CN111657940B - Severe patient rehabilitation training auxiliary device and working method thereof - Google Patents

Severe patient rehabilitation training auxiliary device and working method thereof Download PDF

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CN111657940B
CN111657940B CN202010575682.4A CN202010575682A CN111657940B CN 111657940 B CN111657940 B CN 111657940B CN 202010575682 A CN202010575682 A CN 202010575682A CN 111657940 B CN111657940 B CN 111657940B
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muscle
patient
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oscilloscope
stimulation
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CN111657940A (en
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唐昊
刘冬
张连阳
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Chinese Peoples Liberation Army Army Specialized Medical Center
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/3601—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation of respiratory organs
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/36014—External stimulators, e.g. with patch electrodes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/36014—External stimulators, e.g. with patch electrodes
    • A61N1/3603—Control systems
    • A61N1/36031—Control systems using physiological parameters for adjustment

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Abstract

The invention belongs to the field of patient rehabilitation training, and particularly relates to an auxiliary device for rehabilitation training of critically ill patients and a working method thereof. The technical means adopted by the invention is that the rehabilitation training auxiliary device for the critically ill patient comprises an oscilloscope and also comprises: the central processing unit is in communication connection with the oscilloscope and is used for processing the electric signals acquired by the oscilloscope; the discharging device is electrically connected with the central processing unit and is used for discharging and stimulating muscles required to be recovered by a patient; the myoelectricity acquisition device is electrically connected with the oscilloscope and is used for acquiring the muscle voltage of the patient and displaying the muscle voltage through the oscilloscope. The device can detect the abdominal muscle voltage of a patient, electrically stimulate the abdominal muscle of the patient according to the real-time abdominal muscle voltage, improve the muscle tension, enable the patient to recover the spontaneous breathing ability early, and be separated from a breathing machine or a breathing mask early, so that other recovery exercises can be performed early.

Description

Severe patient rehabilitation training auxiliary device and working method thereof
Technical Field
The invention belongs to the field of patient rehabilitation training, and particularly relates to a critical patient rehabilitation training auxiliary device and a working method thereof.
Background
ICU acquired weakness (ICU-AW) is a common acquired neuromuscular dysfunction in critically ill patients and is one of the more serious complications of ICU. ICU-AW not only prolongs patient ICU mechanical ventilation time and hospitalization time, increases medical costs, but also severely affects the long-term quality of life of the patient.
CU-AW is characterized by symmetrical weakness in the extremities, more pronounced involvement of proximal muscles of the limb (such as the shoulder and hip) than distal, less involvement of facial and extraocular muscles, and involvement of the ventilator, which is more prevalent in mechanically ventilated patients. The clinical manifestations are difficulty in desquamation, paresis or quadriplegia, decreased reflexes and muscle atrophy.
Currently, clinical intervention with early activities is more studied, and students consider that patients should perform early functional exercise and physical therapy once they enter the ICU. Although there is a consensus among experts on the early activity of ICU mechanical ventilation patients, the clinical practice is not good enough, and a one-day-current survey in germany found that only 24% of mechanically ventilated patients and 8% of intubated patients had early out-of-bed activity as a routine care item. The ICU in China also generally has the problems that the patient is braked and calmed when the patient is subjected to mechanical ventilation, and physical therapy is started only after the patient is transferred out of the ICU, so that the morbidity risk of ICU-AW is greatly increased.
Therefore, a device capable of solving the problem that IUC patients are difficult to take off-line is urgently needed at present.
Disclosure of Invention
In order to solve the problem that the offline difficulty in ICU acquired asthenia cannot be effectively solved at present, the invention provides the auxiliary device for the rehabilitation training of the critically ill patient, which can help the critically ill patient to recover the autonomous respiratory capacity and solve the problem of offline difficulty.
In order to achieve the above object, the technical means adopted by the invention is that the rehabilitation training auxiliary device for the critically ill patient comprises an oscilloscope and further comprises: the central processing unit is in communication connection with the oscilloscope and is used for processing the electric signals acquired by the oscilloscope; the discharging device is electrically connected with the central processing unit and is used for discharging and stimulating muscles needing to be recovered of the patient; the myoelectricity acquisition device is electrically connected with the oscilloscope and is used for acquiring the muscle voltage of the patient and displaying the muscle voltage through the oscilloscope.
Preferably, the myoelectricity collecting device monitors the muscle voltage of the abdomen of the patient during breathing through the patch type electrode.
Preferably, the discharge device gives electrical stimulation to abdominal muscles of the patient through the patch electrodes; the discharging frequency, the discharging time and the discharging voltage of the discharging device are controlled by the central processing unit.
Preferably, the method for operating the rehabilitation training aid for critically ill patients is applied to the rehabilitation training aid for critically ill patients, and comprises the following steps: s1: initializing; s2: acquiring basic data to obtain muscle tension V max (ii) a S3: the central processing unit processes the basic data; s4: the central processing unit controls the discharging device to electrically stimulate abdominal muscles; s5: and collecting the current muscle voltage, judging and processing the current muscle voltage by combining basic data, and skipping S4.
Preferably, the S2 mid-myoelectric collection device may collect muscle voltages of a rectus abdominis muscle, a trapezius muscle and a transverse abdominis muscle.
Preferably, the step S2 comprises the following steps: a1: the central processor obtains a change curve Q of the abdominal muscle voltage V during respiration acquired by the non-stimulation myoelectricity acquisition device 0 (ii) a A2: giving the muscle a gradually increasing stimulation current I according to the breathing frequency; a3: obtaining a variation curve Q of the muscle voltage as a function of the stimulation current I 1 (ii) a A4: within a safe current range, when Q 1 Stopping detection when the change is not changed along with the increase of the I; a5: finally obtaining V max Curve Q as a function of I 1 。
Preferably, S3 comprises the following steps: b1: will Q 1 And Q 0 Making a difference to obtain a muscle voltage amplification curve Q which changes along with the current magnitude 2 (ii) a B2: obtaining the wave peak value N of the abdominal muscle voltage when the normal person breathes 1 And Q 0 Wave peak value N in 0 Making a difference to obtain a muscle voltage compensation value N 2 (ii) a B3: at Q 2 Is selected from the group consisting of 2 Equal amplification value N Q The corresponding I is set as the output current I of the discharge device out . If N is present 2 Greater than Q 2 Maximum of N Q Then get the maximum N Q Corresponding I is taken as out . B4: will N Q And N 0 Adding to obtain the expected value N p 。
Preferably, S4 includes the following steps: c1: acquiring a change curve Q of real-time abdominal muscle voltage through a myoelectricity acquisition device 3 And pre-selecting a next stimulation node; c2: the abdominal muscles are output with a given current value at the stimulation node for a certain time.
Preferably, the step S5 includes the following steps: c3: obtaining Q 3 Wave peak value N of 3 And N is p Minus N 3 To obtain a muscle voltage error value N 4 If N is present 4 /N p Jumping to C1 within a first threshold range, if N 4 /N p Not at the first thresholdJumping to C4 within the value range; c4: will N 4 And N 2 Adding up to obtain muscle voltage correction value N 5 (ii) a C5: at Q 2 Is obtained with N 5 Same N Q The corresponding stimulation current I is used as the next stimulation current I next If N is present 5 Greater than Q 2 Maximum of N Q Then get the maximum N Q Corresponding I is taken as next (ii) a C6: at Q 1 Middle search and I next Corresponding muscle tension V max0 With the stimulation current I being performed this time out Corresponding muscle tension V max0 (ii) a C7: will V max0 And V max1 Difference and calculate the ratio N 6 If | N 6 If | is less than the second threshold, jump to C9, if | N 6 If the | is larger than a second threshold value, skipping C8; c8: stopping stimulation and allowing the patient to breathe naturally; c9: will I next Is set to be I nout And jumps to C1.
Preferably, the pre-selection method of the next stimulation node in C1 is that the muscle voltage rise time T is increased due to the normal respiration of the patient 1 The delay time T of the whole device is known 2 Given, therefore, the rise time T is taken 1 -T 2 The corresponding voltage value V is used as an electrical stimulation node; when the muscle voltage is detected to be in a rising state and the voltage value rises to V, the central processing unit controls the discharging device to discharge, so that the abdominal muscles can continue to contract, and the breathing efficiency is improved.
Preferably, N in C7 is 6 Is calculated in the manner of (V) max0 -V max1 )/V max0 。
The beneficial effects created by the invention are as follows: the device can detect the abdominal muscle voltage of a patient, and provides electrical stimulation to abdominal muscles of the patient according to the real-time abdominal muscle voltage to improve the muscle tension, so that the patient can recover the spontaneous breathing ability early and can be separated from a breathing machine or a breathing mask early, and further recovery exercise can be performed early.
Drawings
FIG. 1 is a view showing a constitution of an apparatus
FIG. 2 is a flow chart of the main steps
FIG. 3 is a flowchart of the step S2
FIG. 4 is a flowchart of the step S3
FIG. 5 is a flowchart of the steps of S4 and S5
In the figure: 1. the device comprises a central processing unit, 2, an oscilloscope, 3, a myoelectricity acquisition device, 4 and a discharge device.
Detailed Description
The embodiments of the present invention are described below with reference to specific embodiments, and those skilled in the art will appreciate advantages and effects of the present invention from the disclosure of the present specification. It should be noted that the drawings provided in the following embodiments are only for illustrative purposes, are schematic drawings rather than actual drawings, and are not to be construed as limiting the invention, and in order to better illustrate the embodiments of the invention, some components in the drawings may be omitted, enlarged or reduced, and do not represent the size of an actual product; it will be understood by those skilled in the art that certain well-known structures in the drawings and descriptions thereof may be omitted.
In the description of the present invention, it should be understood that if there are terms such as "upper", "lower", "left", "right", "front", "back", etc., indicating orientations or positional relationships based on the orientations or positional relationships shown in the drawings, the terms are used for convenience of description and simplicity of description, but do not indicate or imply that the designated device or element must have a specific orientation, be constructed in a specific orientation, and be operated, therefore, the terms in the drawings describing the positional relationships are used for illustration only and are not to be construed as limitations of the present invention, and those skilled in the art can understand the specific meanings for the above aspects according to specific situations.
As shown in fig. 1, an auxiliary device for rehabilitation training of a critically ill patient comprises an oscilloscope 2, and further comprises: the device comprises a discharge device 4, a central processing unit 1 and a myoelectricity acquisition device 3. And the central processing unit 1 is in communication connection with the oscilloscope 2 and is used for processing the electric signals acquired by the oscilloscope 2.
And the discharging device 4 is electrically connected with the central processing unit 1 and is used for discharging and electrically stimulating muscles needing rehabilitation of a patient. The discharging device 4 gives electrical stimulation to abdominal muscles of a patient through the patch type electrode. The discharge frequency, discharge time and discharge voltage of the discharge device 4 are controlled by the cpu 1.
And the myoelectricity acquisition device 3 is electrically connected with the oscilloscope 2 and is used for acquiring the muscle voltage of the patient and displaying the muscle voltage through the oscilloscope 2. The myoelectricity acquisition device 3 monitors the muscle voltage of the abdomen of the patient during breathing through the patch type electrode.
As shown in fig. 2, a working method of the rehabilitation training assisting device for the critically ill patient is suitable for the rehabilitation training assisting device for the critically ill patient, and comprises the following steps: s1: initializing S2: acquiring basic data to obtain muscle tension V max (ii) a S3: the central processing unit 1 processes the basic data; s4: the central processing unit 1 controls the discharge device 4 to electrically stimulate abdominal muscles; s5: and collecting the current muscle voltage, judging and processing the current muscle voltage by combining basic data, and skipping S4.
The muscle state of the patient can be known by measuring the muscle tension, and the size of the stimulating current can be more reasonably arranged.
The abdominal muscle voltage of the patient is detected, the abdominal muscle electrical stimulation is given to the patient according to the real-time abdominal muscle voltage, the muscle tension is improved, the patient can recover the spontaneous breathing capacity early, the patient can be separated from a breathing machine or a breathing mask early, and other recovery exercises can be performed early.
In S2, the myoelectric acquisition device 3 can acquire the muscle voltages of the rectus abdominis, the oblique abdominis and the transverse abdominis, respectively. This application has set up electro photoluminescence paster and flesh electricity in the position that each muscle of belly corresponds and has detected the paster.
As shown in fig. 3, S2 includes the following steps: a1: the central processing unit 1 acquires the variation curve Q of the abdominal muscle voltage V during respiration acquired by the non-stimulation myoelectricity acquisition device 3 0 (ii) a A2: giving the muscle a gradually increasing stimulation current I according to the breathing frequency; a3: obtaining variation with stimulation current ICurve Q of the variation of the muscle voltage 1 (ii) a A4: within a safe current range, when Q 1 Stopping detection when the change is not changed along with the increase of the I; a5: finally obtaining V max Curve Q as a function of I 1 。
As shown in fig. 4, S3 includes the steps of: b1: will Q 1 And Q 0 Making a difference to obtain a muscle voltage amplification curve Q which changes along with the current magnitude 2 . B2: obtaining the wave peak value N of the abdominal muscle voltage when the normal person breathes 1 And Q 0 Wave peak value N in 0 Making a difference to obtain a muscle voltage compensation value N 2 . B3: at Q 2 Is selected from the group consisting of 2 Equal amplification N Q The corresponding I is set as the output current I of the discharge device 4 out . If N is present 2 Greater than Q 2 Maximum of N Q Then get the maximum N Q Corresponding I is taken as out . B4: will N Q And N 0 Adding to obtain the expected value N p 。
As shown in fig. 5, S4 includes the steps of: c1: the change curve Q of the real-time abdominal muscle voltage is obtained by the myoelectricity acquisition device 3 3 And pre-selecting a next stimulation node; c2: the abdominal muscles are output with a given current value at the stimulation node for a certain time.
S5 comprises the following steps: c3: obtaining Q 3 Peak value of (N) 3 And N is p Minus N 3 To obtain a muscle voltage error value N 4 If N is present 4 /N p Jumping to C1 within a first threshold range, if N 4 /N p If not, jumping to C4; c4: n is to be 4 And N 2 Adding up to obtain muscle voltage correction value N 5 (ii) a C5: at Q 2 Is obtained with N 5 Same N Q The corresponding stimulating current I is used as the next stimulating current I next If N is present 5 Greater than Q 2 Maximum of N Q Then take the maximum N Q Corresponding I is taken as next (ii) a C6: at Q 1 Middle search and I next Corresponding muscle tension V max0 With the stimulation current I executed this time out Corresponding muscle tension V max0 (ii) a C7: will V max0 And V max1 Difference and calculate the ratio N 6 If | N 6 If | is less than the second threshold, jump to C9, if | N 6 If | is larger than the second threshold, jump to C8. C8: stopping stimulation and allowing the patient to breathe naturally. C9: will I next Is set to be I nout And jump to C1. Wherein the first threshold is in the range (-0.01, 0.01); the second threshold value is 0.1.
As electrical stimulation progresses, the muscle becomes fatigued, so it is necessary to analyze the muscle voltage error value to determine whether the error is a normal error or an error caused by muscle fatigue or muscle growth. And correcting the error result, and simultaneously analyzing and calculating the corrected data to confirm whether the patient needs to continue stimulating. The injury of the patient caused by excessive stimulation is avoided, the proper stimulation can be ensured, and the recovery process of the patient is accelerated.
The pre-selection method of the next stimulation node in C1 is that the muscle voltage rise time T is caused by the normal respiration of the patient 1 The delay time T of the whole device is known 2 Given, therefore, the rise time T is taken 1 -T 2 And the corresponding voltage value V is used as an electrical stimulation node. That is, when the muscle voltage is detected to be in a rising state and the voltage value rises to V, the cpu 1 controls the discharging device 4 to discharge, so that the abdominal muscles continue to contract, thereby improving the breathing efficiency. The selection of stimulation node can be so that discharge device 4 when discharging, and abdominal muscle is in the peak of natural contraction, and the muscle of amazing at this moment for muscle contracts once more, cooperatees with patient's breathing law or the muscle contraction law when breathing, makes the amazing effect maximize, has also avoided breathing conflict simultaneously, can promote the respiratory capacity of patient when breathing at every turn, is favorable to patient to recover early.
N in C7 6 Is calculated in the manner of (V) max0 -V max1 )/V max0 。
The main purpose of the method in the application is to increase the oxygen uptake of the patient by the electrical stimulation according to the breathing rule of the patient, and exercise the abdominal muscles of the patient at the same time, so that the patient can break away from the breathing machine to breathe autonomously as early as possible.
Although the present invention has been described in detail with reference to the preferred embodiments, it will be understood by those skilled in the art that various changes may be made and equivalents may be substituted without departing from the spirit and scope of the present invention. The invention creates the technology, the shape and the construction part which are not described in detail and are all the known technology.

Claims (5)

1. The utility model provides a severe patient rehabilitation training auxiliary device, includes the oscilloscope, its characterized in that still includes:
the central processing unit is in communication connection with the oscilloscope and is used for processing the electric signals acquired by the oscilloscope;
the discharging device is electrically connected with the central processing unit and is used for discharging and stimulating muscles needing to be recovered of the patient;
the myoelectricity acquisition device is electrically connected with the oscilloscope and is used for acquiring the muscle voltage of the patient and displaying the muscle voltage through the oscilloscope;
the working method of the device comprises the following steps:
s1: initializing;
s2: acquiring basic data to obtain muscle tension V max (ii) a The S2 comprises the following steps:
a1: the central processor obtains a change curve Q of the abdominal muscle voltage V during respiration acquired by the non-stimulation myoelectricity acquisition device 0 ；
A2: giving the muscle a gradually increasing stimulation current I according to the breathing frequency;
a3: obtaining a variation curve Q of the muscle voltage as a function of the stimulation current I 1 ；
A4: in the safe current range, when Q 1 Stopping detection when the change is not changed along with the increase of the I;
a5: finally obtaining V max Curve Q as a function of I 1 ；
S3: the central processing unit processes the basic data; the S3 comprises the following steps:
b1: will Q 1 And Q 0 Making a difference to obtain a muscle voltage amplification curve Q which changes along with the current magnitude 2 ；
B2: obtaining the wave peak value N of the abdominal muscle voltage when the normal person breathes 1 And Q 0 Wave peak value N in 0 Making a difference to obtain a muscle voltage compensation value N 2 ；
B3: at Q 2 Is selected from the group consisting of 2 Equal amplification value N Q The corresponding I is set as the output current I of the discharge device out If N is present 2 Greater than Q 2 Maximum of N Q Then get the maximum N Q Corresponding I is taken as out ；
B4: n is to be Q And N 0 Adding to obtain the expected value N p ；
S4: the central processing unit controls the discharging device to electrically stimulate abdominal muscles; the S4 comprises the following steps:
c1: acquiring a change curve Q of real-time abdominal muscle voltage through a myoelectricity acquisition device 3 And pre-selecting a next stimulation node;
c2: outputting a given current value to abdominal muscles at a stimulation node for a certain time;
s5: collecting the current muscle voltage, judging and processing the current muscle voltage by combining basic data, and skipping S4; the S5 comprises the following steps:
c3: obtaining Q 3 Peak value of (N) 3 And N is p Minus N 3 To obtain a muscle voltage error value N 4 If N is present 4 /N p Jumping to C1 within a first threshold range, if N 4 /N p If the current value is not within the first threshold value range, jumping to C4;
c4: will N 4 And N 2 Adding up to obtain muscle voltage correction value N 5 ；
C5: at Q 2 Is obtained with N 5 Same N Q The corresponding stimulation current I is used as the next stimulation current I next If N is present 5 Greater than Q 2 Maximum of N Q Then get the maximum N Q Corresponding I is taken as next ；
C6: at Q 1 Middle search and I next Corresponding muscle tension V max1 With the stimulation current I executed this time out Corresponding muscle tension V max0 ；
C7: will V max0 And V max1 Making a difference and calculating a ratio N 6 If | N 6 If | is less than the second threshold, jump to C9, if | N 6 If the | is larger than a second threshold value, skipping C8;
c8: stopping stimulation and allowing the patient to breathe naturally;
c9: will I next Is set to be I nout And jumps to C1.
2. The critical patient rehabilitation training auxiliary device according to claim 1, wherein the myoelectric collecting device monitors abdominal muscle voltage of the patient during breathing through patch type electrodes.
3. The rehabilitation training aid for critically ill patients according to claim 1, wherein the electric discharge device gives electrical stimulation to abdominal muscles of patients through patch electrodes; the discharging frequency, the discharging time and the discharging voltage of the discharging device are controlled by the central processing unit.
4. The rehabilitation training aid for critically ill patients as claimed in claim 1, wherein the pre-selection of the next stimulation node in C1 is due to the muscle voltage rise time T during normal respiration of the patient 1 The delay time T of the whole device is known 2 Given, therefore, the rise time T is taken 1 -T 2 The corresponding voltage value V is used as an electrical stimulation node; i.e. when it is detected that the muscle voltage is in a rising state and when the voltage value rises to V, the central processing unitThe controller controls the discharging device to discharge, so that abdominal muscles can continue to contract, and the breathing efficiency is improved.
5. The rehabilitation training aid for critically ill patients according to claim 1, wherein N in C7 is 6 Is calculated in the manner of (V) max0 -V max1 )/V max0 。
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