JP2010264079A - Insertion type artificial myocardial system - Google Patents
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Abstract
Description
本発明は、心不全などの際、心臓の収縮を助けるために用いる挿入型人工心筋システムに関するものである。 The present invention relates to an insertion type artificial myocardial system used for assisting the contraction of the heart in the case of heart failure or the like.
従来、致死的な不整脈による心不全、急性心不全、慢性心不全の急性悪化などの急激に進行する重症心不全に対しては、薬剤加療や大動脈バルーンポンプ、補助人工心臓や心臓移植が用いられている。しかしながら、重症心不全の一部は薬剤加療に対する抵抗性があり、また重症なものは薬剤だけでは治療が追い付かない症例が多い。大動脈バルーンポンプは血栓形成の危険があり、心補助効果は不充分である。補助人工心臓は大掛かりな開胸手術が必要なため緊急時に間に合わない。心臓移植は世界的に見てもドナー不足が深刻である。 Conventionally, drug treatment, aortic balloon pumps, auxiliary artificial hearts, and heart transplants have been used for rapidly progressing severe heart failure such as heart failure due to lethal arrhythmia, acute heart failure, and acute deterioration of chronic heart failure. However, some severe heart failure is resistant to drug treatment, and many severe cases fail to catch up with drugs alone. The aortic balloon pump has a risk of thrombus formation, and the cardiac assist effect is insufficient. The auxiliary artificial heart is not in time for an emergency because it requires a large thoracotomy. Heart transplantation has a serious donor shortage worldwide.
このような技術は、例えば特許文献１や特許文献２に開示されている。特許文献１には、補助人工心臓が記載されている。しかし、この特許文献１に開示された方法では、血栓や感染症の危険があるという欠点がある。 Such a technique is disclosed in, for example, Patent Document 1 and Patent Document 2. Patent Document 1 describes an auxiliary artificial heart. However, the method disclosed in Patent Document 1 has a drawback in that there is a risk of blood clots and infectious diseases.
また、特許文献２には、埋め込み型補助人工心臓が記載されている。この特許文献２に開示の方法によると、血栓形成という問題が生じる。 Patent Document 2 describes an implantable auxiliary artificial heart. According to the method disclosed in Patent Document 2, a problem of thrombus formation occurs.
上記のように従来の技術では、薬剤抵抗性の急性心不全に対しては、緊急の救急現場では治療法がないという問題があった。 As described above, the conventional technique has a problem in that there is no cure for drug-resistant acute heart failure at an emergency emergency site.
本発明は、上記状況に鑑みて、心室表面に選択的に吸着することで、必要な部位の心臓の収縮を適切に補助することができる挿入型人工心筋システムを提供することを目的とする。 In view of the above situation, an object of the present invention is to provide an insertion type artificial myocardial system capable of appropriately assisting the contraction of the heart at a necessary site by selectively adsorbing to the surface of the ventricle.
〔１〕挿入型人工心筋システムにおいて、心臓の心筋表面に吸着装置によって吸着され、心臓の心室の収縮の一部を機械的に補助する人工心筋装置を有することを特徴とする。 [1] An insertion type artificial myocardial system is characterized by having an artificial myocardial device that is adsorbed on the myocardial surface of the heart by an adsorbing device and mechanically assists a part of the contraction of the heart ventricle.
〔２〕上記〔１〕記載の挿入型人工心筋システムにおいて、前記吸着装置は心室の収縮力が弱まった部位の外側の心筋表面に空気圧で吸着させ、前記人工心筋装置が前記収縮力の低下した部位だけを収縮補助するようにしたことを特徴とする。 [2] In the insertion type artificial myocardial system according to [1], the adsorbing device is adsorbed by air pressure to the myocardial surface outside the site where the contractile force of the ventricle is weakened, and the artificial myocardial device has reduced the contractile force. It is characterized in that only the part is assisted in contraction.
〔３〕上記〔１〕又は〔２〕記載の挿入型人工心筋システムにおいて、緊急時に、左第四肋間又は左第五肋間の小切開部から、前記人工心筋装置を挿入できるようにしたことを特徴とする。 [3] In the insertion type artificial myocardial system according to [1] or [2], the artificial myocardial device can be inserted from a small incision between the left fourth and fifth ribs in an emergency. Features.
〔４〕上記〔１〕から〔３〕の何れか一項記載の挿入型人工心筋システムにおいて、前記人工心筋装置は、空気圧、油圧、小型モータの圧力、又は形状記憶合金の変形応力を用いて心室を圧迫することで、心臓の収縮を補助することを特徴とする。 [4] In the insertion type artificial myocardial system according to any one of [1] to [3], the artificial myocardial device uses air pressure, hydraulic pressure, pressure of a small motor, or deformation stress of a shape memory alloy. It is characterized by assisting the contraction of the heart by compressing the ventricle.
〔５〕上記〔１〕から〔４〕の何れか一項記載の挿入型人工心筋システムにおいて、前記人工心筋装置（１１）は、第１のドライブライン（１２）と、この第１のドライブライン（１２）から両側に分岐し逆止弁（１３Ａ，１３Ａ′）を有する第２のドライブライン（１３，１３′）と、この第２のドライブライン（１３，１３′）の先端に接続される空気路を有する平板状アーム（１４，１４′）と、この平板状アーム（１４，１４′）に配置される複数の吸盤を有する吸着装置（１５，１５′）と、前記平板状アーム（１４，１４′）間に配置される保持布（１６）と、この保持布（１６）上に配置され前記第１のドライブライン（１２）に接続されるバルーン（１７）を具備することを特徴とする。 [5] In the insertion type artificial myocardial system according to any one of [1] to [4], the artificial myocardial device (11) includes a first drive line (12) and the first drive line. The second drive line (13, 13 ') branching from (12) to both sides and having check valves (13A, 13A') is connected to the tip of the second drive line (13, 13 '). A flat arm (14, 14 ') having an air passage, a suction device (15, 15') having a plurality of suction cups arranged on the flat arm (14, 14 '), and the flat arm (14) , 14 ′) and a balloon (17) disposed on the retaining cloth (16) and connected to the first drive line (12). To do.
本発明によれば、収縮力が弱まっている心室の表面に選択的に吸着させることで、その部位の収縮を適切に補助することができる挿入型人工心筋システムを得ることができる。 ADVANTAGE OF THE INVENTION According to this invention, the insertion type artificial myocardial system which can assist the contraction of the site | part appropriately by selectively making it adsorb | suck to the surface of the ventricle where the contractile force is weak can be obtained.
また、緊急時に、左第四肋間や左第五肋間の小切開部から挿入できる人工心筋装置を提供することができ、救命救急時に簡単に利用できる挿入型人工心筋システムが得られる。 In addition, an artificial myocardial device that can be inserted through a small incision between the left fourth and fifth intercostals in an emergency can be provided, and an insertion type artificial myocardial system that can be easily used for lifesaving is obtained.
本発明の挿入型人工心筋システムは、心臓の心筋の表面に吸着装置によって吸着され、心臓の心室の収縮の一部を機械的に補助する人工心筋装置を有する。 The insertion-type artificial myocardial system of the present invention has an artificial myocardial device that is adsorbed to the surface of the heart's myocardium by an adsorption device and mechanically assists a part of the heart's ventricular contraction.
以下、本発明の実施の形態について詳細に説明する。 Hereinafter, embodiments of the present invention will be described in detail.
図１は本発明の実施例を示す人工心筋装置が心臓に配置された状態を示す図、図２はその人工心筋装置の構成図である。 FIG. 1 is a diagram showing a state in which an artificial myocardial device according to an embodiment of the present invention is placed in the heart, and FIG. 2 is a configuration diagram of the artificial myocardial device.
図１において、１は大動脈、２は大静脈、３は左肺動脈、４は右心房、５は左心房、６は右心室、７は左心室、１１は心臓の収縮力が弱まった部位の外側に配置される人工心筋装置、１２は第１のドライブライン、１３，１３′は第２のドライブライン、１３Ａ，１３Ａ′は負の空気圧の時にのみ開かれる逆止弁、１４，１４′は空気路を有する平板状のアーム、１５，１５′は複数の吸盤を有する吸着装置、１６は保持布、１７は保持布１６上に配置されるバルーン１７である。 In FIG. 1, 1 is the aorta, 2 is the vena cava, 3 is the left pulmonary artery, 4 is the right atrium, 5 is the left atrium, 6 is the right ventricle, 7 is the left ventricle, and 11 is the outside of the site where the contractile force of the heart is weakened. 12 is a first drive line, 13 and 13 'are second drive lines, 13A and 13A' are check valves that are opened only at negative air pressure, and 14 and 14 'are air. A plate-like arm having a path, 15 and 15 ′ are suction devices having a plurality of suction cups, 16 is a holding cloth, and 17 is a balloon 17 disposed on the holding cloth 16.
この人工心筋装置１１は、図２に示すように、第１のドライブライン１２と、この第１のドライブライン１２から両側に分岐する二本の第２のドライブライン１３，１３′に接続される空気路を有する平板状のアーム１４，１４′とを有している。このアーム１４，１４′には、空気路に接続され負の空気圧で心臓の心筋の表面に吸着する複数の吸盤を有する吸着装置１５，１５′が配置されている。これらの各部材は、生体適合性のシリコンなどの材料で製作されている。 As shown in FIG. 2, the artificial myocardial device 11 is connected to a first drive line 12 and two second drive lines 13 and 13 ′ branched from the first drive line 12 to both sides. And plate-like arms 14 and 14 'having air passages. The arms 14 and 14 'are provided with suction devices 15 and 15' having a plurality of suction cups that are connected to an air passage and are sucked to the surface of the heart myocardium with negative air pressure. Each of these members is made of a material such as biocompatible silicon.
また、アーム１４，１４′間には保持布１６が配置され、その保持布１６上に第１のドライブライン１２に接続されるグラスファイバー製などのバルーン１７が配置されている。 A holding cloth 16 is disposed between the arms 14 and 14 ′, and a balloon 17 made of glass fiber or the like connected to the first drive line 12 is disposed on the holding cloth 16.
図２に示される人工心筋装置１１は、右心室６及び左心室７に対応する心臓の収縮力が弱まった部位の外側に、複数の吸盤を有する吸着装置１５，１５′によりセットされる。この吸着装置１５，１５′は心筋の表面に第２のドライブライン１３，１３′からの負の空気圧で固定される。この人工心筋装置１１を配置し、第１のドライブライン１２から空気圧、油圧等でバルーン１７を機械的に駆動することにより、心臓の収縮力が弱まった部位の収縮が補助される。 The artificial myocardial device 11 shown in FIG. 2 is set by suction devices 15 and 15 ′ having a plurality of suction cups outside the portion corresponding to the right ventricle 6 and the left ventricle 7 where the contractile force of the heart is weakened. The suction devices 15 and 15 'are fixed to the surface of the myocardium with negative air pressure from the second drive lines 13 and 13'. The artificial myocardial device 11 is arranged, and the balloon 17 is mechanically driven from the first drive line 12 by air pressure, hydraulic pressure or the like, so that the contraction of the portion where the contraction force of the heart is weakened is assisted.
なお、上記した空気圧・油圧のような流体による補助に代えて、形状記憶合金の変形応力を用いて収縮を行うようにしてもよい。 In addition, it may replace with assistance by fluids, such as the above-mentioned air pressure and hydraulic pressure, and you may make it shrink using the deformation stress of a shape memory alloy.
図３は本発明の実施の態様を示す挿入型人工心筋システムの挿入の様子を示す模式図である。 FIG. 3 is a schematic view showing an insertion state of the insertion type artificial myocardial system showing the embodiment of the present invention.
この図において、１８は人工心筋装置１１の駆動制御装置、１９は駆動制御装置１８へ接続されるチューブ、２０は小切開部、２１は左第四肋間、２２は第四肋骨、２３は第五肋骨である。 In this figure, 18 is a drive control device of the artificial myocardial device 11, 19 is a tube connected to the drive control device 18, 20 is a small incision part, 21 is the left fourth intercostal space, 22 is the fourth rib, and 23 is the fifth. It is a rib.
上記した人工心筋装置１１は、左第四肋間２１（左第五肋間でもよい）の小切開部２０から簡単に挿入できるようにしている。急性の心不全、慢性心不全の急性悪化が起きた場合、この人工心筋装置１１を心臓の収縮力が弱まっている部位の外側にセットして、駆動制御装置１８によりチューブ１９を介して負の空気圧で吸着装置１５，１５′を固定し、バルーン１７を駆動制御装置１８により機械的に駆動させる。このバルーン１７を利用して心室の収縮を助けることで、循環を維持することができる。本発明の人工心筋装置は、左第四肋間２１（又は左第五肋間）の小切開部２０から挿入できる簡単な構成なので、救急現場で役に立つ挿入型人工心筋システムを提供することができる。なお、本発明の人工心筋装置は、患者の体型に応じて、左第六肋間の小切開部から挿入するようにしてもよい。 The above-described artificial myocardial device 11 can be easily inserted from the small incision portion 20 in the left fourth intercostal space 21 (or the left and fifth intercostal space). When acute heart failure or acute exacerbation of chronic heart failure occurs, the artificial myocardial device 11 is set outside the region where the contractile force of the heart is weakened, and the drive controller 18 applies negative air pressure via the tube 19. The suction devices 15 and 15 ′ are fixed, and the balloon 17 is mechanically driven by the drive control device 18. By using this balloon 17 to assist the contraction of the ventricle, circulation can be maintained. Since the artificial myocardial device of the present invention has a simple configuration that can be inserted through the small incision portion 20 in the left fourth intercostal space 21 (or the left fifth intercostal space), it is possible to provide an insertion type artificial myocardial system that is useful at an emergency site. The artificial myocardial device of the present invention may be inserted through a small incision between the sixth left ribs depending on the patient's body shape.
図４は本発明の実施例を示す挿入型人工心筋システムのセットフローチャートである。 FIG. 4 is a set flow chart of an insertion type artificial myocardial system showing an embodiment of the present invention.
（１）まず、左第四肋間２１の小切開部２０から人工心筋装置１１を挿入する（ステップＳ１）。 (1) First, the artificial myocardial device 11 is inserted from the small incision 20 in the left fourth intercostal space 21 (step S1).
（２）人工心筋装置１１を心臓の収縮力が低下した部位に位置決めできたことを確認する（ステップＳ２）。 (2) It is confirmed that the artificial myocardial device 11 can be positioned at a site where the contractile force of the heart is reduced (step S2).
（３）人工心筋装置１１を心臓の収縮力が低下した部位に位置決めできたら、駆動制御装置１８により、チューブ１９を介して第２のドライブライン１３，１３′を負の空気圧にして、人工心筋装置１１を心臓の収縮力低下部位の外側に固定する（ステップＳ３）。 (3) When the artificial myocardial device 11 can be positioned at the site where the contraction force of the heart is reduced, the drive control device 18 makes the second drive lines 13 and 13 'negative air pressure via the tube 19, and the artificial myocardium The apparatus 11 is fixed to the outside of the contraction force reduction site of the heart (step S3).
（４）人工心筋装置１１の固定ができたら、駆動制御装置１８により、チューブ１９−第１のドライブライン１２を介してバルーン１７を駆動させ、心臓の心室の収縮を助ける（ステップＳ４）。つまり、バルーン１７内の空気圧を交互に高くしたり低くしたりして、心室を圧迫することで心臓の収縮を補助する。 (4) When the artificial myocardial device 11 is fixed, the balloon 17 is driven by the drive control device 18 via the tube 19-the first drive line 12 to help the heart ventricle contraction (step S4). That is, the contraction of the heart is assisted by pressing the ventricle by alternately increasing or decreasing the air pressure in the balloon 17.
なお、ここでは、空気圧により、バルーン１７を駆動させるようにしたが、油圧で行うようにしてもよい。また、小型モータの圧力、又は形状記憶合金の変形応力を用いて、心臓の収縮を補助するようにしてもよい。 Here, the balloon 17 is driven by air pressure, but it may be hydraulically performed. Further, the contraction of the heart may be assisted by using the pressure of the small motor or the deformation stress of the shape memory alloy.
なお、本発明は上記実施例に限定されるものではなく、本発明の趣旨に基づき種々の変形が可能であり、これらを本発明の範囲から排除するものではない。 In addition, this invention is not limited to the said Example, Based on the meaning of this invention, a various deformation | transformation is possible and these are not excluded from the scope of the present invention.
本発明に係る人工心筋装置は、心室の心不全だけでなく、心房細動の収縮補助などの様々な分野に適用できる。 The artificial myocardial device according to the present invention can be applied not only to ventricular heart failure but also to various fields such as assisting contraction of atrial fibrillation.
また、本発明の人工心筋装置は、緊急時の蘇生（リサシテーション）システムとして広く用いることができる。 The artificial myocardial device of the present invention can be widely used as an emergency resuscitation system.
１ 大動脈
２ 大静脈
３ 左肺動脈
４ 右心房
５ 左心房
６ 右心室
７ 左心室
１１ 人工心筋装置
１２ 第１のドライブライン
１３，１３′ 第２のドライブライン
１３Ａ，１３Ａ′ 逆止弁
１４，１４′ 空気路を有する平板状のアーム
１５，１５′ 吸着装置
１６ 保持布
１７ バルーン
１８ 駆動制御装置
１９ チューブ
２０ 小切開部
２１ 左第四肋間
２２ 第四の肋骨
２３ 第五の肋骨
1 aorta 2 vena cava 3 left pulmonary artery 4 right atrium 5 left atrium 6 right ventricle 7 left ventricle 11 artificial myocardial device 12 first drive line 13, 13 'second drive line 13A, 13A' check valve 14, 14 ' Flat arm 15, 15 ′ having air passage 16 Adsorber 16 Holding cloth 17 Balloon 18 Drive controller 19 Tube 20 Small incision 21 Left fourth fourth rib 22 Fourth rib 23 Fifth rib
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| WO2009088916A1 (en) * | 2008-01-08 | 2009-07-16 | National Cheng Kung University | Cardiac compression system |
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