CN113041422A - Clinical decision system for hemodialysis access function monitoring and assessment - Google Patents

Abstract

The invention discloses a clinical decision-making system for hemodialysis access function monitoring and evaluation, which comprises a monitoring module for monitoring a patient and a decision-making module for assisting a doctor to make judgment; wherein the monitoring module comprises a hemodialysis machine, a plurality of pressure sensors and an ultrasonic probe sensor which are arranged on an extracorporeal circulation blood path; the decision module comprises a decision tree algorithm made based on a blood vessel access guide and a scoring system matched with the algorithm; the monitoring module transmits the acquired data to the decision module, and the decision module automatically generates corresponding guidance opinions to assist a doctor in making a judgment. The invention can improve the efficiency and the accuracy of hemodialysis vascular access management and provide feasible medical decisions. Meanwhile, the current situations of long culture period and strong professional supply and demand shortage of the vascular access talents are solved, and the understanding of the existing first-line hemodialysis medical staff on vascular access management is facilitated.

Description

Clinical decision system for hemodialysis access function monitoring and assessment

Technical Field

The invention relates to the technical field of medical treatment, in particular to a clinical decision-making system for hemodialysis access function monitoring and evaluation.

Background

Hemodialysis is an important treatment modality for maintaining uremic patients. Vascular access is a necessary condition for hemodialysis to proceed smoothly. The function of the vascular access depends on manual judgment of nurses and doctors for a long time, most findings are delayed, the loss of the patients is caused, and the cost of hospital hospitalization is increased.

At present, the function of the vascular access (whether the blood flow is enough, whether the blood flow is narrow or not, and whether the blood flow is blocked or not) depends on the manual evaluation of doctors and nursing staff, and although the evaluation method is guided by guidelines, the evaluation method is different. Because the evaluation process of each scoring standard is complex and the professionalism is too strong, the evaluation work is difficult. If not, treatment is advanced, causing a portion of the vessel to become completely occluded from stenosis, directly affecting the quality and longevity of the patient's treatment.

Disclosure of Invention

The invention aims to solve the problem that a full-automatic clinical decision system for hemodialysis vascular access is not available in the prior art, and the condition of a patient is delayed if a clinician nurse does not have certain experience or lacks a related access professional doctor, and provides the clinical decision system for hemodialysis access function monitoring and evaluation.

In order to achieve the purpose, the invention adopts the following technical scheme:

a clinical decision-making system for hemodialysis access function monitoring and assessment, comprising a monitoring module for monitoring a patient and a decision-making module for assisting a physician in making a judgment;

wherein the monitoring module comprises a hemodialysis machine, a plurality of pressure sensors and an ultrasonic probe sensor which are arranged on an extracorporeal circulation blood path;

the decision module comprises a decision tree algorithm made based on a blood vessel access guide and a scoring system matched with the algorithm;

the monitoring module transmits the acquired data to the decision module, and the decision module automatically generates corresponding guidance opinions to assist a doctor in making a judgment.

Optionally, the ultrasound probe receptors are disposed in a small pillow portion of the extracorporeal circulation blood circuit.

Optionally, the ultrasonic probe receptor is annular and is sleeved outside the small pillow.

Optionally, the ultrasound probe receptor automatically sends data into the decision module by wireless transmission technology, and the hemodialysis machine parameters are manually entered into the decision module.

Optionally, the hemodialysis machine parameter entries include a type of vascular access during hemodialysis run time, venous pressure in extracorporeal circulation, arterial pressure, transmembrane pressure, blood flow, frequency of alarms, and reason for alarms.

Optionally, the decision tree algorithm comprises the following steps:

step 1: according to the information collected by the detection module, the following requirements are met at the same time: under the conditions that the blood flow (speed) >200ml/min, the arterial pressure > -250mmHg and the venous pressure <160mmHg, entering the step 3; if not, entering the step 2;

step 2: entering step 3 under the condition that step 2.1 and step 2.2 are simultaneously met;

step 2.1: the artificial auscultation meets the conditions of high audible tone in narrow places and inaudible blood flow sound;

step 2.2: the pressure sensor and the ultrasonic probe sensor detect that the pressure of the extracorporeal circulation small pillow is insufficient and the operation of releasing the pressure of the extracorporeal circulation small pillow repeatedly is carried out;

and step 3: scoring by using an STS scoring system, and entering a step 4 if the score is more than three points; if the score is not more than three, entering step 5;

and 4, step 4: the indication of the vascular access interventional operation and percutaneous transluminal vascular (PTA) is provided, and the access doctor is contacted;

and 5: scoring is recommended once every three months.

The invention has the following advantages:

the technology of the invention is externally connected with a self-setting blood flow monitoring device and internally connected with a decision tree algorithm, and finally gives a medical decision, so that the poor function of the blood vessel access can be found as early as possible, and the worse result can be prevented.

The invention can improve the efficiency and the accuracy of hemodialysis vascular access management and provide feasible medical decisions. Meanwhile, the current situations of long culture period and strong professional supply and demand shortage of the vascular access talents are solved, and the understanding of the existing first-line hemodialysis medical staff on vascular access management is facilitated.

Drawings

FIG. 1 is a flow chart of a clinical decision system for hemodialysis access function monitoring and assessment in accordance with the present invention;

FIG. 2 is a system block diagram of a clinical decision system for hemodialysis access function monitoring and assessment in accordance with the present invention;

fig. 3 is a decision tree diagram for monitoring the functions of the hemodialysis autoarteriovenous fistula and the artificial blood vessel in a clinical decision system for monitoring and evaluating the hemodialysis access function according to the present invention.

In the figure: 1 hemodialysis machine, 2 extracorporeal circulation blood circuits, 3 dialyzers, 4 pressure sensors and 5 ultrasonic probe sensors.

Detailed Description

The technical solutions in the embodiments of the present invention will be clearly and completely described below with reference to the drawings in the embodiments of the present invention, and it is obvious that the described embodiments are only a part of the embodiments of the present invention, and not all of the embodiments.

In the description of the present invention, it is to be understood that the terms "upper", "lower", "front", "rear", "left", "right", "top", "bottom", "inner", "outer", and the like, indicate orientations or positional relationships based on the orientations or positional relationships shown in the drawings, are merely for convenience in describing the present invention and simplifying the description, and do not indicate or imply that the device or element being referred to must have a particular orientation, be constructed and operated in a particular orientation, and thus, should not be construed as limiting the present invention.

Referring to fig. 1-3, a clinical decision system for hemodialysis access function monitoring and assessment includes a monitoring module for monitoring a patient and a decision module for assisting a physician in making a decision;

the monitoring module comprises a hemodialysis machine 1, a plurality of pressure sensors 4 and an ultrasonic probe sensor 5, wherein the pressure sensors 4 and the ultrasonic probe sensor 5 are arranged on an extracorporeal circulation blood path 2, the extracorporeal circulation blood path 2 is also connected with a dialyzer 3 in series, the pressure sensors 4 can monitor each pressure point simultaneously, and parameters such as arterial pressure, venous pressure, transmembrane pressure, blood vessel path type and the like can be input into the decision-making system; the ultrasonic probe receptor 5 is arranged on the small pillow part of the extracorporeal circulation blood path 2, and can find out potential blood flow problems which are difficult to find manually by utilizing the ultrasonic principle.

The ultrasonic probe sensor 5 is annular and is sleeved outside the small pillow, the small pillow can be detected in all directions, the ultrasonic probe sensor 5 automatically sends data to the decision module through a wireless transmission technology, the wireless transmission technology can adopt a Bluetooth data transmitter, an NFC data transmitter, a wireless broadband data transmitter and the like, and parameters of the hemodialysis machine 1 are recorded into the decision module in a manual mode.

The parameters of the hemodialysis machine 1 are recorded, including the type of vascular access, venous pressure in extracorporeal circulation, arterial pressure, transmembrane pressure, blood flow, alarm frequency and alarm reason during hemodialysis operation.

The decision module comprises a decision tree algorithm made based on the blood vessel access guide and a scoring system matched with the algorithm;

the monitoring module transmits the acquired data to the decision module, and the decision module automatically generates corresponding guidance opinions to assist a doctor to make a judgment.

As shown in table 1, the decision tree algorithm is formulated based on the chinese vascular access management guideline and the japanese vascular access guideline, and the specific program thereof can be implemented by C + + language programming, which is the prior art and is not described much.

The decision tree algorithm comprises the following steps:

step 1: according to the information collected by the detection module, the following requirements are met at the same time: under the conditions that the blood flow (speed) >200ml/min, the arterial pressure > -250mmHg and the venous pressure <160mmHg, entering the step 3; if not, entering the step 2;

step 2: entering step 3 under the condition that step 2.1 and step 2.2 are simultaneously met;

step 2.1: the artificial auscultation meets the conditions of high audible tone in narrow places and inaudible blood flow sound;

step 2.2: the baroreceptor 4 and the ultrasonic probe receptor 5 detect that the pressure of the extracorporeal circulation pillow is insufficient and the operation of repeatedly releasing the pressure of the extracorporeal circulation pillow is performed;

and step 3: scoring by using an STS scoring system, and entering a step 4 if the score is more than three points; if the score is not more than three, entering step 5;

and 4, step 4: the indication of the vascular access interventional operation and percutaneous transluminal vascular (PTA) is provided, and the access doctor is contacted;

and 5: scoring is recommended once every three months.

TABLE 1 correspondence table of Path guide Shuntrouble scoring (STS scoring System)

When the system is used, a plurality of pressure points on an extracorporeal circulation blood path are monitored through the hemodialysis machine 1, result parameters are recorded manually, the recorded parameters are input into a decision-making system, then an ultrasonic probe is clamped at a small pillow position of the extracorporeal circulation blood path for detection, a small pillow position capacity data parameter obtained by the detection of the ultrasonic probe is transmitted to a computer through a data transmitter and is automatically input into the decision-making system, and finally the decision-making system comprehensively compares all parameters and combines an STS scoring system to give a final decision-making guidance suggestion.

The invention combines manual input and receptor feeling transmission to give decision guidance: 1. alarming slight abnormality, and manually rechecking by a doctor and a nurse in charge; 2. directly giving medical or nursing suggestions outside listing abnormal parameters for moderate to severe abnormity; 3. and (5) carrying out health education suggestion on the patient.

The key point of the vascular access is that a vascular access evaluation system is integrated, and the complete design integrates early warning, evaluation and suggestion of the vascular access, greatly saves labor and increases the sensitivity of function judgment of the vascular access.

The above description is only for the preferred embodiment of the present invention, but the scope of the present invention is not limited thereto, and any person skilled in the art should be considered to be within the technical scope of the present invention, and the technical solutions and the inventive concepts thereof according to the present invention should be equivalent or changed within the scope of the present invention. In the present invention, unless otherwise specifically stated or limited, the terms "cover", "fitted", "attached", "fixed", "distributed", and the like are to be understood in a broad sense, and may be, for example, fixedly attached, detachably attached, or integrated; can be mechanically or electrically connected; they may be directly connected or indirectly connected through intervening media, or they may be connected internally or in any other suitable relationship, unless expressly stated otherwise. The specific meanings of the above terms in the present invention can be understood by those skilled in the art according to specific situations.

Claims (6)

1. A clinical decision-making system for hemodialysis access function monitoring and assessment, comprising a monitoring module for monitoring a patient and a decision-making module for assisting a physician in making a judgment;

wherein the monitoring module comprises a hemodialysis machine (1), a plurality of pressure sensors (4) arranged on an extracorporeal circulation blood circuit (2) and an ultrasonic probe sensor (5);

the decision module comprises a decision tree algorithm made based on a blood vessel access guide and a scoring system matched with the algorithm;

the monitoring module transmits the acquired data to the decision module, and the decision module automatically generates corresponding guidance opinions to assist a doctor in making a judgment.

2. A clinical decision system for hemodialysis access function monitoring and assessment according to claim 1, wherein the ultrasound probe-receptor (5) is disposed in the occipital portion of extracorporeal circulation circuit (2).

3. A clinical decision system for hemodialysis access function monitoring and assessment according to claim 2, wherein the ultrasound probe receptor (5) is ring-shaped and set outside the small pillow.

4. Clinical decision system for hemodialysis access function monitoring and assessment according to claim 1, wherein the ultrasound probe-receptor (5) automatically sends data into a decision module by wireless transmission technology, and the hemodialysis machine (1) parameters are entered into the decision module by manual means.

5. A clinical decision system for hemodialysis access function monitoring and assessment according to claim 1, wherein the hemodialysis machine (1) parameter entries include vessel access type at hemodialysis run time, venous pressure in extracorporeal circulation, arterial pressure, transmembrane pressure, blood flow, alarm frequency and alarm reason.

6. A clinical decision system for hemodialysis access function monitoring and assessment according to claim 1, wherein the decision tree algorithm comprises the steps of:

step 1: according to the information collected by the detection module, the following requirements are met at the same time: under the conditions that the blood flow (speed) >200ml/min, the arterial pressure > -250mmHg and the venous pressure <160mmHg, entering the step 3; if not, entering the step 2;

step 2: entering step 3 under the condition that step 2.1 and step 2.2 are simultaneously met;

step 2.1: the artificial auscultation meets the conditions of high audible tone in narrow places and inaudible blood flow sound;

step 2.2: the pressure sensor (4) and the ultrasonic probe sensor (5) detect that the pressure of the extracorporeal circulation pillow is insufficient and the operation of repeatedly releasing the pressure of the extracorporeal circulation pillow is performed;

and step 3: scoring by using an STS scoring system, and entering a step 4 if the score is more than three points; if the score is not more than three, entering step 5;

and 4, step 4: the indication of the vascular access interventional operation and percutaneous transluminal vascular (PTA) is provided, and the access doctor is contacted;

and 5: scoring is recommended once every three months.

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