Method and device for monitoring work of autonomic nervous system of patient under anesthesia

FIELD: medicine.

SUBSTANCE: group of inventions relates to medicine. Method applies control device, which contains measuring equipment and control unit. Method includes obtaining signal of skin conductivity, measured on the section of patient's skin within the interval of measurement, by means of measuring equipment. In accordance with the invention, by means of control unit calculated is characteristics of skin conductivity signal, representing static dispersion of values of skin conductivity signal throughout the interval of measurements, including calculation of standard deviation of values of skin conductivity signal throughout the interval of measurements. On the basis of said characteristics first outlet signal, indicating on patient's pain state or discomfort, is formed. Second signal, indicating state of patient's recovery, is formed on the basis of the same characteristics. Said control device is described.

EFFECT: increased accuracy of control over the state of autonomic nervous system.

13 cl, 2 dwg

 

The technical field to which the invention relates.

The present invention relates in General to medical technology, in particular to a method and apparatus for monitoring the condition of the patient under General anesthesia.

The level of technology

During surgery it is very important to monitor the level of consciousness and degree of awakening of the patient. To date, there are few reliable ways to implement such tracking. In the field of medical technology, there is a problem performing physical measurements characterizing the activity of the autonomic nervous system of the individual, i.e. the part of the nervous system, not controlled by the will.

In particular, there is a particular need to monitor the status of the autonomic nervous system euthanized not talking of the patient, i.e. the patient under anesthesia or connected to the ventilator, with the aim of identifying the needs of the patient in additional useplease tools due to the appearance of the stimuli Wake-up or additional painkillers tools due to the appearance of painful stimuli.

Tests have shown that the conductivity of the skin changes, representing a time-dependent variable, which in addition to the base, slowly changing value (the so-called basic level, or the average of the level of conductivity for a certain period of time) has another component, including spontaneous waves or fluctuations.

This basic level and characteristics of such fluctuations can be tracked on the monitor qualified operator (e.g., surgeon or anesthesiologist), in order to monitor the status of the autonomic nervous system of the patient.

In document WO 03/94726 disclosed a method and apparatus for monitoring the Autonomous nervous system of a patient under anesthesia. In this way measure the conductivity of a certain area of the skin of the patient. Expect certain characteristics, including the average conductivity of the skin for some period of time and the number of values fluctuations over the same period of time. Based on these characteristics form the two output signals, reflecting, respectively, the pain, the discomfort and the degree of awakening of the patient. Signal the degree of awakening of the form based on the number of fluctuations and the average conductivity value for some period of time.

Disclosure of inventions

The problem to which the present invention is directed is to provide an improved method and an improved device for monitoring the condition of the patient under General anesthesia.

The proposed method and the device described in the attached formula.

Brief description of drawings

The principles of the present invention will be escrita below on the example of the invention, illustrated in the drawings.

Figure 1 presents the block diagram of the preferred alternative implementation of the device according to the invention.

Figure 2 presents the block diagram of the method according to the invention.

The implementation of the invention

Figure 1 presents the block diagram of the preferred alternative implementation of the device according to the invention.

Essential structural elements of hardware devices have been previously described in the publication of the applicant's WO 03/94726 with detailed reference to the block diagram shown in figure 1 given publication, and the corresponding detailed description. The contents of this publication and, in particular, the design of the hardware incorporated into the present text by reference.

In zone 2 the skin part 1 of the patient's body is placed a sensor 3 for measuring the conductivity of the skin. Part 1 of the body is, preferably, an arm or a leg, and zone 2 skin part 1 of the body is, preferably, the palm of the hand or sole of foot. In an alternative embodiment, part 1 of the body may be the patient's forehead. Sensors 3 contain contact electrodes, of which at least two electrodes placed on the skin in zone 2. In one preferred options sensors 3 contain three electrodes: a signal electrode, the measuring electrode and the reference electrode voltage, especiauy constant voltage is applied to the stratum corneum (surface of the Horny layer of the skin) under the measuring electrode. Measuring and signal electrodes are preferably placed on the skin in zone 2. The electrode of the reference voltage can also be placed on the skin in zone 2, but it is preferable to place it in a nearby area that is suitable for the specific conditions of the measurement scheme.

To measure the conductivity of the skin in one of the embodiments uses an alternating current. Used alternating current preferably has a frequency in the range up to 1000 Hz, for example 88 Hz. A signal generator operating at a predetermined frequency, and supplies the current signal to the signal electrode.

The resulting current flowing through the measuring electrode is fed to the transmitter 4, which contains the Converter current to voltage and circuit decomposition emitting active conductivity as a real part of a complex full conduction.

Measuring transducer 4 may also contain circuits of the amplifier and filter. In a preferred embodiment, the measuring transducer includes low-pass filters set as input and output. The purpose of the input low pass filter attenuation of high-frequency interference, such as interference from other medical equipment; in addition, he performs the function antialiasingmode filter, which cuts off high-frequency components, that is, they do not appear in the subsequent chain sampling time.

The control unit 5 has a block 51 of the sampling time the sampling time of the signal transducer. May benefit from the implementation of the sampling time sampling frequency of the order of 20-200 times per second. Next, the control unit is equipped with an analog-digital Converter 52, which converts the measurement data into digital form.

The control unit 5 includes a Central processing unit (CPU) 53 for processing the digitized measurement data, a means of storing information in the form of at least one storage device (memory) for storing data and programs, such as nonvolatile memory 54, and a random access memory (RAM) 55. The control unit 5 has, further, the output interface circuit 61 through which a given output signals 71, 72. In a preferred embodiment, the control unit 5 is equipped with, in addition, a diagram of the display interface 81, which is additionally connected to the display unit 8. May benefit from the implementation in which the control unit 5 also includes a communication port 56 for digital communication with an external device such as a personal computer 10.

In one of the preferred embodiments the non-volatile memory 54 has a permanent memory in the form of block programmable permanent memory or, in the alternate the main version, block flash memory containing at least a program code and constant data, and the RAM 55 is equipped with circuits of memory for storing measurement results and other temporary data.

In addition, the control unit 5 is equipped with the master oscillator (not shown)that outputs the clock signal for the control of the CPU 53. The CPU 53 also contains tools for timing (not shown) for indicating the current time used in the analysis of the measurements. These funds countdown is well known in the art and are often already built into the schemes of microcontrollers or processors, which the specialist deems suitable for use in the composition of the present invention.

The control unit 5 may be microprocessor-based with connecting the input, output, memory, and other peripheral units, or it may be in the form of a microcontroller, which is embedded in some or all of the connected nodes; it can also be enabled unit 51 of the sampling time and/or analog-to-digital Converter 52. The selection of the appropriate execution control unit 5 assumes decisions within the competence of a specialist.

In an alternative embodiment, the control unit is a digital signal processor.

In accordance with the present invention new, with the prize of akami of the invention a method of analysis of signal conduction of the skin carry out control unit 5. Due to the presence of code managing unit 5 is a specialized device for implementing the method according to the invention, represented in particular by the example described below with reference to figure 2.

The control unit 5 is made so that it had the ability to read discretized in time and quantized measurements of the conductivity of the skin of the measuring transducer 4, preferably using executable software code stored in the nonvolatile memory 54 and executed by the CPU 53. Next, the control unit 5 is made so that there is the option of saving the measurement results in allowing reading and writing of the RAM 55. Next, the control unit 5 are made so as to use the code to analyze the measurement results in real time, i.e. simultaneously or in parallel with the measurements.

In this context, the expression "at the same time or in parallel" should be understood in the sense of practical concurrency or parallelism, i.e. in connection with the timing characteristic of the nature of the data measurements. This means that input, preservation and analysis of the results may be held in spaced time intervals, but in this case these time intervals and the intervals between them are so small that individual action is represented by what is happening at the same time.

Next, the control unit 5 are made so as to be able to identify fluctuations of signal conduction of the skin. In particular, the control unit 5 is configured to calculate the value characterizing the statistical variance (for example with the possibility of calculating the standard deviation) values of signal conduction of the skin throughout the measurement interval.

Other functions of the control unit described later with reference to a variant of the method, illustrated in figure 2.

All the above functions of the control unit 5 are provided in the relevant parts of a computer program, stored in memory, preferably in non-volatile memory 54.

The CPU 53, a memory 54 and 55, an analog-to-digital Converter 52, the communication port 56, the interface circuit 81 and the interface circuit 61 is connected to the host bus 59. Details of the structure of the architecture of such tires to create a device based on a microprocessor are well-known specialist in this field.

The interface circuit 61 is a digital or analog output circuit that generates a digital or analog representation of the first and second output signals 71, 72, transmitted from the CPU 53 via the bus 59, when the CPU 53, executing the program code accesses the interface circuit 61.

The first and second output signals 71, 72 reflect with the state of the autonomic nervous system of the patient. Specifically, the first output signal 71 indicates a state of pain or discomfort, and the second output signal 72 in the state of awakening. Data signals 71, 72 can be a convenient way to combine the device with appropriate indicators, such as visual and/or audible indicators.

Further, the device comprises a block 9 of the power source to supply operating power to various parts of the device. Power can be supplied from the battery or from the network.

Can give the advantage to adapt the device to perform the requirements of hospital equipment to ensure patient safety. Such security requirements are relatively simple to execute, if the device is powered from the battery. But if the device is plugged in, the power supply must meet special requirements, or requirements of a galvanic separation is safe for the patient parts of the device (for example, battery-operated) and parts of the device, representing a hazard to the patient. If the device must be connected to external equipment, powered and dangerous for the patient, required galvanic isolation connection device, safe for the patient, and an external equipment which is dangerous is here for the patient. Can take advantage of the implementation of such galvanic isolation through optical separation. Requirements for safety equipment around the patient, and technical solutions implementing such requirements in respect of devices similar to the device according to the present invention, well-known to experts.

Figure 2 presents the block diagram of the method according to the invention.

The method is preferably carried out using a processor as part of a device that generates an output signal reflecting the state of the Autonomous nervous system of a patient under anesthesia, i.e. using is depicted in figure 1 of the CPU 53 in the control unit 5.

The execute method start start step 200.

The initial conditions set at step 210. The specified step 210 may include setting the measurement interval and the return of the first and second output signals 71, 72 on the initial level corresponding to the zero degree of awakening of the patient and the absence of pain.

The duration of the measurement interval may be, for example, within the boundaries of 5-40 with or 10-30 s, or approximately 20 C. there are also other intervals.

Next, at step 220 pickup signal during this interval measurements on a selected area of the patient's skin to measure the signal (t) its conductivity. The signal may be represented as numerical values stored in memory devices such as RAM 55.

Next, at step 230 calculation using, for example, a CPU 53, calculates the characteristic conductance of the skin. Calculation step 230 also includes the calculation of the values characterizing the statistical variance of the signal values of the conductivity of the skin throughout the measurement interval.

In one embodiment, the payment step 230 includes the calculation of the standard (RMS) deviation of the signal values of the conductivity of the skin throughout the measurement interval.

Alternatively, provided the opportunity for computational step 230 to compute an aggregate function, selected from the following list:

deviation, interquartile range, range, mean difference, median absolute deviation, average absolute deviation, variation coefficient, kwartalny the coefficient of dispersion, relative mean difference and the ratio of the deviance to the average.

For clarity, the following further detailed description will be carried out for the variant, according to which at step 230 calculates the standard deviation. However, the specialist in this area will be easily understood that, when the calculated step 230 calculates the statistical variance value is th conductivity of the skin with the use of other statistical functions, the remaining steps of the method and, in particular, obtaining the maximum values used in these steps, you can easily adapt accordingly.

Further, in the first step 240 compare numeric representation of the statistical dispersion of the signal conductivity of the skin, such as standard deviation, compared with the first predefined limit value L1.

If the statistical variance estimate standard deviation, it is desirable that the first limit value L1 lying in the range from 0.01 to 0.30 µs (more preferably in the range of 0,02-0,10 µs), and in the best case scenario was to 0.03 µs.

When to assess the statistical dispersion use a different aggregation function, the corresponding intervals for the first limit value L1 can easily be counted on the basis of the information contained in this description.

If a numeric representation of the statistical dispersion (e.g. standard deviation) exceeds the first limit value L1, perform step 250 the formation of the first output signal. In this step, the first output signal 71 is formed in such a way that it was an indicator of pain or discomfort to the patient. Further execution of the method continues in the second step 260 comparison.

If a numeric representation of the statistical dispersion is not previse the first limit value L1, the execution of the method continues directly to the second step 260 comparison.

Further, in the second step 260 comparison numeric representation of the statistical dispersion (standard deviation) signal conductivity of the skin compared with the second predefined limit value L2.

If the statistical variance estimate standard deviation, it is desirable that the second limit value L2 lying in the range of 0.06-18,0 µs (more preferably in the range of 0.10 to 3.0 µs), and the optimal variant was 0.5 µs.

When to assess the statistical dispersion use a different aggregation function, the corresponding intervals for the second limit value L2 can be easily counted on the basis of the provisions of this specification.

If a numeric representation of the statistical dispersion (e.g. standard deviation) exceeds the second limit value L2, perform step 270 forming the second output signal. In this step, the second output signal 72 is formed so that it was a Wake-up indicator of the patient. After step 270, the execution of the method continues at step 280 final decision.

If a numeric representation of the statistical dispersion does not exceed the second limit, the execution of the method continues directly to step 280 the adoption of OK is Natalenko solutions.

When performing this step, conduct a test to determine whether to complete the process. Such determination may be based, for example, manual data entry by the user. If a decision will be made on completion of the process, it ends in step 290. Otherwise, execution of the method is repeated from step 210 to set the initial conditions.

The above description and drawings illustrate a particular implementation of the present invention. The specialist will be clear that there are many alternative and equivalent embodiments of the present invention is not beyond its capacity. For example, the use of impedance (including resistance) of the skin instead of its conductivity, of course, will give similar results, if subsequent processing of the measured signal will be taken into account the inverse relationship of these variables.

Throughout this description and the claims, the term "patient". Thus it should be clear that, although the present invention is primarily intended for monitoring the health of human beings, the invention, as it turns out, is also applicable for monitoring the health of animals, in particular mammals. Therefore, the term "patient" should be understood as denoting and patients-people, and patients vividly the data.

The invention is not limited to the above illustrative options for implementation. On the contrary, the scope of the invention defined by the following claims.

1. The way to control the state of the autonomic nervous system of the patient under General anesthesia with the use of devices for controlling, containing and measuring equipment and the control unit including:
- obtaining, using measuring equipment signal conductivity of the skin, measured on the skin of the patient during the measurement interval,
characterized in that calculate, using the control unit a signal conductivity of the skin, representing a static variance of the signal values of the conductivity of the skin throughout the measurement interval, including the calculation of the standard deviation of the signal values of the conductivity of the skin throughout the measurement interval,
on the basis of this characteristic by using the control unit form a first output signal indicating a state of pain or discomfort of the patient, and
on the basis of the same characteristics with the help of the control unit form a second output signal indicating the condition of the patient wakes.

2. The method according to claim 1, characterized in that the step of forming a first output signal indicating a state of pain or discomfort of the patient, includes compared the e value, represents the statistical variance, with the first limit value, the first signal is formed so that it points to a state of pain or discomfort of the patient, if the value representing the statistical variance exceeds the first limit value.

3. The method according to claim 2, characterized in that the step of forming a second output signal indicating the condition of the patient wakes, involves the comparison of the values representing the statistical variance, with the second limit value, the second signal is formed so that it points to a state of awakening, if the value representing the statistical variance exceeds the second limit value.

4. The method according to claim 2 or 3, characterized in that the said first limit value lies in the range from 0.01 to 0.30 µs.

5. The method according to claim 4, characterized in that the said first limit value lies in the range of 0,02-0,10 µs.

6. The method according to claim 5, characterized in that the said first limit value is approximately 0,03 µs.

7. The method according to claim 3, characterized in that the second limit value lies in the range of 0.06-18,0 µs.

8. The method according to claim 7, characterized in that the second limit value lies in the range of 0.10 to 3.0 µs.

9. The method according to claim 8, characterized in that specified the th second limit value is about 0.5 µs.

10. The method according to claim 1, characterized in that the specified measurement interval is in the range from 5 C to 40 C.

11. The method according to claim 10, characterized in that the specified measurement interval is in the range from 10 C to 30 C.

12. The method according to claim 11, characterized in that the specified measurement interval is approximately 15 C.

13. Device for monitoring the Autonomous nervous system of a patient under anesthesia, containing measuring equipment to receive the signal of the skin conductivity, measured on the skin of the patient, and the control unit is configured to calculate the characteristics of the signal conductivity of the skin and the formation of the first and second output signals indicating the condition of the patient, according to claims 1 to 12.



 

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FIELD: medicine.

SUBSTANCE: invention relates to medicine. In method realisation active and passive electrodes are installed on the surface of biological tissue. Source of electric energy is switched to them. After that, impact on tissue by two pulses with electric power of specified value following one another is performed on them. Impulse of specified power of larger value follows impulse of specified power of smaller value. Electric parameters of biological tissue, corresponding to each value of specified power, are measured and their ratio is used to estimate electrophysiological state of biological tissue.

EFFECT: invention makes it possible to increase self-descriptiveness and objectivity of method of measuring electric parameters of biological tissue with simplification of realisation of method techniques.

2 cl, 1 dwg, 1 tbl, 2 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to therapy, diagnostics. Method includes analysis of electric parameters before and after treatment. Measurement of skin electric potentials is carried out. Electric potentials are measured in corporal biologically active points (BAP). BAP of the first group are selected from points, located directly in the area of knee joint, such as Zu-San-Li, Du-Bi, Liang-Qui, Yin-Ling-Quan, Yang-Ling-Quan, Xi-Yang-Guan. BAP of the second group are selected from points, located outside knee joint, but on meridians, passing through knee joint, such as Yong-Quan, Xing-Quan, Da-Dun, Qu-Quan, Shu-Fu. Selection of not fewer than 3 from each group is carried out. If average indices of electric potentials, measured in BAP after treatment, are higher relative to indices, measured in BAP before treatment by 25% and higher, it testifies about achievement of treatment effect.

EFFECT: method is objective, simple in implementation, safe for patient.

FIELD: medicine.

SUBSTANCE: invention relates to medicine, namely to diagnostics. Method includes introduction of needle electrodes with active current-conducting end into tumour. After that their advance into tumour depth is performed. As they move, indices of bioimpedance (BIM) are measured five times at current frequency 2 kHz and voltage 1.02 V. If BIM indices decrease in the period of advance of electrodes into tumour depth, tumour is benign. If BIM indices vary, or grow, tumour is malignant.

EFFECT: method reduces tome of examination, is simple in implementation.

3 ex

FIELD: medicine.

SUBSTANCE: invention relates to medicine, therapy, dietetics and can be applied for correction and prevention of obesity. Estimation of indices of body weight (IWB), food status (FS), factual nutrition (FN) and food behavior (FB) is carried out. If patient has disturbed FS, FN and FB, than psychotherapist and dietitian carry out individual (IS) or group sessions (GS) of FB and FN correction with them for ten days, then, 1 time/week for a month. If FS and FN are disturbed, IS and GS are carried out for five days, after that, GS is carried out daily for a month. If FB is disturbed, psychotherapist carries out IS for correction of FB for five days, then, daily GS for month. In case of any combination of FC, FN, FB disturbance: if IWB equals 27-29.9, medication dietressa is administered in dose 1 pill 4 times/day for 3 months. If by FN estimation real daily caloricity of dietary intake (RDC DI) is higher than calculated by 200% and more, gradual reduction of daily calorage is administered: for the first week not more than 15% from initial, for the second - not more than 30%, for the third - not more than 50%, for the fourth - not more than 75% from initial, for the fifth and the following weeks - daily calorage corresponds to individual calculated caloricity of dietary intake with account of power consumption. If RDC DI is higher than calculated by from 199% to 101% reduction of daily calorage is administered: for the first week not more than 20% from initial, for the second - not more than 40%, for the third - not more than 70% from initial, for the fourth and the following - daily calorage corresponds to calculated individual caloricity with account of power consumption. If by data of bio-impedometry content of total water (CTW) in organism is more than 50% higher than consumption of liquid is not more than 1.5 l/day. If CTW reduction is more than 50%, consumption of liquid is not less than 2.5 l/day. If CTW change is 50% and less, consumption of liquid must constitute 2 l/day.

EFFECT: method ensures stable effect of body weight correction, with individualisation of food status, food behavior, factual nutrition, increase of patients' life quality.

2 ex, 1 tbl

FIELD: medicine.

SUBSTANCE: invention relates to medical equipment, namely to means for localisation of tooth root top in endodontics. Method consists in application of device, which contains first conducting electrode, forming endodontic probe, which is introduced into root canal, second electrode, brought into electroconductive contact with mucous membrane of oral cavity, frequency generator, which generates signals of alternating current of groups of frequencies, and means for measuring amplitude of alternating current signal in circuit. Measurement of amplitude of alternating current signals at low frequency and high frequency, determination of coincidence point, in which two levels of current amplitude, measured at said frequencies, cross and are in fact equal, are carried out. Low and high frequencies differ for determination of coincidence point, corresponding to position of root top. Device also contains means for control of selection of first frequency and second frequency and measurement of first level and second level of standardised amplitude of alternating current signals and means for determination and/or signal supply at first value of the level, obtained at first low frequency, without increase of second value of level of alternating current signal, obtained at second high frequency.

EFFECT: application of invention makes it possible to increase accuracy of determination of tooth root top position.

15 cl, 35 dwg

FIELD: medicine.

SUBSTANCE: method involves carrying out urological examination for determining hydrodynamic resistance of ureter calculated from formula Z=8Lμ/(πR4), where Z is the hydrodynamic resistance of ureter, L is the ureter length, R is the ureter radius, μ is the urine viscosity. Angle α at which the ureter enters the urinary bladder is determined from formula cosα = 8l1μ/(ZπR4), where l1 is the perpendicular drawn from the upper edge of the ureter to the its exit projection line, μ is the urine viscosity, Z is the hydrodynamic resistance of ureter, R is the ureter radius. Vesicoureteral reflux recidivation is predicted when the angle of α+90° is less than 120°.

EFFECT: enhanced effectiveness in reducing the number of recidivation cases.

2 dwg, 1 tbl

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