CN1085100C - Hemiparalysis curing instrument by central nervous stimulation - Google Patents
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Abstract
本发明涉及一种电疗装置，尤其是用于检查大脑皮层、脊髓和周围神经并且治疗偏瘫后遗症的一种电刺激装置，由发生高压宽脉冲的电刺激仪和诱发信号的检测装置组成，设有声、光显示器件，不仅能够检查诊断神经中枢及其周围神经的状况、治疗偏瘫后遗症，而且可以检查治疗效果，还可以通过声光信号作用于患者感官，使其了解治疗效果增强治愈信心。
The invention relates to an electrotherapy device, especially an electric stimulation device for examining the cerebral cortex, spinal cord and peripheral nerves and treating sequelae of hemiplegia. , The light display device can not only check and diagnose the condition of the nerve center and its peripheral nerves, treat the sequelae of hemiplegia, but also check the treatment effect, and can also act on the patient's senses through acousto-optic signals to make them understand the treatment effect and enhance their confidence in healing.
Description
本发明涉及一种电疗装置，尤其是用以检查大脑皮层、脊髓和周围运动神经并且治疗偏瘫后遗症的一种电刺激装置。The invention relates to an electric therapy device, especially an electric stimulation device for examining cerebral cortex, spinal cord and peripheral motor nerves and treating sequelae of hemiplegia.
近年来在我国对电疗或理疗装置的研究颇为活跃，其中大部分是基于中医经络理论穴位刺激以导平阴阳而治病健身的仪器，也有针对特殊疾病而对确定的病灶或部位行施刺激治疗的仪器，前者如申请号为94111293.4功率无级自增和浪涌输出的高稳定导平治疗仪，后者如申请号93119769.4电化学癌肿治疗仪。此外还有拾取对应于某种生物活动状态的信息放大处理后输出到导体而进行治病健身或经穴位取得病理生物信息，处理后负反馈至自体原穴位以治病的仪器(或系统)。与此相比较，对基于默顿(Mertou)的发现，研究低阻、高压窄电脉冲通过皮层(而非经络穴位)刺激大脑皮层运动区，并在相应运动部位检出诱发电脉冲用于诊断神经系统功能和治疗偏瘫的仪器显得寥寥。最早出现的是英国Digiter公司的D180型大脑皮层刺激仪，由直流电源、充放电容、隔离输出变压器，输出电阻、开关等组成，这种刺激仪只能提供刺激大脑皮层用的电脉冲，而且只能提供尖脉冲，幅宽也不可调，88年发明人徐军、徐兰筠公开了一种改进后的电刺激仪，专利号88208858.0，它由可调直流电源、开关电路、输出变压器、单脉冲脉宽调节器构成，发生矩形脉冲的高度、宽度都可调节，所得诱发电位重复性也好，但是和前者一样充其量也只能提供刺激大脑皮层的脉冲，不具备检测相关部位所产生诱发电位的功能，何况提供的脉冲仅是单次的，用这种仪器如果去诊断神经系统功能的话已经感到不便，如用于治疗偏瘫后遗症，效率就嫌太低了。In recent years, the research on electrotherapy or physiotherapy devices in our country is quite active, most of which are based on the meridian theory of traditional Chinese medicine to stimulate acupoints to guide the leveling of yin and yang to treat diseases and exercise fitness. The treatment apparatus, the former such as application number 94111293.4 power stepless self-increasing and surge output high stability leveling treatment instrument, the latter such as application number 93119769.4 electrochemical cancer treatment instrument. In addition, there is also an instrument (or system) that picks up information corresponding to a certain biological activity state, amplifies it, and outputs it to a conductor for treatment and fitness, or obtains pathological and biological information through acupoints, and then negatively feeds back to the original acupoints of the body to treat diseases. In contrast, based on Mertou's findings, the study of low-resistance, high-voltage narrow electrical pulses stimulates the motor areas of the cerebral cortex through the cortex (rather than meridian points), and detects evoked electrical pulses at the corresponding motor parts for diagnosis. Instruments for nervous system function and treatment of hemiplegia appear to be few and far between. The first to appear is the D180 cerebral cortex stimulator of the British Digiter Company, which is composed of a DC power supply, a charge-discharge capacitor, an isolated output transformer, an output resistor, and a switch. This stimulator can only provide electrical pulses for stimulating the cerebral cortex, and It can only provide sharp pulses, and the width cannot be adjusted. In 1988, inventors Xu Jun and Xu Lanyun disclosed an improved electric stimulator, patent No. 88208858.0, which consists of adjustable DC power supply, switching circuit, output transformer, single pulse Composed of a pulse width regulator, the height and width of the generated rectangular pulses can be adjusted, and the resulting evoked potentials have good repeatability, but at best, like the former, they can only provide pulses that stimulate the cerebral cortex, and do not have the ability to detect evoked potentials generated by related parts. function, not to mention that the pulse provided is only a single time. It is already inconvenient to use this instrument to diagnose the nervous system function. If it is used to treat the sequelae of hemiplegia, the efficiency is too low.
本发明的目的是公开一种既能提供刺激大脑皮层的脉冲又能检测出相应的诱发电位的仪器，使其不仅能有效地用于神经系统功能诊断，而且更能方便地用于偏瘫后遗症的治疗。The purpose of the present invention is to disclose an instrument that can not only provide pulses to stimulate the cerebral cortex but also detect corresponding evoked potentials, so that it can not only be effectively used in the diagnosis of nervous system function, but also more conveniently used in the diagnosis of sequelae of hemiplegia. treat.
其方案是：一种中枢刺激偏瘫治疗仪， 其特征是由电刺激仪和诱发电位检测装置组成，电刺激仪包括高频开关电源、开关电路、输出变压器、单脉冲脉宽调节器和序列脉冲发生器，高频开关电源输出端接开关电路，开关电路输出端接输出变压器，脉冲序列发生器输出端接单脉冲脉宽调节器输入端，单脉冲脉宽调节器输出端同时与高频开关电源和开关电路相连接，诱发电位检测装置包括测量放大单元、信号处理及显示单元，测量放大单元输出端接信号处理及显示单元，信号处理及显示单元的输出端与电刺激仪相连接。The scheme is: a central stimulation hemiplegia treatment instrument, which is characterized by an electric stimulator and an evoked potential detection device. The electric stimulator includes a high-frequency switching power supply, a switching circuit, an output transformer, a single-pulse pulse width regulator and a sequence pulse Generator, the output terminal of the high-frequency switching power supply is connected to the switching circuit, the output terminal of the switching circuit is connected to the output transformer, the output terminal of the pulse sequence generator is connected to the input terminal of the single-pulse pulse width regulator, and the output terminal of the single-pulse pulse width regulator is connected to the high-frequency switch at the same time The power supply is connected with the switch circuit, and the evoked potential detection device includes a measurement amplification unit, a signal processing and display unit, the output terminal of the measurement amplification unit is connected with the signal processing and display unit, and the output terminal of the signal processing and display unit is connected with the electric stimulator.
诱发电位检测装置还含有生物反馈单元，该单元设有喇叭、电流表等声光显示器件。The evoked potential detection device also includes a biofeedback unit, which is equipped with sound and light display devices such as a speaker and an ammeter.
序列脉冲发生器由振荡源、计数器、译码器、多档开关和锁电路组成，振荡源的脉冲输出端接计数器输入端，计数器输出端接译码器输入端，译码器输出端接多档开关， 多档开关的各档分别对应于不同的设定脉冲数，振荡源的脉冲输出端还与锁电路相连接。The sequence pulse generator is composed of an oscillation source, a counter, a decoder, a multi-speed switch and a lock circuit. The pulse output terminal of the oscillation source is connected to the input terminal of the counter, the output terminal of the counter is connected to the input terminal of the decoder, and the output terminal of the decoder is connected to multiple gear switch, each gear of the multi-gear switch corresponds to a different number of set pulses, and the pulse output terminal of the oscillation source is also connected to the lock circuit.
生物反馈单元包括包括一电压跟随器，该电压跟随器输入端接测量放大单元输出端，其输出端接有喇叭，喇叭声音大小反映肌电信号的大小，其输出端端还接有一二极管箝位电路和检波电路，检波电路接有电流表，电流表的读数大小反映肌电信号的大小，检波电路经分压电路和电压比校器接若干发光二极管，发光二极管亮的数目显示肌电信号的大小。The biofeedback unit includes a voltage follower, the input terminal of the voltage follower is connected to the output terminal of the measurement amplification unit, and the output terminal is connected to a speaker whose sound reflects the magnitude of the myoelectric signal, and the output terminal is also connected to a diode clamp Circuit and detection circuit, detection circuit is connected with ammeter, the reading size of ammeter reflects the size of electromyography signal, detection circuit is connected with some light-emitting diodes through voltage divider circuit and voltage ratio calibrator, the bright number of light-emitting diode shows the size of electromyography signal.
输出变压器为磁饱和脉冲变压器，内阻不小于800欧姆。The output transformer is a magnetically saturated pulse transformer with an internal resistance of not less than 800 ohms.
在治疗仪中设有序列脉冲发生器，因此它发出的用来刺激大脑皮层的脉冲不仅可以是单个的而且可以是幅度、脉宽和间隔都可调节的脉冲序列，因而可以把治疗仪调到最适合治疗的状态，仪器本身设有诱发电位的检测装置，可以随时进行测量，不仅有诊断功能而且有检查治疗效果的功能。There is a sequence pulse generator in the therapeutic apparatus, so the pulse it sends out to stimulate the cerebral cortex can be not only a single pulse sequence but also a pulse sequence with adjustable amplitude, pulse width and interval, so the therapeutic apparatus can be adjusted to In the state most suitable for treatment, the instrument itself is equipped with an evoked potential detection device, which can be measured at any time. It not only has the function of diagnosis but also has the function of checking the effect of treatment.
下面将通过实施例并对照附图详细说明：Below will be described in detail with reference to accompanying drawing by embodiment:
图面说明：Graphic description:
图1是实施例的框图；Fig. 1 is a block diagram of an embodiment;
图2是电刺激仪的结构框图；Fig. 2 is a block diagram of the structure of the electric stimulator;
图3是高频开关电源、开关电路及隔离变压器电路图；Fig. 3 is a circuit diagram of a high-frequency switching power supply, a switching circuit and an isolation transformer;
图4是单脉冲脉宽调节器电路图；Fig. 4 is a circuit diagram of a single pulse pulse width regulator;
图5是序列脉冲发生器电路图；Fig. 5 is a sequence pulse generator circuit diagram;
图6是生物反馈单元电路图。Fig. 6 is a circuit diagram of the biofeedback unit.
实施例是一台具有生物反馈装置的中枢刺激偏瘫治疗仪，它由电刺激仪和诱发电位检测装置组成，其电刺激仪由高频开关电源、开关电路、输出电路、单脉冲脉宽调节器、序列脉冲发生器构成，如图2所示。与对比技术相比增加了序列脉冲发生器。高频开关电源输出端接开关电路，开关电路输出端接输出变压器，脉冲序列发生器输出端接单脉冲脉宽调节器输入端，单脉冲脉宽调节器输出端同时与高频开关电源和开关电路相连接。其高压直流电源采用了高频开关电源，诱发电位检测装置包括测量放大单元、信号处理及显示单元和生物反馈单元，测量放大单元输出端通过生物反馈单元接信号处理及显示单元，信号处理及显示单元的输出端与电刺激仪相连接。测量放大单元有测量电极IN+、IN-、前置放大、隔离、主放大，信号处理及显示采用A/D转换器和计算机。当然为供整套仪器的需要还设有系列电源，它由变压器T1’、电源G2和隔离变压器T2’、T3’、浮地电源G1组成。The embodiment is a central stimulation hemiplegia treatment instrument with a biofeedback device, which is composed of an electric stimulator and an evoked potential detection device, and its electric stimulator is composed of a high-frequency switching power supply, a switching circuit, an output circuit, and a single-pulse pulse width regulator. , The sequence pulse generator constitutes, as shown in Figure 2. A sequential pulse generator is added compared to the comparative technique. The output terminal of the high-frequency switching power supply is connected to the switching circuit, the output terminal of the switching circuit is connected to the output transformer, the output terminal of the pulse sequence generator is connected to the input terminal of the single-pulse pulse width regulator, and the output terminal of the single-pulse pulse width regulator is simultaneously connected to the high-frequency switching power supply and the switch circuit is connected. Its high-voltage DC power supply adopts a high-frequency switching power supply. The induced potential detection device includes a measurement amplification unit, a signal processing and display unit, and a biofeedback unit. The output end of the measurement amplification unit is connected to the signal processing and display unit through the biofeedback unit. Signal processing and display The output end of the unit is connected with the electric stimulator. The measurement amplification unit includes measurement electrodes IN + , IN - , pre-amplification, isolation, and main amplification. A/D converter and computer are used for signal processing and display. Of course, there is also a series of power supplies for the needs of the whole set of instruments, which are composed of transformer T1', power supply G2, isolation transformers T2', T3', and floating power supply G1.
序列脉冲发生器如图5所示，其电路有四个部分：IC8的D、E、F非门和电阻R1、可调电阻R2、电容C1组成振荡源，IC10、IC11、IC12的六个触发器组成的计数器，IC5、IC6、IC7、IC8中8个与非门和一个非门构成的译码器以及IC6C、IC7D两个与非门、IC8B、C两个非门、IC9A触发器构成的锁电路。振荡源向外输出CP脉冲，其输出端同时接到计数器的输入端，计数器连译码器，泽码器输出接到一个多档开关K4，各档对应于1、2、5、10、15、20、30、40、50脉冲，当到了设定脉冲数时，K4输出低电平使IC7D的12脚呈低电平，CP脉冲的输出端被锁死(计数也停止)。因此K4输出“0”，IC9A的D端为“0”后下一个CP脉冲后沿才使IC9A翻转从而使IC7D封锁CP输出，所以输出脉冲是完整的而不会有半个。The sequence pulse generator is shown in Figure 5, and its circuit has four parts: D, E, F gates of IC8, resistor R1, adjustable resistor R2, and capacitor C1 form an oscillation source, and six triggers of IC10, IC11, and IC12 A counter composed of IC5, IC6, IC7, and a decoder composed of 8 NAND gates and a NOT gate in IC5, IC6, IC7, and a decoder composed of two NAND gates IC6C and IC7D, two NOT gates IC8B and C, and IC9A flip-flops lock circuit. The oscillating source outputs CP pulses to the outside, and its output terminal is connected to the input terminal of the counter at the same time. The counter is connected to the decoder, and the output of the encoder is connected to a multi-level switch K4. Each level corresponds to 1, 2, 5, 10, 15 , 20, 30, 40, 50 pulses, when the set number of pulses is reached, K4 outputs low level to make
高频开关电源以功率开关管Tr3为核心构成见图3，Tr3的集电极电路是该电源的主回路，基极上是其驱动电路。Tr3通过变压器T1初级连接滤波电容C1、整流器D1-D4及滤波器L1，T1的次级依次连接电容C3、二极管D5、D6、电容C4及电感L3、电容C5、以至电源的输出端J1-1、J1-2。Tr3的发射极通过变压器T4耦合到驱动管Tr4的集电极上，Tr4的基极(通过R4和IC2三个反向器A、B、C)接到集成电路IC1的A、B两与非门构成的单稳态的输出端，而单稳态电路的输入端通过IC2的反向器E接到IC1的C、D两与非门和IC2的F非门构成的环形振荡器输出端，环形振荡器的一点接高频开关电源输出端的电压取样电路，而取样电路由R0，Tr0、IC3、D10和W1构成。高频开关电源启动时输出端电压为0，取样电压也为0，环形振荡器起振，周期性触发单稳态而单稳态电路又周期性触发Tr4，使Tr4从而Tr3周期性导通，导通时T1的初级向次级输送能量，导通时间取决于单稳输出脉宽，选择导通时间使其和L2(漏感)及C3+C4的乘积相匹配，使Tr3在另电流时导通和关闭，从而减少电压尖峰噪声。Tr3的周期性导通，使电源主回路电压振荡升高直至升到设定值，采样电路使振荡器熄灭，单稳态电路不再翻转，Tr4和Tr3不再导通，主回路电压不再升高，只有当电压降到设定值，环形振荡器才触发单稳态电路，使Tr3导通一次，电源主回路补充能量升高电压。电刺激仪的开关电路和输出部分与对比技术无大区别，输出脉冲变压器用磁饱和式的，而变压器内阻为800Ω，使得输出单位脉冲的能量低于医疗器械行业标准YY0016-93规定的300毫集尔。The high-frequency switching power supply is composed of the power switching tube Tr3 as shown in Figure 3. The collector circuit of Tr3 is the main circuit of the power supply, and the base is its driving circuit. Tr3 is connected to filter capacitor C1, rectifier D1-D4 and filter L1 through the primary of transformer T1, and the secondary of T1 is connected to capacitor C3, diodes D5, D6, capacitor C4, inductor L3, capacitor C5, and the output terminal J1-1 of the power supply in turn. , J1-2. The emitter of Tr3 is coupled to the collector of the driving tube Tr4 through the transformer T4, and the base of Tr4 (through R4 and IC2 three inverters A, B, C) is connected to the A, B two NAND gates of the integrated circuit IC1 The output end of the monostable circuit is formed, and the input end of the monostable circuit is connected to the output end of the ring oscillator composed of the C and D NAND gates of IC1 and the F NOT gate of IC2 through the inverter E of IC2. One point of the oscillator is connected to the voltage sampling circuit at the output end of the high-frequency switching power supply, and the sampling circuit is composed of R0, Tr0, IC3, D10 and W1. When the high-frequency switching power supply is started, the output voltage is 0, the sampling voltage is also 0, the ring oscillator starts to oscillate, and the monostable circuit periodically triggers Tr4, so that Tr4 and Tr3 are periodically turned on. The primary of T1 transmits energy to the secondary when it is turned on, and the turn-on time depends on the monostable output pulse width. The turn-on time is selected to match the product of L2 (leakage inductance) and C3+C4, so that Tr3 is at another current turns on and off, reducing voltage spike noise. The periodic conduction of Tr3 makes the voltage of the main circuit of the power supply oscillate and rise until it reaches the set value, the sampling circuit turns off the oscillator, the monostable circuit no longer flips, Tr4 and Tr3 are no longer turned on, and the voltage of the main circuit is no longer When the voltage rises, only when the voltage drops to the set value, the ring oscillator triggers the monostable circuit, making Tr3 conduct once, and the main circuit of the power supply supplements energy to increase the voltage. The switching circuit and output part of the electric stimulator are not much different from the comparison technology. The output pulse transformer is magnetically saturated, and the internal resistance of the transformer is 800Ω, so that the energy of the output unit pulse is lower than the 300Ω stipulated in the medical device industry standard YY0016-93. millijill.
在偏瘫治疗中，病人的主观努力和配合是很重要的，为充分调动病人积极性，仪器设有生物反馈单元，电路见图6。肌电信号经放大器单元放大后，输入生物反馈单元，首先，它经IC1：A运放组成的电压跟随器进行隔离和功率放大，即放大后的肌电信号AMP接到IC1：A的3脚，IC1的2脚和1脚相连并与喇叭相接，喇叭的另一端接地，喇叭声音的小大，反映肌电信号的大小。In the treatment of hemiplegia, the patient's subjective efforts and cooperation are very important. In order to fully mobilize the enthusiasm of the patient, the instrument is equipped with a biofeedback unit. The circuit is shown in Figure 6. After the myoelectric signal is amplified by the amplifier unit, it is input into the biofeedback unit. First, it is isolated and power amplified by the voltage follower composed of IC1: A operational amplifier, that is, the amplified myoelectric signal AMP is connected to pin 3 of IC1: A , IC1's
IC1的1脚还接到电容C1、C3、电阻R1和二极管D1组成的二极管箝位电路。IC1的1脚接C1，C1的另一端接D1的负极和C3、R1、R2。D1的正极及C3、R1的另一端接地，R2的另一端接IC1：B运放的5脚。IC1：B运放和二极管D2、电容C2、E2组成了检波电路。IC1的7脚接D2的正极，D2的负极接IC1：B运放的6端、E2的正端和C2、电阻R11、电阻R10以及IC1：D运放的13脚。E2的负端和C2的另一端接地。R11的另一端接电流表A的正端，电流表负端接地，电流表A显示肌电信号的大小。电阻R6、R5、R4、R3、R9、R10组成分压电路。R10的另一端接R9及IC1：C运放的9脚。R9的另一端接R3及IC2：D运放的13脚。R3的另一端接R4及IC2：C运放的9脚，R4的另一端接R5及IC2：B运放的6脚，R5的另一端接R6及IC2：A运放的2脚，R6的另一端接地。R8和R7又组成分压器，其R8的一端接地，另一端接R7及IC1的12、10脚和IC2的13、9、6、2脚，R7的另一端接12V。IC1的C、D两运放和IC2的A、B、C、D四个运放组成六个电压比较器，这六个比较器的输出经由电阻R12、R13、R14、R15、R16、R17分别接至发光二极管L1、L2、L3、L4、L5、L6的负极，发光二极管正极连在12V电源。发光二极管亮的数目显示肌电信号大小。
另外，滤波电容E1的正端接12V，负端接地，IC1和1C2的11脚、4脚均分别接至12V和地。In addition, the positive end of the filter capacitor E1 is connected to 12V, the negative end is grounded, and pins 11 and 4 of IC1 and 1C2 are connected to 12V and ground respectively.
由上可见，病人通过自己努力运动病肢，病肢上产生的肌电信号经检出放大后，使生物反馈单元产生声、光、电(电表指针偏转)信号，该信号作用于病人感观，使其增强治疗信心，更加努力地运动病肢，肌电信号进一步加强，声、光、电信号发出更强的信号。如此正反馈，可增加治疗效果。It can be seen from the above that the patient moves the diseased limb with his own efforts, and the myoelectric signal generated on the diseased limb is detected and amplified, so that the biofeedback unit generates sound, light, and electricity (the deflection of the electric meter pointer) signals, which act on the patient's senses. , so that it can enhance confidence in treatment, exercise the sick limb harder, further strengthen the myoelectric signal, and send stronger signals from the sound, light, and electrical signals. Such positive feedback can increase the therapeutic effect.
除上述反馈外，本仪器还设有另一种反馈，即由病人动作病肢，自病肢检出的肌电信号经放大送往计算机进行信号处理后，在适当的时候发出让刺激仪动作的命令，皮层刺激仪发出电脉冲刺激病人皮层相应运动区，使其发出更强的命令肢体运动的电脉冲。由于皮层刺激与病人的主观努力密切结合，从而也达到更好的治疗效果。In addition to the above-mentioned feedback, this instrument also has another kind of feedback, that is, the patient moves the sick limb, and the myoelectric signal detected from the sick limb is amplified and sent to the computer for signal processing. The cortical stimulator sends out electrical pulses to stimulate the corresponding motor areas of the patient's cortex, making them send out stronger electrical pulses that command limb movement. Because the cortical stimulation is closely combined with the patient's subjective efforts, a better therapeutic effect is also achieved.
本仪器还具有运动诱发电位检测功能。皮层刺激仪刺激病人皮层运动区，在相应肢体上引出诱发电位，经放大单元放大并输入计算机进行数据处理，可得到运动诱发电位的波形显示及数据，它可以定量检测病人病情的变化情况，从而为病人和医生提供治疗效果的客观定量诊断结论，这对于提高治疗效果也具有直接和间接的作用。The instrument also has motor evoked potential detection function. The cortical stimulator stimulates the motor area of the patient's cortex, elicits evoked potentials on the corresponding limbs, and is amplified by the amplification unit and input to the computer for data processing. The waveform display and data of the motor evoked potentials can be obtained, which can quantitatively detect the changes in the patient's condition, thereby Provide patients and doctors with objective and quantitative diagnostic conclusions of treatment effects, which also have direct and indirect effects on improving treatment effects.
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| CN102058396B (en) * | 2011-01-28 | 2013-06-05 | 广州军区广州总医院 | Handheld cortex egersimeter and cortex electrostimulation |
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| CN2043120U (en) * | 1988-07-23 | 1989-08-23 | 河南省老年病研究中心 | Electric stimulator |
| CN1088121A (en) * | 1992-12-14 | 1994-06-22 | 上海交通大学 | Myoelectric feedback paralysis due to windstroke therapeutic instrument |
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| CN2043120U (en) * | 1988-07-23 | 1989-08-23 | 河南省老年病研究中心 | Electric stimulator |
| CN1088121A (en) * | 1992-12-14 | 1994-06-22 | 上海交通大学 | Myoelectric feedback paralysis due to windstroke therapeutic instrument |
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