WO2023122903A1 - Procédé et dispositif de commande de ventilation - Google Patents

Procédé et dispositif de commande de ventilation Download PDF

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Publication number
WO2023122903A1
WO2023122903A1 PCT/CN2021/141758 CN2021141758W WO2023122903A1 WO 2023122903 A1 WO2023122903 A1 WO 2023122903A1 CN 2021141758 W CN2021141758 W CN 2021141758W WO 2023122903 A1 WO2023122903 A1 WO 2023122903A1
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oxygen
patient
partial pressure
arterial
threshold
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PCT/CN2021/141758
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English (en)
Chinese (zh)
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黄志文
刘京雷
周小勇
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深圳迈瑞生物医疗电子股份有限公司
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Priority to CN202180100668.1A priority Critical patent/CN117642203A/zh
Priority to PCT/CN2021/141758 priority patent/WO2023122903A1/fr
Publication of WO2023122903A1 publication Critical patent/WO2023122903A1/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

Definitions

  • the invention relates to the technical field of medical devices, in particular to a ventilation control method and device.
  • FiO2 Fraction of inspired oxygen
  • the ventilator can automatically adjust FiO2 according to the patient's specific physiological condition, it can not only help medical staff reduce the workload, but also optimize the patient's oxygen consumption and help the patient recover. Therefore, the research on ventilator ventilation control methods is of great significance.
  • Existing ventilators use the same set of adjustment intervals and adjustment volumes to adjust FiO2 for all patients. These adjustment intervals and adjustment volume settings may be suitable for some patients, but may be adjusted too quickly for other patients. Or it is too slow, that is to say, the existing ventilation control method cannot meet the ventilation needs of different patients.
  • the present invention mainly provides a ventilation control method and device, which are used to solve the problem that the existing ventilation control methods cannot meet the ventilation needs of different patients.
  • an embodiment provides a ventilation control device, comprising:
  • the sensor is used to obtain the real-time blood oxygen parameters of the patient
  • target control parameters for adjusting the inhaled oxygen concentration of the patient, and the target control parameters include target time parameters and/or target airflow parameters.
  • an embodiment provides a ventilation control method, including:
  • the oxygen dissociation curve of the patient is used to represent the corresponding relationship between the patient's arterial partial pressure of oxygen and blood oxygen saturation;
  • target control parameters for adjusting the inhaled oxygen concentration of the patient, and the target control parameters include target time parameters and/or target airflow parameters.
  • an embodiment provides a computer-readable storage medium, the computer-readable storage medium stores computer-executable instructions, and the computer-executable instructions are used to implement the second aspect when executed by a processor.
  • the ventilation control method and device of the above-mentioned embodiments when determining the target control parameters for adjusting the inhaled oxygen concentration, the patient's oxygen dissociation curve and the patient's real-time blood oxygen parameters are fully combined, so that the target control parameters can match the patient's
  • the ventilation requirements under the current physiological conditions can meet the ventilation requirements of different patients under different physiological conditions.
  • Fig. 1 is a schematic structural diagram of a ventilation control device provided by an embodiment of the present invention
  • Fig. 2 is a schematic structural view of a ventilating device provided by an embodiment of the present invention.
  • Fig. 3 is a flowchart of a ventilation control method provided by an embodiment of the present invention.
  • Fig. 4 is a schematic diagram of an oxygen dissociation curve provided by an embodiment of the present invention.
  • Fig. 5 is a flowchart of a ventilation control method provided by another embodiment of the present invention.
  • Fig. 6 is a flowchart of a ventilation control method provided by another embodiment of the present invention.
  • connection and “connection” mentioned in this application all include direct and indirect connection (connection) unless otherwise specified.
  • Respiration refers to the process of inhaling and exhaling gas periodically and rhythmically, absorbing oxygen and expelling carbon dioxide, so as to realize the process of gas exchange.
  • the ventilation equipment is used to provide respiratory support for the patient, it is necessary to adjust the FiO2 according to the specific physiological condition of the patient so that the patient can reach the normal target oxygenation level. Different patients or the same patient in different periods may have different physiological conditions. Therefore, the real-time blood oxygen parameters of the patient are used in this application, which can accurately reflect the oxygen supply demand of the patient at the current moment, and combined with the patient's oxygen dissociation curve. Regulate FiO2.
  • the oxygen dissociation curve is a curve used to represent the correspondence between arterial oxygen partial pressure and blood oxygen saturation.
  • the standard oxygen dissociation curve is obtained based on clinical data statistics, and it is difficult to reflect the individual differences of patients. Different patients or the same patient at different times may have different body temperature, blood PH value, arterial carbon dioxide partial pressure, etc., which will cause the standard oxygen dissociation curve to shift. Therefore, in order to accurately reflect the patient's current oxygen supply demand, What is used in this application is the patient's oxygen dissociation curve, which is based on one or more of the patient's body temperature, blood pH value, and arterial carbon dioxide partial pressure, with full consideration of the patient's current physiological condition. The dissociation curve was corrected.
  • the technical solution described in this application obtains the patient's real-time blood oxygen parameters and the patient's oxygen dissociation curve, and then adjusts FiO2 according to the corresponding position of the patient's current blood oxygen parameter on the patient's oxygen dissociation curve.
  • the ability to combine oxygen and reduced hemoglobin presented in different oxygen partial pressure intervals of the oxygen dissociation curve is used to adjust the adjustment interval of the algorithm and the calculation coefficient of the adjustment amount in real time, so that the algorithm can be based on the patient's blood oxygen. From the corresponding position on the curve, the response speed and adjustment strength of the algorithm can be increased and decreased nonlinearly, so as to match the oxygen demand of different patients and different blood oxygen conditions.
  • FIG. 1 is a schematic structural diagram of a ventilation control device according to an embodiment of the present invention.
  • the ventilation control device 10 provided in this embodiment may include a processor 101 and a sensor 102 , and the processor 101 is connected to the sensor 102 .
  • the sensor 102 is used to obtain the real-time blood oxygen parameters of the patient;
  • the processor 101 is used to obtain the oxygen dissociation curve of the patient, and the oxygen dissociation curve is used to represent the arterial oxygen partial pressure and blood oxygen content of the patient.
  • the processor 101 is in signal connection with the ventilator 11, and controls the inspiratory oxygen concentration of the inhalation gas provided by the ventilator 11 to the patient according to the target control parameters.
  • the ventilation device 11 is used to provide inhalation gas to the patient through a breathing circuit and breathing accessories, and the inhalation gas is oxygen-containing gas.
  • the breathing circuit is composed of an exhalation branch and an inhalation branch
  • the breathing accessories include at least a pneumatic system and a patient interface
  • the patient interface can be a mask, for example.
  • one end of the pneumatic system of the ventilator 11 is connected to the processor 101 for signals, and the other end is connected to the patient interface through the exhalation branch and the inspiratory branch. Gases that match the conditions.
  • the ventilation control device provided in the present application can also be used in anesthesia ventilation equipment (or anesthesia machine for short) to adjust the oxygen concentration in the gas provided by the anesthesia ventilation equipment.
  • FIG. 2 is a schematic structural diagram of a ventilation device provided by an embodiment.
  • the ventilation device 2 provided in this embodiment may include: a ventilation control device 20 , an air source interface 21 , a breathing assistance device 22 , an anesthetic output device 23 , a breathing circuit 24 , a memory 25 and a display 26 .
  • the ventilation control device 20 includes a processor 27 and a sensor 28 .
  • the gas source interface 21 is used to connect with a gas source (not shown in the figure), and the gas source is used to provide gas.
  • the gas can usually use oxygen, nitrous oxide (laughing gas) and air.
  • the gas source can be a compressed gas cylinder or a central gas supply source, which supplies gas to the ventilator through the gas source interface 21, and the types of gas supply include oxygen O2, laughing gas N2O, air, etc.
  • the respiratory assistance device 22 is used to provide power for the patient's involuntary breathing and maintain the airway, that is, to drive the gas input from the gas source interface 21 and the mixed gas in the breathing circuit 24 to the patient's respiratory system, and to drain the gas exhaled by the patient. To the breathing circuit 24, thereby improving ventilation and oxygenation, preventing hypoxia of the patient's body and accumulation of carbon dioxide in the patient's body.
  • the respiratory assistance device 22 can also adjust the oxygen concentration of the gas provided by the gas source interface 21 under the control of the processor 27 .
  • the anesthetic output device 23 is used to provide anesthetic drugs.
  • the anesthetic drugs are mixed in the form of gas into the fresh air introduced by the gas source interface 21 and delivered to the breathing circuit 24 together.
  • the breathing circuit 24 includes an inhalation passage 24a, an exhalation passage 24b and a soda lime tank 24c.
  • the inhalation passage 24a and the exhalation passage 24b communicate to form a closed circuit, and the soda lime tank 24c is arranged on the pipeline of the exhalation passage 24b.
  • the mixed gas of anesthetic vapor and fresh air introduced by the air source interface 21 is input through the inlet of the inhalation passage 24a, and provided to the patient 4 through the patient interface 3 arranged at the outlet of the inhalation passage 24a.
  • Patient interface 3 may be a mask, nasal or endotracheal tube.
  • the inhalation passage 24a is provided with a one-way valve, which is opened during the inhalation phase and closed during the exhalation phase.
  • the exhalation channel 24b is also provided with a one-way valve, which is closed during the inhalation phase and opened during the exhalation phase.
  • the inlet of the exhalation passage 24b communicates with the patient interface 3.
  • the exhaled gas enters the soda lime tank 24c through the exhalation passage 24b, and the carbon dioxide in the exhaled gas is filtered out by the material in the soda lime tank 24c.
  • the carbon dioxide-depleted gas is recirculated into the inspiratory passage 24a.
  • the sensor 28 is used to acquire the real-time blood oxygen parameters of the patient, the airway pressure value and the esophageal pressure value of the patient in the state of ventilation assisted by the ventilation device, etc.
  • the sensor 28 may be connected to the signal output terminals of the first pressure sensor 29a and the second pressure sensor 29d.
  • the first sampling tube can enter the trachea through the oral cavity, and the first pressure sensor 29a can be arranged in the first sampling tube 29b for monitoring the pressure in the trachea (i.e. airway pressure), which is equivalent to For alveolar pressure, the airway pressure electrical signal output by the first pressure sensor 29a is transmitted to the sensor 28 through the first wire.
  • the second sampling tube enters the esophagus through the nasal cavity, and the second pressure sensor 29d can be arranged in the second sampling tube to monitor the pressure in the esophagus, which is equal to the intrathoracic pressure.
  • the converted electric signal is transmitted to the sensor 28 through the second wire.
  • the memory 25 can be used to store data or programs, for example, to store data collected by the sensor, data generated by the processor through calculation, or an image frame generated by the processor.
  • the image frame can be a 2D or 3D image, or the memory 25
  • a graphical user interface, one or more default image display settings, programming instructions for a processor can be stored, for example, computer-executed instructions that can implement the ventilation control method provided by any embodiment of the present application.
  • the memory 25 may be a tangible and non-transitory computer-readable medium such as flash memory, RAM, ROM, EEPROM, and the like.
  • the processor 27 is used to execute instructions or programs to control the breathing assistance device 22, the gas source interface 21 and/or various control valves in the breathing circuit, so that the target control parameters for adjusting the patient's inhaled oxygen concentration can match the patient's
  • the ventilation requirements under the current physiological conditions can meet the ventilation requirements of different patients under different physiological conditions.
  • the processor 27 is also used to process the received data, generate required calculation or judgment results, or generate visualized data or graphics, and output the visualized data or graphics to the display 26 for display.
  • the processor 27 is signal-connected with the sensor 28, and is used to determine the target control parameters for adjusting the patient's inhaled oxygen concentration according to the curve parameters of the patient's oxygen dissociation curve and the patient's real-time blood oxygen parameters.
  • the processor 27 calculates or generate waveforms according to the airway pressure value, esophageal pressure value, gas flow value in the breathing circuit and/or the pressure value in the breathing circuit, for example, the processor 27 Calculate the patient's alveolar pressure in real time, for example, calculate the difference between the airway pressure and the esophagus pressure, and use the difference between the airway pressure and the esophagus pressure as the alveolar pressure. The processor 27 then guides mechanical ventilation based on the real-time calculated alveolar pressure. Operations of mechanical ventilation may include, for example, setting of ventilation parameters and lung recruitment operations.
  • the processor 27 obtains the end-inspiratory alveolar pressure and/or the end-expiration alveolar pressure according to the monitored alveolar pressure, and guides the inspiratory pressure and tidal pressure according to the end-inspiratory pressure and/or the end-expiratory pressure.
  • Setting of ventilation parameters such as volume or positive end-expiratory pressure.
  • the processor 27 obtains the end-expiratory alveolar pressure according to the monitored alveolar pressure, and performs lung recruitment operation according to the guidance of the end-expiratory alveolar pressure.
  • FIG. 1 and FIG. 2 are only schematic, and may also include more or fewer components than those shown in FIG. 1 or FIG. 2 , or have different components from those shown in FIG.
  • the configuration may also include an alarm device for receiving alarm information and outputting the alarm information in one or more ways of sound, light and vibration.
  • Each component shown in FIG. 1 and FIG. 2 may be implemented by hardware and/or software.
  • the ventilation control device shown in FIG. 1 and FIG. 2 can be used to implement the ventilation control method provided by any embodiment of the present invention.
  • the ventilation control method provided by an embodiment of the present invention may include:
  • the patient's real-time blood oxygen parameter can be obtained through the sensor configured by the ventilation control device itself, or the patient's real-time blood oxygen parameter can be obtained through an interconnected external detection device.
  • the external detection device may be, for example, a pulse oximeter, a monitor, and the like.
  • the blood oxygen saturation of the patient can be specifically obtained through the blood oxygen parameter of the patient.
  • the blood oxygen saturation used to reflect the blood oxygen parameters can be obtained, and both can be used to indicate the oxygen content in the patient's blood.
  • the patient's real-time blood oxygen parameter can reflect the oxygen content in the patient's blood at the current moment.
  • real-time blood oxygen saturation may also be included in the real-time blood oxygen parameter.
  • the oxygen dissociation curve expresses the correspondence between arterial partial pressure of oxygen (PaO2) and blood oxygen saturation.
  • the standard oxygen dissociation curve is obtained based on clinical data statistics, as shown in the middle dark curve in Figure 4 .
  • the patient's body temperature, blood pH value, arterial carbon dioxide partial pressure PaCO2, etc. will all affect the oxygen dissociation curve, causing the oxygen dissociation curve to shift to the left or right, thereby affecting the patient's blood oxygen saturation and arterial oxygen partial pressure in the oxygen dissociation curve. Correspondence on the curve.
  • the corresponding partial pressures of arterial oxygen are 30mm Hg, 40mm Hg and 50mm Hg respectively.
  • the patient's oxygen dissociation curve can be obtained by correcting the standard oxygen dissociation curve according to one or more of the patient's body temperature, blood pH value, and arterial carbon dioxide partial pressure. Only by using the oxygen dissociation curve of each patient can the ventilation needs of different patients be met.
  • the patient's oxygen dissociation curve can be determined according to the following expression:
  • PaO2 represents arterial oxygen partial pressure
  • SpO2 represents blood oxygen saturation
  • CP is used to represent the patient's body temperature
  • blood pH value and arterial carbon dioxide partial pressure (PaCO2) Or a variety of effects on the left and right translation of the standard oxygen dissociation curve.
  • the patient's blood pH value is between 7.45-7.55
  • the CP can be set to 0; when the patient's blood pH value decreases by 0.1, the CP increases by 3.5mm Hg offset.
  • the patient's blood pH value can be manually input by the user, or the blood pH value data in the latest blood gas analysis results can be obtained in real time through the network interconnection between the respiratory support equipment, the monitor, and the central station.
  • the patient's body temperature and PaCO2 can be manually input by the user, or can be obtained in real time through the network connection with the monitor and the central station.
  • the PaCO2 in the patient can be calculated from the real-time measurement of the end-tidal carbon dioxide concentration and the CO2 dissociation curve, thereby changing the CP, shifting the oxygen dissociation curve, and matching the patient's current physiological condition.
  • the target control parameters include target time parameters and/or target airflow parameters.
  • the target control parameters for adjusting the patient's inhaled oxygen concentration can be determined according to the curve parameters of the oxygen dissociation curve and the real-time blood oxygen parameters .
  • the patient's oxygen dissociation curve is S-shaped, with a flat lower section, a steep middle section, and a flat upper section.
  • the upper flat area that is, the area with higher PaO2 (such as the area of 60-100mm Hg)
  • oxygen is fully combined with hemoglobin, and the change of arterial partial pressure of oxygen has little effect on blood oxygen saturation, which means that no matter at this time Whether the patient's arterial oxygen partial pressure increases or decreases, as long as it is still in this area, it has little effect on the patient's blood oxygen saturation.
  • the adjustment time interval and/or the inhaled oxygen concentration can be appropriately increased Decrease the adjustment of the inspired oxygen concentration.
  • the blood oxygen saturation becomes very sensitive to the change of arterial oxygen partial pressure, and a slight decrease or increase of arterial oxygen partial pressure will affect the patient's blood Oxygen saturation has a big impact.
  • the adjustment time interval of inhaled oxygen concentration can be appropriately reduced and/or increased. Adjustment of inhaled oxygen concentration.
  • the lower flat area such as the area where PaO2 is less than 40mm Hg, the patient’s blood oxygen saturation is extremely low at this time.
  • the minimum time interval can be used for inhalation at this time.
  • the oxygen concentration is adjusted rapidly so that the patient's blood oxygen saturation can be rapidly increased.
  • different adjustment strategies need to be adopted at different stages of the oxygen dissociation curve in order to meet the ventilation needs of patients under different physiological conditions.
  • the target control parameters for adjusting the inhaled oxygen concentration of the patient can be determined according to the curve parameters of the real-time blood oxygen parameters at the corresponding positions on the oxygen dissociation curve.
  • Curve parameters may include, for example, the slope of the curve.
  • the target control parameters include target time parameters and/or target airflow parameters, which are adjusted by controlling the adjustment time and adjustment amount of the inhaled oxygen concentration.
  • the target time parameter may include an adjustment time interval for adjusting the patient's inhaled oxygen concentration; the target gas flow parameter includes at least one of the gas flow rate, oxygen concentration and air pressure of the patient's inhaled oxygen concentration.
  • the ventilation control method provided in this embodiment determines the target for adjusting the patient’s inhaled oxygen concentration by obtaining the patient’s real-time blood oxygen parameters and the patient’s oxygen dissociation curve, and then according to the curve parameters of the oxygen dissociation curve and the real-time blood oxygen parameters Control parameters.
  • the patient's oxygen dissociation curve is used. Different patients have different oxygen dissociation curves, so it can meet the ventilation needs of different patients; The real-time blood oxygen parameters of the patient can be obtained, which can meet the ventilation needs of the patient under the current physiological condition.
  • the curve parameters of the patient's oxygen dissociation curve are fully combined with the patient's real-time blood oxygen parameters, so that the target control parameters can match the ventilation needs of the patient under the current physiological conditions, thereby meeting the ventilation needs of different patients under different physiological conditions.
  • determining the target control parameters for adjusting the patient's inhaled oxygen concentration may include: when the patient's current partial pressure of arterial oxygen is less than the first arterial When the oxygen partial pressure threshold is reached, the control target time parameter is the first preset target time parameter, and/or, the control target airflow parameter is the first preset target airflow parameter.
  • the patient's current arterial partial pressure of oxygen is less than the first arterial partial pressure of oxygen threshold, it means that the patient is in a state of hypoxia, and at this time it is necessary to use the adjustment interval calculation method of increasing oxygen.
  • the first preset target time parameter follows the patient's current arterial oxygen partial pressure at the time of oxygen dissociation The slope of the curve changes at the corresponding position on the curve, and the first preset target time parameter is negatively correlated with the slope of the curve.
  • the first preset target time parameter is a fixed duration; and when the patient's current arterial partial pressure of oxygen is less than the first arterial partial pressure of oxygen threshold, the first The curve of the preset target time parameter changing with the patient's current arterial oxygen partial pressure is continuous at the first arterial partial pressure of oxygen threshold.
  • the first preset target airflow parameter is a fixed adjustment amount.
  • the first preset target time parameter is a fixed duration. It can be understood that the fixed duration is a duration of a small value, and the fixed adjustment amount is an adjustment value of a larger value.
  • the conventional oxygenation method can be used to adjust .
  • the first preset target time parameter and/or the first preset target airflow parameter change with the slope of the patient's current partial pressure of arterial oxygen at the corresponding position on the oxygen dissociation curve, and the first preset target time parameter and The slope of the curve is negatively correlated, and the first preset target airflow parameter is positively correlated with the slope of the curve.
  • the first preset target time parameter is the first preset fixed
  • the first multiple of the duration the first multiple is the slope of the curve at the corresponding position on the patient's oxygen dissociation curve for the second arterial oxygen partial pressure threshold and the patient's current arterial oxygen partial pressure at the corresponding position on the oxygen dissociation curve. ratio.
  • the first preset target airflow parameter is the third multiple of the first preset fixed adjustment amount
  • the third multiple is the ratio of the slope of the curve at the corresponding position on the oxygen dissociation curve of the patient's current arterial partial pressure of oxygen to the slope of the curve at the corresponding position of the second arterial partial pressure of oxygen threshold on the patient's oxygen dissociation curve.
  • determining the target control parameters for adjusting the patient's inhaled oxygen concentration may also include: if the patient's current arterial partial pressure of oxygen is greater than or equal to The third arterial partial pressure of oxygen threshold, the control target time parameter is the second preset target time parameter; and/or, the control target airflow parameter is the second preset target airflow parameter; wherein, the first preset target time parameter is less than or equal to The second preset target time parameter, the second preset target airflow parameter is less than or equal to the first preset target airflow parameter.
  • the second preset target time parameter is the second multiple of the second preset fixed duration, and the second multiple is the relationship between the slope of the patient's current partial pressure of arterial oxygen at the corresponding position on the oxygen dissociation curve and the third arterial oxygen partial pressure.
  • the pressure threshold is the ratio of the slope of the curve at the corresponding position on the patient's oxygen dissociation curve; the second preset target airflow parameter is the fourth multiple of the second preset fixed adjustment value, and the fourth multiple is the third arterial oxygen partial pressure threshold at The ratio of the slope of the curve at the corresponding position on the patient's oxygen dissociation curve to the slope of the curve at the corresponding position on the oxygen dissociation curve of the patient's current arterial oxygen partial pressure.
  • a proportional-integral-derivative controller can be used to calculate the adjustment amount of inhaled oxygen concentration, and the ratio of the proportional-integral-derivative controller can be compared according to the patient's current partial pressure of arterial oxygen and the patient's oxygen dissociation curve.
  • coefficients, integral coefficients and differential coefficients are used for non-linear adjustment. Specifically, the following expression can be used to adjust the adjustment amount of the inhaled oxygen concentration:
  • Delta O2% represents the adjustment amount of inhaled oxygen concentration
  • P(n), I(n) and D(n) represent the calculation results of the proportional part, integral part and differential part respectively
  • a p , a i and a d are respectively Indicates proportional coefficient, integral coefficient and differential coefficient
  • SpO2 set point refers to the target blood oxygen.
  • the doctor sets the target blood oxygen range according to the patient's physiological condition.
  • the SpO2 set point can be the midpoint of the target blood oxygen range, or it can be automatically assigned according to whether it is currently in an oxygen reduction operation or an oxygen increase operation.
  • the SoO2 set point can be automatically set to the lower limit of the target blood oxygen range, and when the patient's blood oxygen is higher than the target blood oxygen range is in the oxygen reducing operation, The SpO2 set point can be automatically set to the upper limit of the target blood oxygen range.
  • a basic amount of oxygen concentration C(n) can also be introduced, that is, the expression for adjusting the adjustment amount of the inhaled oxygen concentration can be modified as:
  • C(n) The role of the constant C(n) is to bring the basic usage of oxygen concentration, which is used to limit a benchmark oxygen concentration setting according to the patient's condition.
  • C(n) can use a built-in value or a set of built-in coefficients, which are automatically updated and set according to the patient's blood oxygen, physiological parameters, patient type, ventilation mode, ventilation mode, parameter settings, etc.
  • Other implementations of C(n) also include but are not limited to using the average oxygen concentration in the most recent period of time, so as to serve as the baseline of the patient's oxygen concentration, and serve as a reference point for oxygen concentration adjustment when the patient's blood oxygen fluctuates; or the most recent period The average oxygen concentration when the patient's blood oxygen is within the target range; or set by the doctor.
  • the adjustment amount of the inhaled oxygen concentration can be calculated by the above formula, so as to realize the automatic adjustment of the patient's inhaled oxygen concentration . and a d for control.
  • the existing practice is to set a set of coefficients based on experience, and fixed coefficients will lead to failure to meet the needs of different patients or the same patient under different blood oxygen conditions.
  • the adjustment coefficients a p and a i are determined according to the curve parameters of the patient's oxygen dissociation curve and the patient's real-time blood oxygen parameters, combined with the patient's current blood oxygen and the relationship between the current blood oxygen and arterial oxygen partial pressure and one or more of a d .
  • the adjustment coefficient can be increased in the middle steep region of the oxygen dissociation curve, and decreased in the upper flat region.
  • the method of combining oxygen dissociation curve will be closer to the oxygen demand of the patient itself, and can meet the needs of different patients under different physiological conditions.
  • the following uses the adjustment coefficient to represent one or more of the proportional coefficient, integral coefficient and differential coefficient to illustrate how to determine the adjustment coefficient by region.
  • the adjustment coefficient is set as the first preset fixed coefficient.
  • the adjustment coefficient changes with the patient's current arterial oxygen partial pressure at the corresponding position on the oxygen dissociation curve. change, and is positively correlated with the slope of the curve.
  • the adjustment coefficient can be set to the fifth multiple of the second preset fixed coefficient.
  • the fifth multiple is the curve of the patient's current partial pressure of arterial oxygen at the corresponding position on the oxygen dissociation curve.
  • the adjustment coefficient changes with the patient's current arterial oxygen partial pressure at the corresponding position on the oxygen dissociation curve, and is negatively correlated with the curve slope
  • the adjustment coefficient can be set as the sixth multiple of the third preset fixed coefficient, and the sixth multiple is the slope of the curve at the corresponding position of the third arterial oxygen partial pressure threshold on the patient's oxygen dissociation curve and the patient's current arterial oxygen The ratio of the partial pressure to the slope of the curve at the corresponding position on the oxygen dissociation curve.
  • the first preset fixed coefficient is greater than or equal to the second preset fixed coefficient
  • the second preset fixed coefficient is greater than or equal to the third preset fixed coefficient.
  • the following uses a specific example to illustrate how to adjust the inhaled oxygen concentration according to the patient's oxygen dissociation curve and the patient's real-time blood oxygen parameters. It should be noted that, during actual operation, only the adjustment time interval, or only the adjustment coefficient, or both the adjustment time interval and the adjustment coefficient can be adjusted by referring to the following method.
  • the following is an example of an arterial oxygen partial pressure range corresponding to the target blood oxygen range of 55-80mm Hg.
  • the target blood oxygen range can be set by the doctor according to the patient's physiological condition.
  • the first arterial oxygen partial pressure threshold is 55mm Hg
  • the third arterial oxygen partial pressure threshold is 80mm Hg.
  • the threshold of the second arterial partial pressure of oxygen can be set to 40mm Hg.
  • the adjustment time interval T for adjusting the patient's inhaled oxygen concentration in different regions can be determined according to the following expression:
  • current PaO2 represents the arterial oxygen partial pressure of the patient at the current moment, Indicates the slope of the curve of the oxygen dissociation curve.
  • T1 can be a preset minimum adjustment time interval, which is used to limit the fastest oxygen concentration adjustment response speed.
  • T 1 is used to adjust the oxygen concentration. Adjust to achieve the purpose of rapid oxygenation.
  • the calculation method of the aerobic adjustment interval determines the adjustment time interval, that is, the adjustment time interval is the first multiple of T1 .
  • the adjustment time interval is the first multiple of T1 .
  • the adjustment interval calculation method for reducing oxygen can be used.
  • T2 represents the longest adjustment interval, so that the adjustment time
  • the interval T is the second multiple of T2 , that is, when the patient's blood oxygen is close to the upper limit of the target blood oxygen range of 80mmHg, the longest adjustment interval T2 is used to reduce the oxygen, so as to stabilize the patient's blood oxygen as much as possible.
  • the adjustment interval is non-linearly reduced on the basis of T2.
  • T 1 ⁇ T 2 .
  • the adjustment interval should be increased to match the current rate of the combination of oxygen and hemoglobin in the patient, and avoid over-adjustment.
  • the above method of adjusting the time interval in segments according to the patient's arterial oxygen partial pressure is only one of the implementations, and other implementations include but are not limited to Combine relevant physiological parameters or perform segmented settings based on the currently used oxygen concentration, positive end-expiratory pressure and other information.
  • the proportional coefficient ap can be determined according to the following expression:
  • a p can be a preset maximum proportional coefficient, which is used to limit the maximum oxygen concentration adjustment amount of the proportional module when the blood oxygen is extremely low, so as to achieve the purpose of rapid oxygen increase.
  • the proportionality coefficient a p is non-linearly decreased according to the oxygen dissociation curve.
  • the proportionality coefficient a p is the fifth multiple of A p .
  • the proportionality coefficient a p is the sixth multiple of A p1 .
  • a p1 represents the minimum proportional coefficient used when the patient's blood oxygen is higher than the target blood oxygen range, and is used to limit a minimum adjustment amount when the patient's blood oxygen is higher than the target blood oxygen range.
  • the proportional coefficient is increased nonlinearly according to the oxygen dissociation curve, and the adjustment amount is increased.
  • the above-mentioned method of determining the proportionality coefficient in segments based on the patient's arterial partial pressure of oxygen is only one of the implementation methods, and other implementation methods include but are not limited to the patient's oxygenation-related parameters based on the patient's blood oxygen, oxygenation index, ROX index, etc.
  • Physiological parameters may be segmented according to currently used oxygen concentration, positive end-expiratory pressure and other information to determine the proportional coefficient.
  • the integral coefficient a i and the differential coefficient a d can be realized by referring to the determination method of the proportional coefficient a p , which will not be repeated here.
  • the ventilation control method provided in this embodiment may further include:
  • step S502 Determine whether the duration of the current period is greater than or equal to the updated adjustment time interval of the inhaled oxygen concentration. If yes, execute step S503; if not, execute step S504.
  • the new adjustment cycle receive and analyze the blood oxygen data of the patient in real time, and record the duration t of the current cycle, when t is greater than or equal to the adjustment time interval of the updated inhaled oxygen concentration, that is, greater than or equal to the latest adjustment time interval
  • T it is considered that the current period is over, and a new adjustment of the inhaled oxygen concentration is performed.
  • the update method of the latest adjustment time interval T can be updated at the end of the cycle, that is, after the end of each adjustment cycle, according to the average blood oxygen in the current adjustment cycle (or the latest blood oxygen value in the current cycle)
  • the oxygen partial pressure value is calculated according to the calculation method provided in the above-mentioned embodiment to calculate the latest adjustment time interval T, which is used as the time threshold for the end of the next adjustment cycle. It can also be updated in real time within the cycle, that is, after each new blood oxygen value is obtained, the latest T is calculated in the same way as above according to the blood oxygen value. The latest T, then perform an oxygen concentration adjustment.
  • determine the Before the target control parameters for adjusting the inhaled oxygen concentration of the patient may also include:
  • step S602. Determine whether the associated data satisfies the blood oxygen reliability requirement according to a preset determination rule. If it is satisfied, execute step S603; if not, execute step S604.
  • Judging by a preset judgment rule can make the target control parameter determined depending on the blood oxygen parameter with high reliability, thereby improving the reliability of the ventilation control method.
  • the associated data may at least include pulse rate and/or perfusion index and/or blood oxygen signal quality.
  • the step of judging whether the associated data meets the blood oxygen reliability requirement includes:
  • the pulse rate change rate threshold If the change rate of the pulse rate is higher than the pulse rate change rate threshold, the pulse rate does not meet the blood oxygen reliability requirement, otherwise the pulse rate meets the blood oxygen reliability requirement; and/or,
  • the pulse rate is lower than the pulse rate threshold, the pulse rate does not meet the blood oxygen reliability requirements, otherwise the pulse rate meets the blood oxygen reliability requirements; and/or,
  • the perfusion index is lower than the perfusion index threshold, the perfusion index does not meet the blood oxygen reliability requirement, otherwise the perfusion index meets the blood oxygen reliability requirement; and/or,
  • the blood oxygen signal quality is lower than the blood oxygen signal quality threshold, the blood oxygen signal quality does not meet the blood oxygen reliability requirement; otherwise, the blood oxygen signal quality meets the blood oxygen reliability requirement.
  • the step of judging whether the associated data meets the blood oxygen reliability requirement includes:
  • the pulse rate is higher than the pulse rate change rate threshold and whether the pulse rate is lower than the pulse rate threshold, if both are no, that is, the pulse rate meets the blood oxygen reliability requirements, and the blood oxygen level is determined.
  • the data is trusted data.
  • the step of judging whether the associated data meets the blood oxygen reliability requirement includes:
  • the perfusion index is lower than the perfusion index threshold, the perfusion index does not meet the blood oxygen reliability requirement, otherwise the perfusion index meets the blood oxygen reliability requirement.
  • the step of judging whether the associated data meets the blood oxygen reliability requirements includes: judging whether the blood oxygen signal quality is lower than the blood oxygen signal quality threshold; if the blood oxygen signal If the quality is lower than the blood oxygen signal quality threshold, the blood oxygen signal quality does not meet the blood oxygen reliability requirements, otherwise the blood oxygen signal quality meets the blood oxygen reliability requirements.
  • the associated data includes pulse rate and perfusion index
  • the perfusion index is lower than the perfusion index threshold; if so, the perfusion index does not meet the blood oxygen reliability requirement; if not, the perfusion index meets the blood oxygen reliability requirement.
  • the associated data includes any combination of pulse rate, perfusion index and blood oxygen signal quality, for example: pulse rate and blood oxygen signal quality; or, perfusion index and blood oxygen signal quality; or, pulse rate, perfusion index and blood oxygen signal quality Blood oxygen signal quality, when the judgment for any data in the combination is no, determine the blood oxygen data as credible data, if the judgment for any data in the combination is yes, determine the blood oxygen data as unreliable data.
  • pulse rate and blood oxygen signal quality for example: pulse rate and blood oxygen signal quality; or, perfusion index and blood oxygen signal quality; or, pulse rate, perfusion index and blood oxygen signal quality
  • Blood oxygen signal quality when the judgment for any data in the combination is no, determine the blood oxygen data as credible data, if the judgment for any data in the combination is yes, determine the blood oxygen data as unreliable data.
  • the ventilation control method provided by this embodiment also continues to judge whether the number of times the associated data does not meet the blood oxygen reliability requirements continuously reaches the preset threshold, and whether the continuous duration exceeds the preset duration. Due to unreliable blood oxygen data, the automatic adjustment of inhaled oxygen concentration is in an unadjustable state for a long time, which will cause more serious problems. Therefore, it is necessary to carry out an alarm prompt and manual intervention. If the number of times that the associated data does not meet the blood oxygen reliability requirement continuously reaches the preset threshold, and the continuous duration exceeds the preset duration, an alarm message for suspending the adjustment of the inhaled oxygen concentration is generated. Further, the alarm information can also be sent out in one or more ways of sound, light and vibration.
  • any tangible, non-transitory computer-readable storage medium may be used, including magnetic storage devices (hard disks, floppy disks, etc.), optical storage devices (CD-ROM, DVD, Blu Ray discs, etc.), flash memory and/or the like .
  • These computer program instructions can be loaded into a general purpose computer, special purpose computer or other programmable data processing apparatus to form a machine, so that these instructions executed on the computer or other programmable data processing apparatus can generate an apparatus for realizing specified functions.
  • These computer program instructions may also be stored in a computer-readable memory which can instruct a computer or other programmable data processing device to operate in a particular manner such that the instructions stored in the computer-readable memory form a Manufactures, including implementing devices for implementing specified functions.
  • Computer program instructions can also be loaded on a computer or other programmable data processing device, thereby performing a series of operational steps on the computer or other programmable device to produce a computer-implemented process, so that the computer or other programmable device Instructions may provide steps for performing specified functions.
  • the term “comprises” and any other variants thereof are non-exclusive, such that a process, method, article, or apparatus that includes a list of elements includes not only those elements, but also elements not expressly listed or not part of the process. , method, system, article or other element of a device.
  • the term “coupled” and any other variations thereof, as used herein refers to a physical connection, an electrical connection, a magnetic connection, an optical connection, a communicative connection, a functional connection, and/or any other connection.

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  • Health & Medical Sciences (AREA)
  • Emergency Medicine (AREA)
  • Pulmonology (AREA)
  • Engineering & Computer Science (AREA)
  • Anesthesiology (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Hematology (AREA)
  • Life Sciences & Earth Sciences (AREA)
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  • Public Health (AREA)
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  • Measurement Of The Respiration, Hearing Ability, Form, And Blood Characteristics Of Living Organisms (AREA)

Abstract

L'invention concerne un procédé et un dispositif de commande de ventilation (20). Le procédé consiste à : acquérir un paramètre d'oxygène sanguin en temps réel d'un patient (s301) et acquérir une courbe de dissociation de l'oxygène du patient (s302) ; puis en fonction des paramètres de courbe de la courbe de dissociation de l'oxygène et du paramètre d'oxygène sanguin en temps réel, déterminer des paramètres de commande cibles pour ajuster la fraction d'oxygène inspirée du patient (s303), les paramètres de commande cibles comprenant un paramètre de temps cible et/ou un paramètre d'écoulement de gaz cible. Les paramètres de commande cibles pour ajuster la fraction d'oxygène inspirée sont déterminés en tenant pleinement compte de la courbe de dissociation de l'oxygène et du paramètre d'oxygène sanguin en temps réel d'un patient, de telle sorte que les paramètres de commande cibles peuvent correspondre à un besoin de ventilation du patient dans un état physiologique actuel. Par conséquent, les besoins de ventilation de différents patients dans différentes conditions physiologiques peuvent être satisfaits.
PCT/CN2021/141758 2021-12-27 2021-12-27 Procédé et dispositif de commande de ventilation WO2023122903A1 (fr)

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PCT/CN2021/141758 WO2023122903A1 (fr) 2021-12-27 2021-12-27 Procédé et dispositif de commande de ventilation

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Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6148814A (en) * 1996-02-08 2000-11-21 Ihc Health Services, Inc Method and system for patient monitoring and respiratory assistance control through mechanical ventilation by the use of deterministic protocols
US20050109340A1 (en) * 2003-11-21 2005-05-26 Tehrani Fleur T. Method and apparatus for controlling a ventilator
US20060149144A1 (en) * 1997-01-27 2006-07-06 Lynn Lawrence A System and method for automatic detection of a plurality of SPO2 time series pattern types
US20090241956A1 (en) * 2008-03-27 2009-10-01 Nellcor Puritan Bennett Llc Method for controlling delivery of breathing gas to a patient using multiple ventilation parameters
US20100186742A1 (en) * 2009-01-29 2010-07-29 Impact Instrumentation, Inc. Medical ventilator with autonomous control of oxygenation
US20180153440A1 (en) * 2016-12-05 2018-06-07 Medipines Corporation & The Regents Of The University Of California System And Methods For Respiratory Measurements Using Breathing Gas Samples

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6148814A (en) * 1996-02-08 2000-11-21 Ihc Health Services, Inc Method and system for patient monitoring and respiratory assistance control through mechanical ventilation by the use of deterministic protocols
US20060149144A1 (en) * 1997-01-27 2006-07-06 Lynn Lawrence A System and method for automatic detection of a plurality of SPO2 time series pattern types
US20050109340A1 (en) * 2003-11-21 2005-05-26 Tehrani Fleur T. Method and apparatus for controlling a ventilator
US20090241956A1 (en) * 2008-03-27 2009-10-01 Nellcor Puritan Bennett Llc Method for controlling delivery of breathing gas to a patient using multiple ventilation parameters
US20100186742A1 (en) * 2009-01-29 2010-07-29 Impact Instrumentation, Inc. Medical ventilator with autonomous control of oxygenation
US20180153440A1 (en) * 2016-12-05 2018-06-07 Medipines Corporation & The Regents Of The University Of California System And Methods For Respiratory Measurements Using Breathing Gas Samples

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