JPH0324847B2 - - Google Patents

Description

[Detailed Description of the Invention] [Field of Industrial Application] The present invention relates to a ventricular shunt, which is used in daily life during surgery and treatment for hydrocephalus, etc., where intracranial pressure increases, and in particular, to measurement of the flow rate within the shunt. Concerning the ventricular shunt that made it possible to perform.

Intracranial pressure refers to the cerebrospinal fluid present in the cranial cavity,
This refers to the pressure exerted on the inside of the skull by the brain parenchyma, ventricles, cerebrovascular bed, etc. When the brain parenchyma, cerebrospinal fluid cavity, cerebrovascular bed, etc. increase in volume due to lesions or various other causes, intracranial pressure increases. Sometimes. Among diseases that increase intracranial pressure, a condition in which cerebrospinal fluid accumulates abnormally within the skull is called hydrocephalus.As a treatment for this hydrocephalus,
Emergency surgery and intermittent treatment are performed using ventricular shunts.

[Conventional technology]

In general, a ventricular shunt consists of a tubular ventricular catheter inserted into the ventricle and a tubular peritoneal catheter connected to this via a relay chamber such as a reservoir or pump chamber. Excess fluid, ie, excess cerebrospinal fluid resulting from differences in cerebrospinal fluid production and absorption, is allowed to drain into the peritoneal cavity through the ventricular catheter, the relay chamber, and the peritoneal catheter.

All of this treatment of cerebrospinal fluid is done inside the skin to avoid bacterial infection.

A check valve that can be pushed open by the hydraulic pressure of fluid discharged from the ventricle is provided inside the relay chamber, and the flow rate is regulated by this check valve.

[Problem that the invention seeks to solve]

By the way, during hydrocephalus surgery, etc., it may be necessary to measure the flow rate via the aforementioned relay room, but conventional ventricular shunts are not equipped with a flow rate measurement means, so it is not possible to measure the flow rate appropriately for the patient. The problem is that it is difficult to administer appropriate medical treatment.

The present invention aims to solve such problems, and by providing a flow rate measuring means in a relay chamber attached to a patient, a flow rate measuring means that can contribute to appropriate medical treatment is provided. The purpose is to provide a measured ventricular shunt.

[Means for solving problems]

For this reason, the flow measurement type ventricular shunt of the present invention,
In a ventricular shunt that includes a ventricular catheter inserted into the ventricle, a relay chamber connected to the ventricular catheter, and a peritoneal catheter connected to the relay chamber, the upper wall of the relay chamber is formed with a membrane. a pulsating chamber for measuring a flow rate, and a first measuring check valve that can be pushed open by a hydraulic pressure equal to or higher than a first predetermined value in order to introduce a flow from the upstream side into the pulsating chamber; A second measurement check valve is provided that can be pushed open by a fluid pressure of a second predetermined value or more, which is greater than the first predetermined value, in the pulsation chamber to discharge the fluid in the pulsation chamber to the peritoneal catheter. It is characterized by the fact that

[Effect]

In the flow measurement type ventricular shunt of the present invention described above,
Fluid discharged from the patient's ventricle flows into the pulsating chamber through the first measurement check valve with a fluid pressure equal to or higher than a first predetermined value, while inflating the upper wall of the pulsating chamber. When the fluid pressure exceeds a second predetermined value, the fluid in the pulsation chamber flows out into the peritoneal catheter through the second measuring check valve, and the upper wall of the pulsation chamber becomes deflated. Return.

The amount of fluid flowing out of the upper wall of the pulsating chamber with a single pulsation can be measured in advance by conducting a simulation experiment before installing the ventricular shunt on the patient. By measuring the time until the next pulsation, the flow rate can be determined through the calibration means.

〔Example〕

Hereinafter, an embodiment of the present invention will be explained with reference to the drawings. Figures 1 and 2 show a flow measurement type ventricular shunt as an embodiment of the present invention, and Figure 1 shows the ventricular shunt with its upper wall removed. The plan view, FIG. 2 is a sectional view taken along the - arrow in FIG. 1, and FIG. 3 is a plan view with the upper wall of the electromagnetic box used for switching the flow rate of the ventricular shunt removed.

As shown in Figures 1 and 2, a relay chamber 1 made of a soft wall made of silicone resin, etc. is a small chamber-shaped reservoir 1.
A and a valve chamber 1b that communicates with the reservoir 1a, and a tubular ventricular catheter 2 inserted into the patient's ventricle is connected to the reservoir 1a.

In addition, a pulsating chamber C for flow rate measurement is provided in the downstream part of the relay chamber 1, and the upper wall 1e is formed of an elastic membrane. A first measurement check valve 14a that can be pushed open by a hydraulic pressure equal to or higher than a first predetermined value is provided so as to introduce the flow of the first measurement check valve 14a.
A second measuring check valve 14b is provided which can be pushed open by a hydraulic pressure equal to or higher than a second predetermined value, which is greater than the predetermined value of , to discharge the liquid in the pulsation chamber C to the peritoneal catheter 3.

Furthermore, a partition wall 1c is provided to partition the inside of the relay chamber 1 into an upstream compartment A and a downstream compartment B, with the upstream compartment A communicating with the ventricular catheter 2 and the downstream compartment B being connected to the ventricular catheter 2. It communicates with the peritoneal catheter 3 via the pulsation chamber C.

That is, the flow from the downstream compartment B is guided to the first measurement check valve 14a, and the flow from the pulsation chamber C to the first measurement check valve 14a is connected to the first measurement check valve 14a. A partition wall 14c is provided so that the flow toward the peritoneal catheter 3 through the second measurement check valve 14b does not mix with the flow.

Then, fluid discharged from the patient's ventricle passes through the ventricular catheter 2, passes through the reservoir 1a, and then passes through the valve ventricle 1b.
When the discharge liquid flows into the upstream compartment A, the first
A check valve 4, a second check valve 5, and a third check valve 6 are provided on the partition wall 1c at positions spaced apart in the radial direction from a reference position 7 within the valve chamber 1b.

The first check valve 4 has a larger regulated flow rate than the second check valve 5, and the second check valve 5 has a larger regulated flow rate than the third check valve 6, In this embodiment, each of the check valves 4, 5, and 6 is configured as a single slit type check valve, but these may be of a cross slit type, a spring type, or a membrane type. You may also change it to . In addition, even in the case of the maximum flow rate when all the first to third check valves 4 to 6 are open, the first measurement The check valve 14a has a sufficiently large regulated flow rate.

In the upstream compartment A, the partition wall 1c has circular valve seats 4a surrounding each check valve 4, 5, 6, respectively.
5a, 6a are provided, and each valve seat 4a, 5a,
6a to selectively close each of the check valves 4, 5, 6, so that the movable sphere 8 made of a magnetic material can be moved by receiving a magnet generated by an electromagnet from outside the valve chamber 1b. It is enclosed in the upstream compartment A.

Further, at the reference position 7, a circular seat 9 for seating the movable sphere 8 is formed on the surface of the partition wall 1c in the upstream compartment A.

When the movable sphere 8 is seated on each valve seat 4a, 5a, 6a or the circular seat 9, the position of the movable sphere 8 is held by being held between the soft wall of the valve chamber 1b. ing. In addition, flexible receiving plates 4b, 5b, 6b, and 13 for cushioningly receiving the movable sphere 8 that moves by magnetic force are integrated with the partition wall 1c in the vicinity of each valve seat 4a, 5a, and 6a, and the circular seat 9, respectively. It is installed protrudingly.

Further, between the reservoir 1a and the circular seat 9, a sphere holding part 10 is provided as a valve seat, which is formed on the soft wall of the upstream compartment A and the partition wall 1c. By pushing the second movable sphere 11 made of magnetic material with magnetic force, the valve chamber 1 is moved from the reservoir 1a.
Each check valve 4, 5, 6 in the upstream compartment A of b
The flow of liquid towards is blocked.

Then, when keeping the holding part 10 in the open state, the second
A locking plate 12 for locking the movable sphere 11 of
Near the upstream side of the circular seat 9, it is provided on the partition wall 1c integrally with the receiving plate 13 of the movable sphere 8.

Although a magnetic material such as iron is used as the material for each movable sphere 8, 11, it is desirable that the surface of the metal sphere be coated with silicone resin or the like.

As shown in FIG. 3, the electromagnet box 20 is
A plurality of electromagnets 21, 22a, 22b, 23-25 for driving each movable sphere 8, 11 by magnetic force
When using this, the ventricular shunt relay chamber 1 is implanted under the skin of the patient's head.
The electromagnetic box 20 is fixed to the outside of the patient's head via a belt (not shown) along the patient's head.

And each electromagnet 21, 22a, 22b, 23
-25 are each receiving plate 4b, 5b, 6 in relay room 1
b, 13, the locking plate 12, and the holding part 10, so as to be able to take a relative position as shown in FIG.

In addition, each electromagnet 21, 22a, 22b, 23-2
5 is selectively excited.
A wire harness connected to these electromagnets
It is connected to a DC power source via a switch on an operation panel (not shown).

Note that the bottom wall of the electromagnet box 20 is connected to the relay room 1.
A recess corresponding to the height is formed, so that the electromagnetic box 20 can be stably attached to the patient's head.

With the above configuration, electromagnet box 2 in FIG.
Only the pair of electromagnets 22a and 22b at 0 are excited to generate a magnetic force that attracts the movable sphere 8 toward the receiving plate 13 and attracts the second movable sphere 11 toward the locking plate 12. As shown in FIGS. 1 and 2, when the movable sphere 8 is seated on the circular seat 9 and the second movable sphere 11 is engaged with the locking plate 12, the ventricular catheter 2 is removed from the patient's ventricle.
The effluent that has flowed into the reservoir 1a through
It enters the upstream compartment A of the valve chamber 1b, passes through three check valves 4, 5, and 6, and enters the downstream compartment B.

The drained fluid in this downstream compartment B further passes through the peritoneal catheter 3 and flows into the patient's peritoneal cavity.

In this way, the fluid discharged from the ventricle can flow at the maximum flow rate as the sum of the regulated flow rates of the three check valves 4, 5, 6.

Next, when it is desired to reduce the flow rate slightly, by energizing only the electromagnet 25, the movable sphere 8 is attracted so as to be driven from the circular seat 9 toward the receiving plate 6b, and the flow to the third check valve 6 is reduced. A movable sphere 8 is attached to the valve seat 6a in the path.
It is sufficient to close the check valve 6 by closing the check valve 6, and as a result, the discharged liquid is discharged from the first valve, which has a large regulated flow rate.
The flow can only flow through the check valve 4 and the second check valve 5, which has the next highest regulated flow rate.

Also, if you want to make the flow rate even smaller, use the electromagnet 2
After the movable sphere 8 is once returned from the valve seat 6a to the circular seat 9 by excitation of only 2a and 22b, the movable sphere 8 is seated on the valve seat 5a leading to the second check valve 8 by excitation of only the electromagnet 24. The check valve 5 may be closed by using the regulated flow rate, so that the discharged liquid flows only through the first check valve 4, which has the largest regulated flow rate, and the third check valve 6, which has the smallest regulated flow rate. be able to.

Additionally, if you want to minimize the flow rate, electromagnet 2
After the movable sphere 8 is once returned from the valve seat 5a to the circular seat 9 by excitation of only 2a and 22b, the movable sphere 8 is seated on the valve seat 4a leading to the first check valve 4 by excitation of only the electromagnet 23. Then, the check valve 4 can be closed, thereby allowing the drained liquid to flow at the minimum flow rate through only the second and minimum check valves 5 and 6 of the regulated flow rate.

In addition, if it is desired to stop the outflow of fluid through the ventricular shunt, the second movable sphere 11 is moved to the sphere holding part 10 by energizing only the electromagnet 21.
The flow path from the reservoir 1a to the valve chamber 1b may be closed.

As mentioned above, in this embodiment, three check valves 4-
Since 6 have mutually different regulated flow rates, 3
Four-stage flow rate switching is performed using the check valves 4, 5, and 6, but if two check valves are used and each has different regulated flow rates, three-stage flow rate switching can be performed. .

In addition, even if there are two check valves and each check valve has the same regulated flow rate, there are two cases: when the flow is allowed to flow to only one of them, and when it is allowed to flow to both.
Stepwise flow rate switching can be performed.

As described above, the regulated flow rate can be controlled by operating the flow rate switching check valve, but this alone does not allow accurate knowledge of the actual flow rate.

In the ventricular shunt of the present invention, in order to accurately know the above-mentioned flow rate, a pulsating chamber C having an upper wall 1e as a membrane, and first and second measurement check valves 1 are provided.
A flow rate measuring mechanism consisting of 4a and 14b is provided.

That is, the flow that flows into the downstream compartment B through all or part of the flow rate switching check valves 4 to 6 directly flows into the pulsation chamber C through the first measuring check valve 14a. However, since the second measurement check valve 14b does not open unless the liquid pressure in the pulsation chamber C reaches a relatively large predetermined value or more, the membrane upper wall 1e of the pulsation chamber C As the liquid in C increases, it expands, and as the liquid is discharged from the second measurement check valve 14b, it deflates, causing pulsation.

The amount of fluid flowing out with one pulsation of the upper wall 1e of the pulsating chamber C can be measured in advance by conducting a simulation experiment before installing the ventricular shunt on the patient. By measuring the time from one pulsation to the next pulsation, the flow rate can be accurately determined through the calibration means.

Although pulsation phenomena can be detected visually,
A detector including a sensor with an electronic circuit that closes its contacts in response to the pulsation may be attached to the outside of the patient's head, and a recorder may be provided to automatically record the detection results.

In addition, in the above-mentioned simulation experiment, it is desirable to take into account the effect of the patient's head skin covering the upper wall 1e of the pulsation chamber C as an elastic membrane.

〔Effect of the invention〕

As detailed above, according to the flow measurement type ventricular shunt of the present invention, the relay chamber that connects the ventricular catheter and the peritoneal catheter is provided with a flow measurement pulsation chamber whose upper wall is formed of a membrane, A first measurement check valve that can be pushed open by a hydraulic pressure equal to or higher than a first predetermined value is provided in order to introduce a flow from the upstream side into the pulsation chamber, and a first measurement check valve that can be pushed open by a hydraulic pressure equal to or higher than a first predetermined value is provided. It has a simple structure in which a second measuring check valve is provided, which is pushed open by a hydraulic pressure equal to or higher than a second predetermined value and can discharge the fluid in the pulsating chamber to the peritoneal catheter, which is difficult to do in the past. By detecting the pulsations on the upper wall of the pulsation chamber, accurate measurement of the flow rate, which has previously been performed, has the advantage of being extremely easy and safe.

In particular, in the present invention, a pulsation chamber whose upper wall is formed of a membrane is provided in the relay chamber, and a first measuring check valve capable of introducing a flow from the upstream side into the pulsation chamber, and a liquid in the pulsation chamber. A second measuring check valve is provided to allow the fluid to flow out into the peritoneal catheter on the downstream side.
Since the predetermined hydraulic pressure that can open the second measuring check valve is set higher than the predetermined hydraulic pressure that can open the second measuring check valve, pulsation in the pulsation chamber can be performed accurately. By measuring the time from one pulsation to the next, the flow rate can be accurately determined through the calibration means.

[Brief explanation of drawings]

Figures 1 and 2 show a flow measurement type ventricular shunt as an embodiment of the present invention. Figure 1 is a plan view with the upper wall removed, and Figure 2 is the same as in Figure 1.
It is a sectional view taken in the direction of arrows, and FIG. 3 is a plan view showing the electromagnetic box used for switching the flow rate of the ventricular shunt with the upper wall removed. 1... Relay chamber, 1a... Reservoir, 1b... Valve chamber, 1c... Septum, 1e... Elastic membrane on the upper wall of the pulsating chamber, 2... Ventricular catheter, 3... Peritoneal catheter, 4... No. 1 check valve, 5... second check valve, 6... third check valve, 4a, 5a, 6a...
...Circular valve seat, 4b, 5b, 4b...Socket plate, 7...
Reference position, 8...Movable sphere, 9...Round seat, 10...
... Holding part, 11 ... Second movable sphere, 12 ... Locking plate, 13 ... Reception plate, 14a ... First measurement check valve, 14b ... Second measurement check valve , 14c...
...Partition wall, 20...Electromagnetic box, 21, 22
a, 22b, 23-25...electromagnet, A...upstream compartment, B...downstream compartment, C...pulsation chamber.

Claims (1)

[Scope of Claims] 1. In a ventricular shunt comprising a ventricular catheter inserted into a ventricle, a relay chamber connected to the ventricular catheter, and a peritoneal catheter connected to the relay chamber, the relay chamber is provided with a pulsating chamber for flow measurement whose upper wall is formed of a membrane, and a first measuring chamber that can be pushed open by a hydraulic pressure of a first predetermined value or higher to introduce a flow from the upstream side into the pulsating chamber. A stop valve is provided, and the first valve in the pulsation chamber is provided with a stop valve.
A second measurement check valve is provided that can be pushed open by a hydraulic pressure equal to or higher than a second predetermined value that is greater than the predetermined value of , and can discharge the fluid in the pulsation chamber to the peritoneal catheter. , flow-metered ventricular shunt. 2. Claim 1, characterized in that a plurality of flow rate switching check valves are provided upstream of the first measuring check valve in the relay room.
Flow-measuring ventricular shunt as described in section. 3. A partition is provided to partition the interior of the relay chamber into an upstream compartment that communicates with the ventricular catheter and a downstream compartment that communicates with the peritoneal catheter via the pulsation chamber, and the partition wall has the plurality of flow rates. The flow rate measuring type ventricular shunt according to claim 2, characterized in that a switching check valve is provided.