RU47201U1 - DEVICE FOR STUDYING HEMODYNAMICS OF INTERNAL BODIES - Google Patents

Abstract

The utility model relates to medical equipment, with which you can quickly and objectively assess the hemodynamics of internal organs during surgical interventions, including endosurgery, by determining the pressure in the intramural vessels of the hollow organs, pulse rate, the trend of saturation of hemoglobin with oxygen and displaying the photoplethysmogram of hollow and parenchymal organs and, without resorting to laparotomy, make a tactically correct decision. A device for studying the hemodynamics of internal organs, contains branches 1 and 3, a rigid chamber 2, hermetically sealed with an elastic membrane, a light source 4, and an overpressure source 8 connected to the rigid chamber 2 through a pressure gauge 7 with a rubber tube 6, while the rigid hermetic chamber 2 with an elastic membrane is installed on the first branch 1 of the device, and on the second branch 3 there is a two-wave light source 4 and a photodetector 5, the output of which is the output of the device. The device contains an automatic unit 10 for processing and digital indication of the pulse rate, the saturation trend of hemoglobin with oxygen and the display of the photoplethysmogram, connected to the photodetector 5 by wires of the cable 9.

Description

The utility model relates to medical equipment and can be used to study hemodynamics of internal organs during surgical interventions, including endosurgery.

Decisions of a number of significant issues of surgical tactics are associated with determining the state of hemodynamics in the intramural (intra-wall) vascular bed of internal organs. Violation of hemodynamics in the intramural vascular bed acts as a leading link in a number of pathological processes: strangulated hernias, intestinal obstruction, thrombosis and embolism of the mesenteric vessels, ischemic colitis. A number of complications of surgical operations on these organs are associated with impaired intramural hemodynamics: inconsistency of sutures during resections and anastomoses, preservation of non-viable sections of the intestine with intestinal obstruction, with acute circulatory disorders of the parenchymal organs due to injuries. This problem can be solved by determining the state of intramural hemodynamics.

The problem of evaluating (researching) the intramural hemodynamics of hollow and parenchymal organs, in particular in endosurgery (from mini-access), has not yet been solved.

Known works of Seagal M.Z. (Sigal MZ Transillumination during operations on the stomach. Moscow, 1964, p.29-30, 40) - [1], devoted to the study of intramural hemodynamics of hollow organs of the abdominal cavity. The intramural vascular network is of interest to the surgeon in connection with the search for the source of bleeding, the prevention of postoperative gastric hemorrhage, the prevention of ischemic necrosis of the preserved parts of the hollow organs, and the recognition of pathological processes according to the structural features of the vascular network. At the same time, the circulating blood when transillumination (transillumination) emits

intramural vessels against the background of surrounding structures. However, sometimes the ripple may be barely noticeable. The paper presents an original technique for determining blood pressure in extra- and intramural vessels - the maximum, minimum arterial and venous, based on the principle of manometrically controlled compression and visual observation of changes in blood flow during transillumination.

In 1977, the work "Study of blood pressure and blood flow in the intramural vessels of the intestine and other hollow organs during surgery" was published - (Segal Z.M. Study of blood pressure and blood flow in the intramural vessels of the intestine and other hollow organs during the operation. Author's dissertation Kazan, 1977, pp.3.5-7, 10-16, 25-29) - [2], where a method for determining the pressure in the intramural vessels of the hollow organs of the abdominal cavity was developed and experimentally tested.

In the experiment, using the method of intravital transillumination pigmented vasography, a real picture of blood flow through the vessels of the intestine is normal for the first time, with ligation of extraorgan vessels, intestinal obstruction and in the vessels of the intestinal transplant. A regular difference (p <0.05) was found for the indicators of maximum, minimum arterial and venous pressure in the intramural vessels of the proximal jejunum and terminal ileum. Measurements showed that blood pressure in the vessels of the mucous layer is significantly lower compared to pressure in other layers of the intestinal wall (p <0.05). The possibility is not excluded that this circumstance determines the initial necrosis of the mucous layer. A mismatch of blood pressure indices in the intramural arteries of the submucosal layer and arteries of the upper extremities was established. The phenomenon of interconversion of pulsed blood flow (the presence of maximum and pulse pressure, indicating full blood flow) and continuous (lack of maximum and pulse pressure, impaired blood circulation) is established. Arterial and

venous pressure in the intramural vessels of the intestine (in the vessels of the jejunum - 102.4 ± 2.9 / 73.8 ± 2.5; 37.1 ± 2.4, ileum - 70.1 ± 2.1 / 52.8 ± 1.8; 22.3 ± 1.4, blind - 74.0 ± 2.8 / 56.2 ± 2.8; 22.3 ± 4.2, transverse - 84.7 ± 3.3 / 60, 2 ± 2.9; 26.7 ± 2.9, sigmoid-79.1 ± 3.4 / 56.3 ± 2.8; 19.4 ± 2.7 mm Hg.However, indicators must be taken into account systemic pressure, since circulatory disorders in the intramural vessels of the hollow organs of the abdominal cavity may be a consequence of a drop in systemic pressure.

The developed method has the following features:

1. the pressure in individual vessels is determined (distinguished arteries and veins, intramural vessels of the hollow organs of the abdominal cavity, detected by transillumination);

2. The technique is "bloodless";

3. objects of research can be vessels of various calibers;

4. The method is based on the spreading of a hollow organ, tissues and blood vessels in combination with their transillumination.

Thus, the identification of intramural blood flow is necessary:

1. to determine the viability of the affected loop with intestinal obstruction, strangulated hernias, thrombosis and embolism of the mesenteric vessels, with ischemic and necrotic colitis, Crohn’s disease, non-occlusal hemocirculation disorders in the intestinal vessels of the intestine;

2. to address the issue of maintaining the affected loop, parenchymal organ, level and volume of resection;

3. to solve the problem of the presence or absence of ischemic bowel pathology (to maintain the viability of the affected intestine, the pressure in the arteries of the submucosal layer of the intestine must be at least 52/41 mm Hg, when pulse blood flow is present; positive dynamics in the intraparietal vessels, if at weakening of external pressure

there is a simultaneous passive filling of both arteries and veins from both segments of the vessels - the prognosis is unfavorable);

4. to select the location of the suture strip for resections;

5. to determine the viability of the graft;

6. to develop the most hemodynamically advantageous procedures for operations on hollow and parenchymal organs.

The disadvantages of this method are the inability to use in endosurgery due to the bulkiness of the design and due to the subjectivity of visual observation of changes in blood flow during transillumination, as well as the inability to assess the intramural hemodynamics of parenchymal organs.

Various devices are used to study intramural hemodynamics.

A device for studying the hemodynamics of hollow organs according to the copyright certificate No. 1426538, A 61 5/05, publ. 09/30/88, bull. No. 36 - [4], consisting of a pressure chamber made of coaxially located hollow cylinders. Hollow cylinders contain light sources (for transillumination) and have tubes connected to autonomous sources of overpressure. Hollow cylinders are provided with end elastic membranes. The pressure chamber is connected to the lower branches of the device. On the lower jaw mounted fixing and guide racks. The upper jaw is pivotally mounted on the fixing rack, which passes through the slot in the guide rack, equipped with a thread and a clamping nut. A transparent plate that articulates against the pressure chamber is pivotally mounted on the upper jaw.

When using the device, the investigated section of the hollow organ is placed between the pressure chamber and the opposite transparent plate, and the light source located in the coaxial hollow cylinders is turned on. Overpressure is supplied into the cavity of the central hollow cylinder through the pipe until blood is squeezed out of the vessels of the hollow organ into

projection of the elastic membrane, after which the pressure in the hollow cylinder is maintained at a constant level. Then, overpressure is fed into the cavity of the middle hollow cylinder through the pipe until the blood is completely displaced from the vessels of the hollow organ in the projection of the elastic membrane. In the central hollow cylinder decompress to zero. After that, in the cavity of the peripheral hollow cylinder through the pipe serves excess pressure until the blood is completely displaced from the vessels of the stomach in the projection of the elastic membrane. Then decompress to zero in the middle hollow cylinder. And with compression in the peripheral hollow cylinder, the presence or absence of vascular thrombosis of the hollow organ is judged by the presence of “unplaced blood”. Then decompression is performed in the peripheral hollow cylinder and the presence and nature of blood flow over a large area of the hollow organ is observed, its direction and sequence, blood pressure in all intraorgan vessels of the hollow organ is determined, based on which the presence or absence of ischemia, the state of intramural blood circulation are judged.

The disadvantages of this device are the inability to use in endosurgery due to the bulkiness of the design and due to the subjectivity of visual observation of changes in blood flow during transillumination by the presence or absence of thrombosed vessels, the complexity of the technique, the duration of the manipulations, the inability to evaluate the intramural hemodynamics of parenchymal organs.

A device is known (Pulse Oximeter "ELOX-01", Samara, E-mail: biotech@ssau.ru) - [5], in which the sensor emitter (two-wave light source) contains two emitting diodes of red and infrared, alternately fed by pulses current, which are formed in the synchronization device. The finger type sensor is a clamp, consisting of two elements, fastened by an axis, fixed on a finger by a spring. Emitters are installed in the first element, and a photodetector equipped with a convex lens is installed in the second element. The sensor is connected to the processing unit and digital display using a cable.

The radiation transmitted through biological tissues enters the photodetector of the sensor, from where the electrical signal enters the processing and digital indication unit. After digitalization, the constant and pulsating components are introduced into the microprocessor device through the input port, and information about the degree of oxygen saturation of the blood and heart rate is displayed on the liquid crystal display. The device probes a portion of the patient’s body (the first phalanx of the finger) with optical radiation at two wavelengths of the red and near infrared ranges. As a result of pulsations of arterial blood in the tissues, the transmitted radiation contains a pulsating component (pulse wave), the amplitude of which is associated with the absorption of radiation in the hemoglobin of arterial blood. The device determines the relative amplitude of the pulse wave at two wavelengths and calculates the degree (trend) of saturation of hemoglobin with oxygen according to the empirical formula. The heart rate is determined by counting the number of arterial pulsations over a known period of time. The data obtained are subjected to additional statistical processing in order to increase their reliability. The pulse oximeter also provides the display of a photoplethysmogram and a trend of hemoglobin oxygen saturation on a graphic liquid crystal display.

The principle of operation of the ELOX-01 pulse oximeter is based on the difference in spectral characteristics of hemoglobin saturated and unsaturated with oxygen, according to which the device displays the degree (trend) of hemoglobin saturation with oxygen and heart rate, and displays a photoplethysmogram graphically. The device in a short time provides an objective digital assessment of the degree of saturation of hemoglobin with oxygen and heart rate, which can be used to judge both hemodynamic disturbances and local ones.

The disadvantages of this device are the inability to use it in endosurgery due to the bulkiness of the design, the inability to assess the value of intramural pressure of blood vessels.

Known photoelectric sensor for plethysmograph according to copyright certificate No. 306834, A 61 V 5/02, A 61 V 1/32, publ. 04/21/1071 g. No. 20 - [3] contains a housing, in which the branch of the obstetric folding mirror is used. An insert with a selenium photocell mounted in it and a light source - a bulb, the working surfaces of which through special cutouts in the mirror branch are facing the wall of the vaginal cavity, is placed in the branch. Two pairs of insulated wires lead from the photocell and light bulb, respectively, to the recording device and power supply. The operation of the device is based on the fact that the light from the bulb through the cutouts in the branch of the mirror falls on the wall of the vaginal cavity and is reflected on the photocell. The intensity of light reflection depends on the amount of blood in a given area of the body. Since this amount of blood changes with each pulse push, there are pulse variations in the change in light reflection. Changes in reflected light are transformed in the photocell into variations in electrical potentials and then fed to a recording device (an encephalograph, an electrocardiograph), thus the intramural hemodynamics of the vaginal wall are evaluated.

The disadvantages of this device are the inability to use in endosurgery due to the bulkiness of the design, the inability to assess the value of intramural pressure of blood vessels, the device allows you to register only the degree of blood vessels.

For a comparative analysis with the claimed utility model, a device for measuring blood pressure in the vessels of hollow organs according to the copyright certificate No. 360075, A 61 B 5/02, publ. 11/28/72, bull. Number 36. - [6], consisting of a rigid camera, inside of which a light source, a light bulb, is installed. The camera is equipped with a fitting on which a rubber tube is mounted. The wires from the light bulb pass through the fitting, the rubber tube and are led out

out. The chamber is sealed from above by a membrane sandwiched between the inner and outer rings, which are pressed from above by a nut screwed onto the chamber body. Using a rubber tube, the chamber cavity is connected to a rubber bulb (pressure source) through a pressure gauge, by means of which increased pressure is created in the chamber. The device is equipped with elongated branches, one of which is made in the form of a metal tube rigidly connected to the camera and having racks, and the other in the form of a rail pivotally mounted on one of the racks and fixed in a certain position by a dog located on the other rack. At the end of the rail, the eyepiece with lens is pivotally fastened with the help of trims, washers and a screw.

When using the device, the studied section of the wall of the hollow organ (intestines, stomach and others) is installed between the planes of the nut and the eyepiece, the nut and the eyepiece are fixed with a dog and screw, turn on the bulb and blow air into the chamber with a bulb. The rubber membrane stretches under the action of air and presses on the fabric. At the same time, blood vessels are clamped primarily, since they have less resistance to compression. The pressure gauge determines at what pressure the pulsation of arteries visible through the eyepiece in the transmitted light (transillumination) stops and the veins fill with blood, open the valve on the manometer and vent excess air from the chamber and determine the pressure in the intraorgan vessels of the hollow organs, which determine the state of intramural hemodynamics .

The disadvantages of this device are the inability to use in endosurgery due to the bulkiness of the design and due to the subjectivity of visual observation of changes in blood flow during transillumination, the inability to assess the intramural hemodynamics of parenchymal organs.

The technical result, to which the claimed utility model is directed, is to expand the possibility of use

devices by studying the hemodynamics of internal organs during surgical interventions, including endosurgery, by determining the pressure in the intramural vessels of hollow organs and evaluating the intramural hemodynamics of parenchymal organs by pulse rate, degree of oxygen saturation of hemoglobin, photoplethysmogram, improving the accuracy of the device due to automatic and objective determination, digital indication of heart rate, degree of hemoglobin oxygen saturation, photoplethysmogram display.

The technical result is achieved by the fact that in a device for studying the hemodynamics of internal organs containing jaws, a rigid chamber sealed with an elastic membrane, a light source, as well as an overpressure source connected to the rigid chamber via a manometer, the novelty is that a rigid sealed chamber with an elastic membrane is installed on one branch of the device, and on the other branch there is a two-wave light source and a photodetector, the output of which is the output of the device, while the two-wave source The light source is made in the form of red and infrared LEDs, and an automatic processing unit and digital indication of the pulse rate, the hemoglobin oxygen saturation trend and the photoplethysmogram display are connected to the outputs of the photodetector.

The essence of the utility model is illustrated in figure 1, where:

1 - the first branch of the device;

2 - a rigid chamber with an elastic membrane;

3 - the second branch of the device;

4 - two-wave light source made in the form of red and infrared LEDs;

5 - photodetector;

6 - a rubber tube;

7 - manometer;

8 - source of overpressure (for example, a rubber bulb);

9 - cable;

10 - automatic processing unit and digital display.

A rigid chamber 2 with an elastic membrane is fixed on the first branch 1 of the device. On the second 3 branches of the device, a two-wave light source 4 is fixed, made in the form of red and infrared LEDs and 5 photodetectors. The cavity of the rigid chamber 2 with an elastic membrane is connected via a rubber tube 6 to a pressure source 8 (for example, a rubber bulb) through a pressure gauge 7, by means of which increased pressure is generated in the rigid chamber 2 with an elastic membrane. The photodetector 5 is connected by its wires to the cable 9 to an automatic unit 10 for processing and digitally displaying the pulse rate, the hemoglobin saturation trend with oxygen and the photoplethysmogram display.

A device for studying hemodynamics of internal organs works as follows.

The device is designed with the possibility of using it in endosurgery. After a visual examination of the internal organs using standard techniques of surgery and endosurgery, indications are given for the study of the hemodynamics of one or another hollow or parenchymal organ. A device is inserted into the abdominal cavity and the hollow organ is captured so that it is between the branches 1 and 3 of the device. The radiation from the two-wave light source 4 is reflected from the tissues of the hollow organ, perceived and converted by the photodetector 5 into an electrical signal, which is transmitted through the cable 9 to the automatic processing and digital display unit 10. The characteristics of the electrical signal generated by the photodetector 5, directly depend on the spectral characteristics of saturated and unsaturated oxygen hemoglobin. Automatic processing unit and digital display 10 calculates in

depending on the characteristics of the electric signal from the photodetector 5 and displays in digital form information on the pulse rate, the trend of hemoglobin oxygen saturation and photoplethysmogram, which can be used to preliminarily judge the state of intramural blood circulation of the organ.

Then, a source of excess pressure (for example, a rubber bulb) 8 is injected with excess pressure into a rigid chamber with an elastic membrane 2 through a tube 6, while the photodetector 5 continues to receive radiation reflected from the tissues of the organ under study from a two-wave light source 4, and the automatic processing unit also digital Indication 10 continues the objective determination of the pulse rate, the trend of saturation of hemoglobin with oxygen and the display of the photoplethysmogram. The pressure inside the rigid chamber 2 with an elastic membrane as the source of overpressure 8 is injected increases and is measured by a manometer 7. Overpressure through the elastic membrane of the rigid chamber 2 acts primarily on the walls of the intramural vessels of the organ under investigation, causing their occlusion and, therefore, termination ripple, which is digitally displayed on the display of the automatic processing unit and digital display 10 and recorded, while on the gauge 7 the indicator will reflect the pressure in the intramural GOVERNMENTAL vessels investigated a hollow organ.

To study the hemodynamics of the parenchymal organ, a second jaw 3 of the device is applied to its surface, on which a two-wave light source 4 and a photodetector 5 are attached. Radiation from a two-wave light source 4 is reflected from the tissues of the parenchymatous organ and received by the photodetector 5 into an electrical signal, which is transmitted through the cable 9 transmitted to the automatic unit 10 for processing and digital indication, the display of which displays information in digital form on the pulse rate, saturation trend g emoglobin

oxygen, photoplethysmogram, which can be used to judge the state of intramural blood circulation of the parenchymal organ.

Thus, using the device for studying the hemodynamics of internal organs, one can quickly and objectively assess the hemodynamics of internal organs during surgical interventions, including endosurgery, by determining the pressure in the intramural vessels of the hollow organs, pulse rate, the trend of saturation of hemoglobin with oxygen and displaying the photoplethysmogram of hollow and parenchymal organs and, without resorting to laparotomy, make a tactically correct decision.

Clinical studies of the device, conducted at the Department of General Emergency Surgery, Kazan State Medical Academy, showed the feasibility and performance of the proposed technical solution and the achievement of a technical result.

Claims (3)

1. A device for studying the hemodynamics of internal organs, containing jaws, a rigid chamber, hermetically sealed with an elastic membrane, a light source, as well as an overpressure source connected to the rigid chamber through a manometer, characterized in that the rigid sealed chamber with an elastic membrane is mounted on one jaw device, and on the other branch there is a two-wave light source and a photodetector, the output of which is the output of the device. 2. A device for studying hemodynamics of internal organs according to claim 1, characterized in that the two-wave light source is made in the form of red and infrared LEDs. 3. A device for studying hemodynamics of internal organs according to claim 1, characterized in that it further comprises an automatic processing unit and a digital indication of the pulse rate, the saturation trend of hemoglobin with oxygen and the display of the photoplethysmogram connected to the photodetector.