EP0799010B1 - Device intended in particular for the prevention of pressure sores - Google Patents

Abstract

The invention concerns a device intended in particular for the prevention of pressure sores and for treating shock lung. The device is fitted on the underside of a patient's bed and comprises a drive unit actuated by a motor and capable of imparting to the bed frame a precessional motion about the drive unit. The drive unit can be a bearing cage or gear mechanism. As a result of the particular design of elements incorporated in the drive unit, which generate a motion at an angle to the parallel plane of the bed frame, the bed frame is made by the drive unit to move in a precessional path about the drive unit. The drive unit can impart a minimal precessional motion to the bed frame and by so doing can ensure that the position of a bedridden patient undergoes constant tiny adjustments. This prevents the patient from developing pressure sores and, in the treatment of shock lung, allows those alveolar structures in the lung which are still intact to remain aerated. Peripheral or stop elements ensure that the frame is secure during its excursion from its horizontal position as it executes precessional motion and limit the excursion amplitude.

Description

The invention relates to a bedside device, in particular for pressure ulcer prophylaxis.

Seriously ill patients are usually agile Bedside considerably restricted. Especially paralyzed patients (Paraplegia, stroke) are about self mobility either barely or not at all. she lie more or less motionless in bed. This has to Consequence that the support points of her body on the support surface the bed, usually the sacral area, the heels and the shoulders, never change unless by outside Application of force.

In the area of a support point, the bone presses the one above Skin on the contact surface. The skin compressed to a certain extent so that blood flow in this area is restricted or suspended. Consequently there is an undersupply of oxygen in this circumscribed area, hypoxia or anoxia. Hold this Situation for a long time - a few hours are enough -, there are circumscribed tissue defects with cell death (Necrosis), the pressure ulcer.

If treated insufficiently, it can become infected (e.g. through hospital germs). It is not uncommon a sepsis that is especially in seriously ill and thus defensively weakened Can lead to death.

Therapeutic measures are dependent on the extent and stage of the the progressive process on the one hand the surgeon clean up the necrotic area, and above all else the nursing treatment with intensive skin care, antibiotic Local therapy, massage and last but not least constant relocation of the patient to the affected area spare and keep vital. These measures require one high personnel, time and financial expenditure, the mainly due to lack of staff, sometimes only in is operated insufficiently.

In addition to the therapeutic measures taken in the event of Pressure ulcers are inevitable, there is therefore a great need for measures to prevent the development of pressure ulcers can prevent from the outset.

The case is similar in the treatment of Shock lung (ARDS = adult respiralory distress syndrome). At Due to the shock, this clinical picture results in a so-called Membrane syndrome, i.e. the interalveolar septa in the Lungs are caused by edema fluid, fibrin, inflammatory infiltrates and finally massively thickened connective tissue formation, so that gas exchange with the alveoli is no longer possible is. There is an internal suffocation (respiralory distress). Therapeutic ventilation must be provided, which of course only then makes sense if the alveolar structures are still intact are accessible to ventilation. To optimally these areas in the lungs it is advantageous to ventilate, as has already been shown has the body and thus the lungs in the position again and again to change. This is how patients become recently also ventilated in prone or lateral position. This leads to conceivable nursing problems.

From the area of the "Feldenkrais Method" is a moving bed known to perform certain movements and on the Can transfer lying. For example, the German reveals DE 38 00 496 a moving bed for Support of the so-called "Feldenkrais method". Here is supposed to an improvement in muscle tone and a physical and psychological Relaxation can be achieved by the patient standing, sitting or lying down various relatively gentle movements, such as slowly, alternately lifting the arms or legs, light Torso of the fuselage and the like, either do it yourself or can be carried out passively by the teacher. To achieve slight twists of the spine and opposite movements of the mutual The mattress frame oscillates around extremities its longitudinal central axis. With this, movements or sequences of movements modeled, as is usually the case with natural movements occur. A transfer of motion from the bed to the one in it located person is reached with the help of a drive that the a variety of moving parts assembled mattress frames put in a very complex sequence of movements.

For decubitus prophylaxis as well as for the treatment of shock lung this bed with a suggested period of torsional movement from 3 to 20 seconds is not suitable because of such a short period would be perceived as annoying in the long run.

Another type of mobile bed is described in the German patent application DE 42 39 942 is provided for the treatment of sleep disorders. So that this can be put into a rocking movement, it must but freely suspended from the ceiling like a hammock be what its use in the inpatient clinic area as good as makes impossible.

A therapeutic bed is known from US Pat. No. 4,586,492 Frame can be put into a rhythmic circular motion that reminiscent of the movement of a boat on moving seas. The Drive device is below the center of gravity of the Frame arranged and has means for controlling the speed the circular motion. This circular movement is represented by a Drive device realized, which is connected to a lower frame is and drives the upper frame, which is mounted on shock absorbers.

From US 2 808 828 a rocking bed is known, which is a kind Precession movement, i.e. a rocking movement from head to toe or can run from one side to the other. To realize this Movement, the bed frame is connected to a drive device, so that the bed is horizontal as well as vertical Axis oscillates. The drive device is very expensive. A gear transmission is coupled to a cam drive. The cam rotates in a spiral groove, which is the oscillating one Movement realized.

Especially for pressure ulcer prophylaxis and therapy for shock lung the costly and time-consuming manual relocation has already been tried of bedridden patients through automatic repositioning to replace. This is currently supported by water, air or foam-filled special mattresses that partially open conventional hospital beds laid on, but sometimes only integrated in special beds Tobe offered. They have movable elements or chambers that can be filled with air and water Central unit or pump via complex mechanics or Valve control can be controlled so that it is permanent Changes to the contact surface and thus the contact points of the patient lying on such a mattress.

A disadvantage of these known models is that the bedridden Patient is unacceptably affected by it. So will he on the one hand by the not inconsiderable noises of this Drives / pumps, on the other hand by those triggered by them Vibrations disturbed and prevented from sleeping. Lead to this also the often disproportionately large deflections of the bearing surface, the known devices for pressure ulcer prophylaxis cause, and through which the patient literally is "rocked". In addition, these systems are very complex and in addition to the expensive special mattresses have a variety of maintenance-intensive components such as pumps, controls, Valves, lines and seals. Another disadvantage is that these special beds or special mattresses a special Disinfection treatment is required and not in the usual way can be treated in the disinfection spray room because the maintenance-intensive Components against the penetration of disinfectant liquid must be protected. This in turn has an additional effort of workers, increases costs and is also very time consuming.

The present invention seeks to remedy these disadvantages. Based on this prior art, the invention lies Task based on a device, in particular for pressure ulcer prophylaxis provide by a bedridden patient constantly changing his position almost imperceptibly, is relocated without the patient being disturbed by noises or fibrillation is affected immediately if needed is available, i.e. without changing the patient's bed, and so on is compact and functional in that it itself is inexpensive is producible and also saves costs in a conventional one Bedside can be integrated. Furthermore should this device can be designed so that a so equipped Sick bed usually in the disinfection chamber can be disinfected.

According to the invention, this object is achieved through the teaching of the claim 1 solved. Further refinements of the invention are Subject of the subclaims. According to the invention The underside of a bedside grate mountable device suggested by a substantially symmetrical around the center of gravity of the bed base, support and patient Drive device is characterized, by which the Bed frame or the surface normal to the bed frame in a Precession movement can be offset by this drive device can. For this purpose, the drive device has an upper and a lower one Storage on, between which a gear is arranged, in which in the middle is a ring or disc with an inclined surface.

It has been observed that even minimal movements like healthy people, even if they are completely drunk, perform in sleep, represent a sufficient rearrangement, so that decubitus ulcers never appear and are still intact adequate ventilation of the alveolar lung areas. These are minimal constant relocations of the patient according to the invention by the precession movement of the bed reached.

The Gear transmission is designed so that a motor a so-called drive wheel is driven with a gear, which is between an upper and a lower bearing drives another rotating gear. This indirectly driven Gear has either an attached disc or Ring or a centrally located in the driven gear Disc with an inclined surface, with this attached the disc triggering the precession movement differs widely has axial heights.

The upper storage is with a holding device Bed grid connected. The lower storage is with a Recording frame connected. Between the bed grate and the frame, which is between the bed frame and the lower bed frame is arranged, a connecting element is provided. This connecting element can either on the mounting frame or be arranged and connected to the receiving frame and bed frame. The holding device, which is connected to the bed frame and to which the upper bearings are attached Stop element on which in the connecting element, which arranged between the receiving frame and the bed frame intervenes. The connecting element is designed such that that arranged on or connected to the holding device Stop element protrudes into the connecting element, this stop element the deflection of the precession movement of the bed grate through the circumferential inclination element limited. The stop element leads in the connecting element a vertical upward and downward lifting movement during the circulation of the inclination element.

The inclination element or the disc or the ring with inclined According to a preferred embodiment, the surface can be Gear mechanism of the drive device be incorporated, that is can be formed centrally in the indirectly driven gear or be arranged.

The upper bearing and the lower bearing have an inner and outer bearing ring. The inner bearing ring of the upper bearing is fixed with the arranged in or on the gear inclined surface formed disc connected. The outer The bearing ring is firmly attached to the holding device. Of the inner ring of the lower bearing is indirectly driven Gear firmly connected and rotates with this ring, whereby the outer bearing ring is firmly fixed on the receiving frame is.

The entire drive device is one in terms of Disinfectant used in hospitals resistant and flexible rubber or plastic material encased liquid-tight. The rubber or plastic jacket is flexible and follows the precession movement the drive device.

The normal course of nursing and other therapy is not disturbed when using the present invention because the drive devices and the peripheral elements quickly and inexpensively in conventional hospital beds familiar equipment (e.g. electrically adjustable backrests, Attachment options for additional devices, etc. ) integrate to let. With these, the bed frame usually lies with his Edge area on a surrounding projection of the bed frame on. A carrier plate can be mounted on this bearing projection be stored with the dimensions of the bed frame, which the Drive device carries. The bed frame is then again directly on the carrier plate and thus the elements of the Device stored. The dimensions remain one conventional bed received unchanged, what for smooth hospital operation is an advantage.

Essential for the well-being of a bedridden patient is controlled in addition to the low noise and vibration minimalized movement of the bed. This is through the present invention first of all on practical and uncomplicated Way about the dimensioning of the components of the Drive device (e.g. gear diameter, Bearing height and height of the inclination element) and Furthermore, the control is as problem-free as it is precise allows for the drive device in their respective Embodiment can be used.

The parameters of such a controlled and minimized Movement of the bed are advantageous on the control provided means adjustable and changeable. It was found that the frequency of a complete precession movement of the bed should not be less than 1/10 min should not be perceived as disturbing by the patient. Of course, this frequency should be in the interest of the patient kept as low as possible and individually adjustable be. So it can with appropriate physical and illness-related conditions also reduced to 1/1 h be, while still moving the patient in always changed positions is ensured so that pressure ulcers can be effectively prevented and the intact alveolar Structures of the lungs remain available for gas exchange.

The statements made about the frequency also apply accordingly for the amplitude of the precession movement. The one for the patient the limit value of the amplitude, which is still well tolerated, can Radius of about 25 cm around the center of gravity of the bed frame do not deflect more than 3 cm from the horizontal. According to the individually present circumstances should of course the amplitude of the precessional movement of the bed for each patient about the means provided on the controller so low be set as possible. The amplitude of the precession movement is preferably in a range of 3 cm to 10 cm Displacement adjustable from the horizontal. On the circumferential bed profile can advantageously, even after mounting the parts the holding device carrying the drive device, which below the bed base, conventional protective agents, such as e.g. Grid, are attached to prevent the patient from falling out to prevent larger displacement amplitudes and the patient secure overall.

Fig. 1

in schematischer Darstellung die Seitenansicht eines Antriebsvorrichtung mit Zahnradgetriebe.

Fig. 2

in schematischer Darstellung die Draufsicht auf das Zahnradgetriebe mit Neigungselement.

The invention is explained in more detail below on the basis of exemplary embodiments with reference to the accompanying drawings. In these drawings:

Fig. 1

in a schematic representation, the side view of a drive device with gear transmission.

Fig. 2

in a schematic representation, the top view of the gear transmission with inclination element.

1 is a schematic representation of a drive device, which is designed as a gear transmission. A holding device is located below the bed grate 1 12 arranged. This holding device extends essentially in the middle of the longitudinal extension of the bed the entire bed width from left to right bed frame. This Holding device is designed in the manner of a flat bearing surface, the ones extending transversely to the longitudinal direction Extend edge areas away from the bed frame. In the area of Holding device 12, which the engine with gear 16 on next one, joins the rounded bracket area a stop element 15. This stop element 15 is with the holding device following the precession movement firmly connected and engages in a connecting element 14 a. This connecting element 14, which between Receiving frame 17 and bed frame 1 is arranged, in particular as a limit stop to limit the amplitude of deflection of the bed frame from the horizontal. The Precession movement of the bed base 1 is carried out according to FIG the circulation of an inclination disk 13 with respect to its circumference variable axial height expansion reached. The tilt disc is designed in the manner of a wedge plate so that opposing points in their axial height expansion deviate from each other so that a deflection amplitude is guaranteed in the range of 3 to 10 cm. The gear 18, which is driven by a gearwheel connected to the motor 16 is running between an upper bearing 11 and one lower storage 10 um. In the middle, in gear 18, there is one Inclination disc 13 arranged. This inclination disk 13 is tied to the inner bearing ring of the upper bearing 11. The outer bearing ring is firmly connected to the holding device. The gear 18 is with the inner bearing ring of the lower one Bearing 10 connected, the outer bearing ring of the lower Storage 10 is connected to the receiving frame 17. Of the outer bearing ring of the upper bearing 11 is fixed to the Holding device fixed. The inner ring of the lower bearing 10 is firmly connected to the indirectly driven gear and runs around with this bearing ring, the outer bearing ring is firmly fixed on the mounting frame. engine and gears are also arranged and fixed in the receiving frame 17. in the shown in Fig.1 embodiment is Part of the wedge plate 13 with the largest possible axial extent on the side of the drive device opposite the motor. The stop element 15 is in the connecting element 14 inclined towards the receiving frame. In the driven gear 18, the inclination disc 13 is integrated and becomes indirect over the driven gear around them into a rotational movement transferred.

Is the part of the inclination disk 13 with the highest axial extension in the area of the upper bearing 11, which is located in the immediate vicinity of the engine and transmission, so the stop element 15 is in the upper region of the Connecting element 14, which is then the deflection of the Limited precession movement.

From Fig. 2, the arrangement of the Gear transmission of the drive device shown in FIG. 1. About the engine with gear 16 is a smaller one Gear 19 driven. This engages in the larger gear 18 a, in which a wedge or inclined disc in the middle with different heights over the circumference arranged with respect to the flank height of the circumferential gear is. Centered in the direction of the longitudinal axis of the bed frame the stop element lies on the longitudinal axis of the bed frame 15 arranged, which engages in the connecting element 14.

Claims (9)

1. A device, particularly for prevention of bedsores, mounted on the underside of the mattress (1) of a sickbed, comprising a drive device (2) in the form of a gearwheel transmission unit with a ring or disc and driven by a motor and transmission unit (16), wherein the mattress (1) is connected by a retaining device to a top mounting of the drive device (2) and wherein the drive device (2) is disposed substantially symmetrically below the centre of gravity of the mattress,
   characterised in that
   the drive device (2), by means of which the mattress (1), a support and a patient thereon can be set in precessional motion around the drive device (2), has a top mounting (11) and a bottom mounting (10) and a gearwheel (18) in which a disc or ring (13) having an inclined surface rotates centrally is disposed between the top mounting (11) and the bottom mounting (10).
2. A device according to claim 1, characterised in that the top mounting (11) is connected by a retaining device (12) to the mattress (1) and the bottom mounting (10) is connected to a receiving frame (17), a connecting element (14) being disposed between the mattress (1) and the retaining device (12).
3. A device according to claim 1 or 2, characterised in that the retaining device (12) so engages in the connecting element (14) by way of an abutment element (15) that the element (14) limits the deflection of the precessional motion of the mattress (1).
4. A device according to any of the preceding claims, characterised in that the disc or ring (13) disposed inside the gearwheel (18) is in the form of an inclined disc or ring having an axial vertical dimension which varies around its periphery.
5. A device according to any of the preceding claims, characterised in that the disc or ring (13) is incorporated in the gearwheel transmission unit of the drive device (2).
6. A device according to any of the preceding claims, characterised in that means are provided for varying the frequency and amplitude of the precessional motion.
7. A device according to any of the preceding claims, characterised in that the frequency of the precessional motion is from 1/10 minutes to 1 hour.
8. A device according to any of the preceding claims, characterised in that the maximum amplitude of precessional motion reached in a circle of about 25 cm radius around the drive device (2) does not exceed a deflection of the mattress by about 3 cm out of the horizontal position.
9. A device according to any of the preceding claims, characterised in that the drive device (2) is enclosed in a flexible cover which follows the precessional motion.

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