WO2018212067A1 - 増悪予兆装置、酸素濃縮装置および増悪予兆システム - Google Patents
増悪予兆装置、酸素濃縮装置および増悪予兆システム Download PDFInfo
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- WO2018212067A1 WO2018212067A1 PCT/JP2018/018130 JP2018018130W WO2018212067A1 WO 2018212067 A1 WO2018212067 A1 WO 2018212067A1 JP 2018018130 W JP2018018130 W JP 2018018130W WO 2018212067 A1 WO2018212067 A1 WO 2018212067A1
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Definitions
- the present invention relates to an exacerbation predicting device, an oxygen concentrating device, and an exacerbation predicting system, and in particular, makes it possible to predict acute exacerbation of HOT patients mainly in patients with respiratory diseases who receive home oxygen therapy in advance, and to promptly respond to them.
- the present invention relates to a configuration capable of providing information useful for determining or changing diagnosis and treatment policy by a medical person at times.
- Respiratory gas supply device (hereinafter also referred to as oxygen concentrator) for separating and concentrating oxygen in the air to obtain an oxygen-enriched gas
- oxygen concentrator for separating and concentrating oxygen in the air to obtain an oxygen-enriched gas
- various diseases exhibiting hypoxemia mainly in patients with respiratory diseases In contrast, prescribing oxygen therapy using an oxygen concentrator has become increasingly popular.
- Such oxygen therapy may be performed while the patient is admitted to a medical institution, but the patient's basic disease (various diseases such as respiratory disease, heart disease, etc. that exhibit hypoxemia) present chronic symptoms, If it is necessary to perform this oxygen therapy across the body to calm and stabilize the symptoms, the above oxygen concentrator is installed in the patient's home and the oxygen concentrator supplied by the oxygen concentrator is enriched.
- the above-mentioned home oxygen therapy has been prescribed mainly for chronic obstructive pulmonary disease (COPD) and pulmonary tuberculosis sequelae since insurance was applied in 1985.
- COPD chronic obstructive pulmonary disease
- pulmonary tuberculosis sequelae since insurance was applied in 1985.
- the outline of the number of patients is about 260,000 in Japan, and about 160,000 patients are receiving home oxygen therapy (as of 2016).
- HOT patients home treatment
- SpO2 percutaneous arterial oxygen saturation
- Non-Patent Document 1 for 89 months of COPD patients, (1) 8:00 to 16:00, (2) 16:00 to 24:00, (3) 24:00 to 8:00 Observing the average respiratory rate during this period, all 30 patients who were hospitalized due to COPD exacerbation showed a tendency for the average respiratory rate to increase from 5 days before. Further, as shown in Patent Document 1 and Patent Document 2, a system capable of predicting COPD exacerbation has been devised in monitoring with an average respiratory rate or a median respiratory rate.
- Non-Patent Document 2 are examining the effectiveness of telemedicine for patients with severe chronic obstructive pulmonary disease using a bidirectional transmission / reception system equipped with a one-way transmission / reception system and a videophone.
- this examination result as a result of reading various biological information parameters of patients who were hospitalized due to acute exacerbation from home therapy diary, (1) arterial oxygen saturation (SaO2) showed a significant decrease from 10 days before hospitalization (2) Increase in heart rate (HR), increase in respiratory rate (RR), increase in body temperature (BT), change in body weight (BW), respectively, showed significant changes from about 3 weeks before admission It has been revealed.
- SaO2 arterial oxygen saturation
- Non-Patent Document 3 whether or not it is possible to predict the transition from respiratory muscle fatigue to ventilatory assistance with a ventilator by conducting a respiratory physiological test on a patient with chronic respiratory failure. Are considering. In this examination result, it has been clarified that the ratio of the tidal volume to the vital capacity (VT / VC) and the respiratory rate per minute (RR) are predictive values of respiratory muscle fatigue.
- VT / VC vital capacity
- RR respiratory rate per minute
- JP 2016-137251 A Japanese Patent No. 5916618 JP 2002-85566 A
- the average respiratory rate and median indicators reported so far take into account the effects of exertion during arousal and the effects on the respiratory rate due to changes in the sleep stage (respiration rate fluctuation) during sleep.
- an oxygen concentrator having a respiration detection means embodied by a pressure detection unit for supplying an oxygen-concentrated gas in synchronism with patient inspiration is not configured to enable continuous observation of biological information and prediction of the occurrence of acute exacerbations, and medical professionals in medical institutions cannot quickly know the signs of exacerbations. It was.
- the present invention has been made in view of the above-described situation, and it is possible to accelerate acute exacerbation of HOT patients centered on respiratory disease patients who are treated at home without incurring economical burdens and troublesome operations. It is also intended to be capable of predicting in advance with high accuracy and enabling quick response.
- the respiratory rate is reduced for a certain time from the respiratory detection means for continuously detecting the respiratory data of the patient and the continuous respiratory data of the detected patient.
- a calculation means for calculating stable respiration data which is respiration data in a stable state, and a prediction for predicting the occurrence of acute exacerbation in the patient according to the stable respiration data calculated for a certain period of time
- an exacerbation prediction apparatus comprising the means.
- a generating means for concentrating oxygen from the air to generate an oxygen-enriched gas, an oxygen supply passage for supplying the generated oxygen to a patient, and the oxygen supply passage are provided.
- Breathing detection means for continuously detecting the breathing data of the patient, and breathing data in a state where the respiratory rate is stable for a certain period of time from the detected breathing data of the patient.
- an oxygen concentrator comprising: calculation means for calculating certain stable breathing data; and prediction means for predicting occurrence of acute exacerbation in the patient according to the stable breathing data calculated for a certain period.
- a patient-side terminal comprising: a breathing detection unit that continuously detects breathing data of a patient; and a transmission unit that transmits all the detected breathing data of the patient to the outside. And receiving the transmitted breathing data of the patient, and stable breathing which is a breathing data in a state in which the respiratory rate is lowered for a certain time and is stable from the received continuous breathing data of the patient
- An exacerbation prediction system comprising: a calculation means for calculating data; and an external terminal provided with prediction means for predicting the occurrence of acute exacerbation in the patient according to the stable breathing data calculated for a certain period of time.
- an acute exacerbation of a HOT patient centered on a respiratory disease patient who is treated at home can be predicted in an early stage with high accuracy without incurring an economic burden and troublesome operation. Rapid response is possible.
- FIG. 1 is a configuration diagram of an oxygen concentrator equipped with an exacerbation predicting apparatus which is a preferred example according to an embodiment of the present invention.
- the oxygen concentrator 1 of the present embodiment is a device that separates nitrogen in the air and supplies high-concentration oxygen (oxygen-enriched gas) mainly for use in home oxygen therapy. For example, nitrogen is selectively selected from oxygen.
- the molecular sieve zeolite 5A, 13X or lithium-based zeolite as an adsorbent that can be adsorbed on the adsorption cylinder is filled in the adsorption cylinder (in the adsorption unit 5), and the compressed air produced by the air compressor (compressor 4) is filled in the adsorption cylinder.
- This is a pressure fluctuation adsorption type oxygen concentrator that takes out oxygen-enriched gas by supplying it.
- the arrows connecting the blocks represent the air flow
- the solid line represents the electrical connection between the blocks.
- the compressor 4 includes a compressor drive motor for driving the compressor 4, and the compressor drive motor is a drive generated and output by the power supply control unit 3 so as to realize the rotation speed set by the flow rate control unit 14 a ⁇ ⁇ described later.
- the compressor 4 is driven to rotate according to the current.
- the compression mechanism portion of the compressor 4 compresses air by the rotational force obtained by the compressor drive motor, and there are various types depending on the compression method, such as a reciprocating piston type and a rotary scroll type. However, any type may be used as long as it can compress air in the atmosphere.
- the power supply control unit 3 has a function of supplying power to each component included in the apparatus 1 in addition to the drive current output for driving the compressor 4 as described above.
- the conventional typical fixed installation type oxygen concentrator is a method of supplying power only from a household AC power source. It is also possible to change to a three-way power supply system using a built-in battery, a household AC power supply, and a car DC power supply.
- the power supply input end 2 is provided on the outer peripheral portion of the casing facing the outside of the apparatus, and power is supplied by DC from the AC power supply unit 15 or the in-vehicle power supply unit 16 connected to the cigarette lighter contact in the automobile through this. I can receive it.
- a battery 13 that can be repeatedly charged in a removable manner is provided inside the oxygen concentrator 1, and when power cannot be supplied through the power input terminal 2, the battery 13 discharges power. Power is supplied to the control unit 3.
- the battery 13 is normally charged with the power supplied from the AC power supply unit 15 or the in-vehicle power supply unit 16 via the power supply input terminal 2 and the power supply control unit 3 while the battery 13 is attached to the oxygen concentrator 1. It is executed by being supplied.
- the oxygen concentrator 1 of this embodiment which is a pressure fluctuation type adsorbent oxygen concentrator, has an adsorption cylinder (adsorption unit) filled with an adsorbent that selectively adsorbs nitrogen rather than oxygen. 5), the compressed air compressed by the compressor 4 from the atmosphere is supplied, the inside of the adsorption cylinder is pressurized, nitrogen is adsorbed, and oxygen that has not been adsorbed is taken out.
- the oxygen-enriched gas mainly composed of oxygen taken out from the adsorption cylinder is stored in the product tank 6 and then supplied from the product supply end 9 to the outside of the apparatus 1 through the sensor unit 7 and the respiration detection unit 8, and is enriched with oxygen.
- the gas is supplied to the user (oxygen therapy patient) via the nasal cannula 1c, which is a tube member that transports the gasified gas from the oxygen concentrator 1 to the vicinity of the patient's nasal cavity.
- the flow switching valve is switched before the amount of nitrogen adsorbed on the adsorbent is saturated.
- the adsorption cylinder is opened to the atmosphere, the pressure inside the adsorption cylinder is reduced, and nitrogen is desorbed to regenerate the adsorbent.
- the flow path switching valve is controlled by the main control unit 14 so as to be switched at a preset time.
- the pressure inside the adsorption cylinder in the desorption process may be evacuated using a vacuum pump.
- the oxygen concentrator 1 of the present embodiment may be configured to be installed and fixed in a patient's home as in the conventional oxygen concentrator.
- a patent It is desirable to use the configuration described in Japanese Patent No. 3269626 to provide an adsorption unit 5 having rotating valve means for successively and successively forming gas flow paths for pressurization and desorption with respect to a plurality of adsorption cylinders. It is.
- the flow rate setting unit 12 is for setting and operating the flow rate of the oxygen-enriched gas to be supplied by the user such as a patient.
- the dial switch is operated to rotate the dial switch to 1 liter / minute, 2 liter / minute,
- the flow rate control unit 14a that detects the selection value controls the operating speed of the compressor 4 and the adsorption unit 5 to set the desired flow rate. It is realized. That is, the flow rate control unit 14a controls the drive of the compressor 4 by controlling the power supply control unit 3, and controls the adsorption unit 5 as described above to control the flow rate of the oxygen-enriched gas supplied to the patient. Control. In the present embodiment, the flow rate control unit 14a is recorded in the CPU 14.
- the sensor unit 7 measures the actual flow rate of the oxygen-enriched gas in the gas path.
- the sensor unit 7 is composed of an ultrasonic sensor as described in, for example, Japanese Patent Application Laid-Open No. 2002-211402, etc., and two sound waves in the same direction and in the opposite direction to the flow direction of the oxygen-enriched gas flowing in the nasal cannula 1c, For example, the ultrasonic propagation velocity can be measured, and the actual flow rate of the oxygen-enriched gas flowing in the nasal cannula 1c can be measured from the difference between the two measured values. It is preferable that the operation instruction to the compressor 4 and the suction unit 5 in the flow rate control unit 14a is corrected by performing feedback control based on the measured actual flow rate.
- the sensor unit 7 only needs to be able to measure the actual flow rate of the oxygen-enriched gas, and other configurations and methods may be used.
- the configuration related to the basic oxygen concentration function of the oxygen concentrator 1 is not limited to the mode described here, and may be a known configuration or various configurations proposed in the future. I can do it.
- the patient exacerbation prediction apparatus includes a respiration detection unit 8 and a respiration information calculation unit 14b provided in the oxygen concentrator 1.
- the respiration information calculation unit 14b is recorded in the CPU 14.
- the flow rate control unit 14a and the respiration information calculation unit 14b may be separate CPUs.
- a respiration detection unit 8 is provided on the downstream side of the sensor unit 7 in the oxygen flow path of the oxygen concentrator 1. As described in Japanese Patent Application Laid-Open No. 7-96035, the respiration detecting unit 8 according to the present embodiment is configured to detect pressure fluctuation based on expiratory inspiration and based on detection information of the detecting means.
- a respiratory rate measuring device having information processing means for determining the number.
- the information processing means includes a means for digitizing detection information comprising the respiratory waveform detected by the detection means, and a drift component (the drift component of the sensor signal from the digitized respiratory waveform.
- the information preprocessing means including information preprocessing means including a standardization means for obtaining a standardized respiratory waveform excluding a noise component generated by a signal (pulse number) shift due to long-term use)
- the maximum value or minimum value of the shaped respiratory waveform is obtained, and further, the detected value is obtained by multiplying the maximum value or the minimum value by a predetermined detection level rate, and the time when the shaped respiratory waveform becomes the detected value is defined as the respiratory rate.
- a breathing rate counting means for counting is provided. Information on the respiration rate calculated by the respiration detector 8 is sent to the respiration information calculator 14b.
- the information processing means of the respiration detection part 8 may be provided separately from the respiration information calculation part 14b as mentioned above, the respiration information calculation part 14b can also be used as an information processing means.
- the pressure fluctuation information acquired by the pressure fluctuation detecting means of the breathing detection unit 8 is sent to the breathing information calculation unit 14b, and based on this, the respiration rate is calculated in the breathing information calculation unit 14b.
- the specific configuration for detecting the patient's respiration in the respiration detection unit 8 is not limited to the one using the pressure fluctuation detection means, and for example, as in the configuration described in Japanese Patent Application Laid-Open No. 2002-272845, an audio microphone is used.
- a signal (patient breathing sound) is converted into an optical signal, then converted into a voltage signal, and further converted into a frequency to perform analysis in the frequency domain, and a configuration for detecting respiration based on a difference in frequency band.
- a conductive layer is laminated by a method of providing a sensor composed of a pyroelectric element on a nasal cannula or a diaphragm type pressure gauge as described in Japanese Patent Publication No. 5-71894.
- a configuration using a pressure detector that detects a capacitance using a polymer film, or a pressure detector is installed in the oxygen concentrator main body as described in JP-A-2-88078.
- the respiration information calculation unit 14b calculates the following index based on the patient's respiration rate acquired as described above. The significance and calculation method for calculating these indices will be described later.
- the calculated information is sent to the display unit 10.
- Patient respiratory rate (lower value) (2) Patient expiration time (3)
- Patient inspiration time (4) Ratio of patient expiration time to inspiration time (5) Prediction result of occurrence of acute exacerbation of patient
- the patient's respiration rate (lower value) is the respiration rate among all respiration rate (BPM) measured during sleep.
- values common to all patients can be set uniformly in advance, or a medical worker can set the values according to medical findings. .
- the oxygen concentrator 1 is configured to include an interface such as a button or a changeover switch, and data when it is determined that the patient is in a sleep state by operating the interface at the timing before and after going to bed. Is used to calculate the above information.
- the display unit 10 is a display unit including a display member such as a liquid crystal panel and its peripheral interface unit, and displays the information transmitted from the respiration information calculation unit 14b to the outside of the oxygen concentrator 1.
- the contents of the data displayed by the display unit 10 include the contents displayed on the conventional oxygen concentrator such as the display of the operation on state, the display of alarms and alarms, the display of the set flow rate, and the like.
- the information of one or more of the indices (1) to (5) based on the respiratory rate of the patient detected by the respiratory detection unit 8 is included.
- FIG. 2 is a configuration diagram of an exacerbation prediction system according to another embodiment of the present invention.
- the oxygen concentrator 1 includes an information output end 11.
- the information output terminal 11 is an output terminal or a transmission interface for sending data calculated in the oxygen concentrator 1 to a device other than the oxygen concentrator 1 such as a personal computer via a wireless or wired transmission path.
- RS-232C, USB, wireless communication, and other known communication standards may be employed.
- the data output from the information output end 11 to the outside of the oxygen concentrator 1 is, for example, the pressure fluctuation information acquired by the pressure fluctuation detection means of the breathing detection unit 8 or the above (1) calculated by the breathing information calculation unit 14b. It is one or more pieces of information in the index of (5).
- the data output from the information output terminal 11 is transmitted to the receiving server 6b in the remote management center, and the computing device 6a arranged in the management center uses the received data to obtain information (breathing).
- the number and / or the index of (1) to (5) above are calculated, and the prediction of the patient's acute exacerbation is executed using these information.
- a configuration for transmitting various information such as patient biological information from the oxygen concentrator installed at home to the receiving server 6b in the remote management center via the transmission path has been proposed by the applicant first, for example. JP-A-3-143451, JP-A-5-309135, JP-A-6-54910, JP-A-6-233744, JP-A-7-95963, etc. This configuration can be implemented with appropriate assistance.
- information and prediction results based on the above-mentioned patient breathing data are transmitted from the management center to the oxygen concentrator 1 and displayed on the display unit 10 or output from the information output terminal 11.
- information and prediction results based on the above-mentioned patient breathing data can be stored in a storage means (not shown) in the calculation device 6a after calculation, and output and displayed when necessary.
- a storage means not shown
- the structure of the oxygen concentrator 1 becomes simpler and the cost can be reduced.
- a person in charge at the management center or a medical worker at a medical institution can quickly know the prediction of exacerbation and can promptly respond such as contacting or visiting the patient's home. It is also useful for diagnosis and treatment decisions and changes made by medical personnel during outpatient treatment.
- the respiratory data that has been used for grasping the known signs of acute exacerbation of respiratory diseases has been the average value, median value, or instantaneous value of all measured data.
- the inventors of the present application have obtained various and useful information and teachings from patients who receive treatment using oxygen concentrators and medical personnel involved in treatment as a result of disseminating home medical care, particularly home oxygen therapy, for many years. There was an opportunity. As a result of considering the various pieces of information obtained, the inventors of the present application have obtained the following knowledge (1) to (2) that can predict acute exacerbation in an earlier stage with higher accuracy. *
- FIG. 3 which is a schematic diagram of the exhalation inspiration ratio
- the exhalation inhalation ratio of a healthy person as shown in FIG.
- the ratio with the time of exhaling air is approximately 1: 2.
- COPD patients tend to extend expiration time.
- FIG. 5B shows a case where the expiration time is extended to 1: 3. This is because COPD patients are often in a state where the airway is blocked and the airflow is restricted, so that the rib cage expands during inhalation, so air can easily enter, but on the other hand, it becomes narrower when exhaling air Because it is necessary to exhale from the respiratory tract, it takes time to exhale.
- FIG. 3C shows a state where the expiration time is reduced to 1: 1.
- the expiration time becomes shorter during the exacerbation period, because the respiratory tract becomes narrower due to infection and the ventilation volume decreases during the exacerbation period. That is, it is assumed that this is because the number of intakes per unit time is to be increased.
- Respiration is performed to meet the oxygen demand of tissues and organs, and it is considered that there are voluntary breathing and involuntary breathing.
- Voluntary breathing is often conscious at the time of awakening, and can be controlled freely with the voluntary control from the previous motor cortex and within a certain range. Say about breathing.
- voluntary control ceases, for example during sleep, rhythmic contraction of respiratory muscles continues, but breathes unconsciously.
- This is involuntary breathing, which is governed by the brain stem centered on the respiratory center of the medulla oblongata and is said to be in a state where the number of breaths is not stable (a state where the number of breaths fluctuates) in most cases (FIG. 4). ).
- Human breathing rate is defined by various factors, one of which can be explained by the balance of the two elements of “tissue oxygen demand” and “heart and lung oxygen supply capacity”. It is thought that the number of breaths is determined from the oxygen demand of the tissue and the oxygen supply capacity of each individual's cardiopulmonary, but the state where the breathing rate decreases and is stable for a certain period of time is that the "tissue oxygen demand” is constant It is expected that the oxygen demand of the organization is low. If the “tissue oxygen demand” increases when the respiration rate is low, the compensation mechanism for the heart and lungs works immediately to increase the respiration rate, so there is no stable state for a certain period of time.
- both the “tissue oxygen demand” and “the oxygen supply capacity of the heart and lungs” fluctuate in the increasing time zone (upper value) of the number of breathing during nighttime sleep. It is presumed that the number of breathing increases. That is, in the state where the “tissue oxygen demand” is low and the respiratory rate during sleep, which is considered to be stable, is low and stable, the decrease in “oxygen supply capacity of the heart and lungs” We infer that it can be more prominently used as a sign of exacerbation of various diseases including respiratory diseases such as COPD in the form of increased respiratory rate.
- a monitoring index for predicting an advancement sign such as COPD in advance at an earlier stage and with higher accuracy is a state in which the respiratory rate is stable for a certain period of time. Breathing to be treated at home by monitoring and observing the number of steady state (lower value) where the respiration rate during nighttime sleep has fallen for a certain period of time and is stable for a certain period (day or month) It is thought that acute exacerbations of HOT patients, mainly those with genital diseases, can be predicted in advance earlier and with higher accuracy than conventional methods. On the other hand, during awakening, they are engaged in activities such as conversation, meals, labor, room movement, toilets, and baths.
- Oxygen demand for tissues is more frequent and more frequent than sleep. It is difficult to separate the change of supply ability from the complicated mixing.
- At the time of awakening in order to grasp the time zone in which only the “oxygen supply capacity of the heart and lungs” is changing while the “tissue oxygen demand” is constant, there are various factors such as tilt, movement, vibration and shock.
- the inventors of the present application have increased the respiration rate per unit time (upper value, average value, lower value), and the respiration rate has decreased and is in a stable state.
- Can detect that the patient is currently in an exacerbation period by detecting the change in the ratio of the inspiratory time to the expiratory time in the direction of shortening the expiratory time and / or the shortening of the expiratory time. That is, the present inventors have found that acute exacerbation of a patient can be predicted in advance, and have reached the present invention.
- the respiratory pressure pattern ⁇ when the patient's respiratory rate is low and stable, particularly the respiratory pressure pattern in the exacerbation period presents a pressure pattern having unique characteristics for each patient.
- the current respiratory pressure pattern is monitored after knowing in advance the respiratory pressure pattern of a patient in advance, it is detected that the respiratory pressure pattern has approached the pressure pattern of the exacerbation, and the patient It can be known that the patient is in an exacerbation period, and the patient's acute exacerbation can be predicted in advance as described above.
- FIG. 2 is a connection diagram of the apparatus 1
- FIG. 3 which is a schematic diagram of an exhalation-intake ratio
- FIG. 4 which is a schematic diagram of fluctuations in respiratory rate.
- the respiratory information calculation unit 14b of the exacerbation prediction apparatus of the present embodiment or the arithmetic unit 6a of the exacerbation prediction system is configured to predict a patient's acute exacerbation in advance based on the findings of the inventors of the present application described above.
- Patient respiratory rate (lower value) (2) Patient expiration time (3)
- Patient inspiration time (4) Ratio of patient expiration time to inspiration time
- the respiration information calculation unit 14b or the arithmetic device 6a compares the value or inclination of the recorded trend at an arbitrary point in time with a predetermined threshold value so that the acquired information value or inclination is determined in advance. Whether it is within the range or outside the range is determined, and if it is within the range, it is determined that the patient is currently in an exacerbation period.
- the above-mentioned predetermined range is a range predetermined by the above-mentioned threshold value so that it is estimated that this patient is in an exacerbation period if the value of the acquired information is outside this range.
- the respiration information calculation unit 14b or the calculation device 6a uses a determination on the threshold value of any one or a plurality of indexes, or the determination results and evaluation results of various other parameters. For example, the percutaneous arterial blood oxygen saturation (SpO2) is measured at the same timing as the above respiratory data over a plurality of days, and the relationship with the respiratory data is taken into account, etc. It is determined whether or not.
- SpO2 percutaneous arterial blood oxygen saturation
- the respiratory information calculation unit 14b or the arithmetic device 6a transmits the determination result to the display unit 10.
- the display unit 10 displays a warning message such as “The respiratory rate is increasing. Contacting a medical institution is recommended.” Further, a signal including the same contents may be output from the information output terminal 11 so that display on an external display means or display by an external printer is executed.
- the determination may be performed separately or in parallel with the determination based on the comparison between the predetermined threshold value and the measurement data, or by calculating the correlation coefficient in parallel.
- the determination using the correlation coefficient means that the normal respiratory pressure pattern of this patient and / or the exacerbated respiratory pressure pattern is acquired in advance, and the current patient's respiratory pressure pattern is acquired as a pattern already acquired. And the current patient's respiratory pressure pattern is close to the normal respiratory pressure pattern or the exacerbated respiratory pressure pattern, or the difference between these two patterns. It is a method of knowing which one is closer.
- the oxygen enriched gas 1 is inhaled from the oxygen concentrator 1 according to the present embodiment by receiving power supply from a home AC power supply as in the conventional case. I can do it. Further, if the inhalation is performed with the battery 13 driven in the patient's home, the patient 1b can continue the inhalation while freely moving in the patient's home with the device 1 without restriction of the AC outlet. The inconvenience of inhaling through this cannula with an extension tube is eliminated by connecting a cannula with a long extension tube that extends for several meters to the oxygen concentrator.
- the computing device 6a computes the above-mentioned patient respiratory data information at any time or at an appropriate timing while supplying the oxygen-enriched gas, and the memory inside the CPU 14 (Not shown) is recorded and held.
- the medium on which the above information is recorded and held may not be the memory inside the CPU 14, but may be an independently provided memory means, or as a removable memory means, an oxygen concentrator when visiting the medical institution 2a. Instead of the whole 1, only the removable memory means may be taken out and brought into the medical institution 2a.
- the patient brings the oxygen concentrator 1 to the medical institution 2a, he / she can remove the removable memory means from the oxygen concentrator 1 as a method of passing the breathing pattern information to the information device of the medical institution. You may make it perform what is called medium delivery attached to the information equipment of an organization, and delivering.
- these breathing pattern information may be generated not only in the patient's home 1a but also in the patient's outing 3a.
- the patient 1b visits a medical institution along with the oxygen concentrator 1, and the doctor 2b of the medical institution 2a obtains the respiratory data as described above or other configurations.
- the medical staff can grasp the condition of the patient. Helping to greatly improve the therapeutic effect of home oxygen therapy.
- respiration data it is of course possible to configure the respiration data to be printed on a paper medium using a printing means (not shown).
- the breathing pattern information output by the medical institution at the time of hospital visit is affiliated with the affiliated medical institution 4a that conducts medical care in cooperation with the medical institution 2a for the patient via the Internet communication network 5a under security management.
- the medical information may be shared by being transmitted to the medical institution terminal 4c.
- Decreased percutaneous arterial oxygen saturation (SpO2) during night sleep in HOT patients can be combined with respiratory information to understand and predict pathophysiology, and treatment according to the pathologic condition It is possible to provide information to implement at a suitable timing.
- SpO2 percutaneous arterial oxygen saturation
- the respiratory rate is in a state where the sleep breathing is not stable (there is fluctuation), and the fluctuation of the breathing (number of times) at night and the change in SpO2 are observed simultaneously.
- This makes it possible to determine whether the respiratory change has no physiological problem, or whether the cardiopulmonary function cannot cope with oxygen demand.
- the SpO2 value during nighttime sleep decreases, if the respiratory rate is stable for a certain period of time, it is determined that the cardiopulmonary function cannot cope with oxygen demand. This can be explained by the balance of the two factors of "tissue oxygen demand” and “heart and lung oxygen supply ability", although human breathing rate is defined by various factors.
- the number of breaths is determined from the oxygen demand of the tissue and the oxygen supply capacity of each individual's cardiopulmonary.
- SpO2 decreases, that is, if the “tissue oxygen demand” increases, compensation for the heart and lungs Since the mechanism works immediately and increases the respiration rate, it is assumed that no stable state appears for a certain period of time.
- the state in which the respiratory rate is stable for a certain time in this case is an abnormal state in which the “oxygen supply capacity of the heart and lungs” does not react.
- the respiratory information in addition to the respiratory rate, it is also possible to confirm the inclination (change) of inspiration / expiration obtained from the I / E ratio, the intensity of breathing, the I / E ratio and the breathing time.
- the degree of desaturation is calculated by combining respiration information and SpO2 value, and the parameters for treatment (eg, oxygen concentrator flow rate, oxygen in home oxygen therapy, etc.) are fed back to a treatment device such as an oxygen concentrator. It is also possible to control (concentration).
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Abstract
Description
図1は本発明の実施の形態に係る好ましい実施例である増悪予測装置を備えた酸素濃縮装置の構成図である。本実施例の酸素濃縮装置1は、主に在宅酸素療法に用いるために空気中の窒素を分離し高濃度酸素(酸素富化気体)を供給する装置であり、例えば、酸素より窒素を選択的に吸着し得る吸着剤としてモレキュラーシーブゼオライト5A、13X、或いはリチウム系ゼオライトなどを吸着筒(吸着ユニット5内)に充填し、吸着筒に空気圧縮装置(コンプレッサ4)によって作られた加圧空気を供給することで、酸素富化気体を取り出す圧力変動吸着型の酸素濃縮装置である。なお、図1中、各ブロック間を接続する矢印は空気の流れを表し、実線は各ブロック間の電気的接続を表す。
本実施形態に係る患者の増悪予測装置は、酸素濃縮装置1に設けられた呼吸検知部8と呼吸情報算出部14bを備える。本実施形態においては、呼吸情報算出部14bはCPU14に記録されている。流量制御部14aと呼吸情報算出部14bを別のCPUとしてもよい。
(1)患者の呼吸数(下位値)
(2)患者の呼気時間
(3)患者の吸気時間
(4)患者の呼気時間と吸気時間との比率
(5)患者の急性増悪発生の予測結果
ここで、図4の通り、(1)患者の呼吸数(下位値)とは、睡眠中に計測したすべての呼吸回数(BPM)の内、呼吸回数が所定値(例えば下位20%)の範囲内で一定時間(例えば20分以上)、且つある呼吸数の範囲内(例えば±3BPM)で値が推移している安定した状態を示している部分のすべての数値を平均した値とする。また、(2)患者の呼気時間、(3)患者の吸気時間、(4)患者の呼気時間と吸気時間との比率は、いずれも呼吸数が一定時間低下して且つ安定している状態にある指標である。
上述の実施形態は、患者の呼吸数の算出および呼吸数に基づく指標の算出を酸素濃縮装置1の内部で実行するものであるが、これらは酸素濃縮装置1の外部に設置された演算装置を用いて実行することもできる。図2は、本発明の別の実施の形態に係る増悪予測システムの構成図である。
本願発明者らが見出した呼吸器疾患患者を中心としたHOT患者の急性増悪の発生予測を行う原理を説明する。
次に本実施例の増悪予測装置または増悪予測システムの動作を、患者の急性増悪の発生予測を行う動作を中心として説明する。必要に応じて装置1の接続図である図2、呼気吸気比率の模式図である図3、呼吸数のゆらぎの模式図である図4を参照する。本実施例の増悪予測装置の呼吸情報算出部14bまたは増悪予測システムの演算装置6aは、上記した本願発明者らの知見に基づいて患者の急性増悪を前もって予測するよう構成されており、このためにまず、患者が酸素濃縮装置1を使用している状態において呼吸検知部8が検知した患者の呼吸のデータに基づいた下記の情報の内の少なくともいずれかの情報を取得する。 そして、これらの日々取得した呼吸データを経時的にモニタリングし複数日(例えば、数日~数ヶ月)に渡るトレンドを記憶する。
(1)患者の呼吸数(下位値)
(2)患者の呼気時間
(3)患者の吸気時間
(4)患者の呼気時間と吸気時間との比率
通院先での呼吸データの表示や出力の手順を、本実施例の酸素濃縮装置1の一般的な使用方法を含めて、図2を参照しつつ以下に説明することとする。
呼吸器疾患患者を中心としたHOT患者は、夜間睡眠時のSpO2が低下するディサチュレーションが認められるとの報告がある。睡眠中のディサチュレーションは覚醒反応による睡眠の分断や肺高血圧、予後不良に結びつくことが知られている。これまで、呼吸器疾患患者を中心としたHOT患者の医療情報は殆ど把握されていなかった。従来より、外来診療において月1,2回の動脈血液ガスや経皮的動脈血酸素飽和度(SpO2)の測定が実施されているが、それのみでは患者の診断及び治療効果を決定するのに十分な医学的情報が得られなかった。
3 電源制御部
4 コンプレッサ
5 吸着ユニット
8 呼吸検知部
14 メイン制御部
6a 演算装置
Claims (5)
- 患者の呼吸データを連続的に検知する呼吸検知手段と、
前記検知された患者の連続する呼吸データから、呼吸数が一定時間低下して且つ安定している状態にある状態の呼吸データである安定呼吸データを算出する算出手段と、
ある一定期間に算出された前記安定呼吸データに応じて、前記患者における急性増悪の発生を予測する予測手段と、を備えた増悪予測装置。 - 前記安定呼吸データは、呼吸数が一定時間低下して且つ安定している状態にある状態における(a)患者の呼吸数(下位値)、(b)患者の呼気と吸気との時間比率、(c)患者の呼気時間、の内の少なくともいずれかである、請求項1に記載の増悪予測装置。
- 前記安定呼吸データは、呼吸数が一定時間低下して且つ安定している状態にある状態における(a)現在の患者の呼吸圧力パターンと、予め定められた平常時呼吸圧力パターンとの間の相関係数、(b)現在の患者の呼吸圧力パターンと、予め定められた急性増悪時呼吸圧力パターンとの間の相関係数、の内の少なくとも一方である、請求項1に記載の増悪予測装置。
- 空気中から酸素を濃縮して酸素富化気体を生成する生成手段と、
生成された酸素を患者へ供給する酸素供給通路と、
前記酸素供給通路に設けられた患者の呼吸データを連続的に検知する呼吸検知手段と、
前記検知された患者の連続する呼吸データから、呼吸数が一定時間低下して且つ安定している状態にある状態の呼吸データである安定呼吸データを算出する算出手段と、
ある一定期間に算出された前記安定呼吸データに応じて、前記患者における急性増悪の発生を予測する予測手段と、を備えた酸素濃縮装置。 - 患者の呼吸データを連続的に検知する呼吸検知手段と、前記検知された患者のすべての呼吸データを外部へ送信する送信手段と、を有する患者側端末と、
前記送信された患者の呼吸データを受信して、前記受信した患者の連続する呼吸データから、呼吸数が一定時間低下して且つ安定している状態にある状態の呼吸データである安定呼吸データを算出する算出手段と、ある一定期間に算出された前記安定呼吸データに応じて、前記患者における急性増悪の発生を予測する予測手段と、を備えた外部端末と、を備えた増悪予測システム。
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