WO2003050497A1 - Inner pressure monitor of airway - Google Patents

Inner pressure monitor of airway Download PDF

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Publication number
WO2003050497A1
WO2003050497A1 PCT/JP2001/011068 JP0111068W WO03050497A1 WO 2003050497 A1 WO2003050497 A1 WO 2003050497A1 JP 0111068 W JP0111068 W JP 0111068W WO 03050497 A1 WO03050497 A1 WO 03050497A1
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WO
WIPO (PCT)
Prior art keywords
pressure
patient
airway
allowable range
ventilator
Prior art date
Application number
PCT/JP2001/011068
Other languages
French (fr)
Japanese (ja)
Inventor
Toshiharu Katahira
Original Assignee
Pacific Medico Co., Ltd.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
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Publication date
Application filed by Pacific Medico Co., Ltd. filed Critical Pacific Medico Co., Ltd.
Publication of WO2003050497A1 publication Critical patent/WO2003050497A1/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0463—Tracheal tubes combined with suction tubes, catheters or the like; Outside connections
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/08—Bellows; Connecting tubes ; Water traps; Patient circuits
    • A61M16/0816—Joints or connectors
    • A61M16/0841—Joints or connectors for sampling
    • A61M16/0858—Pressure sampling ports
    • G—PHYSICS
    • G01—MEASURING; TESTING
    • G01L—MEASURING FORCE, STRESS, TORQUE, WORK, MECHANICAL POWER, MECHANICAL EFFICIENCY, OR FLUID PRESSURE
    • G01L19/00—Details of, or accessories for, apparatus for measuring steady or quasi-steady pressure of a fluent medium insofar as such details or accessories are not special to particular types of pressure gauges
    • G01L19/08—Means for indicating or recording, e.g. for remote indication
    • G01L19/12—Alarms or signals
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/0051—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes with alarm devices
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/021—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes operated by electrical means
    • 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
    • A61M2230/00—Measuring parameters of the user
    • A61M2230/40—Respiratory characteristics

Definitions

  • the present invention relates to an airway pressure monitoring device. More specifically, the present invention relates to an airway pressure monitoring device for monitoring the pressure of gas supplied from a ventilator to a patient, and thus the airway pressure of the patient.
  • FIG. 7 is an explanatory view of a schematic configuration showing an example of a state of use of a conventional ventilator. It intermittently supplies increased air and other gases to encourage respiration.
  • the exhaled air exhaled from the patient is discharged into the atmosphere from the outlet 4 through the branch pipe 3 as shown in the figure, for example.
  • the pressure of the gas supplied from the ventilator 1 is set so as to be almost always constant, and is constantly monitored so as not to exceed a predetermined allowable range.
  • the above pressure is constantly measured by a pressure measuring means (not shown) provided in the ventilator 1 through a pressure measuring tube 5 connected to the vicinity of the end of the air supply pipe 2 on the patient side. Measures and turns on or blinks an alarm lamp or emits an audible alarm when the measured pressure exceeds or falls below a predetermined allowable range.
  • the upper and lower limits of the allowable range are conventionally manually set with a dial or the like generally provided in a ventilator, so that the work is complicated and troublesome, and the setting is forgotten or the setting is not possible. If appropriate, good monitoring operations may not be possible. In addition, if the ventilator malfunctions and the air supply pressure fluctuates, or if a circuit breaks or leaks, the patient has problems such as respiratory failure or inability to breathe.
  • the present invention has been proposed in view of the above problems, and describes how to set a ventilator. Regardless, it is an object of the present invention to provide a monitoring device capable of satisfactorily monitoring the pressure of gas supplied from a ventilator to a patient and thus the airway pressure of the patient. Disclosure of the invention
  • the airway pressure monitoring device has the following configuration. That is, an airway pressure monitoring device that monitors the airway pressure of a patient to which a ventilator is attached, and a pressure measuring means for measuring the pressure of gas such as air supplied from the human respirator to the patient; Means for determining whether or not the maximum value of the pressure measured by the means is within a predetermined allowable range, and an alarm is issued when the measured value exceeds the allowable range. .
  • the upper limit value and the lower limit value of the allowable range are automatically set.
  • the pressure of the gas supplied to the patient from the ventilator is measured a plurality of times by the pressure measuring means.
  • the average value is calculated, and the upper and lower limits of the allowable range are automatically set based on the average value.
  • FIG. 1 is an explanatory diagram of a schematic configuration showing an example of a use state of a monitoring device according to the present invention.
  • Figure 2 is an enlarged front view of the monitoring device.
  • FIG. 3 is a block diagram showing a schematic configuration of the monitoring device.
  • FIG. 4 is a diagram showing an example of a pressure waveform of a gas supplied from a respirator to a patient.
  • FIG. 5 is a flowchart showing an example of a monitoring operation by the monitoring device.
  • FIG. 6 is an explanatory diagram of a schematic configuration showing another example of a use state of the monitoring device according to the present invention.
  • FIG. 7 is an explanatory diagram of a schematic configuration showing an example of a use state of a conventional artificial respirator. BEST MODE FOR CARRYING OUT THE INVENTION
  • FIG. 1 is an artificial respirator
  • 2 is an air supply pipe
  • 3 is a branch pipe
  • 4 is an outlet
  • 5 is a pressure measurement tube.
  • the above configuration is the same as the above-mentioned conventional example.
  • the present embodiment has a configuration in which a connection tube 7 is communicated to the middle of the air supply pipe 2 via an adapter 6, and a monitoring device 10 is connected to the other end of the connection tube 7.
  • the monitoring device 10 includes pressure measuring means 11 for measuring the pressure of gas such as air supplied from the ventilator 1 to the patient side, and the air supply pressure measured by the pressure measuring means 11.
  • a monitoring control means 12 such as a CPU for monitoring whether or not it is within a predetermined allowable range is built in.
  • the pressure measuring means 11 is configured to measure the pressure in the supply pipe 2 for supplying gas from the ventilator 1 to the patient via the connection tube 7 communicating with the supply pipe 2.
  • the measured pressure is always displayed by the pressure display means 13 shown in FIGS. 2 and 3.
  • the monitoring control means 12 also has a function of automatically setting the upper and lower limits of the allowable range of the pressure of the gas supplied to the patient based on the pressure measured by the pressure measuring means 11.
  • the pressure of the gas supplied from the ventilator 1 to the patient side in the cycle shown in Fig. 4 for example, the peak pressure PX
  • the measurement is performed three times, the average value is calculated, and the upper limit value and the lower limit value are set based on the average value.
  • the method of setting the upper limit value and the lower limit value is appropriately set, for example, by adding or subtracting a predetermined numerical value to the above average value, or by multiplying by a predetermined ratio. Specifically, for example, the about 9 on the average value of. 8 to 1 9 6 P a a (1 0 ⁇ 2 0 mm H 2 ⁇ ) adding a value to a maximum value, approximately from the average 4 9 ⁇ 9 8 P a (5 to: 10 mm H 2 ⁇ ) minus the value should be set as the lower limit.
  • the above numerical values are merely examples, and can be appropriately changed depending on, for example, the type and performance of the ventilator or the condition of the patient.
  • the monitoring device 10 in the present embodiment is configured so that the above-mentioned upper limit value and lower limit value can also be set manually.
  • the front of the monitoring device 10 has a manual setting and an automatic setting as shown in FIG.
  • a manual / automatic switch 15 for switching between settings and an upper limit manual setting dial 16 and a lower limit manual setting dial 17 are provided.
  • the monitoring device 10 can be used when the external power supply is shut off for any reason with the power switch not shown in the figure turned on, for example, when the outlet is accidentally unplugged or when a power failure occurs.
  • a power alarm 18 illuminated by an internal power supply (not shown) and a signal indicating that the pressure measured by the pressure measuring means 11 has exceeded a predetermined upper limit value.
  • An upper-limit alarm lamp 19 to be displayed and a lower-limit alarm lamp 20 to indicate that the temperature has fallen below a predetermined lower limit are provided.
  • the alarm 18 and the alarm lamps 19 and 20 are turned on, At the same time, there is a built-in alarm that emits a hairpin sound, but it is omitted in the figure.
  • reference numeral 21 denotes a lower limit alarm delay setting dial. Normally, the airway pressure falls below the lower limit set value each time the patient inhales, and the lower limit alarm lamp 20 lights up or the alarm sounds at each time. In this embodiment, the time from when the measured value falls below the lower limit to when the alarm is issued can be set arbitrarily from 0.5 seconds to 60 seconds. Have been.
  • reference numeral 22 denotes a lower-limit alarm silencing switch for the operator to temporarily silence the alarm sound when the measured value falls below the lower limit value as required. In the present embodiment, the lower silencing switch 2 is used. When 2 is pressed, the alarm sounds are stopped for 2 minutes, and the alarm sounds again if the cause of the alarm is not eliminated during that time.
  • the monitoring device 10 When monitoring the airway pressure of a patient to which the ventilator is attached by the monitoring device configured as described above, the monitoring device 10 is arranged as shown in FIG. It measures the pressure of the gas supplied to the patient and thereby indirectly monitors the patient's airway pressure.
  • FIG. 10 measures the pressure of the gas supplied to the patient and thereby indirectly monitors the patient's airway pressure.
  • an example of an operation procedure for automatically performing the monitoring operation will be described step by step.
  • Fig. 5 shows the process in which the upper limit and the lower limit of the pressure of the gas supplied to the patient are automatically set and monitored.
  • gas is supplied from the ventilator 1 to the patient.
  • the power switch (not shown) is turned on (step S1)
  • the manual / automatic switch 15 is switched to the automatic (AUTO) side
  • the automatic setting button 14 is pressed (step S2). ).
  • the pressure of the gas supplied from the ventilator 1 to the patient side is sequentially measured by the pressure measuring means 11, and the measured value is displayed on the pressure display means 13 via the monitoring control means 12. Further, the monitoring control means 12 calculates the average value of the maximum pressure PX for a plurality of breathing periods, in this embodiment, for three breathing periods, and sets the upper limit value and the lower limit value of the allowable range based on the average value. Yes (step S3). In the present embodiment, the upper limit value and the lower limit value are displayed on the pressure display means 13 in a different color from the above measured pressure. It is configured as follows.
  • Step S 4 After setting the permissible upper and lower limits of the air supply pressure supplied to the patient as described above, the maximum value of the air supply pressure supplied to the patient by the pressure measuring means 11 is continuously (Step S 4), the monitoring control means 12 determines whether or not the measured value is equal to or greater than the allowable upper limit (Step S 5).
  • the upper limit alarm lamp 19 is turned on, and an alarm sound is emitted from an alarm device or the like not shown in the figure (step S6).
  • the monitoring control means 12 further determines whether or not the measured value is equal to or less than the allowable lower limit (step S7). If so, the lower limit alarm lamp 20 is turned on, and an alarm sound is emitted from an alarm device or the like not shown in the figure (step S8).
  • the alarm lamps 19 and 20 are lit and an alarm sounds to notify the patient or administrator of the abnormality. Is what you can do.
  • the airway pressure of the patient fluctuates with the passage of time, or if necessary, by pressing the automatic setting button again as needed, the average value, upper limit value, and lower limit value are set. Can be reset, and the monitoring operation is subsequently performed based on the set value.
  • the upper limit and the lower limit of the allowable range of the air supply pressure are configured to be set manually, and when set manually, the manual / automatic switch 15 To the (MANU) side, and rotate the upper limit manual setting dial 16 and lower limit manual setting dial 17 to the desired values, respectively, and based on the upper and lower limits,
  • the monitoring operation can be executed in the same manner as described above.
  • the pressure measurement tube 5 is connected to the ventilator 1 near the ventilator 1 via the adapter 6, but as shown in FIG. May be communicated with.
  • Industrial applicability Since the airway pressure monitoring device according to the present invention monitors separately from the monitoring function provided in the ventilator as described above, it is possible to greatly improve reliability in combination with the monitoring function of the ventilator. it can.
  • the airway pressure of a patient with a ventilator is monitored by measuring the pressure of air or other gas that is actually supplied from the ventilator to the patient, more reliable monitoring operations can be performed. It becomes possible.
  • the monitoring device according to the present invention enables good monitoring, so that accidents can be prevented beforehand. Can be.
  • the upper and lower limits of the allowable range of the gas pressure supplied to the patient from the ventilator are automatically set.
  • the pressure of the gas supplied to the patient from the ventilator is measured several times and the average is measured.

Abstract

An inner pressure monitor of airway for especially monitoring the inner pressure of the airway of a patient fixed with a respirator, in which the inner pressure of airway can be monitored well regardless of the setting conditions or the monitoring conditions of a monitoring function provided in the respirator. The monitor for monitoring the inner pressure of the airway of a patient fixed with a respirator, comprises means for measuring the pressure of gas, e.g. air, being supplied to the patient from the respirator, and means for making a decision whether a maximum pressure measured by the pressure measuring means falls within a specified allowable range or not, characterized in that an alarm is delivered when the measurement exceeds the allowable range. Upper limit and lower limit of the allowable range can preferably be set automatically based on the average value of a plurality of pressure measurements of respiration gas being supplied to the patient from the respirator, for example.

Description

明 細 書 気道内圧監視装置 技術分野  Description Airway pressure monitoring device Technical field
本発明は、 気道内圧監視装置に関する。 更に詳しくは、 人工呼吸器から患者に 供給される気体の圧力、 ひいては患者の気道内圧を監視する気道内圧監視装置に 関するものである。 背景技術  The present invention relates to an airway pressure monitoring device. More specifically, the present invention relates to an airway pressure monitoring device for monitoring the pressure of gas supplied from a ventilator to a patient, and thus the airway pressure of the patient. Background art
従来、 呼吸機能が不全もしくは不充分な患者に呼吸を促す手段として人工呼吸 器が用いられている。 図 7は従来の人工呼吸器の使用状態の一例を示す概略構成 の説明図であり、 人工呼吸器 1から送気管 2を介して図に省略した患者の口ある いは気道に空気もしくは酸素を増量した空気等の気体を間欠的に供給して呼吸を 促すものである。 なお患者から排出された呼気は例えば図のような分岐管 3を介 して排出口 4から大気中に放出される。  Conventionally, a ventilator has been used as a means to encourage a patient with respiratory function insufficiency or insufficient respiration. FIG. 7 is an explanatory view of a schematic configuration showing an example of a state of use of a conventional ventilator. It intermittently supplies increased air and other gases to encourage respiration. In addition, the exhaled air exhaled from the patient is discharged into the atmosphere from the outlet 4 through the branch pipe 3 as shown in the figure, for example.
この場合、 人工呼吸器 1から供給される気体の圧力は、 常時ほぼ一定になるよ うに設定すると共に、 所定の許容範囲を超えないように常時監視するようにして いる。 例えば、 図 7のように送気管 2の患者側の端部近傍に連通させた圧力測定 用チューブ 5を介して人工呼吸器 1内に設けた圧力測定手段 （不図示） で上記の 圧力を常時測定し、 その測定圧力が所定許容範囲以上もしくは以下になったとき 警報ランプを点灯もしくは点滅させたり、 警報音を発するようにしている。  In this case, the pressure of the gas supplied from the ventilator 1 is set so as to be almost always constant, and is constantly monitored so as not to exceed a predetermined allowable range. For example, as shown in FIG. 7, the above pressure is constantly measured by a pressure measuring means (not shown) provided in the ventilator 1 through a pressure measuring tube 5 connected to the vicinity of the end of the air supply pipe 2 on the patient side. Measures and turns on or blinks an alarm lamp or emits an audible alarm when the measured pressure exceeds or falls below a predetermined allowable range.
ところが、 上記許容範囲の上限値や下限値は、 従来一般に人工呼吸器に設けた ダイャル等で手動で設定するものであるから作業が煩雑かつ面倒であると共に、 設定を忘れたり、.設定が不適切であると、 良好な監視操作できないおそれがある。 また人工呼吸器が故障して送気圧力が変動したり、 回路の外れや漏れが生じた場 合には患者が呼吸不全となったり、 呼吸不能になる等の問題があった。  However, the upper and lower limits of the allowable range are conventionally manually set with a dial or the like generally provided in a ventilator, so that the work is complicated and troublesome, and the setting is forgotten or the setting is not possible. If appropriate, good monitoring operations may not be possible. In addition, if the ventilator malfunctions and the air supply pressure fluctuates, or if a circuit breaks or leaks, the patient has problems such as respiratory failure or inability to breathe.
本発明は上記の問題点に鑑みて提案されたもので、 人工呼吸器の設定の如何に 拘わらず人工呼吸器から患者に供給される気体の圧力ひいては患者の気道内圧を 良好に監視することのできる監視装置を提供するものである。 発明の開示 SUMMARY OF THE INVENTION The present invention has been proposed in view of the above problems, and describes how to set a ventilator. Regardless, it is an object of the present invention to provide a monitoring device capable of satisfactorily monitoring the pressure of gas supplied from a ventilator to a patient and thus the airway pressure of the patient. Disclosure of the invention
本発明による気道内圧監視装置は、 以下の構成としたものである。 すなわち、 人工呼吸器を取付けた患者の気道内圧を監視する気道内圧監視装置であって、 人 ェ呼吸器から患者に供給される空気等の気体の圧力を測定する圧力測定手段と、 その圧力測定手段で測定した圧力の最大値が所定の許容範囲内にあるか否かを判 定する手段とを備え、 上記測定値が上記許容範囲を超えたとき警報を出すように したことを特徴とする。  The airway pressure monitoring device according to the present invention has the following configuration. That is, an airway pressure monitoring device that monitors the airway pressure of a patient to which a ventilator is attached, and a pressure measuring means for measuring the pressure of gas such as air supplied from the human respirator to the patient; Means for determining whether or not the maximum value of the pressure measured by the means is within a predetermined allowable range, and an alarm is issued when the measured value exceeds the allowable range. .
また上記許容範囲の上限値と下限値とを自動的に設定するようにしたもので、 例えば前記人工呼吸器から患者に供給される気体の圧力を前記圧力測定手段によ り複数回測定してその平均値を算定し、 その平均値に基づいて前記許容範囲の上 限値と下限値を自動的に設定するものである。 図面の簡単な説明  Further, the upper limit value and the lower limit value of the allowable range are automatically set. For example, the pressure of the gas supplied to the patient from the ventilator is measured a plurality of times by the pressure measuring means. The average value is calculated, and the upper and lower limits of the allowable range are automatically set based on the average value. BRIEF DESCRIPTION OF THE FIGURES
図 1は本発明による監視装置の使用状態の一例を示す概略構成の説明図。 図 2 は上記監視装置の拡大正面図。 図 3は上記監視装置の概略構成を示すプロック図。 図 4は人工呼吸器から患者側に供給される気体の圧力波形の一例を示す図。 図 5 は上記監視装置による監視操作の一例を示すフローチャート図。 図 6は本発明に よる監視装置の使用状態の他の例を示す概略構成の説明図。 図 7は従来の人工呼 吸器の使用状態の一例を示す概略構成の説明図である。 発明を実施するための最良の形態  FIG. 1 is an explanatory diagram of a schematic configuration showing an example of a use state of a monitoring device according to the present invention. Figure 2 is an enlarged front view of the monitoring device. FIG. 3 is a block diagram showing a schematic configuration of the monitoring device. FIG. 4 is a diagram showing an example of a pressure waveform of a gas supplied from a respirator to a patient. FIG. 5 is a flowchart showing an example of a monitoring operation by the monitoring device. FIG. 6 is an explanatory diagram of a schematic configuration showing another example of a use state of the monitoring device according to the present invention. FIG. 7 is an explanatory diagram of a schematic configuration showing an example of a use state of a conventional artificial respirator. BEST MODE FOR CARRYING OUT THE INVENTION
以下、 本発明を図に示す実施形態に基づいて具体的に説明する。 図 1において、 1は人工呼吸器、 2は送気管、 3は分岐管、 4は排出口、 5は圧力測定用チュー ブで、 以上の構成は前記従来例と同様である。 本実施形態は上記送気管 2の途中 にアダプタ 6を介して接続用チューブ 7を連通され、 その接続用チューブ 7の他 端に監視装置 1 0を接続した構成である。 その監視装置 1 0内には、 上記人工呼吸器 1から患者側に供給される空気等の 気体の圧力を測定する圧力測定手段 1 1と、 その圧力測定手段 1 1で測定した送 気圧力が所定の許容範囲内にあるか否かを監視する C P U等の監視制御手段 1 2 とが内蔵されている。 Hereinafter, the present invention will be specifically described based on an embodiment shown in the drawings. In FIG. 1, 1 is an artificial respirator, 2 is an air supply pipe, 3 is a branch pipe, 4 is an outlet, and 5 is a pressure measurement tube. The above configuration is the same as the above-mentioned conventional example. The present embodiment has a configuration in which a connection tube 7 is communicated to the middle of the air supply pipe 2 via an adapter 6, and a monitoring device 10 is connected to the other end of the connection tube 7. The monitoring device 10 includes pressure measuring means 11 for measuring the pressure of gas such as air supplied from the ventilator 1 to the patient side, and the air supply pressure measured by the pressure measuring means 11. A monitoring control means 12 such as a CPU for monitoring whether or not it is within a predetermined allowable range is built in.
上記圧力測定手段 1 1は、 上記人工呼吸器 1から患者側に気体を供給する供給 管 2内の圧力を、 その供給管 2内に連通する前記の接続用チューブ 7を介して測 定する構成であり、 その測定圧力は図 2および図 3に示す圧力表示手段 1 3で常 時表示するように構成されている。  The pressure measuring means 11 is configured to measure the pressure in the supply pipe 2 for supplying gas from the ventilator 1 to the patient via the connection tube 7 communicating with the supply pipe 2. The measured pressure is always displayed by the pressure display means 13 shown in FIGS. 2 and 3.
また前記監視制御手段 1 2は、 上記圧力測定手段 1 1で測定した圧力に基づい て、 患者側に供給される気体の圧力の許容範囲の上限値および下限値を自動的に 設定する機能も有しており、 図 2に示す自動設定ポタン 1 4を押すことにより、 例えば図 4に示すようなサイクルで人工呼吸器 1から患者側に供給される気体の 圧力、 特にピーク圧力 P Xを複数回、 本実施形態においては 3回測定して、 その 平均値を算出し、 その平均値に基づいて上限値と下限値が設定されるように構成 されている。  The monitoring control means 12 also has a function of automatically setting the upper and lower limits of the allowable range of the pressure of the gas supplied to the patient based on the pressure measured by the pressure measuring means 11. By pressing the automatic setting button 14 shown in Fig. 2, the pressure of the gas supplied from the ventilator 1 to the patient side in the cycle shown in Fig. 4, for example, the peak pressure PX, In the present embodiment, the measurement is performed three times, the average value is calculated, and the upper limit value and the lower limit value are set based on the average value.
その上限値および下限値の設定方法は、 例えば上記の平均値に所定の数値を加 減する、 或いは所定の比率を掛けて設定する等その他適宜である。 具体的には、 例えば上記の平均値に約 9 8〜 1 9 6 P a ( 1 0〜2 0 mm H 2〇） を加えた値を 上限値とし、 平均値から約 4 9 ~ 9 8 P a ( 5〜： 1 0 mm H 2〇） を引いた値を下 限値として設定すればよい。 なお上記の数値は一例であり、 例えば人工呼吸器の 種類や性能もしくは患者の容体等によって適宜変更することもできる。 The method of setting the upper limit value and the lower limit value is appropriately set, for example, by adding or subtracting a predetermined numerical value to the above average value, or by multiplying by a predetermined ratio. Specifically, for example, the about 9 on the average value of. 8 to 1 9 6 P a a (1 0~2 0 mm H 2 〇) adding a value to a maximum value, approximately from the average 4 9 ~ 9 8 P a (5 to: 10 mm H 2 〇) minus the value should be set as the lower limit. Note that the above numerical values are merely examples, and can be appropriately changed depending on, for example, the type and performance of the ventilator or the condition of the patient.
また本実施形態における監視装置 1 0は、 上記の上限値および下限値を手動で も設定できるように構成されており、 監視装置 1 0の正面には、 図 2に示すよう に手動設定と自動設定とを切り換える手動 · 自動切換スィツチ 1 5と、 上限値手 動設定ダイヤル 1 6および下限値手動設定ダイヤル 1 7とが設けられている。 さらに上記監視装置 1 0には、 図に省略した電源スィッチを入れた状態で何ら かの理由で外部電源が遮断された場合、 例えばコンセントを誤って抜いてしまつ た場合や停電の場合などに内部電源 （不図示） によって点灯する電源アラーム 1 8と、 前記圧力測定手段 1 1で測定した圧力が所定の上限値以上になったことを 表示する上限警報ランプ 1 9と、 所定の下限値以下になったことを表示する下限 警報ランプ 2 0とが設けられ、 それらのアラーム 1 8および警報ランプ 1 9， 2 0が点灯した際には同時に簪報音を発する警報器等が内蔵されているが図には省 略した。 Further, the monitoring device 10 in the present embodiment is configured so that the above-mentioned upper limit value and lower limit value can also be set manually. The front of the monitoring device 10 has a manual setting and an automatic setting as shown in FIG. A manual / automatic switch 15 for switching between settings and an upper limit manual setting dial 16 and a lower limit manual setting dial 17 are provided. In addition, the monitoring device 10 can be used when the external power supply is shut off for any reason with the power switch not shown in the figure turned on, for example, when the outlet is accidentally unplugged or when a power failure occurs. A power alarm 18 illuminated by an internal power supply (not shown) and a signal indicating that the pressure measured by the pressure measuring means 11 has exceeded a predetermined upper limit value. An upper-limit alarm lamp 19 to be displayed and a lower-limit alarm lamp 20 to indicate that the temperature has fallen below a predetermined lower limit are provided. When the alarm 18 and the alarm lamps 19 and 20 are turned on, At the same time, there is a built-in alarm that emits a hairpin sound, but it is omitted in the figure.
なお図中、 2 1は下限警報遅延設定ダイヤルであり、 通常気道内圧は患者の呼 吸の度毎に下限設定値を下回り、 その度毎に下限警報ランプ 2 0が点灯したり、 警報音が発つせられるのを防ぐためのもので、 本実施形態においては測定値が下 限値以下になつてから警報を発するまでの時間を 0 . 5秒から 6 0秒まで任意に 設定できるように構成されている。 また図中 2 2は測定値が下限値以下になった ときの警報音を操作者が必要に応じて一時的に消音するための下限警報消音スィ ツチで、 本実施形態においては該消音スィッチ 2 2を押すと 2分間だけ警報音が 停止され、 その間に警報を発する原因が解消されないと再び警報音を発するよう に構成されている。  In the figure, reference numeral 21 denotes a lower limit alarm delay setting dial. Normally, the airway pressure falls below the lower limit set value each time the patient inhales, and the lower limit alarm lamp 20 lights up or the alarm sounds at each time. In this embodiment, the time from when the measured value falls below the lower limit to when the alarm is issued can be set arbitrarily from 0.5 seconds to 60 seconds. Have been. In the figure, reference numeral 22 denotes a lower-limit alarm silencing switch for the operator to temporarily silence the alarm sound when the measured value falls below the lower limit value as required. In the present embodiment, the lower silencing switch 2 is used. When 2 is pressed, the alarm sounds are stopped for 2 minutes, and the alarm sounds again if the cause of the alarm is not eliminated during that time.
上記のように構成された監視装置によって人工呼吸器を取付けた患者の気道内 圧を監視するにあたっては、 該監視装置 1 0を前記図 1のように配置した状態で 人工呼吸器 1から患者側に供給される気体の圧力を測定し、 それによつて患者の 気道内圧を間接的に監視するもので、 以下その監視操作を自動で行う場合の操作 手順の一例を順を追って説明する。  When monitoring the airway pressure of a patient to which the ventilator is attached by the monitoring device configured as described above, the monitoring device 10 is arranged as shown in FIG. It measures the pressure of the gas supplied to the patient and thereby indirectly monitors the patient's airway pressure. Hereinafter, an example of an operation procedure for automatically performing the monitoring operation will be described step by step.
図 5は患者側に供給する気体の圧力の許容上限値と下限値とを自動設定して監 視する場合のプロセスを示すもので、 先ず、 人工呼吸器 1から患者側に気体が供 給されている状態で図に省略した電源スィッチを投入し （ステップ S 1 ) 、 前記 の手動 · 自動切換スィッチ 1 5を自動 （A U T O ) 側に切換えると共に、 自動設 定ポタン 1 4を押す （ステップ S 2 ) 。  Fig. 5 shows the process in which the upper limit and the lower limit of the pressure of the gas supplied to the patient are automatically set and monitored.First, gas is supplied from the ventilator 1 to the patient. Then, the power switch (not shown) is turned on (step S1), the manual / automatic switch 15 is switched to the automatic (AUTO) side, and the automatic setting button 14 is pressed (step S2). ).
すると、 前記圧力測定手段 1 1によって人工呼吸器 1から患者側に供給される 気体の圧力が順次測定され、 その測定値が監視制御手段 1 2を経て圧力表示手段 1 3で表示される。 また監視制御手段 1 2は複数の呼吸期間、 本実施形態におい ては 3呼吸期間の最大圧力 P Xの平均値を算出し、 その平均値に基づいて前記許 容範囲の上限値と下限値を設定する （ステップ S 3 ) 。 その上限値と下限値は、 本実施形態においては圧力表示手段 1 3に上記の測定圧力とは別の色で表示する ように構成されている。 Then, the pressure of the gas supplied from the ventilator 1 to the patient side is sequentially measured by the pressure measuring means 11, and the measured value is displayed on the pressure display means 13 via the monitoring control means 12. Further, the monitoring control means 12 calculates the average value of the maximum pressure PX for a plurality of breathing periods, in this embodiment, for three breathing periods, and sets the upper limit value and the lower limit value of the allowable range based on the average value. Yes (step S3). In the present embodiment, the upper limit value and the lower limit value are displayed on the pressure display means 13 in a different color from the above measured pressure. It is configured as follows.
上記のようにして患者側に供給される送気圧力の許容上限値と下限値とを設定 した後は、 引き続き圧力測定手段 1 1で患者側に供給される送気圧力の最大値が 連続的に測定され （ステップ S 4 ) 、 その測定値が上記の許容上限値以上である か否かを前記監視制御手段 1 2で判別し （ステップ S 5 ) 、 許容上限値以上であ る場合には上限警報ランプ 1 9が点灯すると共に、 図に省略した警報器等から警 報音が発せられる （ステップ S 6 ) 。  After setting the permissible upper and lower limits of the air supply pressure supplied to the patient as described above, the maximum value of the air supply pressure supplied to the patient by the pressure measuring means 11 is continuously (Step S 4), the monitoring control means 12 determines whether or not the measured value is equal to or greater than the allowable upper limit (Step S 5). The upper limit alarm lamp 19 is turned on, and an alarm sound is emitted from an alarm device or the like not shown in the figure (step S6).
また上記測定値が許容上限値以下である場合には、 さらに上記測定値が前記の 許容下限値以下であるか否かを監視制御手段 1 2で判別し （ステップ S 7 ) 、 許 容上限値以上である場合には下限警報ランプ 2 0を点灯すると共に、 図に省略し た警報器等から警報音が発せられる （ステップ S 8 ) 。  If the measured value is equal to or less than the allowable upper limit, the monitoring control means 12 further determines whether or not the measured value is equal to or less than the allowable lower limit (step S7). If so, the lower limit alarm lamp 20 is turned on, and an alarm sound is emitted from an alarm device or the like not shown in the figure (step S8).
上記のようにして測定圧力'が所定の上限値以上もしくは下限値以下になったと き警報ランプ 1 9、 2 0が点灯すると共に、 警報音が発せられることによって、 患者もしくは管理者に異常を知らせることができるものである。  As described above, when the measured pressure falls below the upper limit or below the lower limit, the alarm lamps 19 and 20 are lit and an alarm sounds to notify the patient or administrator of the abnormality. Is what you can do.
なお上記の監視操作の途中で、 時間の経過とともに患者の気道内圧が変動した 場合や適時必要に応じて前記の自動設定ポタンを再度押すことによつて前記の平 均値や上限値および下限値を再設定することが可能であり、 以後その設定値に基 づいて引き続き監視動作が実行される。  During the above monitoring operation, if the airway pressure of the patient fluctuates with the passage of time, or if necessary, by pressing the automatic setting button again as needed, the average value, upper limit value, and lower limit value are set. Can be reset, and the monitoring operation is subsequently performed based on the set value.
また本実施形態においては、 前述のように送気圧力の許容範囲の上限値および 下限値を手動でも設定できるように構成されており、 手動で設定する場合には、 手動 · 自動切換スィッチ 1 5を手動 （M A N U) 側に切換えると共に、 上限値手 動設定ダイヤル 1 6と下限値手動設定ダイヤル 1 7をそれぞれ回動して所望の値 に設定すれば、 その上限値および下限値に基づいて上記と同様の要領で監視動作 を実行させることができるものである。  Further, in the present embodiment, as described above, the upper limit and the lower limit of the allowable range of the air supply pressure are configured to be set manually, and when set manually, the manual / automatic switch 15 To the (MANU) side, and rotate the upper limit manual setting dial 16 and lower limit manual setting dial 17 to the desired values, respectively, and based on the upper and lower limits, The monitoring operation can be executed in the same manner as described above.
なお上記実施形態は、 圧力測定用チューブ 5をアダプタ 6を介して送気管 2の 人工呼吸器 1に近い位匱に連通させたが、 図 6のように患者により近い送気管 2 内もしくはその近傍に連通させるようにしてもよい。 産業上の利用可能性 本発明による気道内圧監視装置は、 上記のように人工呼吸器に備えられた監視 機能とは別に監視するものであるから、 人工呼吸器の監視機能と相まって、 信頼 性を大幅に向上させることができる。 また人工呼吸器を取付けた患者の気道内圧 を、 人工呼吸器から患者に実際に供給される空気等の気体の圧力を測定して監視 するものであるから、 より確実な監視操作を行うことが可能となる。 しかも人工 呼吸器の監視機能の設定が不充分であったり、 設定忘れ等があっても本発明によ る監視装置により良好に監視することができるから、 不慮の事故を未然に防止す ることができる。 In the above-described embodiment, the pressure measurement tube 5 is connected to the ventilator 1 near the ventilator 1 via the adapter 6, but as shown in FIG. May be communicated with. Industrial applicability Since the airway pressure monitoring device according to the present invention monitors separately from the monitoring function provided in the ventilator as described above, it is possible to greatly improve reliability in combination with the monitoring function of the ventilator. it can. In addition, since the airway pressure of a patient with a ventilator is monitored by measuring the pressure of air or other gas that is actually supplied from the ventilator to the patient, more reliable monitoring operations can be performed. It becomes possible. Moreover, even if the setting of the monitoring function of the ventilator is inadequate or the setting is forgotten, etc., the monitoring device according to the present invention enables good monitoring, so that accidents can be prevented beforehand. Can be.
また人工呼吸器から患者に供給される気体圧力の許容範囲の上限値と下限値と を自動的に設定する、 例えば人工呼吸器から患者に供給される気体の圧力を複数 回測定してその平均値を算出し、 その平均値に基づいて上記許容圧力の上限値と 下限値を自動的に設定するようにすれば、 設定操作を更に簡略化することができ るものである。  In addition, the upper and lower limits of the allowable range of the gas pressure supplied to the patient from the ventilator are automatically set.For example, the pressure of the gas supplied to the patient from the ventilator is measured several times and the average is measured. By calculating the values and automatically setting the upper and lower limits of the allowable pressure based on the average value, the setting operation can be further simplified.

Claims

請 求 の 範 囲 The scope of the claims
1 . 人工呼吸器を取付けた患者の気道内圧を監視する気道内圧監視装置であって、 人工呼吸器から患者に供給される空気等の気体の圧力を測定する圧力測定手段と、 その圧力測定手段で測定した圧力の最大値が所定の許容範囲内にあるか否かを判 定する手段とを備え、 上記測定値が上記許容範囲を超えたとき警報を出すように したことを特徴とする気道内圧監視装置。 1. An airway pressure monitoring device for monitoring a patient's airway pressure equipped with a ventilator, wherein the pressure measuring means measures the pressure of gas such as air supplied from the ventilator to the patient, and the pressure measuring means. Means for determining whether or not the maximum value of the pressure measured in the step is within a predetermined allowable range, and an alarm is issued when the measured value exceeds the allowable range. Internal pressure monitoring device.
2 . 前記許容範囲の上限値と下限値を自動的に設定するようにした請求項 1記載 の気道内圧監視装置。  2. The airway pressure monitoring device according to claim 1, wherein an upper limit value and a lower limit value of the allowable range are automatically set.
3 . 前記人工呼吸器から患者に供給される気体の圧力を前記圧力測定手段により 複数回測定してその平均値を算定し、 その平均値に基づいて前記許容範囲の上限 値と下限値を自動的に設定するようにした請求項 2記載の気道内圧監視装置。  3. The pressure of the gas supplied to the patient from the ventilator is measured a plurality of times by the pressure measuring means, the average value is calculated, and the upper and lower limits of the allowable range are automatically determined based on the average value. The airway pressure monitoring device according to claim 2, wherein the airway pressure monitoring device is configured to be set manually.
PCT/JP2001/011068 2001-12-13 2001-12-18 Inner pressure monitor of airway WO2003050497A1 (en)

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