インプラント施術時における術中管理システムの研究

―モニタリング時における思考過程の支援とECGの描記―

抄録

A new Video Overlay Monitoring System (VOLMS) has been developed to secure safe implant placement environments, through accurate monitoring and recording of the patients, where the operators are responsible also for the whole body control of the patients. In preparation for this research, the system has been set to output the display values on BP-88 (a monitor manufactured by Colin Medical Technology Corporation) as serial data and electrocardiogram (ECG) as analog data. The system is configured with an H8-type microprocessor (Hitachi,Ltd.) and a display controller. ECG is converted from analog to digital at the sampling rate of 1.25 msec to meet the sampling theorem and scrolled for display lasting 6 seconds on a zonal area at the resolution of 480×64 dots.The software has been programmed to proactively support the decision-making process of the operators through audio-visual aids and controls in monitoring the implant placements.
Prior to utilizing the system in a clinical setting, we ran a simulation by entering pseudo living body information into data and function generators, and then analyzed the response data on the display. As a result, it has been confirmed that the system operates properly in simulated settings, showing reasonable values for both vital signs and ECG. With preoperative and alarm level values preset, the system displays a stable mark if the measured values are proximate to the preoperative values or an advisory mark if they show a slight change. If the measured values exceed the alarm level values, the system automatically switches to the remeasurement mode and lists values including the current and preoperative values, the upper and lower limit alarm values and a rate of change for RPP (Rate Pressure Product)over its preoperative value.
In times of alarm or predefined statuses, the system changes the colors on the display and activates an audio guidance function. The data recorded on paper and shown on the display during the monitoring has verified that the variance in similarities of ECG falls within±5%. The system has proved useful in clinical testing as well, having precisely traced abnormal conditions like ventricular extrasystole and atrial fibrillation. Specifically, it was extremely helpful in sinus lift, promptly and accurately reflecting the conditions of the patients. Thus, the system has proved to be effective in improving safety during implant placements and providing information valuable for a variety of researches.