it is necessary to take frequencies as large as possible. However, in this case, long-term electrical stimulation of the diaphragm is impossible due to its fatigue, which at frequencies above 60 Hz is manifested by a progressive decrease in the movement of the diaphragm and, as a result, by a decrease in tidal volume. The lower limit of the decrease in the pulse repetition rate in the burst is limited by the level of the serrated tetanus at a frequency of approximately 8 Hz.

Primary Management (f _nach) and the stop frequency (f _con) pulse repetition frequency in a stack allows to achieve both a smooth profile inhalation at lower f _beginning to level toothed tetanus (9 ... 15 Hz) retaining f _con at smooth tetanus (25 ... 50 Hz), and to increase the duration of continuous electrical stimulation of the diaphragm until its fatigue occurs, while the smoothness of inspiration is achieved with a frequency change factor of approximately 3, for example:

• f _start = 9 Hz, f _end = 27 Hz;

• f _start = 15 Hz, f _end = 45 Hz.

Therefore, in the shaper of the frequency-modulated packs of the FPMF 3 of the shaper of the time parameters of the FPP 2, pulse packs are formed (shown in Fig. 3) with a linear-step law of increasing the frequency of pulses (shown as a straight line) close to the exponential law of physiological inspiration of a person (shown by a dashed line ).

A description of the formation of the pulse repetition rate with an increase within a part of the burst duration is presented, for example, in A.S. SU No. 1429301.

It should be noted that this law is retained when the duration of a burst of impulses (τ _pach ) changes, thereby ensuring smooth muscle contraction and close to the physiological inhalation of a person.

The duration and amplitude of the pulse in the burst reflect the energy parameters of the pulse and are inversely proportional, i.e. increasing the duration can reduce the amplitude and vice versa, at the same time they should not be identified when optimizing the electrostimulating signal.

The range of pulse durations affecting a biological object during electrical stimulation is in the range from 0.1 to 1 ms (see B.M. Gekht, E.A. Kolomenskaya, I.A.Strokov. Electromyographic characteristics of neuromuscular transmission in humans . M .: Nauka, 1974, S. 49-57), while the optimal range for electrical stimulation of the diaphragm with the cutaneous location of the electrodes is in the range from 0.5 to 1 ms.

The threshold amplitude of pulses during electromyostimulation is influenced by many factors, for example:

• design of electrodes 9;

• the degree of contact of the electrodes to the patient's body 13;

• drying of the conductive paste or wipes during the electromyostimulation process;

• choice of overlay points, as well as possible displacement of electrodes 9 during the process of electromyostimulation;

• geometric "parameters" of the patient's body 12;

• anatomy and physiology of the patient's diaphragm.

Under the influence of an electromyostimulation signal with an amplitude of impulses below the threshold value, there is no contraction of the diaphragm, when the threshold value is reached, its contraction begins, and as the amplitude of exposure increases, an increasing number of muscle fibers are involved in contraction, then reaching their limit. The permissible maximum excess of the value of the pulse amplitude over the threshold is limited by the provision of effective (reliable) contraction of the diaphragm in the absence of pain in the patient. Therefore, at each session of electromyostimulation by the power shaper FM 7, it is necessary to provide the required amplitude by adjusting the amplitude of the pulses in the FAI 9 from the initial zero value to the maximum.

When low pulse voltages (for example, logical "1" voltages) from the output of the FVP 2 time parameters shaper arrive at the input of the FAI pulse amplitude shaper 9, pulse voltages of at least 50 V are generated at its output (see, for example, A.S. SU No. 1211840).

The voltage regulator RN 8 (see, for example, the website: https://rusenergetics.ru/praktika/regulyator-napryazheniya) converts these constant impulse voltages at the input (at least 50 V) into continuously adjustable impulse voltages from 0 to 50 V for output (at the output connectors of the EMC device 1).

Changing the pulse duration in the range from 0.5 to 1 ms practically does not affect the comfort of electromyostimulation and the smoothness of inspiration, therefore, the use of pulse-width modulation or adjustment of the pulse duration in the PDI 4 pulse width shaper is impractical (it is irrational from the point of view of increasing the number of EMC device adjustments ), but it is necessary to form pulses with a constant duration, for example, with an average value of 0.75 ms.

It is known that normally breathing is represented by uniform breathing cycles "inhalation - exhalation" in the range from 12 to 16 respiratory movements per minute, the act of inhalation takes place somewhat faster than the act of exhalation, namely, the ratio of the duration of inhalation and exhalation is normally 1: 1 , 1 or 1: 1.4 (see website: https://www.rlsnet.ru/books_book_id_2_page_30.htm). Taking into account this "normal" anatomy and physiology of the human diaphragm, the frequency of electromyostimulating signals F _cc , determined by the formula F _cc = 1 / T _pach (see Fig. 3), in the generator of the repetition rate of pulse packets FCHSP 6 is formed within the "extended" physiological range respiration, for example, discretely adjustable from 11 to 25 breaths / min, thus achieving a wide choice of respiration rate during training impact on the diaphragm.

The ratio of duration τ _Pace packs to the gap between adjacent packs of pulses (T -τ _{Pace Pace),} namely τ _Pace / (T -τ _{Pace Pace)} is nothing else than the ratio of inhalation to exhalation. This ratio τ _pach / (T _pach -T _pach ) in the inhalation / exhalation shaper EFV 5, taking into account the physiology of human diaphragmatic respiration, for example, is discretely set 1: 1 and / or 1: 2.

Consider the procedure for conducting a diaphragm electromyostimulation session.

Before connecting electrodes 10 to the inputs of the EMC device 1, the following steps should be taken:

• smooth regulator of the pulse voltage amplitude (RN 8) is set to the extreme (zero) position;

• a discretely adjustable switch selects the respiration rate (FCHSP 6), for example, 16 breaths / min;

• a discretely adjustable inhalation / exhalation switch (EFV 5) selects the inhalation to exhalation ratio, for example, 1: 1,

then the procedure in the supine patient 12 is performed in the following sequence (patient 12 can carry out independently):

• include EMC device 1 (include power supply 13);

• a smooth regulator of the pulse voltage amplitude (PH 8) is set to the position of effective (reliable) contraction of the diaphragm in the absence of pain in patient 12, then, if necessary, this regulator maintains an effective contraction of the diaphragm during the entire session;

• if necessary, during the procedure, the breathing frequency is changed with a discretely controlled switch (FCHSP 6), and the ratio of inhalation to exhalation with a discretely adjustable inhalation / exhalation switch (FVV 5);

• the duration of the procedure is approximately 20-30 minutes;

• at the end of the procedure, turn off the EMC device 1 (turn off the power supply 13);

• disconnect the insulated wires of the electrodes 10 from the EMC apparatus 1;

• remove the elastic belt 11 with electrodes 10 from the patient's body.

Thus, in the proposed method of electromyostimulation of the diaphragm, by optimal selection and adjustment of the parameters of the output signal of the apparatus, high efficiency of electromyostimulation of diaphragmatic respiration is ensured, namely:

• formation of full-fledged inspiration and long-term continuous electrical myostimulation without diaphragm fatigue;

• effective contraction of the diaphragm, the correspondence of the stimulated contractions of the diaphragm to the modulation of the influencing signal (the absence of unexpected sudden efforts or weakening during the deployment of muscle contraction);

• modeling the electromyostimulation breathing process as close as possible to natural;

• comfort of the electrostimulation process (absence of pain), while achieving:

• training and restoration of breathing in case of various diseases (improvement of indicators of the respiratory system, ensuring the consumption of oxygen by the body and the release of carbon dioxide, compensation of respiratory failure);

• elimination of the consequences of lung damage during rehabilitation;

• in the intensive care unit, forced (forced) breathing of the patient when the ventilator is turned off;

• prevention and strengthening of the respiratory system (strengthening the muscle fibers of the diaphragm, which become stronger, more elastic, more susceptible to stress during breathing);

• increased blood flow to the heart;

• improvement of liver hemodynamics;

• positive massaging effects on the stomach and intestines;

• strengthening the back muscles.

Claims (2)

1. A method of electromyostimulation of diaphragmatic respiration, including the generation by a generator of pulse packs with a modulated pulse repetition rate in a packet, amplifying them in a power amplifier and supplying them through electrodes connected to the patient, fixing the electrodes on the patient's body in the diaphragm projection, while the front two active electrodes are placed in the projection of the attachment of the diaphragm to the chest, and the back two passive electrodes - on the back opposite the front electrodes, connect the isolated electrode wires to the switched off device with a preset zero value of the amplitude of the stimulating pulse voltage, turn on the device and supply to the electrodes a burst of pulses with a frequency varying along stepwise linear law of increase of frequency, is close to exponentially physiological inhalation, characterized in that the increase in pulse frequency in the stack of the initial (f _beginning) to a final (f _con) a pulse repetition frequency in a pack (Hz) osusches tvlyayut during Time 2 / 3τ _Pace with providing a higher rate of increase in the pulse frequency bundle in the initial portion from _{the beginning} to f (f _con - _nach f) / 2 where τ _Pace - burst duration (ms). 2. The method of electromyostimulation of diaphragmatic breathing according to claim 1, characterized in that during the procedure, if necessary, change the frequency of electromyostimulating signals F _cc = 1 / T _pach (breath / min) and the ratio of the duration of inspiration to the duration of exhalation, namely the ratio of the duration of the burst of impulses τ to _Pace interval between bursts of pulses (T _Pace - _Pace τ), where T _Pace - repetition period of bursts.

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