JP5985921B2 - Extracorporeal pacemaker device - Google Patents

Description

  The present invention relates to an external pacemaker device.

  In order to treat patients with heart failure such as bradyarrhythmia, an electrode is inserted from the blood vessel in the left clavicle of the patient, and electrical stimulation by a weak current is supplied to the heart at a predetermined cycle via this electrode. A pacemaker that performs so-called “pacing” is used to control the pulsation of the patient.

  In addition to the implantable pacemaker implanted in the body, there is an external pacemaker in which an electrical stimulation generator that supplies electrical stimulation with a weak current to the heart at a predetermined cycle is arranged outside the patient's body (for example, Patent Document 1). This extracorporeal pacemaker is used for temporary use, but it requires only an electrode to be placed inside the body, making it easy to set and change the output (current and voltage), stimulation frequency, etc. There are advantages such as easy maintenance inspection and battery replacement.

  For example, an external pacemaker is used for emergency treatment when a patient suddenly changes before the operation of the implantable pacemaker, and for checking the optimum output and stimulation frequency of the implantable pacemaker. Extracorporeal pacemakers are also used as life support devices to stabilize the movement of the patient's heart after in-hospital arrhythmia surgery. In these cases, an electrocardiogram telemeter is attached to the patient, and safety is ensured by monitoring the electrocardiogram information of the patient in detail.

JP 2003-126273 A

  As described above, the external pacemaker is attached to a patient together with an electrocardiogram telemeter and used (paced) as an emergency treatment, confirmation of optimal output and stimulation frequency, and a life support device after surgery. Many of these patients to whom a plurality of devices such as an extracorporeal pacemaker and an electrocardiogram telemeter are attached are elderly and patients with heart disease.

  Therefore, when these multiple devices are used by being attached to an elderly person or a patient having a heart disease, it takes time for the attachment work and may be worn for a long time. There is a problem of being big.

  The present invention has been made in view of such a point, and an object thereof is to provide an external pacemaker capable of acquiring an electrocardiogram while pacing without burdening the patient and ensuring the safety of the patient.

One aspect of the extracorporeal pacemaker device of the present invention is connected to a first electrode mounted in a patient's body, and electrically stimulates the patient's myocardium via the first electrode in the patient's body. And a second electrode attached to the surface of the patient's body , and the patient's body via the second electrode on the patient's body surface. A body surface electrocardiogram information measuring unit that measures surface electrocardiogram information and a radio transmitter unit that wirelessly transmits the measured body surface electrocardiogram information, a telemetry circuit unit, and both the pacemaker circuit unit and the telemetry circuit unit are accommodated And a signal between the pacemaker circuit unit and the telemetry circuit unit in the case and the pacemaker circuit unit and the telemetry circuit unit. A configuration comprising a isolation device that allows the feed, the.

  According to the present invention, since the external pacemaker device has a pacing function and a function of transmitting electrocardiogram information, the electrocardiogram can be acquired while pacing the patient without burdening the patient by simply attaching it to the patient. Safety can be guaranteed.

Schematic which shows the structure of the external pacemaker apparatus which concerns on one embodiment of this invention.

  Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings.

  The extracorporeal pacemaker 10 shown in FIG. 1 has a pacemaker function for performing pacing and an electrocardiogram telemeter transmission function for transmitting electrocardiogram information, and is attached to a patient 1 having a heart disease in its housing 12.

  The external pacemaker 10 includes an electrical stimulation generator 21, an intracardiac electrocardiogram information measurement unit 24, a body surface electrocardiogram information measurement unit 31, a wireless transmission unit 33, an antenna 34, a telemetry control unit 35, and a recording unit. 41 and a pacemaker control unit 51. The electrical stimulation generator 21, the intracardiac electrocardiogram information measurement unit 24, the body surface electrocardiogram information measurement unit 31, the wireless transmission unit 33, the telemetry control unit 35, the recording unit 41, and the pacemaker control unit 51 are included in the external pacemaker 10. It is provided in the housing 12. In this external pacemaker 10, the body surface electrocardiogram information measurement unit 31, the radio transmission unit 33, and the telemetry control unit 35 constitute a telemetry circuit unit that realizes an electrocardiogram telemeter function. In the external pacemaker 10, the electrical stimulation generator 21, the intracardiac electrocardiogram information measurement unit 24, the pacemaker control unit 51, and the recording unit 41 constitute a pacemaker circuit unit that implements a pacemaker function. The telemetry circuit section and the pacemaker circuit section are insulated and separated from the viewpoint of patient safety (microshock) so that current does not accidentally flow from the telemetry circuit section to the heart via the pacemaker circuit section. For example, transmission of signals between these circuit units is performed via an isolation device such as an isolation transformer capable of transmitting signals while ensuring insulation.

  The electrical stimulation generator 21, the intracardiac electrocardiogram information measurement unit 24, the body surface electrocardiogram information measurement unit 31, the wireless transmission unit 33, the telemetry control unit 35, the recording unit 41, and the pacemaker control unit 51 are built in the housing 12. It is driven by a battery (not shown) (such as an alkaline single III battery). In addition, in the external pacemaker 10 according to the present embodiment, a battery as a power source for the pacemaker circuit unit and a battery as a power source for the telemetry circuit unit are separately provided in an insulated state, but the invention is not limited thereto. Absent. If the safety of the patient is ensured, for example, the power source for the pacemaker circuit unit may be used as the power source for the telemetry circuit unit, or the power source for the telemetry circuit unit may be used as the power source for the pacemaker circuit unit.

  The housing 12 includes intracardiac connection portions 14 a and 14 b and a body surface electrode connection portion 16. The intracardiac connection portions 14 a and 14 b and the body surface electrode connection portion 16 are provided on a wall portion constituting the outer surface of the housing 12.

  Electrodes (for example, electrode catheters 23a and 23b or pacing electrodes) inserted into the living body (inside the patient 1) are connected to the intracardiac connection portions 14a and 14b. Here, the proximal end portions of the relay cords 25a and 25b are detachably connected to the intracardiac connection portions 14a and 14b. Connected to the distal ends of the relay cords 25a and 25b are the proximal ends of the electrode catheters 23a and 23b in which the distal ends are placed in the heart chamber 2 of the patient 1. When the electrode catheters 23a and 23b are connected to the intracardiac connection portions 14a and 14b, the extracorporeal pacemaker 10 performs pacing and the potential in the heart chamber 2, that is, the heart, via the electrode catheters 23a and 23b. It can measure internal ECG information. When a pacing electrode is connected, the external pacemaker 10 can perform pacing via the pacing electrode.

  The body surface electrode connection portion 16 is connected to electrodes 36a, 36b, and 36c attached to the body surface. Here, the base end portions of the dielectric cords 37a, 37b, and 37c, to which the electrodes 36a, 36b, and 36c are connected at the distal end portions, are detachably connected to the body surface electrode connecting portion 16. The electrodes 36a, 36b and 36c attached to the body surface are preferably disposable bioelectrodes (disposable electrodes) that can be discarded after use from the viewpoint of hygiene.

  The electrode catheters 23a and 23b are inserted from the blood vessels in the left clavicle portion of the patient 1 and are placed in the heart chamber. The electrode catheters 23a and 23b apply an electrical stimulation to the heart by an electrical stimulation pulse having a predetermined pattern (the electrical stimulation pulse width, amplitude, and number of stimulation characteristics) output from the electrical stimulation generator 21, and adjust the heart rate.

  The electrical stimulation generator 21 has an electrical stimulation pulse generation circuit, and generates electrical stimulation pulses according to a preset program. Specifically, in the electrical stimulation generation unit 21, the electrical stimulation pulse generation circuit appropriately receives a predetermined pattern (the electrical stimulation pulse width, amplitude, and stimulation number characteristics) from the pacemaker control unit 51 in advance, A stimulation pulse to be applied to the electrode catheters 23a and 23b is generated. The electrical stimulation generation unit 21 outputs the generated electrical stimulation pulse to the electrode catheters 23a, 23b or pacing electrodes connected via the intracardiac connection units 14a, 14b, and gives a predetermined pattern of electrical stimulation to the heart. .

  The intracardiac electrocardiogram information measuring unit 24 includes a signal processing circuit including an amplifier, an analog / digital (A / D) converter, and the like. The intracardiac electrocardiogram information measuring unit 24 measures intracardiac electrocardiogram information (intracardiac electropotential signal) acquired via the electrode catheters 23a and 23b connected to the intracardiac connection units 14a and 14b. The intracardiac electrocardiogram information measurement unit 24 performs signal processing such as amplification and A / D conversion on intracardiac electrocardiogram information (intracardiac electrocardiogram signal) continuously input from the electrode catheters 23a and 23b. The intracardiac electrocardiogram information is supplied to the pacemaker control unit 51.

  The pacemaker control unit 51 includes a storage device that stores programs for controlling various functions in the pacemaker function, and a CPU (Central Processing Unit) that executes these programs. The pacemaker controller 51 generates electrical stimulation pulses in a predetermined pattern via the electrical stimulation generator 21 and outputs the electrical stimulation pulses to the electrode catheters 23a and 23b (or pacing electrodes). Further, the pacemaker control unit 51 supplies the intracardiac electrocardiogram information from the intracardiac electrocardiogram information measurement unit 24 to the recording unit 41. In this way, the pacemaker control unit 51 can supply the intracardiac electrocardiogram information to the recording unit 41 and record it on the recording medium 43.

  The pacemaker control unit 51 in the present embodiment has a function of generating an electrical stimulation pulse and a function of supplying the measured intracardiac electrocardiogram information to the recording unit 41, but is not limited thereto. For example, the pacemaker control unit 51 may supply the wireless transmission unit 33 with the electrical signal supplied from the intracardiac electrocardiogram information measurement unit 24.

  The recording unit 41 includes a non-volatile recording medium 43 that is detachably attached to the housing 12 (specifically, the recording unit 41 in the housing 12), and the intracardiac electrocardiogram information measuring unit 24 includes the recording medium 43. Record the measured information. Here, the recording unit 41 is supplied from the pacemaker control unit 51, the intracardiac electrocardiogram information measured by the intracardiac electrocardiogram information measurement unit 24, and the electrical stimulation generation unit 21 supplied from the pacemaker control unit 51. Information relating to electrical stimulation applied to the heart (log information when applying electrical stimulation to the heart muscle, hereinafter simply referred to as “log information”) is recorded in the recording medium 43. The intracardiac electrocardiogram information measured by the intracardiac electrocardiogram information measurement unit 24 may be directly input to the recording unit 41. Thus, the recording unit 41 functions as an intracardiac electrocardiogram information recording unit capable of recording intracardiac electrocardiogram information measured by the intracardiac electrocardiogram information measurement unit 24 and a log information recording unit capable of recording log information.

  The recording unit 41 records body surface electrocardiogram information on the recording medium 43 via the telemetry control unit 35. At this time, if recording is performed corresponding to the intracardiac electrocardiogram information and log information that are simultaneously measured, the treatment contents to the patient can be confirmed in time series, and a useful information source for treatment to the patient Become. Thus, the recording unit 41 can also record body surface electrocardiogram information.

  Note that only the log information may be recorded on the recording medium 43. In this case, by using log information and body surface electrocardiogram information stored in a receiving device such as a central monitor, which will be described later, it is possible to confirm the treatment content to the patient in time series, and for the treatment to the patient. A useful source of information.

  As described above, according to the external pacemaker 10, intracardiac electrocardiogram information and log information can be recorded in the recording medium 43. The recording medium 43 may be a flash memory or a nonvolatile memory. As a result, the recording medium 43 can be removed from the external pacemaker 10, and the information can be stored by being mounted on another device capable of displaying the intracardiac electrocardiogram information using the recording medium 43, for example, the measuring device 45.

  The body surface electrocardiogram information measuring unit 31 includes a signal processing circuit including an amplifier, an analog / digital (A / D) converter, and the like. The body surface electrocardiogram information measuring unit 31 is provided with electrodes 36a, 36b, and 36c attached to the body surface of the patient 1 through dielectric cords 37a, 37b, and 37c connected to the body surface electrode connection unit 16 of the housing 12. It is connected to the. The body surface electrocardiogram information measuring unit 31 measures and outputs body surface electrocardiogram information via the electrodes 36a, 36b, and 36c. Specifically, the body surface electrocardiogram information measuring unit 31 is configured to receive a biological signal (body) that is continuously input from the electrodes 36a, 36b, and 36c via the dielectric cords 37a, 37b, and 37c according to an instruction from the telemetry control unit 35. The surface electrocardiogram signal or the like is subjected to signal processing such as amplification and A / D conversion, and is output to the wireless transmission unit 33.

  The wireless transmission unit 33 transmits the biological signal (body surface electrocardiogram information) measured by the body surface electrocardiogram information measurement unit 31 and subjected to signal processing via the antenna 34. For example, the radio transmission unit 33 includes a signal processing circuit including an up-converter and the like, and frequency conversion to a radio frequency band is performed on the body surface electrocardiogram information after signal processing output from the body surface electrocardiogram information measurement unit 31. Apply signal processing. The body surface electrocardiogram information after the signal processing is wirelessly transmitted from the antenna 34. The frequency after frequency conversion is uniquely determined according to the radio channel number indicated in the channel information stored in the telemetry control unit 35.

  Thereby, the wireless transmission part 33 can transmit the supplied body surface electrocardiogram information to receiving apparatuses, such as a central monitor, in real time. Note that a wireless reception unit in a reception device such as a central monitor has a signal processing circuit including a down converter and the like. The radio receiving unit in the receiving apparatus receives a signal (here, surface electrocardiogram information) wirelessly transmitted from the external pacemaker 10 by an antenna, and receives the received signal by performing signal processing such as frequency conversion to baseband. Supply to the control unit on the device side. The control unit displays a waveform of the supplied signal on a display device (for example, a central monitor). Moreover, you may memorize | store in the memory | storage part of receiving apparatuses, such as a central monitor.

  The telemetry control unit 35 includes a storage device that stores programs for controlling various functions in the telemeter transmission function, and a CPU (Central Processing Unit) that executes these programs. The telemetry control unit 35 supplies the biological signal supplied from the body surface electrocardiogram information measurement unit 31 to the wireless transmission unit 33. Note that the storage device included in the telemetry control unit 35 also stores channel information indicating the number of a radio channel uniquely assigned to the telemeter unit.

  In addition, the telemetry control unit 35 supplies the body surface electrocardiogram information supplied from the body surface electrocardiogram information measurement unit 31 to the recording unit 41. Thereby, the telemetry control unit 35 can supply the body surface electrocardiogram information to the wireless communication unit 33 and also to the recording unit 41 to record it on the recording medium 43.

  The external pacemaker 10 according to the present embodiment has a function of generating an electrical stimulation pulse, a function of recording information measured by the intracardiac electrocardiogram information measuring unit 24 in the recording unit 41, and a body surface from the body surface electrocardiogram information measuring unit 31. The electrocardiogram information is supplied to the wireless transmission unit 33, and intracardiac electrocardiogram information, body surface electrocardiogram information, and log information are recorded in the recording unit 41. However, the present invention is not limited to this. The extracorporeal pacemaker 10 may be configured by a plurality of control units having individual functions.

  In this way, the external pacemaker 10 sends the electrical stimulation pulse from the electrode catheters 23a and 23b to the myocardium via the pacemaker controller 51 and the electrical stimulation generator 21, thereby exciting the myocardium. In addition, the external pacemaker 10 transmits the body surface electrocardiogram information measured by the patient 1 to the receiving device of the central monitor in real time via the body surface electrocardiogram information measurement unit 31, the wireless transmission unit 33, and the telemetry control unit 35. it can. Further, the external pacemaker 10 records the intracardiac electrocardiogram information and log information when applying electrical stimulation to the myocardium by the electrical stimulation generator 21, the intracardiac electrocardiogram information measurement unit 24, and the pacemaker controller 51. The data can be stored in a recording medium 43 such as a memory card via the unit 41.

  Also, by recording the intracardiac electrocardiogram information and log information on the recording medium 43 via the recording unit 41, the recording medium 43 is removed from the external pacemaker 10 and can be used in another measuring device (the central monitor may be used). Can be installed. As a result, intracardiac electrocardiogram information and log information can be stored in another measurement device, or a waveform can be displayed on a display device of another measurement device.

  Thus, unlike the conventional case, when using the external pacemaker 10 (pacing), it is not necessary to prepare an electrocardiogram telemeter and attach it to the patient 1 separately.

  That is, it is not necessary to attach a plurality of devices such as an electrocardiogram telemeter to the patient 1 in addition to the external pacemaker 10, and the burden of mounting the plurality of devices is not required along with the labor of the mounting operation.

  Thus, since the electrocardiogram information of the patient 1 can be measured simply by attaching the external base maker 10 to the patient 1, the electrocardiogram is acquired while pacing without imposing a burden on the patient 1, and the state of the heart of the patient 1 The safety of the patient 1 can be ensured by monitoring the above.

  Note that each functional block used in the description of the above embodiment is typically realized as an LSI which is an integrated circuit. These may be individually made into one chip, or may be made into one chip so as to include a part or all of them. The name used here is LSI, but it may also be called IC, system LSI, super LSI, or ultra LSI depending on the degree of integration.

  The embodiment disclosed this time should be considered as illustrative in all points and not restrictive. The scope of the present invention is defined by the terms of the claims, rather than the description above, and is intended to include any modifications within the scope and meaning equivalent to the terms of the claims.

DESCRIPTION OF SYMBOLS 1 Patient 2 Heart chamber 10 Extracorporeal pacemaker 12 Case 14a, 14b Intracardiac connection part 16 Body surface electrode connection part 21 Electrical stimulation generation part 23a, 23b Electrode catheter 24 Intracardiac electrocardiogram information measurement part 25a, 25b Relay code 31 Body surface electrocardiogram information measurement unit 33 Wireless transmission unit 34 Antenna 35 Telemetry control unit 36a, 36b, 36c Electrode 37a, 37b, 37c Dielectric code 41 Recording unit (intracardiac electrocardiogram information recording unit, log information recording unit, body surface electrocardiogram information Recording part)
43 Recording medium 51 Control unit for pacemaker

Claims (7)

A pacemaker circuit unit comprising: an electrical stimulation generator configured to apply electrical stimulation to the patient's myocardium via the first electrode in the patient's body, to which a first electrode attached to the patient's body is connected ; ,
A body surface electrocardiogram information measuring unit that is connected to a second electrode attached to the patient's body surface and measures body surface electrocardiogram information of the patient via the second electrode on the patient's body surface ; a telemetry circuit comprising: a radio transmitting unit that wirelessly transmits the surface electrocardiogram information was measured boss, and
A housing that accommodates both the pacemaker circuit portion and the telemetry circuit portion;
In the housing, an isolation device that insulates and separates the pacemaker circuit unit and the telemetry circuit unit and enables signal transmission between the pacemaker circuit unit and the telemetry circuit unit;
Ru with an extracorporeal pacemaker devices. The pacemaker circuit section further includes a intracardiac electrocardiographic information measuring unit for measuring the intracardiac electrocardiographic information of the patient via the first electrode within the body of said patient,
The external pacemaker device according to claim 1. The pacemaker circuit unit includes an intracardiac electrocardiogram information recording unit capable of recording the intracardiac electrocardiogram information measured by the intracardiac electrocardiogram information measurement unit on a recording medium that is detachably attached to the housing .
The extracorporeal pacemaker device according to claim 2. The pacemaker circuit unit includes a log information recording unit capable of recording log information when electrical stimulation is applied to the myocardium on a recording medium that is detachably attached to the housing .
The external pacemaker device according to claim 1. The pacemaker circuit unit includes intracardiac electrocardiogram information measured by the intracardiac electrocardiogram information measurement unit and log information when applying electrical stimulation to the myocardium on a recording medium that is detachably attached to the housing. Further comprising a recordable recording unit ,
The extracorporeal pacemaker device according to claim 2. The pacemaker circuit part, said the recording medium detachably attached to the housing, wherein the intracardiac electrocardiographic information intracardiac electrocardiographic information measured by the measuring unit, and the log information in conferring electrical stimulation to the heart muscle , together with at least one of the, further comprising a recording unit capable of recording the surface electrocardiogram information measured by the body surface electrocardiogram information measurement unit,
The extracorporeal pacemaker device according to claim 2 . The housing separately includes a first power source for the pacemaker circuit unit and a second power source for the telemetry circuit unit in a state of being insulated and separated,
The extracorporeal pacemaker device according to any one of claims 1 to 6.

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