JP2021164702A - 定量的神経筋系遮断検知システム及び方法 - Google Patents
定量的神経筋系遮断検知システム及び方法 Download PDFInfo
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Abstract
【解決手段】新規のリード線アセンブリと、該リード線アセンブリ上に適切な電極を選択し得、リード線アセンブリを通じて患者に印加された刺激信号を調節し得るモニタとを使用する神経筋モニタリングが記述される。該モニタリングはまた、誤った四連計算の可能性を減少させるためにノイズフロア値を設定し得る。
【選択図】図1
Description
本願は、2016年10月14日出願の米国仮出願番号62/408,327及び2017年3月9日出願の米国仮出願番号62/469,310の利益を主張し、それらの開示は、それらの全体が参照により本明細書に組み込まれる。
神経筋遮断の検出のためのシステム及び方法が記述される。
神経は、純粋な感覚機能を果たさない単に無保護の神経である。尺骨神経は、小指と、薬指の隣接する半分とに直接接続される。したがって、小指に隣接して又は小指上に検知電極を設置することは、幾らかの患者に対して改善した刺激及び検知を提供し得る。
Claims (20)
- 複数の第1の電極と、
複数の第2の電極と、
(a)前記第1の電極を介して患者に一連の刺激信号を印加し、前記第2の電極を介して前記一連の刺激信号への患者の反応を検出し、検出された前記患者の反応から四連(TOF)カウントを決定することと、
(b)前記TOFカウントが所定の閾値以上である場合、ステップ(a)を自動的に反復し、前記TOFカウントが前記所定の閾値未満である場合、前記第1の電極を介して前記患者にテタニック刺激信号を自動的に印加し、ポストテタニックカウント(PTC)を決定することと
を含む自動的モニタリングサイクルを行うようにプログラムされたモニタと
を含む、神経筋モニタリングシステム。 - 前記所定の閾値は1である、請求項1に記載のシステム。
- 前記自動的モニタリングサイクルは、10秒毎に1回のみステップ(a)を反復することを含む、請求項1に記載のシステム。
- 前記モニタは、前記PTCを決定した後に前記自動的モニタリングサイクルを反復するように更にプログラムされる、請求項1に記載のシステム。
- 前記複数の第1の電極及び前記複数の第2の電極は、単一のリード線アセンブリ上に配備される、請求項1に記載のシステム。
- 前記単一のリード線アセンブリは、母指アパーチャを含む、請求項5に記載のシステム。
- 電子診療録を格納するサーバを更に含み、
前記モニタは、ネットワークを通じて前記サーバと通信するように構成される、
請求項1に記載のシステム。 - 前記モニタは、前記ネットワークを通じて前記サーバへ、決定されたTOFカウント又は決定されたPTCを自動的に送信するように構成される、請求項7に記載のシステム。
- 前記モニタは、前記モニタ、第1の電極、及び第2の電極の結合インピーダンスと患者のインピーダンスとの間を区別するように構成され、
前記モニタは、前記モニタ、第1の電極、及び第2の電極の前記結合インピーダンスが所定の閾値を上回る場合に警告信号を発行するように構成される、
請求項1に記載のシステム。 - コモンモード電極を更に含み、
前記モニタは、前記コモンモード電極からコモンモード信号を検出するようにプログラムされる、
請求項1に記載のシステム。 - リード線アセンブリであって、
2つの刺激電極と、
正の筋電図(EMG)信号検出電極と、
負のEMG信号検出電極と、
コモンモード電極と
を含む、前記リード線アセンブリと、
(a)前記刺激電極を介して患者に一連の刺激信号を印加し、前記正のEMG信号検出電極を及び前記負のEMG信号検出電極を介して前記一連の刺激信号への患者の反応を検出し、検出された前記患者の反応から四連(TOF)カウントを決定することと、
(b)前記TOFカウントが所定の閾値以上である場合、ステップ(a)を自動的に反復し、前記TOFカウントが前記所定の閾値未満である場合、前記刺激電極を介して前記患者にテタニック刺激信号を自動的に印加し、ポストテタニックカウント(PTC)を続いて決定することと
を含む自動的モニタリングサイクルを行うようにプログラムされたモニタと
を含む、神経筋モニタリングシステム。 - 前記モニタは、
前記コモンモード電極からコモンモード信号を検知することと、前記コモンモード信号を抑圧することとをするように構成された回路
を含む、請求項11に記載のシステム。 - 前記モニタは、前記自動的モニタリングサイクル中に取得されたデータを電子健康録へ自動的に送信するように構成される、請求項11に記載のシステム。
- 前記モニタは、電極の故障に関係する低信号状態を自動的に検出するように構成される、請求項11に記載のシステム。
- (a)リード線アセンブリ上の複数の刺激電極を介して患者に一連の刺激信号を印加し、前記リード線アセンブリ上の複数の筋電図電極を介して前記一連の刺激信号への患者の反応を測定し、測定された前記患者の反応から四連(TOF)カウントを決定することと、
(b)前記TOFカウントが所定の閾値以上である場合、ステップ(a)を自動的に反復し、前記TOFカウントが前記所定の閾値未満である場合、前記リード線アセンブリを介して前記患者にテタニック刺激信号を自動的に印加し、ポストテタニックカウント(PTC)を決定することと
を含む、神経筋モニタリング方法。 - 前記所定値の閾値は1である、請求項15に記載の方法。
- ポストテタニックカウントを決定した後に、ステップ(a)及び(b)を反復すること
を更に含む、請求項15に記載の方法。 - ステップ(a)は、10秒毎に1回のみ反復される、請求項15に記載の方法。
- 前記方法は、モニタにより実施され、
ネットワーク接続を通じて前記モニタからサーバへTOFカウント又はPTCを送信することを更に含む、
請求項15に記載の方法。 - 前記方法は、モニタにより実施され、
前記患者により生じたインピーダンスを決定することと、
デバイスインピーダンスを決定するために、前記患者の前記インピーダンスを総インピーダンスから減算することと、
前記デバイスインピーダンスが所定の閾値を上回る場合に警告を発行することと
を更に含む、請求項15に記載の方法。
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EP4091661A1 (en) | 2022-11-23 |
JP6911108B2 (ja) | 2021-07-28 |
CN110072451A (zh) | 2019-07-30 |
KR20240051323A (ko) | 2024-04-19 |
EP4091661B1 (en) | 2023-09-06 |
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