CN1057014C - 诱导全身高热的装置 - Google Patents
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Abstract
本发明提供了一种用来治疗癌症患者的诱导全身高热装置,包括:用于围绕患者整个长度、但不包括头部的圆柱体腔;用于湿润腔的装置;从流体加热的表面放射辐射热的装置;以及,循环加热流体的加热贮液器装置。
Description
本发明涉及一种改进的诱导全身高热的装置,以及采用抗肿瘤药(即治疗)与所述的改进的全身高热诱导装置配合使用治疗癌症患者的改进的方法。
从古代开始高热一直被用于治疗各种疾病,包括癌症。在过去的20年中,实验数据提供了支持临床上采用高热治疗肿瘤疾病的证据。高热物理疗法治疗癌症的可能性首先来自下述的观察,有几种癌细胞对超过41℃的温度比它们的正常细胞对此温度更敏感(Giovanella,B.D.,et al. Cancer Res.33:2568-2578(1973),Robins,H.I.,et al.Cancer Res.43:4951-4955(1983)和Flentje,M.,etal. Cancer Res.44:1761-1766 (1984))。
除了这些研究之外,还有临床前的证据以及临床揭示高热可与如麻醉药等药物协同使用(Yatvin,M.B.,et al. Science 205:195-196(1979);Robins,H.I.etal. Cancer Res.,43:3187-3191;Robins,H.I.et al. Cancer,54:2831-2835(1984)),与化疗药物协同使用,(Cohen,J.D.,et al.Cancers Letters 44:205-210(1989);Robins,H.I.,et al. Cancer Res.48:6587-6592;Robins,H.I.,et al,AACR abs.31(1990);Robins,H.I.,et al.,Cancer Res.44:4878-4883(1984)),与干扰素协同使用(Robins,H.I.,et al. Cancer Res.,44:4878-4883(1984);Groveman.D.S.,et al. Cancer Res.44:5517-5521(1984);Robins,H.I.,et al.Cancer Res.49:1609-1615(1989)),以及与放射治疗协同使用(Li G.,et al.Radiat.Res67:491-501(1976);Mivechi,N.F.,et al.Cancer 51:38-43(1983);Steeves.R.et al. Int.J.Radiation Biology 52:935~947(1987);Robins,H.I.,et al.Int.J.Radiat.Oncol.Biol.Phys.15:427~531(1988),Robins,H.I.,et al.Int.J.Radiat.Oncol. Biol.Phys.,18:909-920(1990))。实验室研究反复显示高热的抗肿瘤活性(Robins,H.I.,B.C.Decker,Philaelphia PA pgs 371~373(1988))。
现有的用于诱导全身高热的辐射热技术利用辐射热能,该热能由一个用电加热盘管盖住的金属圆筒发出。这种装置已经用了大约10年左右,参见US PNo.4,501,275。然而,4501275专利描述的装置与已经使用过的装置之间有一主要不同,该45专利所公开的装置不具有湿润患者周围空气的装置,而已经使用过的装置却有这种装置。图6示出了现有技术中的一种辐射加热装置,其中611为控制装置和计量表,612为保护轨,613为视孔,614为密封门,615为软颈护套,616为铜圆柱形仓,617为滑动伸拉平板,618为低密封板,619为头部垫块,620为垫子。
上述的具有湿润患者周围空气的装置之辐射热放射装置一直被广泛地用于临床试验以诱导癌症患者的全身高热(Robins,H.I.,et al.Cancer Res.45:3937~3944(1985);Robins.H.I.,et al.IEEE/Engineering in Medicine and BiologySociety,Chicago,September(1985);Robins,H.I.et al.,in J.Overgaard(ed),Taylor and Francis,London and Philadelphia,pg.269-272(1984))。例如,该装置已被用于癌症患者的全身高热,并接受干扰素的治疗(Robins,H.I.,et al. Cancer Res.49:1609-1615(1989)),并接受局部放疗治疗非小细胞肺癌(Robins,H.I.,et al.Int.J.Radiat.Oncol Biol. Phys.15:427~531(1988)),并接受化疗(Robins,H.I.,et al.Cancer Res.48:6587-6592(1988);Robins,H.I.et al.AACR abs 31(1990)),并接受全身辐照(TBI)治疗低恶性度肿瘤,(Robins,H.I.,et al,Int.J.Radiat.Onclo.Biol.Phys.,18:909-920(1990))以及并接受夺格TBI(ablative TBI)(Robins,H.I.,et al.The Cancer Joumal 1:180-183(1986))。尽管这种装置代表了对先前设计出的全身高热诱导装置的改进,但还包含许多不足。
首先,因为辐射热源是电加热源,即加热电缆,所以很难调控温度,机器的校准也很困难,浪费时间。之所以产生难以校准所述的辐射装置的问题,是因为确定加热电缆的实际表面辐射温度很困难。
其次,因为辐射表面是光滑的,所以全部辐射热交换效率欠佳。结果是,必须在一相对较长的时间内以相对高的温度条件下操作该装置,因此可引起患者不适,还可能出现心脏应激反应。
因此,本发明的目的在于克服现有技术的不足,提供一种易校准、高热稳定的全身高热装置。
本发明提供一种易校准,高温稳定的,在低表面温度下操作的,并具有高效辐射交换的改进的全身高热装置。
具体地讲,本发明提供一种改进的全身高热装置,它在湿润环境下将患者身体温度升至最高达41.8℃,该装置包含从一表面上放射辐射热的装置,其改进包括具有由一流体加热的所述表面放射出的辐射热。
本发明也提供一种向经受全身高热的癌症患者施用抗肿瘤剂的改进方法,其中,在患者施用抗肿瘤剂之前,过程中或之后,在湿润环境下该患者的体温升高最高达约41.8℃,其改进包括将所述的患者暴露在由一流体加热一裙状瓦楞表面(a scalloped surface)放射出的辐射热中。
由此,本发明提供一种诱导全身高热的装置,该装置可在较低表面温度下操作,并具有高效辐射热交换。
附图简要说明:
图1是该装置的正面图。
图2是该装置使用状态中的端视图。
图3是盘管的透视图。
图4是盘管转弯处局部剖视图。
图5是液流图。
图6是现有技术的辐身加热装置的透视图。
图7和8是用本发明的高热诱导装置处理过的狗的时间温度图表。
图1示出了,本发明的诱导患者全身高热的装置10。装置10包括一圆柱形的外罩20,它形成一管状室21,管状室21安装于支架30上。
所述圆柱形的外罩20包括一保温外层22,一中间层,中间层包括4个盘状的金属管23,它们顺次排列,每个管具有一流体入口24和出口25,以及一高温涂料内层26,该层具有最大的放射能力。
湿润系统40经入口部分(未示出)向管状室21供给一无菌湿气,该入口部分位于该装置的后壁11上。
经过一内流管线24和一外流管线25,所述的液体在一反向流分布系统(Counter currentdistribution System)中循环并经过每个所述的4个顺次排列的盘管23。图5是一管道图,它示出在铜盘管各个部分之间的液体反向流分布系统。
在贮液器51中的流体被加热到所需的温度,然后经过浸没式循环器52将其泵向管线入口24,在那里,液体经过每一个入口管线的入口24进入每一个4个顺次排列的盘管23。流体经过每个顺次排列的管线循环,然后经过管线出口25的各自出口排出。在管线出口25处流体再流回贮液器51。这是一个连续的过程。
推车60包括一内支撑腿62支撑的平置的伸拉平板(stretcher)61,图1中只示出一个支撑腿。轴承63提供一推车滑向装置10内的装置。
待治疗的患者躺在伸拉平板上,该平板滑入管状室内。在加热室的内部,安装一非导电的塑料网,以防止患者接触加热室的内部热辐射表面。在该装置的后壁上安装一工业标准为40瓦的灯泡来最大限度地观察治疗中的患者。在该装置的头部安装两个非导热性的耐热有机玻璃门。这些门使患者的头部始终保持在加热室之外。该门的设计上采用一柔软的环状物,它可固定患者颈部周围,借此产生一密封的系统。
在治疗患者前的约12小时,将数字浸没式循环器设置到一所需的温度。保持液体的温度,根据读出数字浸没式循环器示出的温度来调控所述液体的温度。
在加热期内,将高热诱导装置保持在设定的温度下,该温度由数字浸没式循环器产生的液体温度直接决定的。循环器的温度设定不应超过65℃,优选的是标准治疗温度为60℃±0.5℃。由高热诱导装置能在患者身上产生的温度范围是37℃至42℃。最优选的患者温度为41.8℃。用现有技术已知的步骤控制患者体温。加热期后,即,患者达到目标体温之后,拉出伸拉平板使患者从高热装置内移出,并按本领域技术人员公知的步骤用一蒸汽/热罩罩住患者。参见Robins,et al.,Cancer Research,45:3937-3944(1985),所公开内容并入本文作为参考。当患者处于峰值体温时,例如41.8℃,患者已增加的代谢率会保持其身体温度,而不是高热诱导装置起作用。
在优选的实施方案中,全身高热诱导装置的中心由200×61cm铜管构成的盘管组成(管外径:5/8英寸:类型L1/2英寸,内径壁厚为0.040英寸)。该盘管形成一裙状瓦楞表面(scalloped surface),由此,其辐射热放射表面的表面积比光滑表面增加1.57倍。该盘管被分成4个所属部分(每一个由三个100英尺长的管子绕成的32个转弯构成)并头尾相接。其4个部分具有分别的流体入口和一共通的流体出口。沿着有效设计的内外流在每个盘管环之间金属与金属互相接触,产生出一反向流热分布系统。盘管在外面和各端的保温衬也使该系统产生良好的热稳定性。少量的热损失的其它上述设计特征会减少沿盘管位差的温度梯度至忽略的水平。大量的流体和铜管以及综合的保温层给该系统带来可观的热“惰性”,其结果是良好的热稳定性。
用高温-高放射性涂料,即,无光泽的黑色(flat black)涂敷铜盘管表面,目的是增大盘管与患者之间的辐射热交换。
用Neslab Ex-810D型浸没式循环器(Nexlab Instruments,Newington,NH)完成流体的加热和泵送。该浸没式循环器有一800瓦加热器(115伏,60Hz,11Amps)其温度稳定性为±0.1℃,每分钟泵输率为12升(17的头)。
湿润系统采用两个Devilbiss 65超声喷容器(Devilbiss Company,Somerset,PA);位于高热装置后壁的两个无菌湿气的入口部产生的湿度为90-100%,它足以防止气化热的损失。湿度的百分率对于高热诱导装置的操作来说并不是决定性的。在第一个10分钟之后,实际上其湿度达100%。
本高热诱导装置具有一不锈钢板制成的一般的外罩,这个外罩由一个不锈钢支架支撑。这种设计使得其易清洗和消毒。
本发明之高热诱导装置显示出高度的温度稳定性,这是由于特殊的流体热,即水,最优选为油,特殊热的加热惰性,以及反流流体流的缘故。高度的热稳定性有效地减少了管状室的热对流。
另外,辐射面增加的表面积的净效果是增加了辐射热交换的全部效率,因此缩短了加热时间。较快的加热时间使得增加患者的舒适和降低热耐受程度。辐射面增加的表面积也使在操作温度下全身高热(WBH)的表面辐射温度降低几度,结果是在WBH治疗的加热期间增加舒适程度。
高热诱导装置适用于综合物理疗法(multimodality approach)治疗全身癌症。采用现有技术中公知技术,参见Robins,H.I.et al. Cancer Res.44:4878-4883(1984);Robins,H.I. et al.Cancer Res.48:6587-6592;Robins,H.I.,et al.,CancerRes.49:1609-1615(1989);Robins,H.I.,et al,Int.J.Radiat.Oncol.Biol. Phys.15:427-531(1988);Robins,H.I.,et al.Cancer Res.45:3937-3944(1985),这些文献内容引入本文作为参考。对癌症患者使用抗肿瘤药,给药时间是在经受本发明装置进行全身高热治疗前,治疗中或者治疗后。参见Robins,H.I.,etal.AACR abs.31(1990);Robins et al.,″Whole body Hyperthermia:Biological andClinical Aspects″,Springer Verlag,Berlin,Germany,1-84(1992),这些文献的内容引入本文作为参考。术语“抗肿瘤剂”包括,但非限于,全身辐射,局部辐射,化疗药物,如甲氨蝶呤和顺铂化合物,以及生物反应调节剂,例如干扰素和肿瘤坏死因子。
高热诱导装置也能用于治疗胶原性血管疾病,例如关节炎和牛皮癣,并能用于治疗低体温病。另外,该高热诱导装置也能用于增强易变作用剂(Labilizers)的作用,如麻醉剂利多卡因和硫喷尼(thiopentyl)。
实施例1
1)麻醉
在进行全身高热治疗实施全麻前,7只狗禁食18小时。术前给阿托品(0.04mg/kg IM),安定(0.04mg/kg IM)和芬太尼(10mcg/kg IM),20-30分后采用静脉内大剂量给予硫喷妥(5mg/kg IV)和芬太尼(0.4mg/kgIV)实施全麻。大剂量(0.4mg/kg IV)给予Atracurium(Tracurium,BumoughsWellcome Co.,Research Triangle Park,NC 27709,USA),一种非去极化神经肌肉阻断剂,以麻痹呼吸肌。用正压机械式换气机(15-20ml/kg潮容积(tidalvolume)至20-25次呼吸/分)保持换气(Edco 821型,大动物换气机,EdcoScientific,Inc.,Chapel Hill,NC 27514,USA)。连续输注芬太尼(1.0mcg/kg/分钟)和atracurium(8.5mcg/kg/分钟)维持麻醉和麻痹。所需硫喷妥(thiopetal)的剂量(2.5mg/kg IV至全剂量30mg/kg)基于对间接血压,心率,毛细血管扩张程度的评估。每5分钟记录一次可见信号(数据)。经观察对间接尺神经4次顺序刺激(indirect ulnar nerve train-of-four stimulation)(Life Tech Inc.Houston,TX,USA)的腕颤搐反应来评价神经肌肉阻断水平。整个实验以10ml/kg/小时给予静脉内液体,5%右旋糖水溶液(D5W)(Baxter Healthcare Corp.,Deerfield,IL 60015,USA)。在治疗结束时,停止芬太尼-atracurium输注,给阿托品(0.05mg/kg IM),随后给新斯的明(0.05mg/kg IV)。当呼吸肌功能恢复后,终止机械换气。
2、生理监控
连续监控心率和间接收缩、舒张和平均体动脉压(Dinamap,Critikon Inc,Tampa,FL 33630,USA),每10分钟记录一次。连续监控心电图第II导联(Strathem Model SM 1057监视器)。将一脉式血氧定量计(Ohmeda,Boulder,CO,USA)置于舌远端连续监控动脉氧饱和度,每10分钟记录一次。
3、温度探头
狗被麻醉之后移入高热诱导装置(RHB)之前,从设计上要安装热电偶(Bailey Thermalert TH-6,Sensor Tek Inc,Clifton,NJ,USA)。将一直肠探头的一半插入降结肠(the descending colon)。用腹部触诊判断位置。将骨髓温度探头装在髂骨翼,右侧肱骨近端和右侧胫骨中近端上。在无菌条件下剪开,用洗必泰(Nolvasan,Fort Dodge Laboratories,Inc,Fort Dodge,IA 50501,USA)清洁处理术前准备骨髓部位(Prepodyne Povidone Scrub,AMSCO,Medical ProductsDivision,Divsion of American Sterilizer Co.,Erie,PA 16514,USA)。皮肤切口1.5~2cm,钝性拨离皮下组织和肌肉组织,暴露骨位置。采用无菌4-毫米环钻骨活组织采样器械(Richards Manufacturing Co.Inc.,Memphis,TN 381 16,USA)采出1.5至2.0厘米深的骨中心部。然后将预先灭菌和浸没在酒精中的温度探头紧紧地楔入骨髓。用粘胶带将所有温度探头固定在狗身上。
用热电偶测定实验中的温度。用三个5探头的串联联接转换开关盒和一个热电偶指读器来监控温度,该指读器显示0.1℃的温度余差。温度测量系统与抗-铂温度装置(Instrulab,Inc.,Dayton,Ohio,USA)进行校准。校准数据用于校正记录的实验温度的测定。该温度测量系统的全部准确率为±0.1℃。
4、全身高热治疗步骤
在确认温度探头和生理监探感受器准确安装之后,在伸拉平板上的狗滑入预热的高热诱导装置。
高热治疗由加热期,目标温度的平台期,和冷却期组成。在加热期(75-100分钟),狗在高热诱导装置中。平台期被定义(保持60分钟)目标直肠温度(41.8℃)。一旦达到目标直肠温度,狗用热反射毯罩住,并从高热诱导装中移出。在目标温度时狗的非线性增高的基础代谢率与罩住的狗的热损失相等,因此使得在高热诱导装置加热室外面的全身带罩子的狗具有稳定的直肠温度。必要时,假如中心温度持续升高,暴露狗身体部分使得足够的热丢失来调节温度。假如中心温度下降,把带罩子的狗部分移入高热诱导装置,降低传导热的损失。治疗时间定为平台温度的消逝时间(即60分钟)。
平台期结束时,去掉罩在狗身上的罩子,用水或酒精湿润狗的皮肤以蒸发冷却来冷却狗,并把狗暴露在空气下增加放射热损失。至约38至39℃的中心温度的冷却期是40-50分钟。冷却期后,处死动物。进行解剖证实温度探头的位置。典型的全身高热治疗过程持续4至6小时。
5、温度监控
对于每只狗记录其直肠和骨髓的温度。骨髓为髂骨翼,右侧近端肱骨,和右侧中近端胫骨处的骨髓。从记录狗被装入高热诱导装置之前得到基线值开始,在整个步骤中每10分钟记录所有探头的温度读数。
6、统计学分析
根据校正数据,对从直肠和髂骨,肱骨,胫骨骨髓中得到的温度数据进行校正。校正数据分析显示热电偶温度探头在生产厂家所述的准确度内工作良好。用方差分析对重复测定的数据进行比较,其统计学显著性P<0.001。在平台期过程中每次都计算校正的直肠温度和校正的髂骨,肱骨,胫骨骨髓温度(即骨髓减去直肠(温度))的差。这些得到的数值被分别作相对髂骨,肱骨,胫骨骨髓温度。用Tukey′s标准试验对每个部位(即,直肠和骨髓)之间的温度进行比较,其统计学显著性为P<0.001。
虽然真正的热“剂量”并没有测出,为了比较,在WBH平台期中,将校正的骨髓和直肠时间-温度表转换成43℃(t43)时的当量-分钟,其方法是Sapareto和Dewey方法,参见Saparato et al.,Int J.Radiat.Oncol. Biol. Phys.10:787-800(1984)。 其中t43是43℃时的当量时间,T是在时间δt=10分钟的过程中的平均温度(℃),当T≥42.5℃时R=025,当T>425℃时R=0.5。t43的平均值为直肠,髂骨,肱骨,胫骨计算出的,并用Student′s T-检验对比。
7、结果
7只狗在进行WBH期间,高热诱导装置诱导出一个稳定的可复性的加热曲线。至目标温度(41.8℃)的时间为85-100分钟。到达目标的时间变化主要是由于在生理和温度监控器械安置时狗的开始中心温度的高低。加热率是每分钟0.058±0.002℃(平均值±平均的标准误差[SEM])。六只狗的中心温度保持在高的稳定平台期60分钟,一直到开始主动冷却,然而,在一次治疗中,狗的直肠温度降低到低于41.8℃的目标温度,这样必需要把狗放回到诱导高热装置(RHD)中,在41.8℃的平台期过程,平均直肠温度41.9±0.06℃被保持在41.4至42.2℃的范围。
WBH治疗期两只狗的直肠和骨髓部位(髂骨、肱骨和胫骨)与平台期相对骨髓温度(骨髓减去直肠温度)的时间温度图表分别见图7和图8。
可以相信不超出本发明的实质和范围可以实施其它的实施方案。并不希望本发明仅仅限制于上述的实施方案。本领域的技术人员将会实现对这些实施方案的修改。但本发明将由后附的权利要求的范围加以限定。
Claims (8)
1、用于在湿润环境下引起患者体温升高的全身高热装置,包括:
(a)用于围绕所述患者整个长度、但不包括该患者头部的圆柱体腔装置;
(b)用于湿润所述腔装置的装置;
(c)多个顺次并排排列的盘管装置,其具有用于再现性地将所述的患者
加热到高至41.8℃的最高温度的高放射性涂料,所述盘管装置的每
一个都具有独立的流体进口和流体出口,其中,一个盘管装置的出
口与下一个并排的盘管装置的入口邻接;以及
(d)用来同时在每一个所述的盘管装置中循环加热流体的加热贮液器装
置。
2、如权利要求1所述的装置,其特征在于,所述的高放射涂料是无光泽的黑色涂料。
3、如权利要求1所述的装置,其特征在于,所述的贮液器装置包括限制加热流体的温度至65℃的装置。
4、如权利要求1所述的装置,其特征在于,所述并排的盘管装置形成裙状瓦楞表面,该表面承载所述的高放射性涂料。
5、如权利要求4所述的装置,其特征在于,所述的裙状瓦楞表面具有比非裙状瓦楞的平滑表面高1.57倍的表面积。
6、如权利要求1所述的装置,其特征在于,所述的加热流体是水。
7、如权利要求1所述的装置,其特征在于,所述的加热流体是油。
8、如权利要求1所述的装置,其特征在于,所述的盘管装置是铜制的。
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US08/053,883 US5713941A (en) | 1993-04-27 | 1993-04-27 | Apparatus for inducing whole body hyperthermia and method for treatment utilizing said whole body hyperthermia inducing apparatus |
US08/053,883 | 1993-04-27 |
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CN1104547A CN1104547A (zh) | 1995-07-05 |
CN1057014C true CN1057014C (zh) | 2000-10-04 |
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US (1) | US5713941A (zh) |
EP (1) | EP0711131B1 (zh) |
JP (1) | JP3577550B2 (zh) |
KR (1) | KR960701616A (zh) |
CN (1) | CN1057014C (zh) |
AT (1) | ATE229778T1 (zh) |
CA (1) | CA2161407C (zh) |
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- 1994-04-26 EP EP94914918A patent/EP0711131B1/en not_active Expired - Lifetime
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WO1994024952A1 (en) | 1994-11-10 |
DE69431910T2 (de) | 2003-10-02 |
US5713941A (en) | 1998-02-03 |
EP0711131A4 (en) | 1998-10-14 |
DE711131T1 (de) | 1999-06-02 |
EP0711131A1 (en) | 1996-05-15 |
ATE229778T1 (de) | 2003-01-15 |
CA2161407A1 (en) | 1994-11-10 |
DE69431910D1 (de) | 2003-01-30 |
JPH09501327A (ja) | 1997-02-10 |
CN1104547A (zh) | 1995-07-05 |
KR960701616A (ko) | 1996-03-28 |
CA2161407C (en) | 2005-08-02 |
JP3577550B2 (ja) | 2004-10-13 |
EP0711131B1 (en) | 2002-12-18 |
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