WO2016188343A1 - Procédé et dispositif pour estimer la résistance et la compliance à l'air - Google Patents

Procédé et dispositif pour estimer la résistance et la compliance à l'air Download PDF

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Publication number
WO2016188343A1
WO2016188343A1 PCT/CN2016/082321 CN2016082321W WO2016188343A1 WO 2016188343 A1 WO2016188343 A1 WO 2016188343A1 CN 2016082321 W CN2016082321 W CN 2016082321W WO 2016188343 A1 WO2016188343 A1 WO 2016188343A1
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value
flow rate
control period
pressure
formula
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PCT/CN2016/082321
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English (en)
Chinese (zh)
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张开军
唐潮根
伍海波
李增
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深圳市科曼医疗设备有限公司
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Publication of WO2016188343A1 publication Critical patent/WO2016188343A1/fr

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/021—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes operated by electrical means
    • A61M16/022—Control means therefor
    • A61M16/024—Control means therefor including calculation means, e.g. using a processor
    • A61M16/026—Control means therefor including calculation means, e.g. using a processor specially adapted for predicting, e.g. for determining an information representative of a flow limitation during a ventilation cycle by using a root square technique or a regression analysis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/08—Detecting, measuring or recording devices for evaluating the respiratory organs
    • A61B5/085—Measuring impedance of respiratory organs or lung elasticity

Definitions

  • the present invention relates to the field of medical device technology, and in particular to a method and apparatus for estimating air resistance and compliance.
  • the ventilator mainly provides fresh air to patients with respiratory disorders.
  • the compliance of the lungs and the resistance of the lungs are two important parameters.
  • Lung compliance and lung resistance ie, air resistance
  • the compliance of the lungs and the resistance of the pipeline are difficult to calculate directly.
  • the flow rate and pressure values flowing through the breathing circuit are used for estimation.
  • the pressure value obtained by the exhalation pressure sensor is generally the airway pressure
  • the difference between the flow value obtained by the suction end flow sensor and the exhalation flow sensor is the flow rate value
  • Method 1 Based on the breathing circuit pressure formula, using multiple sampling values of airway pressure p and flow velocity v, direct estimation of air resistance R and compliance C by least squares method;
  • Method 2 Establish a systematic RC respiratory mechanics model based on the transfer function of the Z domain of the model (where: a 1 , b 0 , b 1 , b 2 are coefficients to be estimated), using the sample values of the airway pressure p and the flow velocity v, the gas resistance R and the compliance C are estimated using the least squares method.
  • the flow rate takes time from the flow sensor to the pressure sensor.
  • the current flow rate value may be disturbed by the flow rate value of the previous control cycle and limited by the accuracy of the sensor.
  • the estimation accuracy of the two methods is not high, which affects the accuracy of ventilator pressure control ventilation.
  • the problem of estimating the air resistance and compliance during the sampling period is that the flow rate is not constant and the hysteresis of the flow rate is weakened and the flow rate is affected, the accuracy of the air resistance and compliance is improved, and the accuracy of the pressure control ventilation is effectively improved.
  • Device
  • a method of estimating gas resistance and compliance comprising:
  • the air resistance and compliance of the breathing circuit are calculated based on the coefficients of the transfer function.
  • the breathing circuit includes an inspiratory limb and an expiratory limb, the first formula being:
  • P n is the pressure value of the nth control period
  • pinsp is the value of the inspiratory branch at the end of the current control period or at the beginning of the next control period
  • pexp is the end of the current control period or the start of the next control period
  • the expiratory branch pressure values at the time, k 2 and k 3 are coefficients and are constants, respectively.
  • the second formula is:
  • finsp(i) is the value of the i-th inspiratory branch flow rate during the control period
  • fexp(i) is the value of the i-th exhalation branch flow rate during the control period
  • s( i) is the percentage of the difference between the i-th actual flow rate value finsp(i)-fexp(i) in the control period and the average flow rate in the control period as a percentage of the flow rate variance in the control period
  • k 1 is a coefficient and is constant
  • n To control the number of samples in the cycle.
  • the method further includes:
  • Adjusting the coefficients of the corresponding first formula and the second formula in each segment according to a preset rule, and estimating the pressure value in the control period in each segment according to the coefficient-adjusted first formula and the second adjustment according to the coefficient The formula estimates the flow rate value over the control period within each segment.
  • the method before the step of collecting the pressure value and the flow rate value of the breathing circuit in real time, the method further includes:
  • a device for estimating air resistance and compliance comprising:
  • the acquisition module is configured to collect the pressure value and the flow rate value of the breathing circuit in real time
  • a pressure value estimating module configured to estimate a pressure value in the control period by using the collected pressure value and the first formula
  • a flow rate value estimating module configured to estimate a flow rate value within the control period by using the collected flow rate value and a second formula
  • a coefficient estimating module configured to use a pressure value in the control period as an output value of a transfer function of a respiratory mechanics model, and use a flow rate value in the control period as an input value of the transfer function to estimate the transfer function coefficient;
  • a calculation module configured to calculate a gas resistance and compliance of the breathing circuit according to a coefficient of the transfer function.
  • the breathing circuit includes an inspiratory limb and an expiratory limb, the first formula being:
  • P n is the pressure value of the nth control period
  • pinsp is the value of the inspiratory branch at the end of the current control period or at the beginning of the next control period
  • pexp is the end of the current control period or the start of the next control period
  • the expiratory branch pressure values at the time, k 2 and k 3 are coefficients and are constant, respectively.
  • the second formula is:
  • finsp(i) is the value of the i-th inspiratory branch flow rate during the control period
  • fexp(i) is the value of the i-th exhalation branch flow rate during the control period
  • s( i) is the percentage of the difference between the i-th actual flow rate value finsp(i)-fexp(i) in the control period and the average flow rate in the control period as a percentage of the flow rate variance in the control period
  • k 1 is a coefficient and is constant
  • n To control the number of samples in the cycle.
  • the apparatus further includes:
  • a curve drawing module configured to draw a pressure-volume curve of the breathing circuit according to the volume value corresponding to the collected pressure value and the actual flow rate value;
  • a segmentation module configured to segment the collected pressure value and the flow rate value according to the inflection point
  • a segment estimation module configured to adjust a coefficient of the corresponding first formula and the second formula in each segment according to a preset rule, and estimate a pressure value in a control period in each segment according to the first formula after the coefficient adjustment
  • the flow rate value within the control period within each segment is estimated based on the second formula after the coefficient adjustment.
  • the apparatus further includes:
  • the opening adjustment module is configured to obtain an opening value of the control valve in a control period, and adjust a flow rate value of the breathing circuit according to the opening value.
  • Method and device for estimating air resistance and compliance real-time collecting pressure value and flow rate value of breathing circuit; estimating pressure value in control period by using collected pressure value and first formula; using collected flow rate value and second formula Estimating the flow rate value in the control period; using the pressure value in the control period as the output value of the transfer function of the respiratory mechanics model, using the flow rate value in the control period as the input value of the transfer function, estimating the coefficient of the transfer function; The coefficients calculate the air resistance and compliance of the breathing circuit.
  • the collected pressure value and the first formula estimate the pressure value within the control period
  • the collected flow rate value and the The second formula estimates the flow rate value in the control period, and introduces the pressure value in the control period and the flow rate value in the control period into the transfer function of the respiratory mechanics model, instead of directly applying the pressure value and the flow rate value collected in real time to the respiratory mechanics.
  • the transfer function of the model overcomes the limitation of the accuracy of the sensor.
  • the flow rate is not constant during the sampling period and the influence of the hysteresis of the flow rate and the flow rate is weakened, effectively reducing the hysteresis of the gas in the breathing circuit and mutual interference. influences.
  • the pressure value and the flow rate value in the control period are introduced into the transfer function to estimate the coefficient of the transfer function, and the gas resistance and compliance of the breathing circuit are calculated according to the coefficient of the transfer function, thereby improving the estimation accuracy of the air resistance and the compliance. Therefore, it provides a guarantee for effectively improving the accuracy of pressure control ventilation.
  • 1 is a flow chart of a method for estimating air resistance and compliance in one embodiment
  • Figure 2 is a schematic illustration of a breathing circuit in one embodiment
  • Figure 3-1 is a schematic structural view of a respiratory mechanics model in one embodiment
  • 3-2 is a schematic structural view of a respiratory mechanics model in still another embodiment
  • 3-3 is a schematic structural view of a respiratory mechanics model in another embodiment
  • 3-4 is a schematic structural view of a respiratory mechanics model in still another embodiment
  • Figure 4 is a schematic view of a volume-pressure curve in one embodiment
  • Figure 5 is a schematic view showing the structure of an apparatus for estimating air resistance and compliance in one embodiment
  • Figure 6 is a schematic view showing the structure of a device for estimating air resistance and compliance in still another embodiment
  • Fig. 7 is a schematic view showing the structure of an apparatus for estimating air resistance and compliance in another embodiment.
  • a method of estimating air resistance and compliance comprising:
  • step 102 the pressure value and the flow rate value of the breathing circuit are collected in real time.
  • the breathing circuit includes an inspiratory limb and an expiratory limb, which are placed on the ventilator or anesthesia machine.
  • a schematic diagram of the breathing circuit is shown in FIG. 2, wherein the inhalation branch 202 is provided with a first pressure sensor 204, and at the beginning of the inhalation branch, a first flow sensor 206 is provided, and one side of the first flow sensor is provided with control Valve 208.
  • a second pressure sensor 212 is disposed on the expiratory limb 210, and a second flow sensor is disposed on the expiratory limb 214.
  • the first pressure sensor 204, the first flow sensor 206, the second pressure sensor 212, the second flow sensor 214, and the control valve 208 are coupled to the controller 216, respectively.
  • the inspiratory and expiratory branches are connected by a Y-tube 218 and connected to the patient via a Y-tube 218.
  • the gas in the inhalation branch is a mixed gas of oxygen and air
  • the gas in the expiratory branch is the gas exhaled by the patient.
  • the pressure value of the breathing circuit includes the inspiratory branch pressure value and the expiratory branch pressure value
  • the breathing circuit flow rate value includes the inspiratory branch flow rate value and the expiratory branch flow rate value.
  • the collected pressure and flow rate values of the breathing circuit are also referred to as sampled data. If the sampled data accurately reflects the original pressure value and the original flow rate value in the breathing circuit, it can be considered as the pressure value and flow rate value of the breathing circuit collected in real time.
  • Step 104 estimating the pressure value in the control period by using the collected pressure value and the first formula.
  • the first formula is: Where P n is the pressure value of the nth control period, pinsp is the value of the inspiratory branch at the end of the current control period or at the beginning of the next control period, and pexp is the end of the current control period or the start of the next control period
  • the expiratory branch pressure values at the time, k 2 and k 3 are constants, respectively. Specifically, k 2 may be 0 or 1, and k 3 may be 0 or 1.
  • Step 106 estimating the flow rate value in the control period by using the collected flow rate value and the second formula.
  • the second formula is: Where Fn is the flow rate value of the nth control cycle, finsp(i) is the value of the i-th inspiratory branch flow rate during the control period, and fexp(i) is the value of the i-th exhalation branch flow rate during the control period, s( i) is the percentage of the difference between the i-th actual flow rate value finsp(i)-fexp(i) in the control period and the average flow rate in the control period as a percentage of the variance of the flow rate in the control period, k 1 is a constant, and n is the control period The number of internally sampled values. Specifically, k 1 may be 0 or 1.
  • step 108 the pressure value in the control period is taken as the output value of the transfer function of the respiratory mechanics model, and the flow rate value in the control period is used as the input value of the transfer function to estimate the coefficient of the transfer function.
  • a schematic diagram of the structure of the respiratory mechanics model can be represented by any one of Fig. 3-1, Fig. 3-2, Fig. 3-3 and Figs. 3-4.
  • the transfer function of the respiratory mechanics model can be the transfer function of the Z domain.
  • a 1 , b 0 , b 1 and b 2 are coefficients that need to be estimated.
  • the pressure value in the control period is taken as the output value of the transfer function
  • the coefficients of the transfer function are estimated using the least squares method, ie, the values of a 1 , b 0 , b 1 , and b 2 are estimated.
  • Step 110 calculating the air resistance and compliance of the breathing circuit based on the coefficients of the transfer function.
  • the coefficient of the transfer function can calculate the component values in the respiratory mechanics model, and calculate the corresponding equivalent resistance and equivalent capacitance according to the connection relationship between the components in the respiratory mechanics model to obtain the total air resistance and total compliance of the breathing circuit.
  • the first resistor R1 and the first capacitor C1 are connected in series to form a first branch
  • the second resistor R2 and the second capacitor C2 are connected in series to form a second branch
  • the first branch is connected in parallel with the second branch.
  • Any one of a 1 , b 0 , b 1 , and b 2 in the transfer function can be regarded as a function of variables R1, R2, C1, and C2, according to the first resistance, the first capacitance, the second resistance, and The connection relationship of the second capacitor is calculated to obtain an equivalent resistance value and an equivalent capacitance value.
  • the equivalent resistance value is the total air resistance of the breathing circuit
  • the equivalent capacitance is the total compliance of the breathing circuit.
  • the pressure value and the flow rate value of the breathing circuit are collected in real time; the pressure value in the control period is estimated by using the collected pressure value and the first formula; and the flow rate in the control period is estimated by using the collected flow rate value and the second formula Value; the pressure value in the control period is taken as the output value of the transfer function of the respiratory mechanics model, the flow rate value in the control period is used as the input value of the transfer function, the coefficient of the transfer function is estimated; and the gas of the breathing circuit is calculated according to the coefficient of the transfer function Resistance and compliance.
  • the collected pressure value and the first A formula estimates the pressure value in the control period
  • the collected flow rate value and the second formula estimates the flow rate value in the control period
  • the flow rate is not constant during the sampling period, and the hysteresis of the flow rate and the flow rate are affected. Effectively reduce the hysteresis of the gas in the breathing circuit and the effects of mutual interference.
  • the pressure value and the flow rate value in the control period are introduced into the transfer function to estimate the coefficient of the transfer function, and the gas resistance and compliance of the breathing circuit are calculated according to the coefficient of the transfer function, thereby improving the estimation accuracy of the air resistance and the compliance. Therefore, it provides a guarantee for effectively improving the accuracy of pressure control ventilation.
  • the method before the step of collecting the pressure value and the flow rate value of the breathing circuit in real time, the method further comprises: acquiring an opening value of the control valve in the control period, and adjusting a flow rate value of the breathing circuit according to the opening value.
  • the response time of different types of control valves is different, and the control cycle of the control valve is determined according to the response time of the control valve and the control effect.
  • the control period is generally 10ms to 20ms.
  • the sampling frequency of the breathing circuit pressure value and the flow rate value is determined according to the ratio of the response time of the control valve in the control period, and the sampling frequency is a multiple of the control frequency.
  • the selection of the sampling period depends on the ratio of the response time of the control valve to the control period. For example, the ratio is 50%, and the sampling period is selected to be 0.2* control period.
  • the opening value of the control valve can be adjusted.
  • the opening value of the control valve is correspondingly increased, and the flow rate value of the corresponding breathing circuit is increased.
  • the controller changes the opening value at the end of each control cycle, for example, the opening value is 30% in the first control period, and the opening value is changed to 40% in the second control period.
  • the method further comprises: drawing a pressure-volume curve of the breathing circuit according to the volume value corresponding to the collected pressure value and the actual flow rate value; acquiring the pressure- The inflection point in the volume curve; the pressure value and the flow rate value collected according to the inflection point are respectively segmented; the corresponding first formula and the coefficient of the second formula in each segment are adjusted according to a preset rule, and the coefficient is adjusted according to the coefficient a formula to estimate the pressure value and the basis of the control cycle within each segment The adjusted second formula is used to estimate the flow rate value within the control period within each segment.
  • the actual flow rate value refers to finsp(i)-fexp(i).
  • a volume value corresponding to each actual flow rate value is calculated.
  • the volume value (intake branch flow rate value - expiratory branch flow rate value) * sampling time, according to the expiratory branch pressure and volume value to generate the pressure-volume curve of the breathing circuit. Since the breathing circuit is long, the flow rate takes time from the first flow sensor to the second pressure sensor and the current flow rate value may be disturbed by the flow rate value of the previous control cycle. In order to accurately characterize the flow rate value and pressure value for each control cycle, it is necessary The collected pressure value and flow rate value are segmented.
  • the collected pressure value and flow rate value may be separately segmented according to the inflection point in the pressure-volume curve.
  • the pressure value in the control period of each segment is estimated according to the first formula adjusted according to the coefficient in the different segments, and the flow rate value in the control period in each segment is estimated according to the second formula after the coefficient adjustment.
  • the inspiratory curve has two intersections with the expiratory curve, points A and B.
  • P is the inflection point of the inspiratory curve, specifically, by judging the ratio of the variation value ⁇ v(n) of the inner sample period to the change value of the pressure ⁇ p(n) and the variation value ⁇ v of the inner volume of the previous sampling period (n-1) Whether the ratio of the change value of pressure ⁇ p(n-1) is greater than the threshold value, and if so, it indicates that there is an inflection point, that is, point P, in the inhalation branch curve, and the collected pressure value and flow rate can be obtained according to point P.
  • the values are divided into two segments.
  • the first segment corresponds to point A and point P
  • the second segment corresponds to point P and point B.
  • k1 0 to estimate the flow rate value for each control cycle.
  • a device for estimating air resistance and compliance comprising: an acquisition module 502, a pressure value estimation module 504, a flow rate value estimation module 506, a coefficient estimation module 508, and Calculation module 510, wherein:
  • the acquisition module 502 is configured to collect the pressure value and the flow rate value of the breathing circuit in real time.
  • the pressure value estimating module 504 is configured to estimate the pressure value in the control period by using the collected pressure value and the first formula.
  • the breathing circuit includes an inspiratory limb and an expiratory limb, the first formula being: Where P n is the pressure value of the nth control period, pinsp is the value of the inspiratory branch at the end of the current control period or at the beginning of the next control period, and pexp is the end of the current control period or the start of the next control period.
  • P n is the pressure value of the nth control period
  • pinsp is the value of the inspiratory branch at the end of the current control period or at the beginning of the next control period
  • pexp is the end of the current control period or the start of the next control period
  • the expiratory branch pressure values at the time, k 2 and k 3 are coefficients and are constants, respectively.
  • the flow rate value estimating module 506 is configured to estimate the flow rate value in the control period by using the collected flow rate value and the second formula.
  • the second formula is: Where Fn is the flow rate value of the nth control cycle, finsp(i) is the value of the i-th inspiratory branch flow rate during the control period, and fexp(i) is the value of the i-th exhalation branch flow rate during the control period, s( i) is the percentage of the difference between the i-th actual flow rate value finsp(i)-fexp(i) in the control period and the average flow rate in the control period as a percentage of the flow rate variance in the control period, k 1 is a coefficient and is constant, n To control the number of samples in the cycle.
  • the coefficient estimation module 508 is configured to use the pressure value in the control period as the output value of the transfer function of the respiratory mechanics model, and use the flow rate value in the control period as the input value of the transfer function to estimate the coefficient of the transfer function.
  • the calculation module 510 is configured to calculate the air resistance and compliance of the breathing circuit according to the coefficients of the transfer function.
  • the apparatus further includes: a curve drawing module 512, an obtaining module 514, a segmentation module 516, and a segment estimating module 518, wherein:
  • the curve drawing module 512 is configured to draw a pressure-volume curve of the breathing circuit according to the volume value corresponding to the collected pressure value and the actual flow rate value.
  • the acquisition module 514 is configured to acquire an inflection point in the pressure-volume curve.
  • the segmentation module 516 is configured to separately segment the collected pressure value and the flow rate value according to the inflection point.
  • the segment estimation module 518 is configured to adjust the coefficients of the corresponding first formula and the second formula in each segment according to a preset rule, and estimate the pressure value in the control period in each segment according to the first formula after the coefficient adjustment And estimating the flow rate value within the control period of each segment according to the second formula after the coefficient adjustment.
  • the apparatus further includes an opening adjustment module 520 for acquiring an opening value of the control valve during the control period, and adjusting a flow rate value of the breathing circuit according to the opening value.

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Abstract

L'invention concerne un procédé pour estimer la résistance et la compliance à l'air, comprenant les étapes consistant à : acquérir en temps réel des valeurs de pression et des valeurs de débit d'un circuit respiratoire (102); estimer les valeurs de pression dans une période de commande à l'aide des valeurs de pression acquises et d'une première formule (104); estimer les valeurs de débit acquises dans la période de commande à l'aide des valeurs de débit acquises et d'une seconde formule (106); estimer des coefficients d'une fonction de transfert d'un modèle mécanique respiratoire à l'aide des valeurs de pression dans la période de commande en tant que valeurs de sortie de la fonction de transfert et à l'aide des valeurs de débit dans la période de commande en tant que valeurs d'entrée de la fonction de transfert (108); et calculer la résistance et la compliance à l'air du circuit respiratoire en fonction des coefficients de la fonction de transfert (110). A l'aide de ce procédé, on surmonte les limites dans la précision de détection et le problème du débit changeant dans une période d'échantillonnage, on peut réduire l'influence exercée par le retard de débit et l'interférence mutuelle de débits, on améliore la précision d'estimation de la résistance et de la compliance à l'air, et on améliore de manière efficace la précision de ventilation régulée en pression. En outre, l'invention concerne un dispositif pour estimer la résistance et la compliance à l'air.
PCT/CN2016/082321 2015-05-27 2016-05-17 Procédé et dispositif pour estimer la résistance et la compliance à l'air WO2016188343A1 (fr)

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CN105854142B (zh) * 2016-05-10 2018-08-31 苏州鱼跃医疗科技有限公司 一种基于反向传播算法的呼吸机治疗压力稳定方法
CN111888599B (zh) * 2018-12-10 2022-10-04 深圳市科曼医疗设备有限公司 呼吸机压力维持装置
CN112169103A (zh) * 2020-09-27 2021-01-05 湖南明康中锦医疗科技发展有限公司 自适应调整升降压速度的方法及其应用、呼吸支持设备
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