EP2265239B1 - Dispositif de diagnostic, d'exécution et/ou de régulation de fonctions physiologiques, en particulier sur un patient anesthésié - Google Patents

Dispositif de diagnostic, d'exécution et/ou de régulation de fonctions physiologiques, en particulier sur un patient anesthésié Download PDF

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Publication number
EP2265239B1
EP2265239B1 EP09732481.8A EP09732481A EP2265239B1 EP 2265239 B1 EP2265239 B1 EP 2265239B1 EP 09732481 A EP09732481 A EP 09732481A EP 2265239 B1 EP2265239 B1 EP 2265239B1
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Prior art keywords
pressure
patient
control device
temperature
sleeve
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EP09732481.8A
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German (de)
English (en)
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EP2265239A1 (fr
Inventor
Ulrich Pfeiffer
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Philips Medizin Systeme Boeblingen GmbH
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UP Med GmbH
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H9/00—Pneumatic or hydraulic massage
    • A61H9/005—Pneumatic massage
    • A61H9/0078—Pneumatic massage with intermittent or alternately inflated bladders or cuffs
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H31/00—Artificial respiration by a force applied to the chest; Heart stimulation, e.g. heart massage
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H31/00—Artificial respiration by a force applied to the chest; Heart stimulation, e.g. heart massage
    • A61H31/02—Iron lungs
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H9/00—Pneumatic or hydraulic massage
    • A61H9/005—Pneumatic massage
    • A61H9/0078—Pneumatic massage with intermittent or alternately inflated bladders or cuffs
    • A61H9/0092—Cuffs therefor
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
    • A61H2201/02—Characteristics of apparatus not provided for in the preceding codes heated or cooled
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
    • A61H2201/02—Characteristics of apparatus not provided for in the preceding codes heated or cooled
    • A61H2201/0207—Characteristics of apparatus not provided for in the preceding codes heated or cooled heated
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
    • A61H2201/02—Characteristics of apparatus not provided for in the preceding codes heated or cooled
    • A61H2201/0214—Characteristics of apparatus not provided for in the preceding codes heated or cooled cooled
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
    • A61H2201/16—Physical interface with patient
    • A61H2201/1602—Physical interface with patient kind of interface, e.g. head rest, knee support or lumbar support
    • A61H2201/165—Wearable interfaces
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
    • A61H2201/50—Control means thereof
    • A61H2201/5002—Means for controlling a set of similar massage devices acting in sequence at different locations on a patient
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
    • A61H2201/50—Control means thereof
    • A61H2201/5007—Control means thereof computer controlled
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2201/00—Characteristics of apparatus not provided for in the preceding codes
    • A61H2201/50—Control means thereof
    • A61H2201/5058—Sensors or detectors
    • A61H2201/5082—Temperature sensors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2205/00—Devices for specific parts of the body
    • A61H2205/06—Arms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2205/00—Devices for specific parts of the body
    • A61H2205/08—Trunk
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2205/00—Devices for specific parts of the body
    • A61H2205/10—Leg
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2230/00—Measuring physical parameters of the user
    • A61H2230/04—Heartbeat characteristics, e.g. E.G.C., blood pressure modulation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2230/00—Measuring physical parameters of the user
    • A61H2230/04—Heartbeat characteristics, e.g. E.G.C., blood pressure modulation
    • A61H2230/06—Heartbeat rate
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2230/00—Measuring physical parameters of the user
    • A61H2230/08—Other bio-electrical signals
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2230/00—Measuring physical parameters of the user
    • A61H2230/20—Blood composition characteristics
    • A61H2230/207—Blood composition characteristics partial O2-value
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2230/00—Measuring physical parameters of the user
    • A61H2230/25—Blood flowrate, e.g. by Doppler effect
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2230/00—Measuring physical parameters of the user
    • A61H2230/30—Blood pressure
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2230/00—Measuring physical parameters of the user
    • A61H2230/50—Temperature
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61H—PHYSICAL THERAPY APPARATUS, e.g. DEVICES FOR LOCATING OR STIMULATING REFLEX POINTS IN THE BODY; ARTIFICIAL RESPIRATION; MASSAGE; BATHING DEVICES FOR SPECIAL THERAPEUTIC OR HYGIENIC PURPOSES OR SPECIFIC PARTS OF THE BODY
    • A61H2230/00—Measuring physical parameters of the user
    • A61H2230/65—Impedance, e.g. skin conductivity; capacitance, e.g. galvanic skin response [GSR]

Definitions

  • the invention relates to a device for the diagnosis, execution and / or regulation of physiological functions.
  • ventilation is performed in a general anesthesia with positive pressures, whereby the redistribution of the circulating blood volume from intrathoracic to extrathoracic is intensified.
  • a compensatory increase in heart rate usually remains, as the counter-regulation by the sympatheticus is inhibited by anesthetics.
  • US 2008/045866 A1 discloses an apparatus for diagnosing, performing and / or regulating physiological functions, particularly in an anesthetized patient, comprising a pressure cuff adapted to be attached to at least one arm and / or at least one leg of a patient, the length of the Pressure cuff is selected such that the pressure cuff extends at least 20cm towards the heart, pressure increasing means and pressure decreasing means associated with the pressure cuff for applying external compression to the at least one arm and / or the at least one leg, at least one sensor for Detecting a blood pressure of the patient, and a controller arranged to receive signals from the at least one sensor and to control the pressure increasing and decreasing means in dependence on the signal values of the at least one sensor.
  • the object of the present invention was to provide a device for the diagnosis, execution and / or regulation of physiological functions, which avoid the disadvantages of the prior art.
  • the effects of an inventive device are at least partially compensated by the inventive device, at least partially, the effects of anesthesia introduction. It can be counteracted by the device according to the invention the redistribution of the circulating blood volume by suitable external compression. At the same time, the patient core temperature is thereby preferably also increased
  • the diagnostic application is also opened up in order to determine whether the patient's heart would respond to a volume dose, i. whether it is volume-responsive, which determines which part of the Frank Starling curve the heart is working on.
  • a volume dose i. whether it is volume-responsive, which determines which part of the Frank Starling curve the heart is working on.
  • diagnostic compression e.g. There is an increase in the venous return current and increase in the preload of the heart, which increases the stroke volume of the volume-responsive heart in the extremities or the lower half of the body.
  • the indication for the administration of cardiovascular active medication can be made.
  • a pressure device (10) is a device with which an external pressure can be applied to at least part of the limb of the patient.
  • the printing device 10 is based on the principle of compression
  • the pressure device comprises at least one pressure cuff (11).
  • a pressure cuff is a cuff that can be attached to a limb and then cause external compression by increasing or decreasing applied pressure.
  • Such a pressure cuff can be designed similar to a piece of clothing and be designed, for example, as a pressure pants or sleeves or upper part.
  • the pressure pants also includes the feet, the pressure leg also the respective foot and the pressure sleeve and the respective hand
  • the pressure device extends over at least 20 cm, more preferably over at least 30 cm, most preferably over at least 40 cm of the body part towards the heart. Prints are applied in the printing device that are well below the arterial pressures.
  • the pressure device is therefore designed to apply a pressure of less than the arterial pressure in the corresponding body part.
  • the pressure device is therefore preferably designed to apply a pressure of less than 20 mmHg, particularly preferably less than 10 mmHg, above the corresponding venous pressure in the corresponding body part. Thus, the arterial circulation of this body part is not stopped.
  • a body region or body part is an area or a part of the body of the patient, for example the upper body.
  • a limb or limb is preferred at least part of the upper extremity (shoulder girdle, Arm, hand) or lower limb (hip, buttocks, thighs, lower legs, feet).
  • shoulder girdle, Arm, hand or lower limb
  • hip, buttocks, thighs, lower legs, feet In the foreground are the extremities, if there are no operations on them. In particular, it may also be the free extremities, for example arms or legs.
  • the pressure device (10) is preferably designed for at least two extremities.
  • the pressure device (10) is designed for at least one arm and / or at least one leg.
  • the pressure increasing means (21) and pressure lowering means (22) are means which can increase or decrease the pressure in the pressure means (10). They represent a type of supply device for the printing device. By changing the pressure in the printing device, the externally applied pressure is changed. This can be done by the use of pumps that promote a suitable medium and thereby change the applied pressure.
  • the pressure booster increases the pressure and thus increases the compression. Preferably, the pressure increase is 10 to 20 mmHg.
  • the pressure used is according to the invention between the venous and the arterial blood pressure. With a human the mean venous blood pressure in the respective body regions is approximately 0 to 30 mmHg and the mean arterial blood pressure is approximately 60 to 140 mmHg.
  • the procedure described above leads to a compression of the extrathoracic venous system primarily in the extremities and possibly in the abdomen.
  • the thorax itself can not be used to compress the venous system.
  • the applied pressure is lowered, for example in the corresponding chamber between the inside of the chamber and the skin of the patient, wherein in individual structures of the chamber, a greatly increased pressure can be used.
  • the pressure on the inside of the chamber and the skin of the patient can be lowered below the atmospheric pressure.
  • a suction effect is preferably exerted on the thorax, so that it comes in the expiratory phase to an enlargement of the chest and thus an inhalation of the patient can be effected.
  • the exhalation may be effected passively by the retracting force of the ribcage and the lungs, or even forced (supported) exhalation may be effected by generating a positive pressure in the interior of the chamber by preferably reducing or shutting off the suction effect.
  • the control device (30) is preferably a processor or a computer unit.
  • the control device controls the pressure increase and decrease means.
  • This control device can be discontinued exclusively for this task, for example, a processor that is installed and provided exclusively for the device according to the invention, or by a device with be taken, which already fulfills other tasks, such as an existing computer, especially a monitor that already applies to the patient.
  • the control device is designed to control a pump which supplies a pressure medium via the pressure increase and decrease pressure means in the printing device or leaves out of the printing device.
  • the control device may preferably also be associated with a memory.
  • the pressure in the printing device is continuously controlled. It is thus possible to control the pressure preoperatively during the entire operation and the aftercare postoperatively or before anesthesia is initiated. It is thus possible to adjust the pressure again and again. By this constant adjustment of the pressure, a displacement of the blood volume within the patient can be effected. It is thus possible via the control device not only inflate the pressure device or drain medium, but to control the pressure targeted over time.
  • a device in which the pressure device (10) has more than one pressure segment (15). This makes it possible to apply the external pressure even more accurate and more variant rich.
  • the individual pressure segment can be controlled independently.
  • a separate pressure can be set in each pressure segment by the control device, which is applied to the region of the extremity of this pressure segment.
  • the pressure segments can also be controlled in groups. This makes it possible to apply a special print pattern, preferably to vary over time or to apply the same pressure in different combined into a group pressure segments. It is also conceivable to design the pressure segments jointly controllable, either with the same pressure or with different pressures in the pressure segments at the same time.
  • the individual pressure segments are also tempered, also different temperature, in particular also over the time variable temperature. Temperable here means setting a temperature in the pressure segment, preferably on the conditioning of the pressure medium, more preferably the air or water, in the pressure segment of the pressure chamber or the pressure cuff. It can be an increase or a decrease of temperature.
  • the segments may be at the e.g. lying on the back of patients in addition to the horizontal segmentation are also arranged vertically one above the other to be able to counteract the gravitational increased accumulation of blood in dependent (med.: dorsal or posterior) peripheral body regions by increased pressure in the lower vertical pressure segments stronger.
  • an apparatus in which the pressure increasing means (21) comprise a fluid or a gas that can be supplied to the pressure device (10) or in which the pressure reduction means (22) comprise a fluid or a gas which is removable from the printing device (10). In this way, the pressure in the printing device can be easily controlled.
  • a fluid is primarily water into consideration.
  • the gas used is preferably room air.
  • a negative pressure or subatmospheric pressure suction
  • suction can thereby also be set between the inside of the chamber and the skin of the patient or by changing the segmental applied pressure according to a pressure pattern on the venous blood distribution in the patient and the venous blood flow into the relevant one peripheral body regions are influenced.
  • a device is provided, in which the pressure device (10) can be controlled pneumatically or hydraulically. By a pneumatic control, for example, the compression pressure of the segments of the pressure can be easily adjusted.
  • a device in which the printing device (10) is air-conditioned, in particular physiologically air-conditioned.
  • Climatizable here means that the temperature and / or humidity is adjustable. This can be done by an air conditioning device. This preferably comprises tempering or a tempering and / or a moisture conditioning. In this way, it is additionally possible to regulate the body shell temperature of the patient in the area of the pressure device. It is preferably provided that the individual segments of a printing device can be individually conditioned or tempered.
  • pressure chambers are provided over the lower half of the body, the arms, and possibly over the rib cage.
  • the air (or the medium) in the Segments or chambers is pneumatically controlled and physiologically conditioned. All chambers are constructed either as reusable systems, but preferably as single-use systems.
  • the pressure and temperature conditions in each pneumatic chamber are regulated by a supply and control device separately or together or grouped. Before induction of anesthesia can be warmed up by appropriate temperatures in the chambers (by continuous circulation tempered air or tempered water), the body shell, so that it does not lead to a drop in temperature in the body core with induction of anesthesia. This avoids the problems of intraoperative and postoperative hypothermia.
  • the body shell temperature of the patient can preferably be lowered or raised in a targeted manner.
  • external compression may be applied to extrathoracic body regions, particularly to the lower body and arms.
  • blood from the low-pressure system venous vascular system
  • the "squeezing" of the venous system is preferably carried out peristaltically, for example in a frequency range of 1-4 / minute.
  • An additional applied higher-frequency modulation of the basic "Auspress" pressure leads to a vibration and even better promotion of both the arterial and the venous blood.
  • the artificial infusion of fluids to maintain the intrathoracic blood volume is thereby partially or completely unnecessary.
  • a tightly closing pressure chamber is provided above the thorax (chest) as a pressure device.
  • the thorax chamber closes hermetically airtight around the thorax in a limp-flexible manner.
  • pressure line structures are preferably incorporated (for example, pressure hoses), which take on filling with pressure medium corresponding pressure a more rigid, outwardly arching arc shape and thereby generate a negative pressure on the chest, resulting in air or breathing gas flowing into the Lungs to an enlargement of the thorax and thus leads to a Einamtung.
  • the exhalation may be effected passively by the retracting force of the ribcage and the lungs, or even forced (supported) exhalation may be effected by generating a positive pressure in the interior of the chamber by, preferably, reducing or eliminating the suction effect.
  • the enlargement of the thorax due to the external suction also causes an intrathoracic suction effect, which promotes the redistribution of the circulating blood volume from extra to intrathoracic.
  • appropriate cyclic control of the pressure in the thoracic chamber stiffening system support or complete ventilation is possible. As a result, the same volumes could be realized in the respiratory cycle with less positive pressure of the ventilator and thus also with low intrathoracic pressures.
  • control device (30) is set up to receive signals from at least one sensor (35). In this way, measured signals can be forwarded to the control device for further processing. The control device can then determine or apply a corresponding pattern for regulating the pressure in the pressure device as a function of these measured signals or measured values.
  • the skin temperature, core temperature, the pulse oxymetric oxygen saturation and heart rate, conductivity and / or humidity can additionally be detected via this at least one sensor.
  • at least one sensor may be provided in the thoracic chamber (s) for sensing the ECG and thoracic electrical impedance to measure heart rate, impedance cardiac output, impedance-thoracic fluid volume, and impedance tidal volume.
  • a device in which the control device (30) is set up in order to be able to process venous return flow and / or preload of the heart and / or stroke volume of the heart. So can these values of the control device for adjusting the pressure are taken into account.
  • a device is provided in which the control device (30) is set up, the temperature in the pressure device (10) as a function of the signal values of the sensors (35) and / or values derived therefrom, for example the pulse pressure variation PPV, global end diastolic volume, intrathoracic blood volume, cardiac output, arterial pressure, etc.
  • an apparatus in which the control device (30) is arranged to control the pressure and / or the temperature in the pressure device (10) according to a pressure or temperature pattern that changes over time.
  • a pressure or temperature pattern that changes over time.
  • These pressure or temperature patterns are preferably variable or adjustable as a function of the measured values or the derived values.
  • the control is thus preferably online, ie in a control loop in response to the measured or derived values.
  • control device (30) is coupled to a monitor (39).
  • the supply and control device preferably couples with a monitor.
  • the monitor preferably records intrathoracic fluid and blood volumes as a sum or in individual compartments.
  • the monitor preferably determines the heartbeat and cardiac output and / or continuously collects the body core temperature.
  • the monitor is preferably caused to increase the compression pressure on user-selectively preselectable body compartments to a preselected maximum pressure (preferably peristaltically vibrating / oscillating) with decreasing intrathoracic fluid and blood volume and consequently decreasing cardiac output to move more blood back into the chest and increase cardiac output.
  • a preselected maximum pressure preferably peristaltically vibrating / oscillating
  • the compression pressure can also be lowered or even not applied at all.
  • the pressure in the pressure cuff or the segments is not held constant sturdy, but there is a directed control of the individual pressure segments successively continuous pressure wave, which contributes blood quasi peristaltic with oscillating superposition of peripheral to pump centrally, for example with a Period of 15 s.
  • Such a wave-like compression can be controlled the more accurate and effective, the more individual controllable pressure segments, for example, the pressure cuff or pressure pants for the lower Body region exists.
  • the wave-like compression can - depending on need and cycle condition - start from atmospheric pressure or even a higher pressure and return to it.
  • the peak pressure, that is the maximum pressure in the pressure pattern, of the pressure wave to be generated is chosen so that the average venous pressure in the body region to be compressed is safely exceeded, but certainly below the mean diastolic arterial pressure.
  • the mean pressure of the applied pressure pattern can be below, equal to or above the venous pressure of the corresponding body region.
  • the body core temperature can be controlled by appropriate heating of the peripheral and abdominal or thorax pressure chambers by appropriate control of the temperature of the air flowing through the chambers under pressure or by additional convective heating by means of other heat sources.
  • the monitor preferably causes the supply and / or control device to run through a preselectable compression pressure pattern in preselectable time units in preselectable body compartments or pressure segments. This is preferably an increase and a release of the compression pressure, but it can also be a release of the compression pressure subsequent recovery.
  • a device in which the pressure device (10) has at least one sealing collar (13).
  • the pressure device (10) has at least one sealing collar (13).
  • sealing sleeves are provided, which are formed tight fitting. These sealing cuffs can be provided, for example, around the hip at the pressure chamber compartment for the lower half of the body or at the upper arm at the extremity chambers.
  • a device in which the at least one sealing collar (13) has at least one sensor (35).
  • the thus accommodated sensors are so well on the patient due to the close body contact of the sealing cuff.
  • the sealing cuffs therefore preferably have various noninvasive biosensors, e.g. for ECG, temperature, oscillometric or other blood pressure measurement, sphygmomanometry, pulse oximetry, electrical impedance tomography and / or electrical impedance cardiography.
  • biosensors e.g. for ECG, temperature, oscillometric or other blood pressure measurement, sphygmomanometry, pulse oximetry, electrical impedance tomography and / or electrical impedance cardiography.
  • disposable biosensors can also be provided in the corresponding disposable collars or already incorporated.
  • the chamber system is designed so that it obstructs as little as possible the actually operation.
  • the chamber systems for the lower half of the body could also serve as a storage surface for surgical instruments, etc.
  • a pressure sleeve has been described as embodiment of the invention, which encloses the corresponding body part.
  • the pressure cuff air is preferably used as the medium and in addition to the pneumatic control of the compression pressure is preferably a temperature of the cuff by continuous circulation tempered air to prevent heat loss of the body and to transfer heat to the body can.
  • All sleeves can be constructed either as reusable systems, but preferably as disposable systems.
  • the pressure cuffs are preferably designed individually for each of the legs, including the feet 2.
  • the pressure cuffs are designed in the sense of a "pressure pants” as pants, which closes at the level of the pelvic girdle.
  • single arm cuffs are provided with the inclusion of the hands, as well as a "pressure jacket”.
  • a particular advantage of the pressure cuff is the almost ideal protection against storage damage which can be achieved at the same time.
  • a whole-body surgical suit is provided. This can be attracted to the patient already on station.
  • the surgical field is preferably previously prepared sterile on station and is located under a transparent window in the surgical suit.
  • the sterile covers are preferably integrated in the suit and are only deployed at the beginning of the operation. All connections of the biosensors and the pneumatic / climatic control are preferably designed flange. This allows an enormous process advantage in the perioperative process.
  • FIG. 1 shows a schematic view of an embodiment of an apparatus of the present invention.
  • a device 1 for the diagnosis, execution and / or regulation of physiological functions, in particular in an anesthetized patient, comprises a pressure device 10.
  • This pressure device 10 is designed as a pressure cuff in the form of a sleeve for an upper arm with an attached hand part in the form of a glove.
  • a control device 30 is provided which is connected to a pressure increasing means 21 and a pressure reducing means 22.
  • the pressure increasing means 21 and the pressure reducing means 22 are connected via lines 25.1 and 25.2 to the printing device 10.
  • the printing device 10 consists of six pressure segments 15.1 to 15.6.
  • pressure segments 15.1 to 15.6 are arranged along the arm to be encompassed by the printing device at regular intervals so that they represent approximately equal sections adjacent to each other.
  • the first five pressure segments 15.1 to 15.5 are designed as pressure cuffs with a cylindrical cross section, in which the arm can be inserted.
  • the sixth section is designed as a pressure segment 15.6 in the form of a glove into which the hand can be inserted.
  • the individual pressure segments 15.1 to 15.6 are through the pressure increasing means 21 and pressure reducing means 22 via the lines 25.1 and 25.2 individually controllable.
  • temperature control means 29 are connected, via which the medium used in the pressure increasing means 21 and pressure reducing means 22, here air, can be tempered.
  • the temperature control means 29 is also connected to the control unit 30, so that it can be controlled via the control unit 30.
  • the pressure cuff and sensors 35.1 and 35.2 are provided.
  • the sensor 35.1 is a temperature sensor and the sensor 35.2 is a sensor for measuring the moisture of the skin.
  • an arm of a patient is inserted into the pressure device 10 in the form of a sleeve with the glove section 15.6.
  • the sensors 35.1 and 35.2 are fixed on the skin.
  • the pressure segments 15.1 to 15.6 are now set to a predetermined pressure. This pressure is applied to the patient's arm.
  • the controller 30 now controls the pressure increasing means 21 and the pressure reducing means 22 so that a pressure wave is sent across the segments 15.6 to 15.1.
  • the segments 15.1 to 15.6 can also be controlled in groups and the pressure in all these segments can be increased and decreased periodically. This also shifts the blood volume in the body.
  • the tempering device 29 can be used to temper the air or the pressurized fluid, which is then conducted into the sleeve. This allows the cuff to be heated or cooled to control the temperature of the arm. Alternatively, it would also be possible for the Tempering device 29 is incorporated directly as a heating coil in the pressure cuff and generates heat or cold there electrically or chemically.
  • FIG. 2 shows a view of another embodiment of the present invention for the legs.
  • the device for diagnosis, execution and / or regulation of physiological functions 1 comprises a pressure device 10, which is designed in the form of a "trouser". These "pants” each include a leg dress with bootlet and a section for the hip area. At the top, this pressure device 10 is limited by a sealing collar 13.
  • the "pressure pants” 10 further comprises individual pressure segments 15. 1 to 15.7, which are arranged adjacent to each other from the hip area to the footlet.
  • the pressure device 10 or the individual pressure segments 15.1 to 15.7 are connected via lines 25.1 to 25.7 with a control device 40.
  • the control device 40 comprises pressure increasing means 21 and pressure reducing means 22, an air conditioning device 27 and a control device 30.
  • the air conditioning device 27 comprises moisture conditioning means 28 and temperature control means 29.
  • In the region of the sealing sleeve 13 is a sensor 35th arranged by the contact pressure of the Sealing collar 13 is fixed on the skin of the patient.
  • the patient is now the "pressure pants" 10 is tightened and sealed by means of the sealing sleeve 13 in the hip area against the skin of the patient so that air from the pressure pants 10 can not escape.
  • the control device 40 is now applied via the pressure increasing means 21 and pressure reducing means 22, a printing pattern.
  • This ambient air is pressed or subtracted in the individual pressure segments.
  • the pressure segments 15.2 to 15.7 can be joined together either for both legs, so that a print pattern acts in parallel on the corresponding body regions under the respective pressure segments. It is also conceivable to provide pressure segments 15.2 to 15.7 separately for the right and the left leg and to control the individual pressure segments 15.2 left to 15.7 left and 15.2 right to 15.7 right individually and separated from each other.
  • the air conditioning device 27 it is possible to adjust the temperature or humidity of the air supplied via the lines 25.1 to 25.7.
  • the jacket temperature of the patient can be regulated.
  • Temperature or humidity of the patient or the air in the pressure chambers can be detected via the sensor 35. This measured value can be supplied again as the regulating device in order to readjust temperature and humidity via the air-conditioning device 27.
  • Peristaltic and rhythmic compression can be used to avoid infusion. It can also promote the peripheral circulation become.
  • these pressure pants embolic prophylaxis is possible.
  • FIG. 3 shows a view of an example of the rib cage.
  • a printing device 10 is provided in the form of a "vest".
  • the sealing collars are designed to fit against the skin of the patient without exerting any pressure on the patient. Preferably, these sealing collars are sealed by using, for example, gel between the sealing sleeve and the skin.
  • pressure segments 15.1 are provided in the form of tubular chambers and fixedly attached to the pressure vest.
  • pressure segments 15.2 are also provided in the form of tubular chambers.
  • These pressure segments 15.2 and 15.2 are preferably designed for a high pressure, preferably up to a bar and especially longitudinally stretchable, but not in diameter stretchable. They may be made of silicone, for example, so that change such hoses when using such pressures in length and thus lead to an expansion or a reduction of the vest. It is also conceivable that these tubular pressure chambers are ruffled applied to the vest or sewn, ie as a kind of Zieharmonikaschlauch. It would then be fixed on the side of the contact with the vest more material of the tubular pressure segment per stretch, as on the side facing away from the vest is present. This would also expand the vest when inflating such Zieharmonika Quilt Designen depending on the nature of the application.
  • the pressure vest itself has at least one pressure segment 15.3, via which pressure can be applied directly to the surface of the patient in the region of the vest.
  • the individual pressure segments 15.1 to 15.3 are connected via hose lines 25.1 to 25.3 with the control device 40 - for example, as in FIG. 2 - connected.
  • About the pressure segments 15.3 can again similar to the embodiments of the FIGS. 1 and 2 a pressure pattern is exerted on the patient and the body temperature is regulated.
  • the pressure is here in the venous pressure range or slightly above (0-30 torr).
  • the pressure segment 15.3 is acted rhythmically and vibrating with pressure. About the tubular pressure segments 15.1 and 15.2, however, can be supported by appropriate action, the breathing of the patient or even performed independently. This should be based on the FIGS. 4a and 4b will be explained in more detail.
  • FIG. 4 a shows another view of the example FIG. 3 in the inhaled state.
  • the lines and the control device off FIG. 3 are not shown here again.
  • Now compressed air has been introduced into the only longitudinally stretchable pressure segments 15.2 and these then expand.
  • the pressure segments 15.1 are pressureless or even supplied with subatmospheric pressure, which is a Shortening causes and overall erecting the structure similar to the change in the rib position during spontaneous inhalation has the consequence.
  • subatmospheric pressure which is a Shortening causes and overall erecting the structure similar to the change in the rib position during spontaneous inhalation has the consequence.
  • the vest is widened and thereby exerted a suction effect on the chest.
  • the chest raises and simultaneously the patient breathes.
  • FIG. 4 b shows another view of the example FIG. 3 in the exhaled state.
  • the compressed air from FIG. 4 a drained again and now the tubular pressure segments 15.2 pull back together (for acceleration or "forced exhalation" they can be contracted with subatmosppianm pressure), at the same time the pressure segments 15.1 are pressurized, which in total - as in spontaneous breathing - to lower the Rib cage leads.
  • This is preferably supported by an appropriate choice of material for these tubular pressure segments 15.1 and 15.2, for example, by being formed from an elastic, only longitudinally stretchable material and biased so that they are in the deflated state of FIG. 4 b exercise a slight pressure on the chest.

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  • Health & Medical Sciences (AREA)
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  • Animal Behavior & Ethology (AREA)
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  • Physical Education & Sports Medicine (AREA)
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  • Heart & Thoracic Surgery (AREA)
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  • Accommodation For Nursing Or Treatment Tables (AREA)

Claims (10)

  1. Dispositif (1) de diagnostic, d'exécution et/ou de régulation de fonctions physiologiques, en particulier sur un patient anesthésié, comprenant
    un brassard compressif (10) qui est conçu pour être placé de telle façon sur au moins un bras et/ou au moins une jambe d'un patient, qu'il entoure la main de l'au moins un bras, respectivement le pied de l'au moins une jambe, dans lequel la longueur du brassard compressif (10) est ainsi choisie que le brassard compressif (10) s'étend au moins sur 20 cm en direction du coeur,
    des moyens d'augmentation de la compression (21) et des moyens d'abaissement de la compression (22) qui sont attribués au brassard compressif (10), pour appliquer une compression extérieure sur l'au moins un bras et/ou l'au moins une jambe,
    au moins un capteur (35) pour détecter une pression sanguine du patient, et
    un dispositif de commande (30) qui est ainsi doté qu'il reçoit les signaux de l'au moins un capteur (35) et commande en continu les moyens d'augmentation de la compression (21) et les moyens d'abaissement de la compression (22) en fonction des valeurs de signal de l'au moins un capteur (35) et/ou de valeurs qui en sont dérivées de telle façon qu'une compression sur l'au moins un bras et/ou l'au moins une jambe est appliquée qui est située entre la pression artérielle et la pression veineuse du patient.
  2. Dispositif selon la revendication 1, dans lequel le brassard compressif (10) comprend plusieurs segments de compression (15).
  3. Dispositif selon l'une des revendications précédentes, dans lequel les moyens d'augmentation de la compression (21) comprennent un fluide ou un gaz qui peut être amené vers le brassard compressif (10) et/ou les moyens d'abaissement de la compression (22) comprennent un fluide ou un gaz qui peut être retiré du brassard compressif (10).
  4. Dispositif selon l'une des revendications précédentes, dans lequel le brassard compressif (10) peut être commandé de façon pneumatique et/ou peut être climatisante.
  5. Dispositif selon l'une des revendications précédentes, dans lequel la température de la peau, la température profonde du corps, la conductibilité et/ou l'humidité peut être détectée par l'au moins un capteur (35).
  6. Dispositif selon l'une des revendications précédentes, dans lequel le dispositif de commande (30) est prévu pour traiter le retour veineux et/ou la précharge du coeur et/ou le volume de pulsations du coeur de sorte que ces valeurs puissent être prises en compte par le dispositif de commande pour régler la compression.
  7. Dispositif selon l'une des revendications précédentes, dans lequel le dispositif de commande (30) est prévu pour régler la température dans le brassard compressif (10) en fonction des valeurs de signal des capteurs (35) et/ou de valeurs qui en sont dérivées.
  8. Dispositif selon l'une des revendications précédentes, dans lequel le dispositif de commande (30) est prévu pour commander la compression et/ou la température dans le brassard compressif (10) selon un modèle de compression, respectivement de température se modifiant dans le temps.
  9. Dispositif selon l'une des revendications précédentes, dans lequel le dispositif de commande (30) est couplé à un écran (39).
  10. Dispositif selon l'une des revendications précédentes, dans lequel le brassard compressif (10) présente au moins un brassard d'étanchéité (13), dans lequel l'au moins un brassard d'étanchéité (13) présente l'au moins un capteur (35).
EP09732481.8A 2008-04-18 2009-04-17 Dispositif de diagnostic, d'exécution et/ou de régulation de fonctions physiologiques, en particulier sur un patient anesthésié Active EP2265239B1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE102008019647A DE102008019647A1 (de) 2008-04-18 2008-04-18 Vorrichtung zur Diagnose, Ausführung und/oder Regulierung physiologischer Funktionen, insbesondere bei einem anästhesierten Patienten
PCT/EP2009/002837 WO2009127427A1 (fr) 2008-04-18 2009-04-17 Dispositif de diagnostic, d'exécution et/ou de régulation de fonctions physiologiques, en particulier sur un patient anesthésié

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EP2265239A1 EP2265239A1 (fr) 2010-12-29
EP2265239B1 true EP2265239B1 (fr) 2016-10-12

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US (2) US20110098741A1 (fr)
EP (1) EP2265239B1 (fr)
JP (1) JP5497004B2 (fr)
CN (1) CN102006849B (fr)
DE (1) DE102008019647A1 (fr)
WO (1) WO2009127427A1 (fr)

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EP2265239A1 (fr) 2010-12-29
JP2011516223A (ja) 2011-05-26
US20170367922A1 (en) 2017-12-28
CN102006849B (zh) 2017-05-10
WO2009127427A1 (fr) 2009-10-22
DE102008019647A1 (de) 2009-11-05
CN102006849A (zh) 2011-04-06
US20110098741A1 (en) 2011-04-28
JP5497004B2 (ja) 2014-05-21

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