Disclosure of Invention
Based on the above, the invention aims to provide an automatic puncturing device and an automatic puncturing system for hemodialysis arteriovenous fistula, which are used for improving the accuracy of hemodialysis puncturing, improving the treatment efficiency of an upper machine of hemodialysis and reducing the operation intensity of medical staff.
In one aspect, the present invention provides an automatic puncturing system for hemodialysis arteriovenous fistula, comprising:
The first acquisition module is used for acquiring a target position point of the puncture position, and forming a dense-order ray set by taking the target position point as a guide;
The screening module is used for acquiring an intersection area of rays concentrated by rays and a needle inlet area, wherein the intersection area is a puncture needle inlet area set Mi, an obstacle area is screened out and removed according to the puncture needle inlet area set Mi so as to obtain an effective puncture needle inlet area, the effective puncture needle inlet area comprises a plurality of puncture paths, the puncture length Si of each puncture path is obtained according to the puncture needle inlet area set Mi, and the obstacle area comprises an arteriovenous vessel wall, an internal fistula stoma and a last dialysis puncture point;
The optimizing module is used for calculating and obtaining the vertical distance d between the curved surface puncture point and the puncture path of the obstacle according to the point-to-tangent plane calculation formula, and optimizing the puncture path and the obstacle distance target according to the minimum distance dmin between the curved surface puncture point and the puncture path so as to obtain the optimal puncture path according to the optimizing index Q;
The second acquisition module is used for acquiring a target puncture length corresponding to the optimal puncture path according to the optimal puncture path;
the third acquisition module is used for acquiring the angle adjustment amplitude of the puncture needle during puncture according to the puncture angle amplitude evaluation function so as to acquire the optimal angle adjustment amplitude;
and the puncture module is used for adjusting the amplitude according to the optimal puncture path, the target puncture length and the optimal angle and performing internal fistula puncture on the patient by combining a preset path planning algorithm.
According to the automatic puncture system for the hemodialysis arteriovenous internal fistula, the target position point of the puncture position is determined firstly, then the effective puncture needle insertion area is determined according to the target position point, the optimal puncture path, the target puncture length and the optimal angle adjustment amplitude are obtained according to the effective puncture needle insertion area, and the internal fistula puncture is carried out on a patient by combining the path planning algorithm, so that the patient can be automatically punctured, the operation of hands on a medical staff is avoided, the accuracy of hemodialysis puncture is improved, and the operation intensity of the medical staff is reduced.
In addition, the automatic puncture system for hemodialysis arteriovenous fistula according to the invention can also have the following additional technical characteristics:
Further, in the step of screening out and removing the obstacle region according to the puncture needle-insertion region set Mi to obtain an effective puncture needle-insertion region, the mathematical expression of the effective puncture needle-insertion region is:
；
Wherein Oe,k is the starting point coordinate Oe,k(xk,yk,zk of any puncture path, and k is the puncture path; ot is the center coordinate point Ot(xt,yt,zt of the target indwelling target at the end of the indwelling catheter after needle insertion of the internal fistula).
Further, the mathematical expression of the puncture length Si is:
；
Where (xe,i,ye,i,ze,i) is the coordinates of the puncture needle insertion point Oe,i.
Further, in the step of optimizing the puncture path and the obstacle distance target according to the minimum distance dmin between the curved surface puncture point and the puncture path to obtain the optimal puncture path according to the optimization index Q, the mathematical expression of the optimization function is:
；
Wherein L (i) is the length of the ith path; d (i) is the minimum length of the ith path and the obstacle; average length of all paths; Is the average value of the minimum distance between all paths and the obstacle; muD is a length weight factor of the puncture path, muD∈[0,1];μL is a distance weight factor of the puncture path and an obstacle, muL∈[0,1],μD+μL =1, and the calculated data can obtain a balanced optimal solution between the shortest puncture path and the whole course and the obstacle object by adjusting the weight factors muD and muL.
Further, in the step of calculating the vertical distance d between the curved surface puncture point and the puncture path of the obstacle according to the point-to-tangent plane calculation formula, and optimizing the puncture path and the obstacle distance target according to the minimum distance dmin between the curved surface puncture point and the puncture path to obtain the optimal puncture path according to the optimization index Q,
The point-to-tangent plane calculation formula is:
；
Wherein f=f0 (x, y, z) is a mathematical expression of the surface of the peripheral obstacle at the time of puncture; o0=(x0,y0,z0) is the coordinates of any point on the surface of the obstacle;、 AndRespectively representing derivation of X, Y, Z in three axial directions at the F (O) position;
obtaining the normal vector of the point O0(x0,y0,z0) on the curved surface according to the point-to-tangent plane calculation formula；
The direction vector of the puncture path is:
；
wherein,。
Further, in the step of obtaining the angle adjustment amplitude at the time of puncture of the puncture needle according to the puncture angle amplitude evaluation function to obtain the optimal angle adjustment amplitude, the mathematical expression of the puncture angle amplitude evaluation function is:
；
wherein,；；；
Where i= {1,2,3, …, n }; n is the total amount of evaluation paths; a (i) is the angle adjustment times of the ith path; The average value of the adjustment times of all the path angles is obtained; muD+μL+μa =1.
The application also provides automatic puncturing equipment for the hemodialysis arteriovenous fistula, which comprises an AGV mobile trolley, a bedside arm nursing device, an operating device and a control unit, wherein the control unit is used for connecting the bedside arm nursing device and the operating device, and the operating device comprises an end puncturing actuator and a mechanical arm which is movably connected with the AGV mobile trolley and the end puncturing actuator;
The bedside arm nursing device comprises a fixed bottom plate, an auxiliary mechanism and a puncture mechanism, wherein the auxiliary mechanism and the puncture mechanism are arranged on one side of the fixed bottom plate, the auxiliary mechanism comprises an X-axis screw rod, a Z-axis screw rod and a Y-axis screw rod, the X-axis screw rod and the Z-axis screw rod are movably connected with each other, and the X-axis screw rod is fixedly connected with the fixed bottom plate;
The auxiliary mechanism further comprises an arteriovenous fistula visual image detection component and an arm profiling pressing component which are respectively connected with the Z-axis screw rod, the arteriovenous fistula visual image detection component is connected with the control unit and used for detecting and displaying a puncture range, the arm profiling pressing component comprises a negative pressure pump, a silica gel arm profiling pressing block and a hollow connecting rod which is connected with the negative pressure pump and the silica gel arm profiling pressing block, the negative pressure pump is connected with the control unit, the silica gel arm profiling pressing block is used for pressing an arm, and the silica gel arm profiling pressing block is arranged at one end, close to the fixed bottom plate, of the arteriovenous fistula visual image detection component;
The puncture mechanism comprises an arteriovenous pipeline and a puncture needle, the arteriovenous pipeline comprises a venous pipeline and an arterial pipeline, the puncture needle comprises a venous pipeline puncture needle and an arterial pipeline puncture needle, and the tail end puncture actuator is movably connected with the arteriovenous pipeline and the puncture needle.
Detailed Description
In order that the invention may be readily understood, a more complete description of the invention will be rendered by reference to the appended drawings. Several embodiments of the invention are presented in the figures. This invention may, however, be embodied in many different forms and should not be construed as limited to the embodiments set forth herein. Rather, these embodiments are provided so that this disclosure will be thorough and complete.
It will be understood that when an element is referred to as being "mounted" on another element, it can be directly on the other element or intervening elements may also be present. When an element is referred to as being "connected" to another element, it can be directly connected to the other element or intervening elements may also be present. The terms "vertical," "horizontal," "left," "right," and the like are used herein for illustrative purposes only.
Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. The terminology used herein in the description of the invention is for the purpose of describing particular embodiments only and is not intended to be limiting of the invention. The term "and/or" as used herein includes any and all combinations of one or more of the associated listed items.
In order to improve the accuracy of hemodialysis puncture, improve the treatment efficiency of a hemodialysis upper machine and reduce the operation intensity of medical staff, the application provides automatic puncture equipment and system for hemodialysis arteriovenous internal fistula, which are characterized in that a target position point of a puncture position is firstly determined, then an effective puncture needle-in area is determined according to the target position point, according to the effective puncture needle insertion area, the optimal puncture path, the target puncture length and the optimal angle adjustment amplitude are obtained, and the path planning algorithm is combined to perform internal fistula puncture on the patient, so that the patient can be automatically punctured, the upper hand operation of medical staff is avoided, the accuracy of hemodialysis puncture is improved, and the operation intensity of the medical staff is reduced.
Specifically, set up the operation that the other arm nursing device of bed carries out the cooperation operation with the operating means on the AGV travelling car, realize automatic puncture, avoid manual operation, improved treatment effeciency and alleviateed medical personnel's operation intensity. The control unit is arranged to allocate the arterial and venous pipeline, the puncture needle and the bedside arm nursing device to operate, the bedside arm nursing device acts on the hemodialysis machine of the patient through the fixed bottom plate, arm pre-positioning is provided for puncture, and the auxiliary mechanism is used for accurately capturing and displaying the puncture range, so that the puncture precision is improved; further, an end puncture actuator in the operating device is used for grabbing an arteriovenous pipeline and a puncture needle for puncture operation, so that manual puncture is avoided, the efficiency is improved, and meanwhile, the operation intensity of medical staff is relieved; after the puncturing is finished, the arm is pressed by the arm profiling pressing component and the hemostatic plaster is attached, so that the operation flow is standardized and the safety of the puncturing operation is improved; improves the accuracy of hemodialysis puncture, the treatment efficiency of the hemodialysis machine and reduces the operation intensity of medical staff.
Specifically, please refer to fig. 1-3, the automatic puncturing device for hemodialysis arteriovenous fistula includes an AGV moving trolley 1, further, the device further includes a bedside arm nursing device 6, an operating device and a control unit for connecting the bedside arm nursing device 6 and the operating device, the bedside arm nursing device 6 is arranged beside the hemodialysis machine, the operating device includes an end puncturing actuator 4 and a mechanical arm for movably connecting the AGV moving trolley 1 and the end puncturing actuator 4, and the end puncturing actuator 4 is driven to adapt to the bedside arm nursing device 6 through the movement of the mechanical arm so as to perform puncturing operation. The automatic puncturing equipment for the hemodialysis arteriovenous fistula further comprises an electric connection box 2, wherein the electric connection box 2 is connected with the operation device and the control unit to control the tail end puncturing actuator 4 and the mechanical arm in the operation device to operate.
In this embodiment, the bedside arm care device 6 includes a fixed bottom plate 16, an auxiliary mechanism and a puncture mechanism disposed on one side of the fixed bottom plate 16, wherein the auxiliary mechanism includes an X-axis screw 20 and a Z-axis screw 22 perpendicular to each other, and a Y-axis screw 21 movably connecting the X-axis screw 20 and the Z-axis screw 22, and the X-axis screw 20 is fixedly connected to the fixed bottom plate 16. As a specific example, the auxiliary mechanism further includes an X-axis servo motor, a Y-axis servo motor, and a Z-axis servo motor respectively connected with the control unit; the X-axis servo motor is arranged in the X-axis screw rod 20 to drive the Y-axis screw rod 21 to reciprocate along the X-axis screw rod 20; the Y-axis servo motor is arranged in the Y-axis screw rod 21 to drive the Z-axis screw rod 22 to move up and down along the Y-axis screw rod 21; the Z-axis servo motor is arranged in the Z-axis screw rod 22 so as to drive the arteriovenous fistula visual image detection assembly 23, the iodophor spraying module and the arm profiling pressing assembly to reciprocate along the Z-axis screw rod 22, the arteriovenous fistula visual image detection assembly 23 is arranged on the upper side of the Z-axis screw rod 22 through the L-shaped connecting block 24, the iodophor spraying module is arranged on the lower side of the Z-axis screw rod 22 through the U-shaped connecting piece 25, and the arm profiling pressing assembly is connected with the Z-axis screw rod through a stud. Specifically, the iodophor spraying module comprises an iodophor liquid bottle 11, a nozzle 26 and a transmission pipe for connecting the iodophor liquid bottle 11 with the nozzle 26, wherein the nozzle 26 is connected with the Z-axis screw rod 22 through a U-shaped connecting piece 25, and the transmission pipe is arranged along the Z-axis screw rod 22 and the Y-axis screw rod 21.
As a specific example, the range of the spray diameter of iodophor is not less than 8cm. Specifically, the visual image detection assembly of the arteriovenous fistula recognizes the puncture range needing to be punctured, and signals are sent to an X-axis servo motor, a Y-axis servo motor and a Z-axis servo motor of the bedside arm nursing device through the control unit so as to adjust the position of a nozzle of the iodophor spraying module, so that the optimal iodophor spraying position point is achieved.
In order to improve the safety of the puncturing process, in this embodiment, the bedside arm care device 6 further includes a pressing arm mechanism 19 for pressing the arm of the patient during puncturing to avoid potential safety hazards caused by increased blood vessel reflux pressure. Specifically, the arm pressing mechanism 19 is disposed on the other side of the fixed bottom plate 16, and the arm pressing mechanism 19 includes a base and an annular through hole disposed on the base, and the center of the annular through hole is disposed in line with the length direction of the X-axis screw 20. In a specific implementation, after the arm of the patient passes through the annular through hole, the visual image detection component 23 of the arteriovenous fistula can detect and identify the arm of the patient, so that the puncture range is displayed. Specifically, when the arteriovenous fistula visual image detection assembly 23 recognizes the patient's arm, the compression arm mechanism 19 is activated and the base is tightened to compress the arm.
For better carrying out puncture operation, the auxiliary mechanism further comprises an arteriovenous internal fistula visual image detection component 23 and an arm profiling pressing component which are respectively connected with the Z-axis screw rod 22, the arteriovenous internal fistula visual image detection component 23 is used for identifying whether an arm of a patient enters a puncture operation area, the arteriovenous internal fistula visual image detection component 23 is connected with a control unit and used for detecting and displaying a puncture range, and specifically, the arteriovenous internal fistula visual image detection component 23 comprises an image acquisition unit, such as a camera, the image acquisition unit is arranged on the Z-axis screw rod 22 and is connected with the control unit, and the image acquisition unit uploads acquired image data to the control unit for data processing so as to identify the arm of the patient. The arm profiling pressing assembly comprises a negative pressure pump 8, a silica gel arm profiling pressing block 9 and a hollow connecting rod 10 for connecting the negative pressure pump 8 and the silica gel arm profiling pressing block 9, the negative pressure pump 8 is connected with a control unit, the silica gel arm profiling pressing block 9 is used for pressing an arm, and the silica gel arm profiling pressing block 9 is arranged at one end, close to the fixed bottom plate 16, of the internal arteriovenous fistula visual image detection assembly 23. Further, the auxiliary mechanism further comprises a hemostatic plaster assembly, the hemostatic plaster assembly comprises a support bottom plate 18, a hemostatic plaster electric reel box 31 and a volume label tray 30, wherein the hemostatic plaster electric reel box 31 and the volume label tray 30 are arranged on the support bottom plate 18, and the support bottom plate 18 is connected with the Y-axis screw 21 and is arranged at one end of the Y-axis screw 21, which is close to the X-axis screw 20; an electric reel and a plurality of hemostatic patches are arranged inside the hemostatic patch electric reel box 31; when the silicone arm profiling pressing block 9 moves onto the volume label tray 30, the electric reel rotates to push out the hemostatic plaster, and the silicone arm profiling pressing block 9 adsorbs the pushed out hemostatic plaster through negative pressure to attach the hemostatic plaster to the puncture. Specifically, as shown in fig. 3, the pressing block 9 for profiling the silica gel arm is provided with 2×4 holes, the diameter of each hole is 5mm, and the holes are connected with the negative pressure pump 8 through a hollow connecting rod 10, when the system sends out the signals for adsorbing the hemostatic plaster, the negative pressure pump 8 is started, so that the pressing block 9 for profiling the silica gel arm can adsorb the hemostatic plaster, and finally the purpose of sticking the hemostatic plaster is realized.
As a specific example, the puncture mechanism further includes a steel needle storage box 12 and a fixed connection member 29, the steel needle storage box 12 is used for storing used waste puncture needles, in this embodiment, the fixed connection member 29 is an L-shaped fixed connection member, one end of the fixed connection member 29 is connected with the steel needle storage box 12, the other end is provided with a mounting platform, the mounting platform is located above the steel needle storage box 12, and the puncture mechanism is arranged on the mounting platform; the steel needle storage box 12 and the auxiliary mechanism are arranged on the same side of the fixed bottom plate 16. Further, the puncture mechanism comprises an arteriovenous line and a puncture needle, the arteriovenous line comprises a venous line and an arterial line, the puncture needle comprises a venous line puncture needle 27 and an arterial line puncture needle 28, and the tail end puncture actuator 4 is movably connected with the arteriovenous line and the puncture needle. The mounting platform is provided with a clamping groove 15 for placing an arterial and venous pipeline, an arterial pipeline induction sensor 14 and a venous pipeline induction sensor 13, and the clamping grooves, the arterial pipeline induction sensor 14 and the venous pipeline induction sensor 13 are all mounted on the L-shaped fixed connecting piece. The arterial line induction sensor 14 and the venous line induction sensor 13 respectively have the functions of sensing the current position states of the arterial line and the venous line; when the system finishes pre-flushing, medical staff places the pipeline on the clamping groove 15, the sensor senses that the pipeline is arranged on the clamping groove, the system can prompt that the pipeline is placed, and a next puncture command can be performed. When a pipe is removed, the system prompts the pipe to be removed.
In order to enable the end puncture actuator 4 to better identify and position the bedside arm nursing device 6 and improve the puncture efficiency, in the embodiment, the operation device further comprises an arm detection camera 5, and the arm detection camera 5 is connected with the control unit and is arranged at the tail end of the mechanical arm. When the AGV moving trolley 1 receives a puncture command and travels to the patient nursing bed 3 through the AGV magnetic navigation ground mark 7, the operating device detects the arm of the patient through the arm detection camera 5, and then the puncture operation is completed. The bedside arm nursing device 6 also comprises a positioning mark point 17 arranged on the fixed bottom plate 16, wherein the positioning mark point 17 is arranged at one end part of the fixed bottom plate 16 and is respectively arranged at two opposite sides of the fixed bottom plate 16 with the X-axis screw rod 20. As a specific example, when the manipulator arm brings the manipulator near the bedside arm care device 6, the positioning marker 17 provides path guidance for the arm detection camera 5 to enable the end puncture actuator 4 to be accurately positioned and matched to the bedside arm care device 6. Further, when the end puncture actuator 4 performs a puncture operation, the control unit locates the location mark point 17 as a coordinate origin O (0, 0), and establishes a spatial coordinate system through the coordinate origin O (0, 0), and in the technical scheme of the present application, each functional unit on the hemodialysis arteriovenous fistula automatic puncture device and the arm of the patient can obtain corresponding three-dimensional coordinates through the spatial coordinate system, and the functional unit includes a fixed bottom plate 16, an auxiliary mechanism and a puncture mechanism, and prepares to locate the needle tip, the puncture range and the puncture port of the puncture needle through the three-dimensional coordinates.
Referring to fig. 4, a flowchart of the use of the automatic puncturing device for hemodialysis arteriovenous fistula is shown, and the flowchart is applied to the control unit, and specifically includes steps S101-S105:
s101, acquiring a puncture command, and sending the puncture command to the AGV mobile trolley, so that the AGV mobile trolley positions a target patient and a target bedside arm nursing device according to the puncture command.
As a specific example, the puncture instructions include patient information, couch information, and puncture type, the patient information including patient name and patient condition; the bed information comprises the bed floors of the patient and the bed serial numbers; puncture types include arterial puncture and venous puncture.
In the actual operation process, the steps of acquiring the puncture command and transmitting the puncture command to the AGV mobile cart to enable the AGV mobile cart to position the target patient according to the puncture command comprise the steps of S1011-S1014:
s1011, according to the number of clinical dialysis machines in the hemodialysis room, determining the treatment condition of each hemodialysis machine, and setting and distributing a nursing bed sensing station.
S1012, acquiring pipeline installation and pre-flushing information of the hemodialysis machine so as to position the hemodialysis machine with the pre-flushing completed according to the pipeline installation and pre-flushing information.
As a specific example, pre-punching refers to: in the dialysis treatment process, the pipeline is required to be filled with normal saline, air is exhausted, and air in the dialyzer and the pipeline is exhausted through pre-flushing, so that air embolism is avoided. The dialysis membrane is infiltrated and humidified, so that the blood is fully contacted with the dialysate during dialysis, a better clearing effect is achieved, and the occurrence of blood membrane reaction is reduced.
S1013, judging whether the pre-washed hemodialysis machine can be started up or not.
If the on-machine operation is possible, step S1014 is executed;
S1014, positioning a target hemodialysis machine according to the pre-flushed hemodialysis machine, determining a target patient according to the target hemodialysis machine, and sending a puncture command to the AGV mobile trolley so that the AGV mobile trolley positions the target patient according to the puncture command.
In this embodiment, a corresponding bedside arm care device is mounted beside each hemodialysis machine. The fixed bottom plate of the bedside arm nursing device is arranged on a nursing bed and can be adjusted according to the puncture position of the internal fistula arm of the patient; the arteriovenous fistula visual image detection assembly is arranged on the bedside arm nursing device, when an arm is placed on the fixed bottom plate, the arteriovenous fistula visual image detection assembly is started to identify and judge the arteriovenous fistula, and a target position point of a puncture position required to be punctured is determined.
In the process that the AGV mobile trolley searches for the target hemodialysis machine to determine the target patient to puncture, the AGV mobile trolley obtains an optimal traveling route according to the target hemodialysis machine, when the patient on a plurality of target hemodialysis machines needs to be punctured, the traveling route can be planned according to the puncturing sequence to execute puncturing instructions, and when all the puncturing instructions are completed, the AGV mobile trolley returns to a doctor operation desk/nurse station. Further, the doctor may prepare the AGV for the next penetration operation at the operator station.
It should be further noted that, in this embodiment, according to the layout condition of hemodialysis room, the AGV magnetic navigation ground mark evenly distributed pastes subaerial with AGV magnetic navigation ground mark, pastes subaerial AGV magnetic navigation ground mark and constructs the travel path of AGV travelling car. And a puncture command is sent out from a control unit in the hemodialysis room nurse station, and the AGV mobile trolley moves to the side of the hemodialysis machine to be performed according to the puncture command, namely the side of the hemodialysis puncture nursing bed.
Further, the control unit preferentially selects the nearest completion point according to the information fed back by the arm nursing devices at the side of the bed and the completion sequence of the machine self-inspection on the hemodialysis machine, walks to the nearest completion point and completes the first puncture task. Through the different hemodialysis machine position points and the signal transmission codes that set up, after the machine-on self-checking of hemodialysis machine is accomplished, corresponding code data feedback to the main control panel of nurse station to synchronous with information transmission to AGV travelling car. In the technical scheme, after completing all on-machine treatment puncture tasks of the hemodialysis machine, the AGV mobile trolley automatically returns to a doctor operation desk/nurse station to wait for the next shift dialysis operation.
S102, acquiring a target positioning identification point according to a target bedside arm nursing device, establishing a three-dimensional coordinate system by taking the target positioning identification point as a coordinate origin, and acquiring three-dimensional coordinates of each functional unit according to the three-dimensional coordinate system to provide path guidance for operation of an operating device, wherein each functional unit comprises a fixed bottom plate, an auxiliary mechanism and a puncture mechanism.
S103, acquiring the relative position relation between the tail end puncture actuator and the target positioning identification point according to the three-dimensional coordinates of the target positioning identification point so as to guide the tail end puncture actuator to position and match to the target positioning identification point according to the relative position relation.
And S104, when the arm of the patient is identified on the bedside arm nursing device, identifying and displaying a puncture range through the internal arteriovenous fistula visual image detection assembly, positioning the puncture opening according to the puncture range, and acquiring the three-dimensional coordinates of the puncture opening by combining a three-dimensional coordinate system.
The operating device is provided with an arm detection camera, and the arm detection camera adjusts the movable position of the mechanical arm according to the position of the arm of the patient so as to adapt the tail end puncture actuator to the position of the puncture range.
S105, guiding the end puncture actuator to position and match the end puncture actuator to the puncture opening according to the three-dimensional coordinates of the target positioning identification point and the three-dimensional coordinates of the puncture opening so as to puncture.
Specifically, by combining the visual image detection assembly of the arteriovenous fistula, the puncture needle is visually guided in a puncture range to obtain puncture data, an actual puncture point is obtained according to the puncture data to puncture, and the puncture data comprise a puncture position, a puncture direction and a puncture angle.
In this embodiment, the patient information is associated with the bedside arm care device, and when the internal fistula puncture is performed each time, the control unit memorizes the position state of the internal fistula puncture of the patient on the hemodialysis machine, and when the patient needs to perform the internal fistula puncture next time, the control unit automatically calculates according to the clinical requirement according to the last puncture position and adjusts the coordinate position of the internal fistula puncture. Further, in the actual puncturing process, the requirements of clinical dialysis puncturing are as follows: the puncture point at the arterial end is more than 3cm away from the internal arteriovenous fistula; the distance between the arteriovenous puncture points is preferably more than 10 cm; the distance between the next internal fistula puncture position point and the last internal fistula puncture position point is more than 1cm, and the current puncture position state is recorded.
In some alternative embodiments, an origin coordinate position point A (0, 0) is arranged on the fixed bottom plate, and the arteriovenous fistula visual image detection assembly automatically recognizes the origin coordinate position point A (0, 0) and simultaneously recognizes the puncture arm image and determines a puncture coordinate point B (X, Y, Z) and sends the puncture arm image and the puncture coordinate point B to the control unit. Further, the arm detection camera on the end puncture actuator performs association of coordinate positions according to the fed back origin coordinate position points A (0, 0) and puncture coordinate points B (X, Y, Z), and executes a puncture command so as to ensure the accuracy of the actual puncture points.
As a specific example, since the on-machine time of dialysis is relatively short and the speed is relatively high, the automatic puncturing equipment of hemodialysis arteriovenous fistula is required to have a certain moving speed, and meanwhile, the moving safety is ensured; in this embodiment, the start-up operation speed is set to 0.4m/s to 0.8m/s according to the distance information obtained at the position points of the different hemodialysis machines.
The automatic puncturing equipment for the hemodialysis arteriovenous internal fistula can effectively record the state and information condition before and after the current puncturing before and after each internal fistula puncturing. In some optional embodiments, an alarm prompt lamp is further arranged on the hemodialysis machine, and the alarm prompt lamp is connected with the control unit so that when dialysis puncture is completed or puncture abnormality occurs, the control unit can prompt in time, specifically wait for turning on a yellow lamp, turn on a red lamp abnormally, and finish turning on a green lamp.
Through setting up the operation that the other arm nursing device of bed carries out the cooperation operation with the operating means on the AGV travelling car, realize automatic puncture, avoid manual operation, improved treatment effeciency and alleviateed medical personnel's operation intensity. Specifically, the control unit is arranged to allocate the arterial and venous line, the puncture needle and the bedside arm nursing device to operate, the bedside arm nursing device acts on the hemodialysis machine of the patient through the fixed bottom plate, provides arm pre-positioning for puncture, and accurately captures and displays the puncture range through the auxiliary mechanism, so that the puncture precision is improved; further, an end puncture actuator in the operating device is used for grabbing an arteriovenous pipeline and a puncture needle for puncture operation, so that manual puncture is avoided, the efficiency is improved, and meanwhile, the operation intensity of medical staff is relieved; after the puncturing is finished, the arm is pressed by the arm profiling pressing component and the hemostatic plaster is attached, so that the operation flow is standardized and the safety of the puncturing operation is improved; improves the accuracy of hemodialysis puncture, the treatment efficiency of the hemodialysis machine and reduces the operation intensity of medical staff.
In order to facilitate an understanding of the invention, several embodiments of the invention will be presented below. This invention may, however, be embodied in many different forms and should not be construed as limited to the embodiments set forth herein. Rather, these embodiments are provided so that this disclosure will be thorough and complete.
Example 1
Referring to fig. 5, an automatic puncturing method for hemodialysis arteriovenous fistula according to a first embodiment of the present invention includes steps S201 to S206:
s201, acquiring a target position point of the puncture position, and forming a security level ray set by taking the target position point as a guide.
In actual clinical application, the puncture path of the indwelling needle for dialysis is planned, a mathematical model of the puncture path can be simplified into an indwelling catheter tail end target indwelling target after needle insertion of an needle insertion point and an internal fistula, a formed directional line segment is provided, and a central coordinate point of the target indwelling target is set as follows: ot=(xt,yt,zt); and during puncturing, the movement range of the needle insertion point is expressed as:
；
Where Oe,i=(xi,yi,zi) is the departure point coordinate of the puncture path, i.e., the needle insertion point coordinate.
After the target site of puncture indwelling is determined, dense rays with a certain density are formed by taking the indwelling target site as a guide, and the intersection part of the rays and the needle insertion area is used for representing the whole set Mi when the puncture needle is inserted, and the set is expressed as。
As a specific example, to further demonstrate the feasibility of the present solution, modeling simulation was performed on the present solution to document the practicality of the present solution, specifically: on the skin surface of an internal fistula in the arm of a patient, the planar coordinates of z=300 are set, where the area as a puncture needle can be expressed as:
；
the needle insertion range was set to xmin=400mm,ymin=400mm,xmax=600mm,ymax =600 mm. The puncture needle insertion point is set as follows: ot= (500,500,300).
When simulation analysis is performed on puncture planning, obstacle objects need to be simplified, four boundary obstacle spheres are arranged in MATLAB software, and spherical coordinates are respectively [100 500 300;500 100 300;300 300 400;100 100 300], setting the radius of the obstacle to be 100mm; a bottom surface is provided as a puncture needle retaining plane area, the area range being long x width=400 x 400, z=200. While corresponding regions are displayed in MATLAB as shown in fig. 6.
In combination with MATLAB software tool, in the clearly planned puncture needle insertion area, the needle insertion point with the step length of 10mm is set, and the collection of all needle insertion paths combined by the needle insertion points can be drawn, as shown in fig. 7.
S202, acquiring an intersection area of rays concentrated by rays and a needle insertion area, wherein the intersection area is a puncture needle insertion area set Mi, screening out and removing an obstacle area according to the puncture needle insertion area set Mi so as to obtain an effective puncture needle insertion area, wherein the effective puncture needle insertion area comprises a plurality of puncture paths, and the puncture length Si of each puncture path is obtained according to the puncture needle insertion area set Mi, wherein the obstacle area comprises an arteriovenous vessel wall, an internal fistula stoma and a last dialysis puncture point.
In the formed collection of puncture needle insertion regions Mi, the needle insertion path inevitably has some obstacle regions, such as an arteriovenous vessel wall, an internal fistula, and a last dialysis puncture point, which need to be removed. Specifically, by adopting an image processing mode, a point cloud set of the obstacle areas can be obtained: ; during the penetration needle insertion, the needle insertion path cannot intersect with other obstacle areas, namely: Therefore, it is necessary to remove the penetration path intersecting other obstacle regions or objects, resulting in a further remaining path to form an effective penetration needle area, denoted as a collection of penetration needle paths avoiding other obstacle regions or objects. The mathematical expression of the effective penetration needle insertion area is:
；
Wherein Oe,k is the starting point coordinate Oe,k(xk,yk,zk of any puncture path, and k is the puncture path; ot is the center coordinate point Ot(xt,yt,zt of the target indwelling target at the end of the indwelling catheter after needle insertion of the internal fistula).
After the method of avoiding the action path of the obstacle region or object is determined, it is necessary to determine an optimal puncture path in Tk. When the disposable indwelling needle for dialysis is used for clinical operation, under the precondition that the puncture steel needle does not generate obvious bending deformation, the direct length of the puncture path needs to be considered, and the shorter the puncture path is, the smaller the damage to the arteriovenous fistula of the arm of a patient in clinic is; however, too short a time does not allow the blood to be drawn out efficiently. Based on the puncture needle insertion point Oe,i, the puncture length Si of the puncture path can be expressed by the following formula:
；
Where (xe,i,ye,i,ze,i) is the coordinates of the puncture needle insertion point Oe,i.
The puncture speed of the indwelling needle for dialysis of the internal fistula puncture robot is set to be Vi (T), and the puncture needle insertion time is set to be Ti, so that:
。
As a specific example, as shown in fig. 7, a plurality of needle insertion routes are generated according to the puncture points, and for the generated needle insertion routes to intersect with the obstacle, it is necessary to delete them, and finally, to determine a puncture route suitable for clinical application. It can be analyzed that according to the path set of the original and the puncture points, a part of feasible paths Oa remain under the influence of boundary conditions or obstacle objects, and further, the target optimization analysis is performed on the remaining paths.
S203, calculating to obtain the vertical distance d between the curved surface puncture point and the puncture path of the obstacle according to a point-to-tangent plane calculation formula, and optimizing the puncture path and the obstacle distance target according to the minimum distance dmin between the curved surface puncture point and the puncture path so as to obtain the optimal puncture path according to the optimization index Q.
When performing clinical operation of hemodialysis internal fistula puncture, the arterial and venous vessel wall, the internal fistula stoma, the last dialysis puncture point and the like need to be avoided, and the distance between the internal fistula puncture path and the peripheral obstacle is also an important factor in the evaluation of the optimal path in combination with the consideration of clinical safety. However, unavoidable errors occur during the operation, and a certain clearance allowance needs to be formed between the puncture path and the peripheral obstacle during the analysis to ensure the safety of the clinical operation.
Specifically, the surface of the peripheral obstacle during puncturing can be expressed by the equation f=f0 (x, y, z), and the normal equation corresponding to the position O0=（x0,y0,z0 at any point on the surface of the obstacle is:
；
It is possible to obtain the tangential plane equation at any point position O0=（x0,y0,z0) on the surface of the obstacle in the obstacle region:
；
Wherein f=f0 (x, y, z) is a mathematical expression of the surface of the peripheral obstacle at the time of puncture; o0=(x0,y0,z0) is the coordinates of any point on the surface of the obstacle;、 AndRespectively representing derivation of X, Y, Z in three axial directions at the F (O) position;
The normal vector of point O0(x0,y0,z0) on the surface can be obtained according to the point-to-tangent plane equation；
According to the puncture path, the direction vector of the puncture path can be obtained as follows:
；
In the practical calculation process, the curved surface can be decomposed into a plurality of area ranges by using a regular geometric shape to carry out simplified calculation, and the method is matched withVertical vectorThe following relationship is satisfied:
；
therefore, the perpendicular distance d between the curved surface puncture point and the puncture path can be calculated by using a point-to-tangent plane formula. By setting a set of distances of the puncture path from the obstacle, dmin is taken as the minimum distance of the path from the puncture, and the optimized objective is the path and the obstacle distance target.
In the distance between the path and the obstacle, the weight is required to be distributed, and the path and the obstacle are selected and judged by medical staff, is that in a certain process of puncturing the target, which position target meets the expected requirement. Thus, the weight factor muL epsilon [0,1] of the length of the path is set, and the distance weight factor muD epsilon [0,1] of the puncture path and the obstacle meets the following relation: muD+μL =1.
Thus, the mathematical expression of the optimization function is:
；
Wherein L (i) is the length of the ith path; d (i) is the minimum length of the ith path and the obstacle; average length of all paths; Is the average value of the minimum distance between all paths and the obstacle; muD is a length weight factor of the puncture path, muD∈[0,1];μL is a distance weight factor of the puncture path and an obstacle, muL∈[0,1],μD+μL =1, and the calculated data can obtain a balanced optimal solution between the shortest puncture path and the whole course and the obstacle object by adjusting the weight factors muD and muL.
S204, obtaining the target puncture length corresponding to the optimal puncture path according to the optimal puncture path.
S205, obtaining the angle adjustment amplitude of the puncture needle during puncture according to the puncture angle amplitude evaluation function so as to obtain the optimal angle adjustment amplitude.
The mathematical expression of the puncture angle amplitude evaluation function is:
；
wherein,；；；
Where i= {1,2,3, …, n }; n is the total amount of evaluation paths; a (i) is the angle adjustment times of the ith path; The average value of the adjustment times of all the path angles is obtained;
In the evaluation function, μD、μL, and μa are weight coefficients, μD+μL+μa =1; by adjusting the weight coefficients, an optimal balance can be obtained among the three influencing factors. After the coefficients are determined, all feasible puncture path evaluation functions Q can be calculated, and the puncture paths obtained by the smaller evaluation functions Q are the optimal puncture paths based on the basic requirements and conditions for internal fistula protection of the patient.
According to the optimization step and combining with the puncture angle amplitude evaluation function, the optimization under a single target is performed, specifically as follows:
First, the puncture path length target is referred to. Neglecting the distance of the arranged obstacle, and ensuring that the obstacle is not touched during puncture. Thus, the set influence factor μL=1、μD =0.
And calculating the length according to the feasible puncture path obtained in the simulation, wherein the range of the needle inlet evaluation function Q is [100,141.4], and the minimum Q value is selected as the optimal puncture path. As shown in fig. 8, a schematic diagram of puncture path optimization under a puncture path length target is shown, and the best path scheme is labeled in the drawing.
Next, regarding the puncture path and the obstacle distance target, the set influence factor μL=0、μD =1. The feasible puncture path avoiding the obstacle is selected, the minimum distance of the surface of the obstacle is calculated, and the distribution range of Q is obtained as [200,450], so that the optimal path scheme marked in fig. 9 is obtained, and fig. 9 is a schematic diagram of the puncture path and the puncture path under the obstacle distance target. The minimum distance from obstacle A [100 100 300] is 63.7mm and the minimum distance from obstacle B [500 100 300] is 185.3mm.
Finally, various objectives regarding the penetration path are optimized.
The puncture path optimization under two target states is obtained, and in order to comprehensively consider influence factors, the puncture paths under the optimization of a plurality of targets can be obtained by giving proper weight coefficients to each optimization target. Here, two cases are set, respectively: increasing the influencing factor of the puncture path length target, amplifying the muD factor, or increasing the puncture path and the obstacle distance target, and amplifying the muL factor.
In the first case, the influence factor μL=0.8、μD =0.2 is set, so that the distribution range of Q corresponding to all possible puncture paths is [200,300], the smallest Q is selected as the optimal puncture path, the marked path is the optimal path determined according to the requirement, and as shown in fig. 10, the puncture path is optimized for the puncture path first. Meanwhile, the minimum distance between the path and the obstacle is selected, DMIN1=86.6mm,DMIN2 =185.3mm, and the path length L is 300mm.
In the second case, the influence factor μL=0.3、μD =0.7 is set, so that the distribution range of Q corresponding to all possible puncture paths is [300,420], the smallest Q is selected as the optimal puncture path, and the marked path is the optimal path determined according to the requirement, as shown in fig. 11, and is optimized for the obstacle distance-first puncture path. At the same time, the minimum distance between the path and the obstacle is selected, DMIN1=7.2mm,DMIN2 =63.1mm, and the path length L is 415.3mm.
S206, adjusting the amplitude according to the optimal puncture path, the target puncture length and the optimal angle and performing internal fistula puncture on the patient by combining a preset path planning algorithm.
As shown in fig. 12, as a specific example, the RRT algorithm is used as a preset path planning algorithm to perform puncture needle path planning to perform internal fistula puncture on a patient, and is a sampling-based algorithm, and is extended from a puncture starting point, sampling is performed through a random function in space to obtain a random point, a node extension strategy is used to obtain a new node, whether the new node is added into a random tree is determined through collision detection, and a target point is finally added into the random tree through multiple exploration and extension to plan a puncture path.
In summary, according to the automatic puncturing method for hemodialysis arteriovenous internal fistula in the embodiment, the target position point of the puncturing position is determined firstly, then the effective puncturing needle insertion area is determined according to the target position point, the optimal puncturing path, the target puncturing length and the optimal angle adjusting amplitude are obtained according to the effective puncturing needle insertion area, and the internal fistula puncturing is carried out on a patient by combining a path planning algorithm, so that the automatic puncturing can be carried out on the patient, the hands of medical staff are avoided, the accuracy of hemodialysis puncturing is improved, and the operation intensity of the medical staff is reduced.
Example two
A second embodiment of the present invention provides an automatic puncturing system for an arteriovenous fistula, which is applied to an automatic puncturing device for an arteriovenous fistula, in particular to a control unit, the system comprising:
The first acquisition module is used for acquiring a target position point of the puncture position, and forming a dense-order ray set by taking the target position point as a guide;
The screening module is used for acquiring an intersection area of rays concentrated by rays and a needle inlet area, wherein the intersection area is a puncture needle inlet area set Mi, an obstacle area is screened out and removed according to the puncture needle inlet area set Mi so as to obtain an effective puncture needle inlet area, the effective puncture needle inlet area comprises a plurality of puncture paths, the puncture length Si of each puncture path is obtained according to the puncture needle inlet area set Mi, and the obstacle area comprises an arteriovenous vessel wall, an internal fistula stoma and a last dialysis puncture point;
The optimizing module is used for calculating and obtaining the vertical distance d between the curved surface puncture point and the puncture path of the obstacle according to the point-to-tangent plane calculation formula, and optimizing the puncture path and the obstacle distance target according to the minimum distance dmin between the curved surface puncture point and the puncture path so as to obtain the optimal puncture path according to the optimizing index Q;
The second acquisition module is used for acquiring a target puncture length corresponding to the optimal puncture path according to the optimal puncture path;
the third acquisition module is used for acquiring the angle adjustment amplitude of the puncture needle during puncture according to the puncture angle amplitude evaluation function so as to acquire the optimal angle adjustment amplitude;
and the puncture module is used for adjusting the amplitude according to the optimal puncture path, the target puncture length and the optimal angle and performing internal fistula puncture on the patient by combining a preset path planning algorithm.
In summary, in the automatic puncture system for hemodialysis arteriovenous internal fistula in this embodiment, through determining the target position point of the puncture position first, then determining the effective puncture needle insertion area according to the target position point, obtaining the optimal puncture path, the target puncture length and the optimal angle adjustment amplitude according to the effective puncture needle insertion area, and performing internal fistula puncture on the patient by combining the path planning algorithm, so that the automatic puncture can be performed on the patient, the hands-on operation of medical staff is avoided, the accuracy of hemodialysis puncture is improved, and the operation intensity of the medical staff is also reduced.
In the description of the present specification, a description referring to terms "one embodiment," "some embodiments," "examples," "specific examples," or "some examples," etc., means that a particular feature, structure, material, or characteristic described in connection with the embodiment or example is included in at least one embodiment or example of the present invention. In this specification, schematic representations of the above terms do not necessarily refer to the same embodiments or examples. Furthermore, the particular features, structures, materials, or characteristics described may be combined in any suitable manner in any one or more embodiments or examples.
The foregoing examples illustrate only a few embodiments of the invention and are described in detail herein without thereby limiting the scope of the invention. It should be noted that it will be apparent to those skilled in the art that several variations and modifications can be made without departing from the spirit of the invention, which are all within the scope of the invention. Accordingly, the scope of protection of the present invention is to be determined by the appended claims.