JP4538711B2 - Physiological state management system and physiological state management method - Google Patents

Description

  The present invention is a physiological state management method for managing these indices to optimum values using indices indicating the physiological state of the subject for life support of the subject who is difficult to maintain life due to trauma, The present invention relates to a physiological state management system, a brain temperature management device, a ventilator, and an anesthesia device.

  Conventionally, in ICU, in order to treat a patient at the boundary of life and death, the physiological state of the patient is strictly managed. Specifically, the patient's respiration rate, heart rate, blood pressure, body temperature, consciousness level, and other indices are measured, and individual doctors adjust based on the experience according to the measured values.

  For example, in brain hypothermia, the brain temperature and body temperature are controlled at low temperatures by measuring the temperature and deep body temperature of the patient's head, neck, and trunk, and maintaining these temperatures at low temperatures. In anesthesia, the concentration and amount of anesthetic gas are adjusted by measuring the patient's body temperature, heart rate, and blood pressure. Further, in artificial respiration, a patient's peripheral arterial blood oxygen saturation is measured to adjust the amount of air and the amount of oxygen contained in the air.

  However, in the method of manually adjusting the index indicating the physiological state as described above, it is difficult for an expert doctor to maintain it, and it is difficult to maintain the index strictly. Moreover, since the dangerous area of the physiological state is estimated based on the experience and intuition of the doctor, the psychological burden on the doctor is large.

  Accordingly, an object of the present invention is to provide a physiological state management system that can easily and surely adjust a patient's physiological state indicated by an index and can reduce a physical (physical) burden and a psychological burden of a doctor. To do.

The present inventor has taken the above circumstances into consideration, and as a result of repeating the research so far, has completed the following inventions (1) to (7) that solve the above problems. And the invention which is going to receive a patent in this application based on these inventions is as follows. That is, a brain temperature management device used in brain cryotherapy for protecting a subject's brain in a low temperature state, the brain temperature detecting sensor for detecting the subject's brain temperature, and the subject cooling for cooling the subject And a control device for controlling the temperature of the subject cooling means, the control device comprising: a target value setting means for setting a target value of the brain temperature; a current value detected by the brain temperature detection sensor; Based on the difference from the target value, parameter estimation means for mathematically repeatedly estimating the parameters of the subject cooling means, and driving the subject cooling means based on the parameters, Output means for repeatedly bringing the current value close to the target value. The subject cooling means of the invention according to claim 1, which is an independent claim, is a contact cooling device that indirectly cools the brain of the subject by contacting the subject from the body surface side, and the control The device compares the brain temperature output of the reference model with the target value using the transfer function thermal model between the subject and the contact cooling device as a reference model, and inputs the cooling temperature input of the reference model based on the difference. And, based on the difference between the brain temperature output of the reference temperature detection sensor and the brain temperature output of the reference model and the cooling temperature input of the reference model, while making the brain temperature output of the reference model follow the target brain temperature cooling curve. By adjusting the output means , control is performed to cause the brain temperature of the subject to follow the brain temperature output of the reference model. Further, the subject cooling means of the invention according to claim 4 that is an independent claim is an air cooling device that cools air around the subject and indirectly cools the brain of the subject, and the control The apparatus performs the same control as the invention according to claim 1 using a transfer function thermal model between the subject and the air cooling apparatus as a reference model. Furthermore, the subject cooling means of the invention according to claim 6 which is independent term, change in body properties by injection of chemicals into the body of the subject, or the subject's brain by the cerebral blood flow the Ri injection cooler der indirectly cooled, the control device performs the same control as the invention according to claim 1 transfer function thermal model of the injection cooling device and the subject as a reference model.

  (1) A physiological state management system for managing an index indicating a physiological state of a subject to an optimum value, a detection sensor for detecting a current value of the indicator, an output device for changing the physiological state of the subject, and A control device for controlling the output device, the control device, based on a target value setting means for setting a target value of the index, and a difference between the current value detected by the detection sensor and the target value, Parameter estimation means for mathematically estimating the parameters of the output device; and output means for driving the output device based on the parameters to bring the current value of the index closer to the target value. A physiological state management system characterized by that.

  Here, the parameters are estimated according to medical judgment based on a large amount of patient physiological data.

  The physiological state of human beings not only changes depending on age, sex, etc., but even the same person constantly changes depending on the date and time. For this reason, even if an attempt is made to control the human physiological state by classical feedback control, the system parameters may not be constant, and thus the subject's physiological state may not be reliably handled.

  However, according to the invention of (1), optimal adaptive control (optimum adaptive control) is performed on the index indicating the physiological state of the subject. That is, the target value of the index is set to an optimal value, and the current value of the index is detected by the detection sensor. Next, the parameter of the output device is mathematically estimated based on the difference between the detected current value and the target value. Subsequently, the current value of the index is brought close to the target value by outputting from the output device to the subject based on the parameter. Thereafter, the current value detection, parameter estimation, and output from the output device are repeated.

  Therefore, the parameters can be changed according to the physiological state of the subject regardless of the individual differences of the subject, environmental fluctuations, treatment progress, etc. The physiological state can be easily and reliably adjusted, and the physical burden and psychological burden on the doctor can be reduced.

  As a result, resuscitation, lifesaving, and long-time surgery for clinically critical patients can be realized.

  (2) A brain temperature management device used in brain hypothermia therapy for protecting a subject's brain at a low temperature, the brain temperature detecting sensor for detecting the subject's brain temperature, and cooling the subject's head A head cooling device, a neck cooling device for cooling the subject's neck, a body cooling device for cooling the subject's torso, and a control device for controlling the temperature of each of these cooling devices, The control device mathematically sets the parameters of each cooling device based on a difference between the target value setting means for setting the target value of the brain temperature and the current value detected by the brain temperature detection sensor and the target value. A brain temperature management device comprising: parameter estimation means for estimation; and output means for driving the respective cooling devices based on the parameters to bring the current value of the index closer to the target value .

  Examples of the head cooling device, the neck cooling device, and the trunk cooling device include a cooling cap, a cooling muffler, and a cooling blanket. Moreover, as a cooling system of each apparatus, there exist a water cooling system and an air cooling system, for example.

  The control device is, for example, a distributed temperature control device that can adjust the cooling cap, the cooling muffler, and the cooling blanket to different temperatures.

  The detection sensor is, for example, a temperature sensor provided inside the cooling cap, the cooling muffler, and the cooling blanket that contacts the subject.

  According to the invention of (2), as in (1), the parameters of the control device are changed in accordance with the physiological state of the subject regardless of the individual differences of the subject, environmental fluctuations, treatment progress, etc. Therefore, the physiological state indicated by the index can be adjusted easily and reliably corresponding to the physiological state of the subject, and the physical burden and psychological burden of the doctor can be reduced.

  (3) Each said cooling device is an air-cooling type brain temperature management device.

  The brain temperature management device is, for example, a box-like brain cooling incubator that is sealed with the whole body of a subject. This brain cooling incubator can be applied not only to adults but also to newborns. In this brain cooling incubator, low temperature cooling air is circulated in the incubator, and the brain of the subject is cooled by adjusting the temperature of the cooling air.

  According to the invention of (3), there are the following effects as compared with the case where each cooling device is of the water cooling type. 1) Surgical regions such as the head, neck and chest can be cooled more effectively. 2) The temperature difference in the cooling part can be eliminated. 3) Since the weight of each cooling device can be reduced, the pressure on the subcutaneous peripheral circulation can be reduced. 4) Pressure sores caused by contact cooling can be avoided. 5) The patient's skin color can be easily observed. 6) The conditions for performing therapeutic treatments such as infusion and wrinkle removal can be improved. 7) Since the system is narrow and sealed, environmental management over a wide area such as indoors is not necessary.

  (4) A portable brain temperature management device used in brain cryotherapy for protecting a subject's brain in a low temperature state, the brain temperature detecting sensor being arranged on the subject's head and detecting the temperature of the head surface A head cooling device that cools the head of the subject, and a control device that controls the temperature of the cooling device, the control device including target value setting means for setting a target value of the brain temperature; Parameter estimation means for mathematically estimating a parameter of the cooling device based on a difference between the current value detected by the brain temperature detection sensor and the target value; and driving the cooling device based on the parameter The portable brain temperature management apparatus, comprising: an output unit that brings the current value of the index closer to the target value.

  According to the invention of (4), as in (1), the parameters of the control device are changed in accordance with the physiological state of the subject regardless of the individual differences of the subject, environmental changes, treatment progress, etc. Therefore, the physiological state indicated by the index can be adjusted easily and reliably corresponding to the physiological state of the subject, and the physical burden and psychological burden of the doctor can be reduced.

  (5) An artificial respiration apparatus for performing artificial respiration on a subject, an oxygen saturation detection sensor for detecting peripheral arterial blood oxygen saturation of the subject, a pneumatic feeder for sending air to the subject, and the pneumatic feeder A control device for controlling the amount of air, and the control device includes target value setting means for setting a target value of the peripheral arterial blood oxygen saturation, a current value detected by the oxygen saturation detection sensor, and the target value. Parameter estimation means for mathematically estimating the parameters of the pneumatic feeding device based on the difference between them, and driving the pneumatic feeding device based on the parameters to bring the current value of the index closer to the target value And an output means.

  According to the invention of (5), as in (1), the parameters of the control device are changed in accordance with the physiological state of the subject regardless of the individual differences of the subject, environmental fluctuations, treatment progress, etc. Therefore, the physiological state indicated by the index can be adjusted easily and reliably corresponding to the physiological state of the subject, and the physical burden and psychological burden of the doctor can be reduced.

  (6) An anesthesia apparatus for anesthetizing a subject, an anesthetic gas detection sensor for detecting at least one of a breath anesthetic gas concentration and a blood anesthetic gas concentration of the subject, and anesthesia for sending an anesthetic to the subject An infusion device, and a control device for controlling the anesthetic amount of the anesthesia infusion device, wherein the control device is a target value setting means for setting a target value of the index; a current value detected by the anesthetic gas detection sensor; Parameter estimation means for mathematically estimating the parameter of the anesthesia injection device based on a difference from a target value; and driving the anesthesia injection device based on the parameter to obtain the current value of the index as the object An anesthesia apparatus comprising output means for approaching the value.

  According to the invention of (6), as in (1), the parameters of the control device are changed in accordance with the physiological state of the subject regardless of the individual differences of the subject, environmental fluctuations, treatment progress, etc. Therefore, the physiological state indicated by the index can be adjusted easily and reliably corresponding to the physiological state of the subject, and the physical burden and psychological burden of the doctor can be reduced.

  (7) A physiological condition management method for managing an index indicating a physiological condition of a subject to an optimal value that provides a therapeutic effect, the target value setting procedure for setting the target value of the index to an optimal value; A current value detection procedure for detecting a current value of the index with a detection sensor, a parameter estimation procedure for mathematically estimating a parameter of the output device based on a difference between the detected current value and the target value; and An output procedure for causing the current value of the index to approach the target value by outputting from the output device to the target person, and a procedure for repeating the current value detection procedure, the parameter estimation procedure, and the output procedure. A physiological state management method comprising:

  According to the invention of (7), as in (1), the parameters of the control device are changed in accordance with the physiological state of the subject regardless of the individual differences of the subject, environmental fluctuations, treatment progress, etc. Therefore, the physiological state indicated by the index can be adjusted easily and reliably corresponding to the physiological state of the subject, and the physical burden and psychological burden of the doctor can be reduced.

  The present invention has the above-described configuration and has the following effects. Overall, it contributes to the automation of the most difficult part of medical management. That is, the automation of the measurement management of the physiological state can automate the management of the empirical temperature management curve, the respiratory gas concentration management, and the anesthesia depth.

  (A) Physiological data vital to life support, such as body temperature, breathing, circulation, and depth of anesthesia, can be detected in abnormalities through automated measurement and management in a multi-channel, large capacity, keeping patient life within a safe range at all times. can do. Medical personnel can perform various conceivable clinical procedures without requiring the advanced body temperature management techniques required so far. For example, for patients undergoing rehabilitation, patients other than medical staff can easily manage patients. In addition, effects such as being effective in an emergency, being able to cope with individual differences, and being capable of remote operation can be expected.

  (B) The body temperature such as the patient's brain temperature is automatically managed to the target temperature by the whole body surface cooling device. This will reduce medical costs and medical errors, and reduce labor and stress for healthcare professionals. Precise temperature adjustment is possible, increasing the effectiveness of brain cryotherapy itself.

  (C) When ventilatory failure occurs, the automatic control system for arterial blood / alveolar carbon dioxide concentration using adaptive control (or optimal control) and fuzzy control enables monitoring of peripheral oxygen saturation by air and oxygen inhalation and It will be a new medical method for patient-friendly control from a viewpoint. For patients with hypoxia, peripheral oxygen saturation is controlled to a desired value. Assures stable operation for mask misalignment, gas leakage, and cough so that the input / output characteristics of the entire control system satisfy appropriate transient characteristics. By controlling the ventilation volume and inhaled oxygen partial pressure without pain for the patient, it is possible to control biochemical indices reflecting physiological information. Judgment of the ventilation effect and treatment effect by the individuality performed by the doctor can be objectively performed.

  (B) When the system of (c) is used together, there is a risk that the anesthesia depth is estimated and judged by fuzzy theory comprehensively from expiratory gas, blood gas partial pressure, central venous pressure, electrophysiological information, deep body temperature, etc. Call the anesthesiologist's attention. Especially during surgery, the patient must be observed over a long period of time, which reduces labor and leads to prevention of anesthesia accidents. In other words, it is an extremely effective medical means that can avoid a patient's life crisis due to mistakes caused by long-time restraint and reduced concentration during surgery.

  (D) In the activity level management system, when used for anesthesia depth control, various volatile and nonvolatile anesthetics and oxygen can be mixed to perform general anesthesia and resuscitation management of the patient. That is, it is extremely effective for objectively monitoring the anesthesia level (depth) and using it in an operating room or ICU as a system for controlling it. This system consists of control of anesthetic gas supply by respiratory management and an auxiliary circulator for direct intravenous injection of anesthetic by circulation.

  (E) By adopting an incubator type automatic temperature management system, it is possible to automate brain temperature management with higher accuracy than using a blanket. Furthermore, by applying optimum adaptive control to the system, it is possible to realize an optimum and precise temperature management process.

  Hereinafter, the best mode for carrying out the present invention will be described with reference to FIGS.

[Configuration of physiological condition management system]
FIG. 1 shows a configuration of a physiological state management system according to an embodiment of the present invention. The physiological state management system is a system that manages the physiological state of the human body, detects the physiological state of the human body with various sensors attached to each part of the human body, and each part of the human body according to the detected physiological state The physiological state of the human body is controlled by controlling each device attached to the body. This physiological state management system includes a fully automatic body heat management device 101, a fully automatic in-vivo gas management device 201, and an activity level management device 301.

  The fully automatic body heat management apparatus 101 includes a control device (not shown) including a CPU, a RAM, a ROM (not shown), and a connection interface (not shown) for connecting peripheral devices. Consists of. The aforementioned peripheral devices include a device for cooling a human torso and a sensor for detecting temperatures of various parts of the human torso. This sensor may be connected to an activity level management device 301 described later. Information on the body heat detected by the sensor is transmitted to the control device. Based on the transmitted information, the control device controls the device for cooling the human torso based on a predetermined control method in order to reach a target body heat condition. By repeating such control, the body temperature of the human body becomes the target temperature. In this embodiment, the temperature of the brain can be managed by mounting the above-described sensor particularly on the head of a human body. The above-described apparatus for cooling the human torso is composed of a blanket capable of circulating cooling water therein and a pipe for refluxing or perfusing the cooling water with the fully automatic body heat management apparatus 101. It is a blanket method. Alternatively, as will be described later, it may be an incubator system in which a human body is stored and cold air is fed into the box and refluxed.

  The fully automatic internal gas management apparatus 201 includes a control device (not shown) including a CPU, RAM, ROM (not shown) and the like, and a connection interface (not shown) for connecting peripheral devices. It is an artificial respiration device composed of The peripheral devices described above include a breathing cylinder that collects exhaled air discharged from the human body and sends inhaled air to the human body, and a sensor (including a pulse oximeter described later) that detects the oxygen saturation of the human body. This sensor may be connected to an activity level management device 301 described later. In addition, information related to the oxygen concentration of the breath detected by the breath gas analyzer (oxygen meter) is transmitted to the control device. Based on the transmitted information, the above-mentioned control device controls the above-described respiratory cylinder based on a predetermined control method, and adjusts the amount of inhalation to be delivered to the human body, thereby achieving the target oxygen saturation level of the human body. To the situation. By repeating such control, the oxygen concentration of each tissue of the human body, particularly the arterial blood / alveolar carbon dioxide concentration or the peripheral arterial blood oxygen saturation becomes the target saturation.

  The activity level management device 301 includes a control device (not shown) including a CPU, a RAM, a ROM (not shown), and a connection interface (not shown) for connecting to peripheral devices. Is done. The peripheral devices described above include an intravenous drug control device that automatically injects various drugs (such as anesthetics) into the human body, an inhalation anesthesia control device, and various monitoring sensors that monitor the physiological activity of the human body. is there. The various monitoring sensors may include a sensor that detects the temperature of various parts of the human torso and a sensor (including a pulse oximeter) that detects the oxygen concentration of each tissue of the human body. . Information on the physiological activity state of the human body detected by this sensor, body heat information detected by the fully automatic body heat management apparatus 101 and transmitted to the activity level management apparatus 301, and activity level management detected by the fully automatic body gas management apparatus 201 The information on arterial blood / alveolar carbon dioxide concentration or peripheral arterial blood oxygen saturation transmitted to the device 301 is transmitted to the control device. Based on the transmitted information, the above-described control device controls the above-mentioned intravenous drug control device and the inhalation anesthesia control device based on a predetermined control method to reach the target state of physiological activity of the human body. By repeating such control, the physiological activity state of the human body becomes the target physiological activity state.

  In this way, the three devices, the fully automatic body heat management device 101, the fully automatic body gas management device 201, and the activity level management device 301, work together to manage the body heat of the patient who has performed medical measures, the body gas management and the living body. Manage activity levels and automatically maintain patient life. Body heat management enables automatic management of brain temperature. In addition, by performing whole-body integrated management, it is possible to perform integrated biological management at the time of life-sustaining emergency.

  Adjust the effectiveness of these systems and make overall adjustments as appropriate to ameliorate the patient's condition. This adjustment is based on a control theory that takes into account the physician's rule of thumb. Since these theories are programmed and incorporated in each control device of the comprehensive management system, medical staff can use them without being aware of this. This control theory is called “adaptive control”, and details thereof will be described later. The present invention is characterized in that “adaptive control” is first applied to a medical device.

[Application of physiological condition management system to human body]
FIG. 2 shows an outline of managing a physiological state by applying the physiological state management system to a human body. In the figure, the fully automatic body heat management device 101 controls the body cooling device 102 attached to the human body in cooperation with the fully automatic body gas management device 201 and the activity level management device 301, thereby reducing the body temperature of the human body. The situation to control is shown. Physiological control of body temperature is extremely important for the proper progression of biochemical reactions. In particular, it has been clinically recognized that maintaining hypothermia during cerebral contusion restores brain function without loss. Indirect body temperature control is possible by attaching a head cooling device 104, a neck cooling device 103, and a torso cooling device 102 (see FIG. 6) for each part of the whole body by controlling the external temperature to the human body. A mask 202 is connected to the fully automatic in-vivo gas management device 201, and controls the concentration of exhaled gas discharged from the human body, the amount of inhaled air and the oxygen concentration drawn into the human body.

[Concept of operation of physiological state management system]
FIG. 3 is a conceptual diagram of the operation of the above-described physiological state management system (life maintenance management system). The activity level management device 301 is connected to each system monitoring sensor, a display device for displaying various warnings or the like, an alarm for generating a warning sound, an intravenous drug control device, and an inhalation anesthesia control device. Each system monitoring sensor is attached to each part of the human body, monitors various indexes indicating the physiological state of the human body at predetermined time intervals, and supplies the information to the activity level management apparatus 301. The activity level management apparatus 301 supplied with this information comprehensively determines and evaluates the physiological state of the human body. And according to the result of the judgment and evaluation, a warning is displayed on the above-mentioned display device, or a warning sound is generated by the above-mentioned alarm. Similarly, the activity level of the human body is controlled by controlling the intravenous drug control device and the inhalation anesthesia control device according to the judgment / evaluation results. Alternatively, a signal is sent to the fully automatic body heat management apparatus 101 to control the body temperature of the human body, or the oxygen concentration of each tissue of the human body, particularly arterial blood / alveolar air, is sent to the fully automatic body gas management apparatus 201. A signal is sent to control the carbon dioxide concentration or peripheral arterial oxygen saturation.

[Various monitoring sensors]
FIG. 4 shows an example of various monitoring sensors provided in the physiological state management system and the attachment parts of the human body of those sensors.

  Various monitoring sensors include respiratory system monitoring sensors, circulatory system monitoring sensors, muscle / nervous system monitoring sensors, electrolyte / metabolism / body heat system monitoring sensors, and urinary system monitoring sensors.

  The temperature of a plurality of points on the body surface is measured by the monitoring sensor, and the deep body temperature of a specific part is theoretically calculated from the surface temperature distribution (see FIG. 8). In particular, deep body temperature is calculated for brain temperature measurement.

  The fully automatic internal gas management device 201 comprehensively monitors the patient's physiological data obtained from various monitoring sensors, and performs comprehensive judgment / evaluation and display / alarm based on the patient's respiratory and circulatory system gas concentrations The outline which performs in-vivo gas concentration control is shown. At this time, a mask (see FIG. 8) is used which is easy to put on and take off artificially, but cannot be easily removed by other force after wearing.

  The fully automatic in-vivo gas management apparatus 201 automatically controls the arterial blood / alveolar carbon dioxide concentration of a patient with insufficient ventilation using a gas concentration measurement control system. The method is based on monitoring of peripheral oxygen saturation by inhalation of air and oxygen and from the patient's point of view. This is based on a new method for performing automatic control based on procedures. This is a method of controlling peripheral oxygen saturation to a desired value even for patients with hypoxia.

  The poles on the complex plane are determined so that the input / output characteristics of the entire control system satisfy the appropriate transient characteristics, and the operation always exists in the stable region. It is possible to deal with the leak to some extent. It guarantees stable operation against coughing and fighting. Although only the ventilation volume and inspiratory oxygen partial pressure (concentration) can be operated, it is epoch-making that control of metabolic rate and blood flow is unnecessary because a chemical index reflecting the physiological state is selected. Since the judgment of the effect of the ventilation volume and the treatment effect by the individual difference performed by the doctor is logically described, this method makes it easy for the patient to give the ventilation volume.

  The activity level management device 301 comprehensively monitors the patient's physiological data obtained from various monitoring sensors, performs comprehensive judgment / evaluation of the patient's physiological state, display / alarm, and controls the degree of biological activity (FIG. 3). FIG. 7). In addition, the patient's total physiological state and evaluation necessary for body temperature management and respiratory management are transmitted to the fully automatic body heat management device 101 and the fully automatic body gas management device 201.

  If the depth of anesthesia exceeds a certain level, spontaneous breathing stops, so breathing management is performed using an artificial respirator. At this time, metabolism such as gas exchange must be performed appropriately, so the respiratory method is determined from the patient's physiological condition monitored mainly by the gas components contained in the patient's exhaled gas, and respiratory management is performed .

  When a patient's decline in circulatory function is monitored due to a decrease in metabolic function, this is automatically adjusted to an appropriate state by appropriate medication.

[Subsystem of physiological condition management system]
FIG. 5 is a list of subsystems of the physiological state management system. The physiological state management system includes a plurality of individual control management systems. As described above, the sub-systems of the physiological state management system according to the present embodiment are the fully automatic body heat management device 101, the fully automatic body gas management device 201, and the activity level management device 301.

[Configuration of each subsystem]
Referring to FIG. 6, a body cooling device 102, a neck cooling device 103, and a head cooling device 104 are connected to the fully automatic body heat management device 101 through a perfusion pipe 105 and a return pipe 106. The fully automatic body heat management apparatus 101 sends cooling water to the trunk cooling apparatus 102 through the perfusion pipe 105 and collects the cooling water through the reflux pipe 106. The brain temperature is controlled by the head and neck, and the bilinear system is controlled by controlling the temperature and flow rate of circulating blood. In addition, a device for making a judgment and alarm for a physiologically dangerous abnormal temperature is mounted on the fully automatic body heat management device 101 (see FIG. 7). Further, as shown in FIG. 8, the fully automatic body heat management apparatus 101 includes a dedicated sensor and a temperature measuring circuit for measuring the deep body temperature from the temperature of the skin surface.

  Further, referring to FIG. 6, the fully automatic internal gas management apparatus 201 includes an inspiratory tube, an expiratory tube, a control valve that controls the flow path of inhalation and exhalation of the patient, a thermal humidifier that humidifies the exhaled air to an appropriate humidity, and a human body. A pulse oximeter that detects oxygen saturation is connected. The fully automatic in-vivo gas management device 201 controls the cylinder according to the oxygen saturation level of the human body detected by the pulse oximeter under the control of the driving computer, and adjusts the amount of inhalation sent to the human body. The pulse oximeter may be connected to either the fully automatic in-vivo gas management device 201 or the activity level management device 301 as described above.

  Further, referring to FIG. 6, the activity level management device 301 includes, as various monitoring sensors, a rectal thermometer, a peripheral thermometer attached to the head and toes, a sphygmomanometer that measures central venous pressure and arterial pressure, and an electrocardiogram. A sensor for taking the breath, a breath gas analyzer provided in the mask 202, a chest wall stethoscope, a urinary sensor for detecting urinary excretion, a pulse oximeter for detecting the oxygen saturation of the human body, and the like are connected. The pulse oximeter may be connected to either the fully automatic in-vivo gas management device 201 or the activity level management device 301 as described above. As control devices controlled by the activity level management device 301, there are an inhalation anesthesia controller and an infusion / blood transfusion / medicine intravenous controller. The activity level management device 301 comprehensively determines and evaluates the detection results of the various monitoring sensors described above, and controls the inhalation anesthesia controller and the infusion / blood transfusion / intravenous drug control controller to administer anesthesia to the patient. Or adjust the patient's activity level by inhalation.

  It should be noted that adjusting the patient's body temperature includes changing the physical properties and changing the thermal conductivity by injecting a specific medicine into the patient's body. It also includes improving the brain temperature cooling rate by injecting a specific drug into the patient's body to increase cerebral blood flow and facilitate heat extraction.

[Hardware overview]
FIG. 7 is a schematic hardware diagram of the fully automatic body heat management apparatus 101, the fully automatic internal gas management apparatus 201, and the activity level management apparatus 301.

  The fully automatic body heat management apparatus 101 is roughly divided into an electrical part and a machine part. The electric part has a control function, and a PC (personal computer) constitutes its main control circuit. An A / D (analog-to-digital conversion) board, a D / A (digital-to-analog conversion) board, and an I / O (input / output) board are connected to the PC. A biological function information input temperature sensor that detects body temperature and a flow rate sensor that detects the flow rate of cooling water flowing through the perfusion pipe 105 are connected to the A / D board via a signal converter. And the information on the flow rate of the cooling water are digitally converted and supplied to the PC. The D / A board is connected to a flow rate valve for adjusting the flow rate of the cooling water flowing through the perfusion pipe 105 and a heater for raising the temperature of the water cooling blanket to warm the patient's torso. PC control signals are converted to analog to control these devices. In addition, a power supply and an alarm device are connected to the I / O. The mechanical part includes a cold water tank for storing cold water and a pump for sending the cold water in the cold water tank to the body cooling device 102 and the like. A fuselage cooling device 102 and the like are connected to this machine part. The fuselage cooling device 102 is a cooling blanket, and in addition, a cooling cap (a head cooling device 104 that cools the head of a human body), a cooling muffler ( A neck cooling device 103) for cooling the neck of the human body is connected.

  This fully automatic body heat management apparatus 101 maintains the patient's brain and trunk at a low body temperature by means of a body heat regulation system based on the monitored patient physiological data and a programmed life support procedure.

  The fully automatic internal gas management apparatus 201 includes three PCs: a control PC (personal computer), a measurement PC, and a communication PC. The control PC calculates control data and generates a control signal based on the calculation result of the sensor input transmitted from the measurement PC. The control signal generated here is transmitted to the communication PC. An operation panel, various sensors, a motor (a motor for driving a cylinder for sending inspiration), and a respiratory gas monitor are connected to the measurement PC. Between the measurement PC and the operation panel, a manual operation input signal is transmitted from the operation panel to the measurement PC, and data for display data output is transmitted from the measurement PC to the operation panel. Signals of sensor input information are transmitted from various sensors to the measurement PC. Control data for motor control is transmitted from the measurement PC to the motor. As described above, the communication PC controls communication of various signals transmitted and received between the measurement PC and each connected device (operation panel, various sensors, motor, respiratory gas monitor).

  The various monitoring sensors connected to the activity level management device 301 are classified according to the other two management systems (the fully automatic body heat management device 101 and the fully automatic body gas management device 201), and monitoring is also performed.

  The activity level management device 301 uses the patient's physiological data monitored for each of the other two management systems to determine the individual differences, temporal variability, and non-linearity of the living body regarding the physiological state and total physiological state of each patient system. Judgment and evaluation taking into account gender.

  The activity level management device 301 collectively displays the determined and evaluated patient-specific systematic and overall physiological / pathological conditions so as to reduce the burden on the administrator, and issues an alarm as necessary.

  The activity level management device 301 manages and controls the patient's life activity level. For this purpose, the patient's life activity level is controlled by appropriate anesthetic administration, infusion / blood transfusion management and drug administration management according to the patient's depth of anesthesia, each system and comprehensive physiological state judgment / evaluation.

  The activity level management device 301 is used to mix volatile anesthetics such as laughing gas and oxygen to manage the patient during general anesthesia and resuscitation. Therefore, it can be used as an anesthesia depth management device by respiratory management including a gas supply unit, a breathing circuit unit, and a determination mechanism at the time of surgery. The gas supply unit consists of an oxygen flush device that mixes volatile and non-volatile anesthetics for oxygen supply during resuscitation and sends a large amount of oxygen in an emergency.

[Adult cooling incubator]
An overview of a brain cooling incubator for adult brain cryotherapy is shown in FIG. As described above, this incubator replaces a cooling blanket (body cooling device 102), a cooling cap (human head cooling device 104), and a cooling muffler (neck cooling device 103 that cools the neck of the human body). Can be cooled.

  Patients with cerebral cryotherapy are placed on a reticular support, allowing whole-body air cooling. The cooling air sent into the incubator passes through a humidifier and is controlled so that the humidity is almost 100%, but the temperature can be adjusted according to the purpose of cooling. Further, by increasing the flow velocity of the cooling air in the incubator, the air temperature in the cooling device is made uniform and at the same time the cooling efficiency is increased. The incubator body is made of a two-layer transparent material that is decompressed to a nearly vacuum state, so it has excellent heat insulation. Therefore, the internal thermal environment of the incubator is hardly affected by the external environmental temperature.

  As a modified example of such an incubator, for example, there is a system for managing the patient's body temperature, particularly the brain temperature, by cooling the entire patient's room with an air conditioner. Also, in the inside of an ambulance, the patient's brain temperature can be managed by similarly cooling the whole air.

[Incubator with optimal adaptive control]
Hereinafter, based on FIGS. 10 to 15, a case where “optimum control” is applied to an adult cooling incubator as the fully automatic body heat management apparatus 101 will be described. “Optimum control” is a system that combines a cooling blanket (body cooling device 102), a cooling cap (head cooling device 104), and a cooling muffler (neck cooling device 103) as the fully automatic body heat management device 101. Here, as a specific application example of “optimal control”, a case where it is applied to an adult cooling incubator will be described. In the past, water-cooled blankets etc. were the main brain temperature management devices, but there were problems such as inability to directly cool the whole body, and there was a need for non-contact, air-cooled, sealed temperature management devices. Based on the request that an adult cooling incubator was devised upon request. That is, the adult cooling incubator to which “optimum control” is applied is an automatic temperature control system for brain hypothermia that overcomes all problems.

  The “optimal control” is applicable not only to the fully automatic body heat management apparatus 101 but also to the fully automatic body gas management apparatus 201 and the activity level management apparatus 301. Furthermore, the present invention is applicable not only to the fully automatic body heat management device 101, the fully automatic body gas management device 201, and the activity level management device 301, but also to the fully automatic body heat management device 101 and the fully automatic body gas management device 201. The present invention can also be applied to a system in which the activity level management apparatus 301 is combined.

[What is optimal adaptive control?]
The brain temperature automatic control system by optimal control shown in FIG. 10 is realized by model reference type adaptive control. At this time, how to determine the chilled water temperature as a control input is performed using a signal synthesis adaptive control system and an optimum regulator as shown in FIG. That is, the brain temperature output of the reference model is compared with the target brain temperature, the cooling temperature input of the reference model is determined based on the difference, and the optimal tracking that causes the brain temperature output of the reference model to follow the target brain temperature cooling curve Adopt control method. At the same time, the signal synthesis adaptive control system is the difference between the brain temperature output of the clinical PI biological thermal system (the thermophysical system in which the patient-incubator is always handled as one unit) and the brain temperature output of the reference model. Based on the cold water temperature input, the cooling air temperature input of the PI living body thermal system is adjusted in real time. Thereby, control is performed so that the brain temperature output of the PI living body thermal system follows the brain temperature output of the reference model. Therefore, the brain temperature output of the PI living body thermal system can follow the target brain temperature / cooling curve.

  That is, “optimal control” is a control system characterized by a specific parameter, where a difference between an output value and a target value with respect to a certain input value to the system is mathematically analyzed, and a certain constraint condition (evaluation function). The output value of the system follows the target value by repeating the calculation of the above parameters so that the difference is minimized under each of the input values and reflecting the calculated parameter in the system for each input value. This is the control that makes possible.

  Below, the algorithm of the optimal control with respect to a reference model and the adaptive control with respect to a PI living body thermal system is shown.

[P-B (patient-blanket) transfer function thermal model]
A characteristic change appears in the patient's brain temperature with respect to the temperature change of the cold water blanket. The temperature management process of brain hypothermia can be divided into four stages, namely, a cooling period, a maintenance period, a rewarming period, and a management period, depending on the level of brain temperature and the progress of the treatment process. For example, in the cooling period, even if the cold water temperature of the water-cooled blanket is lowered, the brain temperature hardly changes at first, and changes suddenly after a while. After that, it changes slowly and finally becomes a constant value. Such a time delay in brain temperature change also exists during the rewarming phase of brain hypothermia.

Therefore, from the viewpoint of system theory, the cold water temperature T _water of the water cooling blanket and the brain temperature T _{brain of the} patient are set as the temperature input and the temperature output of the system, respectively, and the dynamic characteristics of the P-B living body thermal system are first-order lag and time delay The following P-B transfer function thermal model G (s) is expressed approximately.

Here, T _brain (s) and T _water (s) are Laplace transform values for changes in brain temperature and cold water temperature, respectively. s is a Laplace operator, and K, L, and τ are system gain, dead time, and time constant, respectively.

[Verification of patient-blanket transfer function thermal model]
In order to verify the validity of the P-B transfer function thermal model, a simulation experiment of brain temperature PID control is performed using this model. Optimum adjustment values for each constant of the PID regulator are given as follows according to the Zigler-Nichols method.

Based on the difference between the target brain temperature R and the brain temperature output T _brain of the model (e = R−T _brain ), the cold water temperature input T _water of the model is determined by the following control law.

[Discrete time representation of reference model]
From the convenience of digital control and computer program, the following description will be given in the form converted to a discrete time system.

  In the P-B transfer function thermal model, the dead time is extremely small compared to the time constant, so that the dead time can be substantially ignored. Therefore, the following difference equation (3) can be obtained from the equation (1).

  Here, the subscript model means a reference model. i is the number of samples, and the time-series number i corresponds to the sampling time iν when the sampling period is ν. The following equation holds.

[Optimal tracking algorithm]
Consider performing optimal tracking control on a P-B transfer function thermal model that is a reference model. Here, the definition is as follows.

  According to this definition, the following error system can be obtained.

However, the state variable X (i) and the coefficient matrix A, G, _{G R} is as follows.

  Therefore, the chilled water temperature input to the reference model can be calculated as follows in order to perform the optimal tracking control.

Here, T _{model, brain} (0) and T _{model, water} (0) are the brain temperature output and the cold water temperature input of the reference model in an equilibrium state, respectively.

H ₁ and h ₂ are state feedback coefficients for optimal tracking control, and can be given in advance as follows.

The parameters q ₁ , q ₂ and r are determined so as to obtain the optimum tracking effect. Since (6) is a Riccati equation, P can be obtained from equation (6).

[Model reference type adaptive control algorithm]
When dealing with biological systems, there are not only individual differences but also fluctuations in its characteristics over time and environmental changes. Therefore, it is impossible to grasp and fully describe all the characteristics of patients clinically. For such a biological system, model reference type adaptive control having an identification function for constantly grasping the characteristics of the system at any sample time is considered effective.

  Here, in order to realize the target brain temperature cooling process, the cooling air temperature input of the PI living body thermal system (actually, the PI physical thermal model) is adjusted according to the following algorithm. That is, the identification model of the PI living body thermal system is assumed as follows.

  At this time, initial values of the adaptive parameter vector, the adaptive state vector, and the adaptive gain are set as follows.

  At this time, the parameter adjustment rule and the adaptive gain can be given as follows.

  However, the following equation holds.

  Therefore, the cooling air temperature input of the PI living body thermal system is given as follows.

The parameters f ₁ , f ₂ and h can be arbitrarily determined so as to give a desired adaptive control effect.

[Automatic control system of brain temperature]
FIG. 10 is a conceptual diagram of a configuration of an automatic brain temperature control system. The flow of chilled water temperature adjustment by automatic control and manual control is shown by a solid line and a dotted line, respectively. The automatic control mechanism is implemented in software.

[Structure of patient thermal model]
FIG. 11 shows a patient thermal model. In this figure, the patient's body is represented by eight sections: head, face, neck, upper limb, chest, abdomen, lower limb, and heart. Each tissue of the head, chest, and abdomen is divided into three layers: a core layer such as brain, lung, and internal organs, an inner layer composed of skeleton and muscle, and an outer layer composed of skin and subcutaneous fat. The face, neck, and upper and lower limbs are divided into two layers, an inner layer and an outer layer.

  The cooling device, which is the external environment of the living body, is regarded as a part of the patient thermal model.

  From the viewpoint of blood flow, it is assumed that all layers of the model are connected in parallel. The reason is that convective heat exchange between blood and tissue occurs in a living body mainly in a thin blood vessel bed having an inner diameter of 0.2 mm to 0.5 mm. The heart sent blood to and contained blood from each layer, including the lungs. If the coronary circulation to the heart itself is ignored, the amount of blood circulating to the lungs can be considered equal to the total amount of circulating blood to the other layers.

  In terms of heat exchange, metabolic energy is transferred from the outer layer of each section to the cooling device. In the lung, metabolic heat production of the lung parenchyma occurs, and a certain heat loss due to respiration occurs. Further, it is assumed that interlayer heat exchange exists only between layers of the same section, and there is no heat conduction between the sections. Note that uniform physiological parameters and representative temperatures are assumed for the heart and each layer. That is, the patient thermal model constructed here is a lumped constant model.

[State space representation of patient thermal model]
In all the above-mentioned layers, the energy balance relationships such as the intra-layer heat storage E, intra-layer metabolic heat production Q, heat balance W by circulating blood, heat exchange C with adjacent layers, heat transfer D to the cooling device, etc. The equation that defines the representative temperature can be described as follows:

Here, the representative temperature of each layer is T [° C.], the blood temperature is T _bl [° C.], the temperature of the adjacent section is T _c [° C.], the temperature of the cooling device is T _apparatus [° C.], and the surface area is S [m ³ ]. ], The volume of each layer is V [m ³ ], the conduction heat exchange ratio between each adjacent section is k [W / m ² / ° C.], and the convective heat exchange ratio from the human body to the cooling device is k _sa [W / m]. ² / ° C.], density is ρ [kg / m ³ ], ρ _bl = 1069 [kg / m ³ ], heat capacity is c [J / kg / ° C.], c _bl = 3650 [J / kg / ° C.], blood When the perfusion rate is w [m ³ blood / s / m ³ tissue] and the metabolic heat production is q [W / m ³ ], each term of the equation (8) can be expressed as follows.

  However, in Equation (8), D appears only in the outer layer, and C is two terms in the inner layer of the head, chest, and abdomen. Q is the difference between metabolic heat production and heat loss due to breathing in the lung.

  In the heart, equation (8) becomes:

  Here, ΣW means the sum of heat balance between the heart and each layer due to circulating blood. Therefore, the head 3 layers (brain, inner layer, outer layer), face 2 layers (inner layer, outer layer), neck 2 layers (inner layer, outer layer), upper extremity 2 layers (inner layer, outer layer), chest 3 layers (heart, Eighteen differential equations are obtained for the inner layer, outer layer), the abdominal layer 3 (internal organs, inner layer, outer layer), the lower extremity layer 2 (inner layer, outer layer), and the entire heart. Furthermore, these equations are put together to obtain the following equation of state.

However, T (18 × 1) is a vector composed of the representative temperature of each layer including the brain temperature T _brain , and T _apparatus (3 × 1) is a vector composed of the temperature of the cooling device. A (18 × 18) and B (18 × 3) are coefficient matrices whose elements can be calculated from physiological parameters, and represent dynamic characteristics inside the system and external influences, respectively. Q (18 × 1) is a vector consisting of metabolic heat production of the tissue and heat loss due to respiration. Further, C = [1, 0,..., 0] (1 × 18).

  In order to obtain the coefficient matrices A and B of the system, the shape parameters and physiological parameters of each layer are required.

  In this embodiment, the shape parameters are determined by proportional distribution of the respective layers of each section based on the distributed constant model of Fiala et al., And the respective lengths and radii are obtained. Based on this, physiological parameters such as density, volume, mass, specific heat, blood perfusion rate per volume, and metabolic heat production rate under normal conditions are determined.

  The interlayer heat exchange coefficient between layers in the same section is calculated according to the method by Lou and Yang. At that time, the data of Werner and Webb are mainly used for the thermal conductivity of each layer. Using these data, all the shape and physiological parameters necessary for the analysis can be calculated.

  The heat transfer from the living body surface to the cooling device is determined by the temperature difference between them and the size of the surface heat transfer coefficient, as shown in Equation (13). In the case of cerebral hypothermia, the heat transfer is greater than in a normal quiescent atmospheric environment. The reason is the large temperature difference and heat transfer coefficient between the living body surface and the cooling device.

  By the way, since there is no accurate data on the heat transfer coefficient between the living body surface and the cooling device, an appropriate value is given with reference to experimental data on a naked mannequin in a stationary aquarium.

  On the other hand, as a result of increasing the heat transfer to the cooling device, it can be seen from the equation (8) that the representative temperature of each layer in the equilibrium state is lower than the normal body temperature in the atmospheric environment. Therefore, it is difficult to set a normal body temperature for each layer of the patient thermal model as the initial temperature. Therefore, in this embodiment, metabolic heat production in each layer of the patient thermal model is set higher than normal, and the initial temperature of the patient thermal model is determined by the following equation.

  However, T (0) (18 × 1) is a vector composed of the initial representative temperature of each layer. α is a correction coefficient for the metabolic heat production rate.

[Configuration of experimental apparatus]
FIG. 12 is a diagram showing a configuration of an experimental apparatus using a mannequin in the present example.

  In this experiment, the mannequin is placed in a box-type incubator, the incubator is cooled, the mannequin brain temperature, the air temperature in the incubator and the wind speed are measured, and the cooling of the incubator is controlled based on the measurement results.

  The incubator is provided with two fans inside the incubator and one outside the incubator, and a fan for blowing air. One of the fans inside the incubator is for direct ventilation to the mannequin. The other fan is attached to the cooling fin (heat radiating plate) and is used to blow air around the cooling fin.

  A Peltier element is provided outside the bottom of the incubator. A cooling fin is in contact with the upper surface so as to sandwich the Peltier element. On the other hand, below the Peltier element, a heat dissipation fin (heat radiating plate) is in contact with the surface. The Peltier element and the heat dissipation fin are outside the incubator, and the cooling fin is inside the incubator.

  When the Peltier element is energized, heat is transferred from the surface on the cooling fin side to the surface on the heat dissipation fin side by the Peltier effect. Therefore, the air around the cooling fin has a relatively low temperature, and the air on the heat dissipation fin side has a relatively high temperature. The air around the cooling fin is diffused inside the incubator by a fan attached to the cooling fin. The air around the heat dissipation fins is diffused outside the incubator by a fan attached to the heat dissipation fins. In this way, heat exchange between the inside and outside of the incubator is performed.

  The sensor for detecting the air temperature and the wind speed installed in the incubator and the sensor for detecting the brain temperature of the mannequin respectively transmit detection signals to the control device. The control device that has received the detection signal performs A / D conversion to convert the detection signal into digital information. Next, this digital information is input to execute the control program. This control program is a program that performs control by an algorithm based on the “optimum adaptive control” theory. This program obtains the execution result so that the brain temperature of the mannequin follows the target value. Further, the control information, which is the execution result of the control program, is converted into a control signal by performing D / A conversion. Further, the control signal is transmitted to the voltage variable DC power supply, and the voltage variable DC power supply controls the voltage based on the control signal, thereby adjusting the outputs of the Peltier element and the three fans. In this way, the temperature in the incubator is controlled using the “optimal adaptive control” theory, so that the mannequin brain temperature follows the target value.

  By applying such an experimental device, it is possible to realize a simulator that simulates the transition of the brain temperature of the human body according to the temperature change of a cooling device such as an incubator.

[Model reference adaptive control of brain temperature]
Signal synthesis adaptation makes the brain temperature output of the biological thermal system follow the brain temperature output of the reference model. The control algorithm within the dotted line in FIG. 13 corresponds to the automatic control mechanism in FIG. 10 and can be realized by software.

[Relationship between brain temperature, air temperature in incubator and metabolic rate of patient's body]
Referring to FIG. 14, when the metabolic rate of the patient's human body increases by 5%, the brain temperature T _brain (Temperature) increases and changes slightly higher than T _{model, brain} (Temperature). At this time, the air temperature T _air (Temperature) in the incubator is temporarily lowered from around 25 ° C. to around 15 ° C. Then, the brain temperature T _brain temporarily decreases to a temperature lower than the target brain temperature T _{model, brain} , and then gradually approaches T _{model, brain} . Even if the air temperature T _{air in the} incubator is raised from 15 ° C. and kept at around 25 ° C., the brain temperature T _brain gradually rises, but only asymptotically _approaches T _{model and brain} and exceeds T _{model and brain.} There is no.

Next, when the metabolic ratio of the patient's human body returns to the original state, the brain temperature T _brain decreases and changes to around 32 ° C. At this time, the incubator air temperature T _air is temporarily raised from 25 ° C. to near 30 ° C. Then, the brain temperature T _brain temporarily rises asymptotically to T _{model, brain} . Even if the air temperature T _{air in the} incubator is lowered from around 30 ° C. and kept at around 25 ° C., the brain temperature T _brain gradually rises, but only asymptotically _approaches T _{model, brain} and exceeds T _{model, brain} . There is nothing.

  By controlling the air temperature in the incubator in this way, the brain temperature can be adaptively adjusted according to the change in the metabolic ratio of the human body, and can be kept close to the target brain temperature.

[Simulation result of model reference adaptive control of brain temperature]
Referring to FIG. 15, the brain temperature output T _{brain of} the PI living body thermal model and the brain temperature output T _{model, brain of the} reference model according to changes in the incubator air temperature T _air and the cold water temperature T _water as input values. It can be seen that is almost the same. The temperature input of the reference model is given by the optimal tracking control law, and the brain temperature output of the reference model follows the target brain temperature cooling curve R well. At the same time, the temperature input of the PI biological temperature model is automatically adjusted by the signal synthesis adaptive control law based on the error between its own output and the brain temperature output of the reference model and the temperature input of the reference model. The brain temperature output of the biological temperature model closely follows that of the reference model. As a result, the two brain temperature outputs of the PI living body thermal model and the reference model both closely follow the target brain temperature cooling curve R, and the three curves almost overlap. The simulation results show an important feature that adaptive control algorithms do not require any prior information about changes in the situation or environment, and that these fluctuations can be automatically detected and accommodated during the control process. Yes.

[Modification]
In the present embodiment, it is assumed that each control device of the fully automatic body heat management device 101, the fully automatic body gas management device 201, and the activity level management device 301 is configured by a PC (personal computer). With the recent miniaturization and high performance of PCs, it is possible to reduce the size of the control device. Therefore, an embodiment in which the fully automatic body heat management apparatus 101, the fully automatic in-vivo gas management apparatus 201, and the activity level management apparatus 301 have a size and weight that allow each apparatus to be carried is possible.

  As mentioned above, although the Example of this invention was described, it has only illustrated the specific example and does not specifically limit this invention. That is, the present invention is a physiological state management system that manages an index indicating the physiological state of a subject to an optimal value, a detection sensor that detects a current value of the indicator, and an output device that changes the physiological state of the subject And a control device for controlling the output device, wherein the control device is based on a target value setting means for setting a target value of the index, and a difference between the current value detected by the detection sensor and the target value. Parameter estimation means for mathematically estimating the parameters of the output device, and output means for driving the output device based on the parameters to bring the current value of the index closer to the target value. The physiological state management system is characterized by the fact that each hand of the detection sensor, output device, control device, target value setting means, parameter estimation means, output means, etc. Specific structure of may be suitably designed or modified.

  According to the present embodiment, rapid anesthesia and high effect anesthesia can be achieved by direct intravenous injection of an anesthetic by circulation. In addition, exhalation gas analysis, blood gas analysis, arterial pressure, central venous pressure, electrocardiogram, electroencephalogram, electromyogram, deep body temperature, rectal temperature, urine components and urine volume, chest wall auscultation sound, comprehensive anesthesia Judgment and alerting the anesthesiologist and monitoring the depth of anesthesia. At this time, pulmonary artery pressure and gas analysis are important. That is, when the pressure of the pulmonary artery and the gas analysis of the pulmonary artery blood (mixed venous blood) are life-threatening like a seriously injured patient, the arterial pressure is continuously measured invasively. Since excessive or insufficient blood volume has a significant effect on gas exchange in the lungs, central venous pressure reflects this. From the frequent occurrence of anesthesia accidents and the need for guidelines, the level of anesthesia is objectively evaluated, the depth is monitored, and these are controlled objectively. Determining the depth of anesthesia comprehensively and describing this depth in concrete numerical steps.

  Physiological status of patients with severe medical / surgical symptoms are integrated individually and integrated by the three systems and integrated system of body heat management system, body gas concentration management system, and activity level management system of the present invention. Specially used in the intensive care unit due to the integrated management system in the form. Physiological data that is difficult to obtain continuously can be easily collected for medical purposes. By setting externally the target physiological state that is suitable for life support without bothering medical professionals, it is possible to achieve objectivity in medical care. Brings some important indicators and work.

  First, regarding body temperature management, the patient's body temperature is precisely controlled during trauma. For example, during cold brain therapy, the cooling water temperature and the cooling of the entire body including the head, neck, and torso are more reliably achieved by using cooling accessories. At the same time, it brings diversity to the temperature regulation. As for the gas concentration management system, this is used as a respiratory device, and the respiratory gas concentration is automatically measured and adaptively controlled, and the oxygen saturation of peripheral arterial blood is not related to individual differences within a physiologically safe range. The target value given by the doctor is freely realized by the control performed. In addition, as a method of alarm activation at the time of abnormal ventilation, a method that is always supported by state observation and network check is used. Therefore, this is a fully automated respiratory management system.

  For the activity level depending on the depth of anesthesia, basic and necessary measures such as measurement of chemical substances in blood and measurement and fine adjustment of anesthetic gas concentration in exhaled gas can be taken.

  This makes it possible to easily realize optimal body temperature management, blood gas concentration control, and optimal anesthesia depth at the time of life crisis and surgery, and have a medically innovative effect.

  It should be noted that the effects described in the embodiments of the present invention only list the most preferable effects resulting from the present invention, and the effects of the present invention are limited to those described in the embodiments of the present invention. is not.

It is a block diagram of the comprehensive management system of the physiological state in a present Example. BRIEF DESCRIPTION OF THE DRAWINGS It is a schematic diagram which applies the comprehensive management system of the physiological state in a present Example to a human body. It is explanatory drawing of the concept of operation | movement of the physiological condition management system in a present Example. It is explanatory drawing of the monitoring system of the whole body physiological data of the physiological condition management system in a present Example. It is a block diagram of the subsystem of the physiological condition management system in a present Example. It is a block diagram of each subsystem of the physiological condition management system in a present Example. It is a hardware block diagram of each subsystem of the physiological condition management system in a present Example. It is explanatory drawing of the sensor for skin temperature measurement and the mask for respiration management of the physiological condition management system in a present Example. It is explanatory drawing of the incubator for adult cooling of the physiological condition management system in a present Example. It is explanatory drawing of the automatic control system of the brain temperature of the physiological condition management system in a present Example. It is a block diagram of the patient temperature model of the brain temperature of the physiological condition management system in a present Example. It is a block diagram of the experimental apparatus by the mannequin of the physiological condition management system in a present Example. It is a block diagram of model reference type adaptive control of brain temperature of the physiological state management system in the present embodiment. It is a related figure of the brain temperature in the physiological condition management system in a present Example, the air temperature in an incubator, and the metabolic ratio of a patient's human body. It is a figure showing the simulation result of the model reference type adaptive control of the brain temperature of the physiological condition management system in a present Example.

Explanation of symbols

101 Fully Automatic Body Heat Management Device 201 Fully Automatic Body Gas Management Device 301 Activity Level Management Device

Claims (6)

A brain temperature management device used for brain cryotherapy that protects a subject's brain by maintaining a low temperature state,
A brain temperature detection sensor for detecting the brain temperature of the subject, a subject cooling means for cooling the subject, and a control device for controlling the temperature of the subject cooling means,
The control device includes target value setting means for setting a target value of the brain temperature;
Based on the difference between the current value detected by the brain temperature detection sensor and the target value, parameter estimation means for mathematically repeatedly estimating the parameters of the subject cooling means,
An output unit that repeatedly approaches the current value of the brain temperature to the target value by driving the subject cooling unit based on the parameter; and
The subject cooling means, Ri contact cooling apparatus der which the body surface side in contact with the subject indirectly cool the brain of the subject,
The control device uses the transfer function thermal model between the subject and the contact cooling device as a reference model, compares the brain temperature output of the reference model with the target value, and based on the difference, the cooling temperature of the reference model The input is determined, and the brain temperature output of the reference model follows the target brain temperature cooling curve, and at the same time, the difference between the output of the brain temperature detection sensor and the brain temperature output of the reference model, and the cooling temperature input of the reference model A brain temperature management apparatus that controls the brain temperature of the subject to follow the brain temperature output of the reference model by adjusting the output means based on the output means . In the brain temperature management device according to claim 1,
The contact cooling device is a cooling cap to be worn on the head of the subject, a cooling muffler to be worn on the neck of the subject, or a cooling blanket to be worn on the torso of the subject. Temperature management device. In the brain temperature management device according to claim 1 or 2,
The contact cooling device is an air-cooled brain temperature management device. A brain temperature management device used for brain cryotherapy that protects a subject's brain by maintaining a low temperature state,
A brain temperature detection sensor for detecting the brain temperature of the subject, a subject cooling means for cooling the subject, and a control device for controlling the temperature of the subject cooling means,
The control device includes target value setting means for setting a target value of the brain temperature;
Based on the difference between the current value detected by the brain temperature detection sensor and the target value, parameter estimation means for mathematically repeatedly estimating the parameters of the subject cooling means,
An output unit that repeatedly approaches the current value of the brain temperature to the target value by driving the subject cooling unit based on the parameter; and
The subject cooling means, Ri indirectly air cooler der to cool the brain of the subject to cool the air around the subject,
The control device compares a brain temperature output of the reference model with the target value using a transfer function thermal model between the subject and the air cooling device as a reference model, and based on the difference, the cooling temperature of the reference model The input is determined, and the brain temperature output of the reference model follows the target brain temperature cooling curve, and at the same time, the difference between the output of the brain temperature detection sensor and the brain temperature output of the reference model, and the cooling temperature input of the reference model A brain temperature management apparatus that controls the brain temperature of the subject to follow the brain temperature output of the reference model by adjusting the output means based on the output means . In the brain temperature management device according to claim 4,
The air cooling device is a brain temperature management device that is a box-like brain cooling incubator that holds the whole body of the subject and is sealed. A brain temperature management device used for brain cryotherapy that protects a subject's brain by maintaining a low temperature state,
A brain temperature detection sensor for detecting the brain temperature of the subject, a subject cooling means for cooling the subject, and a control device for controlling the temperature of the subject cooling means,
The control device includes target value setting means for setting a target value of the brain temperature;
Based on the difference between the current value detected by the brain temperature detection sensor and the target value, parameter estimation means for mathematically repeatedly estimating the parameters of the subject cooling means,
An output unit that repeatedly approaches the current value of the brain temperature to the target value by driving the subject cooling unit based on the parameter; and
The subject cooling means, injection change in the physical properties of the body by chemicals into the body of the subject, or, Ri injection cooler der indirectly cool the brain of the subject by the cerebral blood flow,
The control device compares a brain temperature output of the reference model with the target value using a transfer function thermal model between the subject and the injection cooling device as a reference model, and based on the difference, the cooling temperature of the reference model The input is determined, the brain temperature output of the illumination model follows the target brain temperature cooling curve, and at the same time, the difference between the output of the brain temperature detection sensor and the brain temperature output of the reference model, and the cooling temperature input of the reference model A brain temperature management device that controls the brain temperature of the subject to follow the brain temperature output of the reference model by adjusting the output means based on the above .

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