A kind of endovascular prosthesis positioning indicating method, device and systemTechnical field
The present invention relates to medical instruments field, be specifically related to a kind of endovascular prosthesis positioning indicating method, device and system.
Background technology
Vivo inserted tube placing operation is that endovascular device (such as conduit, stylet, seal wire) is inserted body vessels to provide treatment, gives the treatment technology of the clinical demand such as pharmaceutical preparation, hemodialysis by one.Through periphery venipuncture central vein catheter technology (PICC); utilize conduit to puncture from the vein of periphery arm; conduit goes directly near the large vein of heart; while effectively treating, avoid medicine contact with the direct of arm vein; available protecting veins of upper extremity; reducing the generation of complication, alleviate the pain of patient, is a kind of method of intubation that clinical treatment is conventional.And wherein positioning catheter end is a key operation in tube placing operation, how to put in pipe process by conduit in strict accordance with desired trajectory walking and tip finally enters superior vena cava is the problem that this area studies for a long period of time,
In prior art, the postoperative X-ray that utilizes is to confirm catheter tip whether positive stop usually.But, in technique scheme, because pipe position can not be put by Real-time Feedback, such as X-ray result display catheter tip is not at superior vena cava, then need again to put pipe, add the misery of patient, and equipment---the X-ray machine needing use operation extra, complex operation, cost is higher.And then along with the development of science and technology, this area has occurred utilizing the mode such as ultrasonic detector and ECG signal to assist carrying out the technology that Real-Time Monitoring puts tip end position, but put the intuitive whether tip end arrive desired location and judge it is a difficult problem of not yet capturing.
Summary of the invention
In order to solve the problem, the invention provides a kind of endovascular prosthesis positioning indicating method, device and system, by implementing technical solution of the present invention, put pipe operator can Real-time Obtaining to conduit position in the blood vessel, and intuitive prompting is obtained accurately when catheter tip arrives desired location, improve working performance and the accuracy of operator, reduce the misery of patient, save producer's cost.
First aspect of the present invention provides a kind of endovascular prosthesis positioning indicating method, and described method comprises the steps:
Obtain catheter in blood vessel position signalling;
Described catheter tip location is determined according to described catheter position signal;
When described catheter tip is positioned at preset range, give user prompting.
Preferably, when catheter tip arrives described preset range, give user visual cues, and/or auditory cues.
Preferably, described in give user prompting comprise display early warning line, when described acquisition catheter in blood vessel position signalling exceeds early warning line, give user prompting.
Preferably, described method specifically comprises:
Obtain stable body surface kinetocardiogram ECG signal and Ink vessel transfusing ECG signal, described Ink vessel transfusing ECG signal is the ECG signal be placed in the blood vessel of conduit;
From described body surface ECG signal, select a P crest value as P ripple reference value;
The amplitude value of one of them P crest value of Ink vessel transfusing ECG signal described in interval acquiring at preset timed intervals, as current P crest value;
Calculate the ratio of described current P crest value and described P ripple reference value;
The position of described catheter tip is determined according to described ratio;
Show the early warning line drawn according to 7 times of values of described P ripple reference value;
When described current P crest value exceedes described early warning line, prompting early warning signal.
Second aspect of the present invention provides a kind of endovascular prosthesis positioning indicating device, comprising:
Signal acquiring unit, for obtaining catheter in blood vessel position signalling;
Positioning unit, for determining described catheter tip location according to described catheter position signal;
Tip element, for when described catheter tip is positioned at preset range, gives user prompting.
Preferably, described Tip element comprises visual cues when catheter tip arrives described preset range, and/or auditory cues.
Preferably, described Tip element comprises display interface, for showing early warning line, when described acquisition catheter in blood vessel position signalling exceeds early warning line, gives user prompting.
Preferably, described signal acquiring unit is ECG signal acquiring unit, and for obtaining stable body surface ECG signal and Ink vessel transfusing ECG signal, described Ink vessel transfusing ECG signal is the ECG signal be placed in the blood vessel of conduit;
Described endovascular prosthesis positioning indicating device also comprises:
First selection unit, for selecting a P crest value as P ripple reference value from described body surface ECG signal;
Second selection unit, for the amplitude value of one of them P crest value of Ink vessel transfusing ECG signal described in interval acquiring at preset timed intervals, as current P crest value;
Computing unit, for calculating the ratio of described current P crest value and described P ripple reference value;
Described positioning unit determines described catheter tip location according to described ratio;
Described Tip element comprises display interface, at least shows the P ripple image of Ink vessel transfusing ECG signal, and early warning line, and described early warning line draws based on 7 times of values of P ripple reference value; When described current P crest value exceedes the early warning line of described display interface, described Tip element prompting early warning signal.
3rd aspect of the present invention provides a kind of cardiac electricity detecting system, and for implementing ECG detecting when paracentesis and tube placing operation, described system comprises above-mentioned endovascular prosthesis positioning indicating device.
4th aspect of the present invention provides a kind of ultrasonic system, for implementing paracentesis and tube placing operation, comprising: ultrasonic main frame, ultrasonic probe and above-mentioned endovascular prosthesis positioning indicating device.
Further, the integrated ECG module of described ultrasonic main frame, the ECG module utilizing described ultrasonic main frame integrated when implementing tube placing operation and three conducting wires obtain body surface ECG signal and Ink vessel transfusing ECG signal.
Endovascular prosthesis positioning indicating method provided by the invention, comprises step: obtain catheter in blood vessel position signalling; Described catheter tip location is determined according to described catheter position signal; When described catheter tip is positioned at preset range, give user prompting.Endovascular prosthesis art has been come by surgeon usually, in the process of putting pipe, doctor need be absorbed on hand put pipe action, judge whether catheter tip location arrives active position according to the length of reserved conduit and experience, confirm to put pipe accuracy and completeness after putting pipe and completing, obviously easily make a mistake.The present invention intuitively effectively reminds operator to put pipe progress according to preset information, while ensureing that putting tube side sequence efficiently carries out, operator can be realized and be absorbed in conduit in hands, reduce the frequency that in display screen and hands, conduit two side monitors, avoid the mistake caused by " wholeheartedly multiplex ".
Endovascular prosthesis positioning indicating device provided by the invention, comprises signal acquiring unit, positioning unit and Tip element.Device provided by the invention is by signal acquiring unit Real-time Obtaining signal, such as ultrasonic signal or ECG signal, be arranged in the position of blood vessel according to the feedback positioning catheter of signal again and then judge whether accurately to put pipe, Tip element intuitively effectively reminds operator to put pipe progress and accuracy according to preset information, and structure is simple, easy to operate.
Endovascular prosthesis positioning indicating device provided by the invention, by obtaining stable body surface ECG signal and Ink vessel transfusing ECG signal, according to both P Bob value effective location catheter tip location.Because all patients all can obtain Ink vessel transfusing electrocardiogram by the mediation of seal wire, namely while avoiding mobile patient to carry out X-ray place tube located, this device can be suitable for all patients, has applicable universality, advantage simple to operate.
Endovascular prosthesis positioning indicating device provided by the invention, Tip element can according to preset range predetermined threshold value, such as, when the ratio of current P crest value and body surface P ripple reference value is 7, catheter tip is pointed out to enter correct superior vena cava position in the mode of vision and/or audition.Further, according to the P ripple reference line of body surface ECG signal, multiple proportion is utilized effectively to draw out early warning line, give the prompting of operator's more intuitive, prompting catheter in blood vessel is positioned at preset range, improves and puts pipe accuracy and operating efficiency, reduces the error rate that anthropic factor causes.
The present invention also provides the ultrasonic system of cardiac electricity detecting system or the integrated ECG module comprising above-mentioned place tube located suggestion device.Need first to implement paracentesis before implementing tube placing operation, paracentesis can use conventional ultrasound systems to guide puncture.After paracentesis complete, obtain the ECG signal of system and utilize ECG signal to carry out putting pipe with the relationship schedule putting catheter tip location in pipe process to operate.Use the ultrasonic system of integrated ECG module furthermore achieved that and use same set of equipment to implement paracentesis and tube placing operation, simplify the operation of tube placing operation, provide cost savings.
Accompanying drawing explanation
Fig. 1 is apparatus structure schematic diagram described in first embodiment of the invention;
Fig. 2 is apparatus structure schematic diagram described in second embodiment of the invention;
Fig. 3 is display interface schematic diagram described in third embodiment of the invention;
Fig. 4 is another display interface schematic diagram described in third embodiment of the invention;
Fig. 5 is method flow diagram described in fourth embodiment of the invention;
Fig. 6 is ultrasonic system structural representation described in fifth embodiment of the invention;
Detailed description of the invention
Below in conjunction with the Figure of description in the present invention, be clearly and completely described the technical scheme in invention, obviously, described embodiment is only the present invention's part embodiment, instead of whole embodiments.Based on the embodiment in the present invention, those of ordinary skill in the art, not making the every other embodiment obtained under creative work prerequisite, belong to the scope of protection of the invention.
First embodiment of the invention will be described in detail to a kind of endovascular prosthesis positioning indicating device.Described in the present embodiment, device concrete structure refers to Fig. 1, comprises signal acquiring unit 101, positioning unit 102, and Tip element 103.
Endovascular prosthesis refers to intubation intervention venous procedures, espespecially intubation intervention central vein program, refers to venous duct to be placed on directly lead in the vein of heart.Central vein catheter intervention device can comprise central venous catheter (CVC), insert conduit (PICC) and other equipment through peripheral vein.Simultaneously for Real-Time Monitoring conduit is arranged in the position of blood vessel, the mode such as ultrasonic detector, cardioelectric monitor of can quoting is assisted.The present embodiment puts pipe for PICC, conduit is that high-biocompatibility material is made, built-in with sonac or the seal wire connecting ECG tri-conducting wire in the catheter, signal acquiring unit 101 acquires the ultrasonic signal of ultrasonic detector feedback or the electrocardiosignal of electrocardioscanner feedback by seal wire.According to the catheter position signal that signal acquiring unit 101 is fed back, signal and catheter tip are in endovascular position and are associated by positioning unit 102, accurately draw catheter tip location.
In PICC tube placing operation, superior vena cava (SVC) hypomere is target region of interest.When default catheter tip is positioned at superior vena cava (SVC) hypomere in Tip element 103, give user visual cues.This visual cues can be the combination of user's any one mode appreciable or mode, as visual cues, auditory cues, sensory cue.Such as, described Tip element comprises display unit, and when catheter tip is positioned at superior vena cava (SVC) hypomere, device highlights information, such as color tips or graphical cues.In a further advantageous embodiment, described Tip element comprises light display unit, and when catheter tip is positioned at superior vena cava (SVC) hypomere, device such as to flash at the light prompting.In a preferred embodiment, described Tip element can also comprise voice unit (VU), and when catheter tip is positioned at superior vena cava (SVC) hypomere, device gives the alarm sound.
Second embodiment of the invention provides a kind of endovascular prosthesis positioning indicating device being applied to PICC tube placing operation, is described in detail below to this device.Device concrete structure described in the present embodiment refers to Fig. 2, comprising: ECG signal acquiring unit 201, first selection unit 202, second selection unit 203, computing unit 204, positioning unit 205 and Tip element 206.Wherein, the first selection unit 202, second selection unit 203 is all connected with ECG acquiring unit 201, computing unit 204 respectively, and computing unit 204 is also connected successively with positioning unit 205, Tip element.
ECG (Electrocardiogram) i.e. electrocardiogram, that heart is in each cardiac cycle, in succession excited by pacemaker, atrium, ventricle, along with bioelectric change, drawn the figure of the potential change of various ways from body surface by electrocardiograph, and different parts electrode catheter being placed in heart then can record the electrocardiogram of intracavity.In the present embodiment conduit in advance built-in metal seal wire conduit is supported.Connect three conducting wires in a conventional manner, after ECG signal acquiring unit 201 obtains body surface ECG signal, get the left upper extremity electrode in three conducting wires or the wire guide in right upper extremity Electrode connection conduit, further conduit just obtains Ink vessel transfusing ECG signal by wire guide when Ink vessel transfusing is advanced.
Body surface ECG comprises multiple heart cycle waveform, and each waveform has a P wave component.When the maintenance of body surface ECG signal is stablized, the amplitude value detecting its multiple P wave-wave peak even if long-time is also roughly the same.First selection unit 202 selects a P crest value as P ripple reference value from described body surface ECG signal.
The amplitude value of the second selection unit 203 one of them P crest value of interval acquiring Ink vessel transfusing ECG signal at preset timed intervals, as current P crest value, to obtain Ink vessel transfusing physiological parameter in real time, and then determines to put pipe progress.Particularly, this prefixed time interval can be set to 10 seconds.
Find under study for action, it is different that catheter tip is in endovascular position, and endovascular P crest value is also different, and body surface P crest value is stablized.In the present embodiment by the ratio of endovascular real-time P crest value and body surface P ripple reference value as the parameter associating catheter tip and be in vessel position.
See table 1, be wherein one group of clinical laboratory data, P ripple reference value is 1.11mm.
| Position | Current P crest value (mm) | Range of error (mm) | Ratio |
| Axillary vein | 1.11 | ±0.36 | 1.00 |
| Subclavian vein | 1.12 | ±0.28 | 1.01 |
| Venae brachiocephalicae | 1.56 | ±0.45 | 1.41 |
| Superior vena cava epimere | 4.03 | ±1.87 | 3.63 |
| Superior vena cava stage casing | 5.90 | ±2.45 | 5.32 |
| Superior vena cava hypomere | 7.90 | ±2.95 | 7.12 |
| Junction, right room | 9.87 | ±2.77 | 8.89 |
| In the middle part of right room | 5.00 | ±1.76 | 4.50 |
| Bottom, right room | 2.50 | ±1.73 | 2.25 |
Table 1
Computing unit 204 is namely for calculating the ratio of P crest value and P ripple reference value in blood vessels present.This ratio may be slightly different because of individual difference, but not too large with the correlation difference of intravascular site.
Positioning unit 205 is associated for being in endovascular position according to described ratio and catheter tip, determines the position of described catheter tip.
In the present embodiment, Tip element 206 comprises auditory tone cues unit, and when in default blood vessels present, the ratio of P crest value and P ripple reference value is 7.0, auditory tone cues unit sends early warning signal, reminds and puts pipe operator current catheter position close to area-of-interest (i.e. superior vena cava hypomere).
The endovascular prosthesis positioning indicating device that third embodiment of the invention provides is out of shape the one of device described in embodiment two.
Tip element 206 also comprises user's display interface 301.User's display interface 301 at least comprises ECG display interface 302, one or more ECG signal can be shown.In the present embodiment, as shown in Figure 3, described user's display interface 301 comprises and ECG display interface 302 and ultrasonoscopy display interface 303, ECG display interface shows P ripple reference line 304, the P ripple image of the current ECG signal of Ink vessel transfusing and early warning line 305.Described P ripple reference line 304 is according to selecting the P crest value of arbitrary body surface ECG signal to draw as P ripple reference value.Described early warning line is multiple proportion based on P ripple reference value and draws, and is to draw based on 7 times of P ripple reference value in the present embodiment.Above-mentioned functions module all can linkage function button, and to show, to hide, to adjust window and/or startup, elimination, to close this function, function button can be any one or a few control mode in touch screen button, integrated functionality button or remote access manipulation.
ECG signal acquiring unit 201 first obtains body surface ECG signal by connection three conducting wire, ECG display interface 302 shows body surface ECG signal P ripple figure, first selection unit 202 is selected to draw P ripple reference value from described body surface ECG signal, draw out P ripple reference line 304, and draw early warning line 305 according to P ripple reference value 7 times of relations.Can preferably arrange, after drafting P ripple reference line 304, eliminate the function of body surface ECG signal P ripple figure, display interface only shows P ripple reference line 304 and early warning line 305, increase the terseness of display interface, highlight the position relationship of P crest value and early warning line at that time.Wire guide in left upper extremity electrode in three conducting wires or right upper extremity Electrode connection conduit, conduit acquires Ink vessel transfusing ECG signal by wire guide ECG signal acquiring unit 201 when Ink vessel transfusing is advanced, ECG display interface 302 shows Ink vessel transfusing ECG signal P ripple figure, Real-Time Monitoring P crest value, this crest value the closer to early warning line, then shows that conduit is more close and puts pipe area-of-interest.When the Ink vessel transfusing P crest value that computing unit 204 draws and P ripple reference value ratio close to 7.0 time, when namely P crest value arrives early warning line at that time, Tip element 206 provides visual cues and/or auditory cues.
One as the present embodiment is out of shape, and ECG display interface 401 is divided into two regions, left and right as shown in Figure 4, P ripple Figure 40 2 of left region display body surface ECG signal, P ripple Figure 40 3 of right region display Ink vessel transfusing ECG signal and early warning line 404.Select the P crest value of the arbitrary body surface ECG signal of left region display interface as P ripple reference value, then draw early warning line 404 according to the multiple proportion of P ripple reference value.Draw based on 7 times of P ripple reference value in the present embodiment.
Fourth embodiment of the invention provides a kind of endovascular prosthesis positioning indicating method, and described method such as Fig. 5 comprises the steps: 501 acquisition catheter in blood vessel position signallings; 502 according to catheter position signal determination catheter tip location; 503 when catheter tip is positioned at preset range, gives user prompting.
The present embodiment puts pipe for PICC, conduit is that high-biocompatibility material is made, built-in with sonac or the seal wire connecting ECG tri-conducting wire in the catheter, acquire the ultrasonic signal of ultrasonic detector feedback or the electrocardiosignal of electrocardioscanner feedback by seal wire.Catheter position signal combination physiological medical science presupposed information determination catheter tip according to feedback is in endovascular position.When catheter tip is positioned at superior vena cava (SVC) hypomere, device highlights information, such as color tips or graphical cues.In a further advantageous embodiment, described Tip element comprises light display unit, and when catheter tip is positioned at superior vena cava (SVC) hypomere, device such as to flash at the light prompting.In a preferred embodiment, described Tip element can also comprise voice unit (VU), and when catheter tip is positioned at superior vena cava (SVC) hypomere, device gives the alarm sound.
Preferably, according to ECG signal monitoring endovascular prosthesis position, specifically comprise: obtain stable body surface kinetocardiogram ECG signal and Ink vessel transfusing ECG signal according to ECG tri-conducting wire method, described Ink vessel transfusing ECG signal is the ECG signal be placed in the blood vessel of conduit; From described body surface ECG signal, select a P crest value as P ripple reference value; The amplitude value of one of them P crest value of Ink vessel transfusing ECG signal described in interval acquiring at preset timed intervals, as current P crest value; Calculate the ratio of described current P crest value and described P ripple reference value; The position of described catheter tip is determined according to ratio; Show the early warning line drawn according to 7 times of values of described P ripple reference value; When described current P crest value exceedes described early warning line, prompting early warning signal.
The embodiment of the present invention five will be described in detail to a kind of ultrasonic system, and the system concrete structure described in the present embodiment refers to Fig. 6, comprising: the ultrasonic main frame 601 of integrated ECG module, ultrasonic probe 602 and endovascular prosthesis positioning indicating device 603.
Endovascular prosthesis positioning indicating device 603 can be any one in embodiment two to three, repeats no more herein.
The integrated ECG module of ultrasonic main frame 601 and three conducting wires are utilized to obtain stable body surface ECG signal and Ink vessel transfusing ECG signal when implementing tube placing operation.
The paracentesis implemented before tube placing operation utilize ultrasonic main frame 601 and ultrasonic probe 602 to perform.
A kind of endovascular prosthesis positioning indicating device provided the embodiment of the present invention above, method and system are described in detail, but the explanation of above embodiment just understands structure of the present invention and core concept thereof for helping, and should not be construed as limitation of the present invention.Those skilled in the art are in the technical scope that the present invention discloses, and the change that can expect easily or replacement, all should be encompassed within protection scope of the present invention.