Ventilator ventilation control method and apparatus, ventilator and medium

Abstract

The present application relates to the technical field of breathing machine ventilation management, and discloses a breathing machine ventilation control method, device, breathing machine and medium, comprising: obtaining preset ventilation parameters when all lung parameter information is normal; when the breathing machine operates in a preset ventilation mode according to the preset ventilation parameters, performing blood oxygen saturation detection on a target object to obtain a blood oxygen detection result; performing inhaled oxygen concentration detection on the target object to obtain an inhaled oxygen detection result; performing acid-base value detection on the target object to obtain an acid-base detection result; performing respiration detection on the target object to obtain a respiration detection result; performing tolerance detection on the target object, and ending mechanical ventilation when the tolerance detection is passed. The present application realizes the operation of the breathing machine in a preset ventilation mode when all lung parameter information is normal, thereby improving the precision and accuracy of breathing machine ventilation control, simplifying the detection and adjustment process of complex parameters, and further realizing precise control to end mechanical ventilation.

Description

Technical Field

[0001] This invention relates to the field of ventilator ventilation management technology, and in particular to a ventilator ventilation control method, device, ventilator, and medium. Background Technology

[0002] Mechanical ventilation is an effective medical intervention used with the help of medical equipment such as ventilators to maintain airway patency, improve ventilation and oxygenation, and reduce the morbidity and mortality of patients with acute respiratory failure. The ultimate goal of using mechanical ventilation on patients is to improve their physical condition so that they can be extubated and breathe naturally.

[0003] Termination of mechanical ventilation refers to the process of slowly removing ventilator support. In existing technologies, clinicians cannot precisely control the duration of mechanical ventilation, thus increasing morbidity and mortality rates associated with prolonged mechanical ventilation. Therefore, this invention provides a ventilator ventilation control method that precisely controls when to terminate mechanical ventilation. Summary of the Invention

[0004] This invention provides a ventilator ventilation control method, device, ventilator, and medium to solve the problem of accurately controlling when to terminate mechanical ventilation in the prior art.

[0005] A method for controlling ventilation on a ventilator, comprising:

[0006] Anomaly detection is performed on the lung parameter information of the target object. When the anomaly detection result indicates that the lung parameter information is not abnormal, the preset ventilation parameters corresponding to the target object are obtained.

[0007] When the ventilator is running in a preset ventilation mode according to the preset ventilation parameters, the blood oxygen saturation of the target object is detected to obtain the blood oxygen detection result.

[0008] When the blood oxygen detection result indicates that the blood oxygen saturation is greater than a preset blood oxygen threshold, the inhaled oxygen concentration of the target object is detected to obtain the inhaled oxygen detection result.

[0009] When the inhaled oxygen detection result indicates that the inhaled oxygen concentration is less than a preset inhaled oxygen threshold, the target object is subjected to acid-base value detection to obtain acid-base detection results.

[0010] When the acid-base detection result indicates that the acid-base value is within a preset acid-base range, the target object is subjected to spontaneous breathing detection to obtain the breathing detection result.

[0011] When the respiratory test results indicate that the spontaneous breathing test has been passed, the target subject undergoes a tolerance test, and mechanical ventilation is terminated when the tolerance test is passed.

[0012] A ventilator ventilation control device, comprising:

[0013] The ventilation parameter module is used to detect abnormalities in the lung parameter information of the target object. When the abnormality detection result indicates that the lung parameter information is not abnormal, the preset ventilation parameters corresponding to the target object are obtained.

[0014] The blood oxygen detection module is used to detect the blood oxygen saturation of the target object when the ventilator is running in a preset ventilation mode according to the preset ventilation parameters, and to obtain the blood oxygen detection result.

[0015] The inhaled oxygen detection module is used to detect the inhaled oxygen concentration of the target object when the blood oxygen detection result indicates that the blood oxygen saturation is greater than a preset blood oxygen threshold, and to obtain the inhaled oxygen detection result.

[0016] The acid-base detection module is used to detect the acid-base value of the target object when the inhaled oxygen detection result indicates that the inhaled oxygen concentration is less than a preset inhaled oxygen threshold, and to obtain the acid-base detection result.

[0017] The autonomous breathing detection module is used to perform autonomous breathing detection on the target object when the acid-base detection result indicates that the acid-base value is within a preset acid-base range, and to obtain the breathing detection result;

[0018] The mechanical ventilation termination module is used to perform a tolerance test on the target subject when the respiratory test results indicate that the spontaneous breathing test has passed, and to terminate mechanical ventilation when the tolerance test is passed.

[0019] A ventilator includes a memory, a controller, and a computer program stored in the memory and executable on the controller. When the controller executes the computer program, it implements the ventilator ventilation control method described above.

[0020] A computer-readable storage medium storing a computer program that, when executed by a controller, implements the ventilator ventilation control method described above.

[0021] The ventilator ventilation control method, device, ventilator, and medium provided by this invention achieve the acquisition of preset ventilation parameters when all lung parameters are normal by detecting abnormalities in the target subject's lung parameter information. By sequentially performing blood oxygen saturation detection, inhaled oxygen concentration detection, pH value detection, spontaneous breathing detection, and tolerance detection on the target subject, the next parameter can be detected when the previous detection result meets the condition, thereby improving the precision and accuracy of ventilator ventilation control, simplifying the complex parameter detection and adjustment process, and ultimately achieving precise control to terminate mechanical ventilation. Attached Figure Description

[0022] To more clearly illustrate the technical solutions of the embodiments of the present invention, the drawings used in the description of the embodiments of the present invention will be briefly introduced below. Obviously, the drawings described below are only some embodiments of the present invention. For those skilled in the art, other drawings can be obtained based on these drawings without creative effort.

[0023] Figure 1 This is a flowchart of a ventilator ventilation control method according to an embodiment of the present invention;

[0024] Figure 2 This is a schematic diagram of the ventilation control device for a ventilator in one embodiment of the present invention. Detailed Implementation

[0025] The technical solutions of the embodiments of the present invention will be clearly and completely described below with reference to the accompanying drawings. Obviously, the described embodiments are only some, not all, of the embodiments of the present invention. Based on the embodiments of the present invention, all other embodiments obtained by those skilled in the art without creative effort are within the scope of protection of the present invention.

[0026] This invention provides a ventilator ventilation control method, in one embodiment, such as... Figure 1 As shown, its technical solution mainly includes the following steps:

[0027] S10, perform anomaly detection on the lung parameter information of the target object. When the anomaly detection result indicates that the lung parameter information is not abnormal, obtain the preset ventilation parameters corresponding to the target object.

[0028] Understandably, preset ventilation parameters refer to the operating parameters of the ventilator set in advance. The target population refers to patients after local or abdominal surgery.

[0029] Specifically, the system detects lung parameters of the target subject using a ventilator and then checks for underlying lung diseases based on these parameters. If an underlying lung disease is present, abnormal test results indicate abnormal lung parameters, and the ventilator's ventilation is adjusted to match the management of the underlying lung disease. If no underlying lung disease is present, the system checks if the target subject has undergone a single-lung transplant (one lung function is nearly normal, while the other has obstruction or restrictive problems). If a single-lung transplant is present, abnormal test results indicate abnormal lung parameters, and the ventilator's ventilation is adjusted to match the management of a single-lung transplant. If no single-lung transplant is present, abnormal test results indicate normal lung parameters. Then, preset ventilation parameters corresponding to the target subject are acquired and input into the ventilator, causing the ventilator to operate at these preset ventilation parameters.

[0030] In one embodiment, postoperative ventilation settings for target subjects with underlying lung disease are similar to those for patients without postoperative chronic lung disease. Air trapping is a major problem in COPD (chronic obstructive pulmonary disease), and appropriate tidal volumes (6-8 ml / kg IBW) and respiratory rates (12-18 breaths / min) should be selected. The plateau pressure for COPD target subjects should be controlled below 25 cmH2O. For target subjects with chronic restrictive lung disease, smaller tidal volumes (4-6 ml / kg IBW) and faster respiratory rates (20-30 breaths / min) should be set to avoid higher plateau pressures. For patients with a single lung transplant, the ventilator settings should ensure maximum function of the transplanted lung. If the transplanted lung has chronic obstruction, the ventilator should provide adequate volume and a slower frequency.

[0031] S20, when the ventilator is running in a preset ventilation mode according to the preset ventilation parameters, the blood oxygen saturation of the target object is detected to obtain the blood oxygen detection result.

[0032] Understandably, a preset ventilation mode refers to a pre-set ventilation model corresponding to preset ventilation parameters, such as VCV (volume-controlled ventilation) or PCV (pressure-controlled ventilation). Blood oxygen saturation test results are used to characterize blood oxygen saturation and the preset blood oxygen threshold.

[0033] Specifically, when the ventilator is running in a preset ventilation mode according to preset ventilation parameters, i.e., continuous ventilation (VCV or PCV), with a tidal volume (VT) of 6 to 8 ml / kg, a respiratory rate of 12 / min, an inspiratory time (Ti) less than or equal to 1 s, a positive end-expiratory pressure (PEEP) of 5 cmH2O, and a FiO2 (inspirated oxygen concentration) of 100%, the ventilator defaults to PCV mode with a tidal volume of 6 ml / kg, a respiratory rate of 12 / min, an inspiratory time of 0.3 s, a PEEP of 5 cmH2O, and a FiO2 of 100%. After the ventilator parameters are set, mechanical ventilation is initiated for the target subject. Then, the target subject's blood oxygen saturation is measured, i.e., blood gas analysis is performed percutaneously to obtain the blood oxygen saturation, which is then compared with a preset blood oxygen threshold to obtain the blood oxygen detection result.

[0034] S30, when the blood oxygen detection result indicates that the blood oxygen saturation is greater than the preset blood oxygen threshold, the inhaled oxygen concentration of the target object is detected to obtain the inhaled oxygen detection result.

[0035] Understandably, the results of the inhaled oxygen test are used to determine the inhaled oxygen concentration and the value of the preset inhaled oxygen threshold.

[0036] Specifically, when the blood oxygen saturation test result indicates that the blood oxygen saturation is greater than a preset blood oxygen threshold, the inhaled oxygen concentration of the target subject is measured. This can be achieved by directly measuring the oxygen concentration output by the oxygen inhalation device, indirectly estimating the inhaled oxygen concentration by measuring the patient's physiological parameters, or using specific instruments or equipment to measure the inhaled oxygen concentration. Then, the inhaled oxygen concentration is compared with the preset inhaled oxygen threshold to obtain the inhaled oxygen test result.

[0037] S40, when the inhaled oxygen detection result indicates that the inhaled oxygen concentration is less than a preset inhaled oxygen threshold, the target object is subjected to acid-base value detection to obtain acid-base detection results.

[0038] Understandably, acid-base test results are used to characterize whether the acid-base value of the target object is within a preset acid-base range, that is, whether it is in acid-base balance.

[0039] Specifically, when the inhaled oxygen detection result indicates that the inhaled oxygen concentration is less than the preset inhaled oxygen threshold, the acid-base value of the target object corresponding to the ventilator operating in the preset ventilation mode is detected. That is, the acid-base value of the target object and the preset acid-base range are obtained, and the obtained acid-base value of the target object is compared with the preset acid-base range to determine whether the acid-base value of the target object is within the preset acid-base detection range. The comparison result is determined as the acid-base value detection result.

[0040] S50, when the acid-base detection result indicates that the acid-base value is within the preset acid-base range, the target object is subjected to autonomous breathing detection to obtain the breathing detection result.

[0041] S60, when the respiratory test results indicate that the spontaneous breathing test has passed, a tolerance test is performed on the target subject, and mechanical ventilation is terminated when the tolerance test is passed.

[0042] Understandably, respiratory test results are used to characterize whether a spontaneous breathing test has been passed. Termination of mechanical ventilation means removing the intubation tube and ceasing ventilation on the target individual.

[0043] Specifically, when the acid-base test results indicate that the acid-base value is within the preset acid-base range, a spontaneous breathing test is performed on the target subject. This involves first determining whether spontaneous breathing effort and hemodynamic stability are achieved. If so, ventilation is initiated under the current preset ventilation parameters. The ventilator automatically switches to a set flow rate or pressure trigger, triggering ventilation three times consecutively, once every three minutes, to obtain the respiratory test results. Once the respiratory test results indicate that the spontaneous breathing test is passed, a tolerance test is performed on the target subject. This involves removing the preset ventilator duration to determine if the target subject can breathe spontaneously. If the target subject can breathe spontaneously, the tolerance test is considered passed, and the intubation tube is removed, ending mechanical ventilation.

[0044] This invention, through anomaly detection of lung parameters in the target subject, enables the acquisition of preset ventilation parameters when all lung parameters are normal. By sequentially performing blood oxygen saturation, inhaled oxygen concentration, pH, spontaneous breathing, and tolerance tests on the target subject, the next parameter is tested only when the previous test result meets the requirements. This improves the precision and accuracy of ventilator ventilation control, simplifies the complex parameter detection and adjustment process, and ultimately achieves precise control for terminating mechanical ventilation.

[0045] In one embodiment, step S20 involves detecting the blood oxygen saturation of the target object to obtain a blood oxygen detection result, which includes a first blood oxygen detection result and a second blood oxygen detection result; including:

[0046] S201, obtain the blood oxygen saturation of the target object, and compare the blood oxygen saturation with the preset blood oxygen threshold.

[0047] S202, when the blood oxygen saturation is less than or equal to the preset blood oxygen threshold, a first blood oxygen detection result is obtained, and the inhaled oxygen concentration is increased so that the blood oxygen saturation is greater than the preset blood oxygen threshold.

[0048] S203, when the blood oxygen saturation is greater than the preset blood oxygen threshold, a second blood oxygen detection result is obtained.

[0049] Understandably, a preset blood oxygen threshold refers to a blood oxygen saturation level set in advance based on the target subject. The first blood oxygen detection result is used to indicate that the blood oxygen saturation is less than or equal to the preset blood oxygen threshold. The second blood oxygen detection result is used to indicate that the blood oxygen saturation is greater than the preset blood oxygen threshold.

[0050] Specifically, after detecting the blood oxygen saturation of the target subject corresponding to the ventilator operating in a preset ventilation mode, i.e., using a blood oxygen saturation monitor, the blood oxygen saturation corresponding to the target subject is obtained. Then, a preset blood oxygen threshold is retrieved from the database, and the blood oxygen saturation is compared with the preset blood oxygen threshold. When the blood oxygen saturation is less than or equal to the preset blood oxygen threshold, a first blood oxygen detection result is obtained. Then, the inhaled oxygen concentration is increased by adjusting the oxygen flow rate and oxygen pressure of the ventilator to increase the inhaled oxygen concentration so that the blood oxygen saturation is greater than the preset blood oxygen threshold. When the blood oxygen saturation is greater than the preset blood oxygen threshold, a second blood oxygen detection result is obtained. In one embodiment, after ventilation begins, SpO2 (blood oxygen saturation) is monitored. When SpO2 < 92%, FiO2 is increased by titration to make SpO2 > 92%, thus obtaining a blood oxygen saturation greater than the preset blood oxygen threshold.

[0051] In this embodiment, by comparing blood oxygen saturation and a preset blood oxygen threshold, the first blood oxygen detection result and the second blood oxygen detection result are obtained. By increasing the inhaled oxygen concentration when the first blood oxygen detection result is obtained, the blood oxygen saturation is made to be greater than the preset blood oxygen threshold. In turn, the algorithm control simplifies the complex adjustment process and improves the adjustment efficiency.

[0052] In one embodiment, step S30 involves detecting the inhaled oxygen concentration of the target object to obtain an inhaled oxygen detection result, wherein the inhaled oxygen detection includes a first oxygen detection result and a second oxygen detection result; including:

[0053] S301, obtain the inhaled oxygen concentration of the target object, and compare the inhaled oxygen concentration with the preset inhaled oxygen threshold.

[0054] S302, when the inhaled oxygen concentration is greater than or equal to the preset inhaled oxygen threshold, a first oxygen detection result is obtained, and the positive end-expiratory pressure is increased so that the inhaled oxygen concentration is less than the preset inhaled oxygen threshold.

[0055] S303, after continuously adjusting the first preset duration of the positive end-expiratory pressure, the blood oxygen saturation and the inhaled oxygen concentration are re-detected. Then, when it is determined that the blood oxygen detection result indicates that the blood oxygen saturation is greater than the preset blood oxygen threshold and the inhaled oxygen concentration is less than the preset inhaled oxygen threshold, a second oxygen detection result is obtained.

[0056] Understandably, a preset blood oxygen threshold refers to a pre-set inhaled oxygen concentration based on the target individual. The first oxygen detection result indicates that the inhaled oxygen concentration is greater than or equal to the preset inhaled oxygen threshold. The second oxygen detection result indicates that the inhaled oxygen concentration is less than the preset inhaled oxygen threshold.

[0057] Specifically, the inhaled oxygen concentration of the target subject is obtained. This can be achieved by measuring the oxygen concentration inhaled by the target subject using an oxygen analyzer connected to a ventilator, or by collecting a blood sample from the target subject using a blood gas analyzer to indirectly calculate the inhaled oxygen concentration. Then, a preset inhaled oxygen threshold is obtained, and the inhaled oxygen concentration is compared with the preset inhaled oxygen threshold. When the inhaled oxygen concentration is greater than or equal to the preset inhaled oxygen threshold, a first oxygen detection result is obtained. The positive end-expiratory pressure (PEEP) is then increased, specifically by increasing the PEEP by 2 cmH2O, to make the inhaled oxygen concentration less than the preset inhaled oxygen threshold. Further, after continuously adjusting the PEEP for a first preset duration (two minutes), blood oxygen saturation is re-detected. When the blood oxygen detection result indicates that the blood oxygen saturation is greater than the preset blood oxygen threshold, the inhaled oxygen concentration is re-detected. A second oxygen detection result is obtained when the blood oxygen detection result indicates that the blood oxygen saturation is greater than the preset blood oxygen threshold and the inhaled oxygen concentration is less than the preset inhaled oxygen threshold. If the inhaled oxygen concentration is greater than or equal to the preset inhaled oxygen threshold, the positive end-expiratory pressure is increased again to make the inhaled oxygen concentration less than the preset inhaled oxygen threshold, until the inhaled oxygen concentration is determined to be less than the preset inhaled oxygen threshold, and then the second oxygen detection result is obtained.

[0058] In this embodiment, by comparing the inhaled oxygen concentration with a preset inhaled oxygen threshold, the first oxygen detection result and the second oxygen detection result are obtained. When the first oxygen detection result is obtained, the positive end-expiratory pressure is increased and the blood oxygen saturation and inhaled oxygen concentration are re-detected, so that the inhaled oxygen concentration is less than the preset inhaled oxygen threshold, thereby simplifying the complex adjustment process and improving the adjustment efficiency.

[0059] In one embodiment, step S40 involves performing pH value detection on the target object to obtain pH detection results, which include a first pH detection result and a second pH detection result; including:

[0060] S401, Obtain the acid-base detection value of the target object, and compare the acid-base detection value with the preset acid-base range.

[0061] S402, when the acid-base detection value is less than the minimum value of the preset acid-base range, a first acid-base detection result is obtained, and the respiratory rate, tidal volume, or positive end-expiratory pressure is increased so that the acid-base detection value increases to within the preset acid-base range.

[0062] S403, when the acid-base detection value is greater than the maximum value of the preset acid-base range, a second acid-base detection result is obtained, and the respiratory rate, tidal volume, or positive end-expiratory pressure is reduced so that the acid-base detection value is reduced to within the preset acid-base range.

[0063] Understandably, the first acid-base test result is used to characterize the minimum acid-base value that is less than the preset acid-base range. The second acid-base test result is used to characterize the maximum acid-base value that is greater than the preset acid-base range. The preset acid-base range refers to the normal acid-base balance range of the target object.

[0064] Specifically, the actual pH value of the target object is obtained, that is, the target object's blood is analyzed using a blood gas analyzer to obtain the pH value. Then, a preset pH range is retrieved from the database, and the pH value is compared with the preset pH range. When the pH value is less than the minimum value of the preset pH range, the first pH value is obtained, indicating an acidic pH, decreased hemoglobin's oxygen-binding capacity, and excessive carbon dioxide. In this case, the respiratory rate, tidal volume, or positive end-expiratory pressure is increased to raise the pH value back to within the preset pH range, thereby achieving acid-base balance. When the pH value is greater than the maximum value of the preset pH range, the second pH value is obtained, indicating an alkaline pH, the rate of carbon dioxide expulsion exceeds the rate of carbon dioxide production, and hyperventilation occurs. In this case, the respiratory rate, tidal volume, or positive end-expiratory pressure is decreased to reduce the pH value back to within the preset pH range, thereby achieving acid-base balance.

[0065] In this embodiment, by comparing the acid-base detection value with a preset acid-base range, it achieves the following: Firstly, it adjusts the respiratory rate, tidal volume, or positive end-expiratory pressure based on the first acid-base detection result to increase the acid-base detection value to within the preset acid-base range. Secondly, it adjusts the respiratory rate, tidal volume, or positive end-expiratory pressure based on the second acid-base detection result to decrease the acid-base detection value to within the preset acid-base range. This simplifies the complex adjustment process and improves adjustment efficiency.

[0066] In one embodiment, step S50, which involves performing spontaneous breathing detection on the target object to obtain breathing detection results, includes:

[0067] S501, obtain the inhaled oxygen concentration and positive end-expiratory pressure corresponding to the target object, as well as the spontaneous inhalation threshold and spontaneous exhalation threshold.

[0068] S502, compare the inhaled oxygen concentration with the spontaneous inhalation threshold, and compare the positive end-expiratory pressure with the spontaneous exhalation threshold.

[0069] S503, when the inhaled oxygen concentration is less than or equal to the spontaneous inhalation threshold and the positive end-expiratory pressure is less than or equal to the spontaneous exhalation threshold, spontaneous breathing detection is performed on the target object to obtain the breathing detection result.

[0070] Understandably, the spontaneous inhalation threshold is used as a threshold for the concentration of oxygen inhaled during spontaneous breathing monitoring, for example, 50 percent. The spontaneous expiratory threshold is used as a threshold for positive end-expiratory pressure during spontaneous breathing monitoring.

[0071] Specifically, after acid-base balance is achieved, the oxygen concentration inhaled by the target subject is measured using an oxygen analyzer connected to the ventilator, thus obtaining the inhaled oxygen concentration corresponding to the target subject. The positive end-expiratory pressure (PEEP) detected by sensors on the ventilator is also read. Then, the spontaneous inhalation threshold and spontaneous exhalation threshold are retrieved from the database. Next, the inhaled oxygen concentration and the spontaneous inhalation threshold, as well as the PEEP and the spontaneous exhalation threshold, are compared. When the inhaled oxygen concentration is less than or equal to the spontaneous inhalation threshold, and the PEEP is less than or equal to the spontaneous exhalation threshold, a spontaneous breathing test is performed on the target subject, thus obtaining a breathing test result characterizing whether the spontaneous breathing test has passed. Further, when the inhaled oxygen concentration is greater than the spontaneous inhalation threshold, and / or the PEEP is greater than the spontaneous exhalation threshold, the ventilation mode and ventilation parameters are readjusted to ensure that the inhaled oxygen concentration is less than or equal to the spontaneous inhalation threshold, and the PEEP is less than or equal to the spontaneous exhalation threshold.

[0072] In this embodiment, by comparing the inhaled oxygen concentration and the spontaneous inhalation threshold, and by comparing the positive end-expiratory pressure (PEEP) and the spontaneous exhalation threshold, spontaneous breathing detection is achieved when the inhaled oxygen concentration is less than or equal to the spontaneous inhalation threshold, and the PEEP is less than or equal to the spontaneous exhalation threshold. When the inhaled oxygen concentration is greater than the spontaneous inhalation threshold, and / or the PEEP is greater than the spontaneous exhalation threshold, the ventilation mode and ventilation parameters of the ventilator are readjusted so that the inhaled oxygen concentration is less than or equal to the spontaneous inhalation threshold, and the PEEP is less than or equal to the spontaneous exhalation threshold.

[0073] In one embodiment, step S503, which involves performing spontaneous breathing detection on the target object to obtain breathing detection results, includes:

[0074] S5031, automatically switch the triggering mode of the ventilator operating in the preset ventilation mode to gas flow triggering or gas pressure triggering.

[0075] S5032, within a second preset time period, the ventilator continuously triggers a preset number of ventilation tests at the same interval, and when all the ventilation tests are passed, a respiratory detection result representing the success of the spontaneous breathing test is obtained.

[0076] Specifically, after determining that the inhaled oxygen concentration is less than or equal to the spontaneous inhalation threshold and the positive end-expiratory pressure is less than or equal to the spontaneous exhalation threshold, the triggering method of the ventilator, which is operating in a preset ventilation mode, is automatically switched to gas flow triggering or gas pressure triggering. Then, within a second preset duration, the ventilator triggers a preset number of ventilation tests at the same intervals, for example, three consecutive ventilation tests, one every three minutes. When each mechanical ventilation test is passed, a respiratory detection result indicating that the spontaneous breathing test has been passed is obtained. When at least one mechanical ventilation test is not triggered, a respiratory detection result indicating that the spontaneous breathing test has been failed is obtained.

[0077] In this embodiment, by continuously triggering a preset number of ventilation tests at the same interval within a second preset time period, the respiratory detection results characterizing whether the spontaneous breathing test has passed are obtained, thereby improving the precision and accuracy of ventilator ventilation control and simplifying the complex detection process of spontaneous breathing test.

[0078] In one embodiment, step S60, which involves performing a tolerance test on the target object and ending mechanical ventilation when the tolerance test is passed, includes:

[0079] S601, obtain the tolerance parameters corresponding to the target object, and perform anomaly detection on the tolerance parameters to obtain the parameter detection results.

[0080] S602, when the parameter detection result indicates that the tolerance parameter is abnormal, reassess whether the target object should terminate mechanical ventilation.

[0081] S603, when the parameter detection results indicate that the tolerance parameters are not abnormal, the tolerance test is determined to be passed, and mechanical ventilation is terminated.

[0082] Understandably, parameter detection results refer to whether the parameters of the monitored target subject are abnormal at the end of extubation and ventilation. Tolerance parameters refer to parameters related to tolerance testing, such as airway resistance.

[0083] Specifically, the tolerance parameters of the target subject during the spontaneous breathing experiment are monitored, namely, the airway resistance, compliance, and pressure-volume loop (a method for assessing the dynamic characteristics of the respiratory system, i.e., reflecting the function of the respiratory system by measuring the relationship between pressure and volume) corresponding to the target subject. Then, anomaly detection is performed on the tolerance parameters, i.e., determining whether the tolerance parameters are within the normal range. This involves detecting anomalies in the airway resistance, compliance, and pressure-volume loop. When the parameter detection results indicate that the tolerance parameters are abnormal, i.e., the tolerance parameters are not within the normal range, the tolerance test is failed, and the target subject is reassessed to determine whether to terminate mechanical ventilation. When the parameter detection results indicate that the tolerance parameters are normal, the tolerance parameters are within the normal range, the tolerance test is determined to be passed, and mechanical ventilation is terminated by extubation.

[0084] In this embodiment, anomaly detection of tolerance parameters corresponding to the target object is performed to obtain the parameter detection results. When the parameter detection results indicate that the tolerance parameters are abnormal, the target object's blood oxygen saturation is re-detected. When the parameter detection results indicate that the tolerance parameters are normal, the tolerance test is confirmed to have passed, and mechanical ventilation is precisely terminated.

[0085] It should be understood that the sequence number of each step in the above embodiments does not imply the order of execution. The execution order of each process should be determined by its function and internal logic, and should not constitute any limitation on the implementation process of the embodiments of the present invention.

[0086] In one embodiment, a ventilator ventilation control device is provided, which corresponds one-to-one with the ventilator ventilation control methods described in the above embodiments. For example... Figure 2 As shown, the ventilator ventilation control device includes a ventilation parameter module 10, a blood oxygen detection module 20, an inhaled oxygen detection module 30, a pH detection module 40, a spontaneous breathing detection module 50, and a mechanical ventilation termination module 60. Detailed descriptions of each functional module are as follows:

[0087] The ventilation parameter module 10 is used to detect abnormalities in the lung parameter information of the target object. When the abnormality detection result indicates that the lung parameter information is not abnormal, the preset ventilation parameters corresponding to the target object are obtained.

[0088] The blood oxygen detection module 20 is used to detect the blood oxygen saturation of the target object and obtain the blood oxygen detection result when the ventilator is running in a preset ventilation mode according to the preset ventilation parameters.

[0089] The inhaled oxygen detection module 30 is used to detect the inhaled oxygen concentration of the target object when the blood oxygen detection result indicates that the blood oxygen saturation is greater than a preset blood oxygen threshold, and to obtain the inhaled oxygen detection result.

[0090] Acid-base detection module 40 is used to detect the acid-base value of the target object when the inhaled oxygen detection result indicates that the inhaled oxygen concentration is less than a preset inhaled oxygen threshold, and obtain the acid-base detection result.

[0091] The autonomous breathing detection module 50 is used to perform autonomous breathing detection on the target object when the acid-base detection result indicates that the acid-base value is within a preset acid-base range, and obtain the breathing detection result;

[0092] The mechanical ventilation termination module 60 is used to perform a tolerance test on the target subject when the respiratory test results indicate that the spontaneous breathing test has passed, and to terminate mechanical ventilation when the tolerance test has passed.

[0093] In one embodiment, the blood oxygen detection result includes a first blood oxygen detection result and a second blood oxygen detection result; the blood oxygen detection module 20 includes:

[0094] A blood oxygen comparison unit is used to obtain the blood oxygen saturation of the target object and compare the blood oxygen saturation with the preset blood oxygen threshold.

[0095] The first blood oxygen detection unit is used to obtain a first blood oxygen detection result when the blood oxygen saturation is less than or equal to the preset blood oxygen threshold, and to increase the inhaled oxygen concentration so that the blood oxygen saturation is greater than the preset blood oxygen threshold.

[0096] The second blood oxygen detection unit is used to obtain a second blood oxygen detection result when the blood oxygen saturation is greater than the preset blood oxygen threshold.

[0097] In one embodiment, the inhaled oxygen detection includes a first oxygen detection result and a second oxygen detection result; the inhaled oxygen detection module 30 includes:

[0098] An inhaled oxygen comparison unit is used to obtain the inhaled oxygen concentration of the target object and compare the inhaled oxygen concentration with the preset inhaled oxygen threshold.

[0099] The first oxygen detection unit is used to obtain a first oxygen detection result when the inhaled oxygen concentration is greater than or equal to the preset inhaled oxygen threshold, and to increase the positive end-expiratory pressure so that the inhaled oxygen concentration is less than the preset inhaled oxygen threshold.

[0100] The second oxygen detection unit is used to re-detect blood oxygen saturation and re-detect inhaled oxygen concentration after continuously adjusting the positive end-expiratory pressure for a first preset duration, and then obtain the second oxygen detection result when it is determined that the blood oxygen detection result indicates that the blood oxygen saturation is greater than the preset blood oxygen threshold and the inhaled oxygen concentration is less than the preset inhaled oxygen threshold.

[0101] In one embodiment, the acid-base detection result includes a first acid-base detection result and a second acid-base detection result; the acid-base detection module 40 includes:

[0102] An acid-base comparison unit is used to acquire the acid-base detection value of the target object and compare the acid-base detection value with the preset acid-base range;

[0103] The first acid-base detection unit is used to obtain a first acid-base detection result when the acid-base detection value is less than the minimum value of the preset acid-base range, and to increase the respiratory rate, tidal volume or positive end-expiratory pressure so that the acid-base detection value increases to be within the preset acid-base range.

[0104] The second acid-base detection unit is used to obtain a second acid-base detection result when the acid-base detection value is greater than the maximum value of the preset acid-base range, and to reduce the respiratory rate, tidal volume, or positive end-expiratory pressure so that the acid-base detection value is reduced to within the preset acid-base range.

[0105] In one embodiment, the spontaneous breathing detection module 50 includes:

[0106] The parameter acquisition unit is used to acquire the inhaled oxygen concentration and positive end-expiratory pressure corresponding to the target object, as well as the spontaneous inhalation threshold and spontaneous exhalation threshold.

[0107] A threshold comparison unit is used to compare the inhaled oxygen concentration with the spontaneous inhalation threshold, and to compare the positive end-expiratory pressure with the spontaneous exhalation threshold;

[0108] The breathing detection unit is used to perform spontaneous breathing detection on the target object when the inhaled oxygen concentration is less than or equal to the spontaneous inhalation threshold and the positive end-expiratory pressure is less than or equal to the spontaneous exhalation threshold, and to obtain the breathing detection result.

[0109] In one embodiment, the respiratory detection unit includes:

[0110] The trigger switching subunit is used to automatically switch the triggering mode of the ventilator operating in the preset ventilation mode to gas flow triggering or gas pressure triggering.

[0111] The breathing detection subunit is used to trigger a preset number of ventilation tests continuously at the same interval within a second preset time period, and to obtain a breathing detection result indicating that the spontaneous breathing test has been passed when all the ventilation tests are passed.

[0112] In one embodiment, the mechanical ventilation termination module 60 includes:

[0113] The parameter measurement unit is used to acquire the tolerance parameters corresponding to the target object, and to perform anomaly detection on the tolerance parameters to obtain the parameter detection results.

[0114] A reassessment unit is used to reassess whether the target object should terminate mechanical ventilation when the parameter detection result indicates that the tolerance parameter is abnormal.

[0115] The tolerance test pass unit is used to determine that the tolerance test has passed and terminate mechanical ventilation when the parameter test results indicate that the tolerance parameter is not abnormal.

[0116] Specific limitations regarding the ventilator ventilation control device can be found in the above description of the ventilator ventilation control method, and will not be repeated here. Each module in the aforementioned ventilator ventilation control device can be implemented entirely or partially through software, hardware, or a combination thereof. These modules can be embedded in the ventilator's controller in hardware form or independent of it, or stored in the ventilator's memory in software form, so that the controller can call and execute the corresponding operations of each module.

[0117] In one embodiment, a ventilator is provided, comprising a controller, a memory, a network interface, and a database connected via a system bus. The controller provides computing and control capabilities. The memory includes a readable storage medium and internal memory. The readable storage medium stores an operating system, computer programs, and a database. The internal memory provides an environment for the operation of the operating system and computer programs in the readable storage medium. The network interface is used to communicate with an external terminal via a network connection. When executed by the controller, the computer program implements a ventilator ventilation control method.

[0118] In one embodiment, a ventilator is provided, including a memory, a controller, and a computer program stored in the memory and executable on the controller, wherein the controller executes the computer program to implement the ventilator ventilation control method described above.

[0119] In one embodiment, a computer-readable storage medium is provided having a computer program stored thereon, which, when executed by a controller, implements the above-described ventilator ventilation control method.

[0120] Those skilled in the art will understand that all or part of the processes in the methods of the above embodiments can be implemented by a computer program instructing related hardware. The computer program can be stored in a non-volatile computer-readable storage medium. When executed, the computer program can include the processes of the embodiments of the above methods. Any references to memory, storage, databases, or other media used in the embodiments provided by this invention can include non-volatile and / or volatile memory. Non-volatile memory can include read-only memory (ROM), programmable ROM (PROM), electrically programmable ROM (EPROM), electrically erasable programmable ROM (EEPROM), or flash memory. Volatile memory can include random access memory (RAM) or external cache memory. By way of illustration and not limitation, RAM is available in various forms, such as static RAM (SRAM), dynamic RAM (DRAM), synchronous DRAM (SDRAM), dual data rate SDRAM (DDRSDRAM), enhanced SDRAM (ESDRAM), synchronous link DRAM (SLDRAM), RAMbus direct RAM (RDRAM), direct memory bus dynamic RAM (DRDRAM), and RAMbus dynamic RAM (RDRAM), etc.

[0121] Those skilled in the art will clearly understand that, for the sake of convenience and brevity, the above-described division of functional units and modules is used as an example. In practical applications, the above functions can be assigned to different functional units and modules as needed, that is, the internal structure of the device can be divided into different functional units or modules to complete all or part of the functions described above.

[0122] The above-described embodiments are only used to illustrate the technical solutions of the present invention, and are not intended to limit it. Although the present invention has been described in detail with reference to the foregoing embodiments, those skilled in the art should understand that modifications can still be made to the technical solutions described in the foregoing embodiments, or equivalent substitutions can be made to some of the technical features. Such modifications or substitutions do not cause the essence of the corresponding technical solutions to deviate from the spirit and scope of the technical solutions of the embodiments of the present invention, and should all be included within the protection scope of the present invention.

Claims

1. A ventilator, characterized in that, The ventilator includes a controller, which is configured to perform the following steps: Anomaly detection is performed on the lung parameter information of the target object. When the anomaly detection result indicates that the lung parameter information is normal, the preset ventilation parameters corresponding to the target object are obtained. Among them, the lung parameter information is used to detect whether the target object has underlying lung disease. When there is no underlying lung disease, it is detected whether the target object has undergone single lung transplantation. When there is no single lung transplantation, it is determined that the anomaly detection result indicates that the lung parameter information is normal. When the ventilator is running in a preset ventilation mode according to the preset ventilation parameters, the blood oxygen saturation of the target object is detected to obtain the blood oxygen detection result. When the blood oxygen detection result indicates that the blood oxygen saturation is greater than a preset blood oxygen threshold, the inhaled oxygen concentration of the target object is detected to obtain the inhaled oxygen detection result. When the inhaled oxygen detection result indicates that the inhaled oxygen concentration is less than a preset inhaled oxygen threshold, the target object is subjected to acid-base value detection to obtain acid-base detection results. When the acid-base detection result indicates that the acid-base value is within a preset acid-base range, the target object is subjected to spontaneous breathing detection to obtain the breathing detection result. When the respiratory test results indicate that the spontaneous breathing test has been passed, the target subject undergoes a tolerance test, and mechanical ventilation is terminated when the tolerance test is passed. The inhaled oxygen detection includes the results of the first oxygen detection and the second oxygen detection. The step of detecting the inhaled oxygen concentration of the target object to obtain the inhaled oxygen detection result includes: Obtain the inhaled oxygen concentration of the target object and compare the inhaled oxygen concentration with the preset inhaled oxygen threshold; When the inhaled oxygen concentration is greater than or equal to the preset inhaled oxygen threshold, a first oxygen detection result is obtained, and the positive end-expiratory pressure is increased so that the inhaled oxygen concentration is less than the preset inhaled oxygen threshold. After continuously adjusting the first preset duration of the positive end-expiratory pressure, the blood oxygen saturation and the inhaled oxygen concentration are re-detected. Then, when it is determined that the blood oxygen detection result indicates that the blood oxygen saturation is greater than the preset blood oxygen threshold and the inhaled oxygen concentration is less than the preset inhaled oxygen threshold, a second oxygen detection result is obtained.

2. The ventilator as described in claim 1, characterized in that, The step of performing spontaneous breathing detection on the target object and obtaining breathing detection results includes: Obtain the inhaled oxygen concentration and positive end-expiratory pressure corresponding to the target object, as well as the spontaneous inhalation threshold and spontaneous exhalation threshold; Compare the inhaled oxygen concentration with the spontaneous inhalation threshold, and compare the positive end-expiratory pressure with the spontaneous expiratory threshold; When the inhaled oxygen concentration is less than or equal to the spontaneous inhalation threshold and the positive end-expiratory pressure is less than or equal to the spontaneous exhalation threshold, spontaneous breathing detection is performed on the target subject to obtain breathing detection results.

3. The ventilator as described in claim 2, characterized in that, The step of performing spontaneous breathing detection on the target object and obtaining breathing detection results includes: The triggering mode of the ventilator operating in the preset ventilation mode will be automatically switched to gas flow triggering or gas pressure triggering. Within a second preset duration, the ventilator continuously triggers a preset number of ventilation tests at the same intervals, and when all the ventilation tests are passed, a respiratory detection result indicating that the spontaneous breathing test has been passed is obtained.

4. The ventilator as described in claim 1, characterized in that, The step of performing a tolerance test on the target object and ending mechanical ventilation when the tolerance test is passed includes: Obtain the tolerance parameters corresponding to the target object, and perform anomaly detection on the tolerance parameters to obtain the parameter detection results; When the parameter detection results indicate that the tolerance parameter is abnormal, the mechanical ventilation of the target object should be reassessed. When the test results of the parameters indicate that the tolerance parameters are normal, the tolerance test is deemed to have passed, and mechanical ventilation is terminated.

5. The ventilator as described in claim 1, characterized in that, The acid-base detection results include a first acid-base detection result and a second acid-base detection result; The step of performing pH value detection on the target object to obtain pH detection results includes: Obtain the acid-base detection value of the target object, and compare the acid-base detection value with the preset acid-base range; When the acid-base detection value is less than the minimum value of the preset acid-base range, a first acid-base detection result is obtained, and the respiratory rate, tidal volume, or positive end-expiratory pressure is increased so that the acid-base detection value increases to be within the preset acid-base range. When the acid-base detection value is greater than the maximum value of the preset acid-base range, a second acid-base detection result is obtained, and the respiratory rate, tidal volume, or positive end-expiratory pressure is reduced so that the acid-base detection value is reduced to within the preset acid-base range.

6. The ventilator as described in claim 1, characterized in that, The blood oxygen detection results include a first blood oxygen detection result and a second blood oxygen detection result; The step of detecting blood oxygen saturation in the target object to obtain blood oxygen detection results includes: Obtain the blood oxygen saturation of the target object and compare the blood oxygen saturation with the preset blood oxygen threshold; When the blood oxygen saturation is less than or equal to the preset blood oxygen threshold, a first blood oxygen detection result is obtained, and the inhaled oxygen concentration is increased so that the blood oxygen saturation is greater than the preset blood oxygen threshold. When the blood oxygen saturation is greater than the preset blood oxygen threshold, a second blood oxygen detection result is obtained.

7. A ventilator ventilation control device, characterized in that, include: The ventilation parameter module is used to detect abnormalities in the lung parameter information of the target object. When the abnormality detection result indicates that the lung parameter information is normal, the preset ventilation parameters corresponding to the target object are obtained. Among them, the module detects whether the target object has underlying lung disease based on the lung parameter information. If there is no underlying lung disease, it detects whether the target object has undergone a single lung transplant. If there is no single lung transplant, it determines that the abnormality detection result indicates that the lung parameter information is normal. The blood oxygen detection module is used to detect the blood oxygen saturation of the target object when the ventilator is running in a preset ventilation mode according to the preset ventilation parameters, and to obtain the blood oxygen detection result. The inhaled oxygen detection module is used to detect the inhaled oxygen concentration of the target object when the blood oxygen detection result indicates that the blood oxygen saturation is greater than a preset blood oxygen threshold, and to obtain the inhaled oxygen detection result. The acid-base detection module is used to detect the acid-base value of the target object when the inhaled oxygen detection result indicates that the inhaled oxygen concentration is less than a preset inhaled oxygen threshold, and to obtain the acid-base detection result. The autonomous breathing detection module is used to perform autonomous breathing detection on the target object when the acid-base detection result indicates that the acid-base value is within a preset acid-base range, and to obtain the breathing detection result; The mechanical ventilation termination module is used to perform a tolerance test on the target subject when the respiratory test results indicate that the spontaneous breathing test has passed, and to terminate mechanical ventilation when the tolerance test is passed. The inhaled oxygen detection includes a first oxygen detection result and a second oxygen detection result; the inhaled oxygen detection module includes: An inhaled oxygen comparison unit is used to obtain the inhaled oxygen concentration of the target object and compare the inhaled oxygen concentration with the preset inhaled oxygen threshold. The first oxygen detection unit is used to obtain a first oxygen detection result when the inhaled oxygen concentration is greater than or equal to the preset inhaled oxygen threshold, and to increase the positive end-expiratory pressure so that the inhaled oxygen concentration is less than the preset inhaled oxygen threshold. The second oxygen detection unit is used to re-detect blood oxygen saturation and re-detect inhaled oxygen concentration after continuously adjusting the positive end-expiratory pressure for a first preset duration, and then obtain the second oxygen detection result when it is determined that the blood oxygen detection result indicates that the blood oxygen saturation is greater than the preset blood oxygen threshold and the inhaled oxygen concentration is less than the preset inhaled oxygen threshold.

8. A computer-readable storage medium storing a computer program, characterized in that, The computer program is executed by the controller to perform the following steps: Anomaly detection is performed on the lung parameter information of the target object. When the anomaly detection result indicates that the lung parameter information is normal, the preset ventilation parameters corresponding to the target object are obtained. Among them, the lung parameter information is used to detect whether the target object has underlying lung disease. When there is no underlying lung disease, it is detected whether the target object has undergone single lung transplantation. When there is no single lung transplantation, it is determined that the anomaly detection result indicates that the lung parameter information is normal. When the ventilator is running in a preset ventilation mode according to the preset ventilation parameters, the blood oxygen saturation of the target object is detected to obtain the blood oxygen detection result. When the blood oxygen detection result indicates that the blood oxygen saturation is greater than a preset blood oxygen threshold, the inhaled oxygen concentration of the target object is detected to obtain the inhaled oxygen detection result. When the inhaled oxygen detection result indicates that the inhaled oxygen concentration is less than a preset inhaled oxygen threshold, the target object is subjected to acid-base value detection to obtain acid-base detection results. When the acid-base detection result indicates that the acid-base value is within a preset acid-base range, the target object is subjected to spontaneous breathing detection to obtain the breathing detection result. When the respiratory test results indicate that the spontaneous breathing test has been passed, the target subject undergoes a tolerance test, and mechanical ventilation is terminated when the tolerance test is passed. The inhaled oxygen detection includes the results of the first oxygen detection and the second oxygen detection. The step of detecting the inhaled oxygen concentration of the target object to obtain the inhaled oxygen detection result includes: Obtain the inhaled oxygen concentration of the target object and compare the inhaled oxygen concentration with the preset inhaled oxygen threshold; When the inhaled oxygen concentration is greater than or equal to the preset inhaled oxygen threshold, a first oxygen detection result is obtained, and the positive end-expiratory pressure is increased so that the inhaled oxygen concentration is less than the preset inhaled oxygen threshold. After continuously adjusting the first preset duration of the positive end-expiratory pressure, the blood oxygen saturation and the inhaled oxygen concentration are re-detected. Then, when it is determined that the blood oxygen detection result indicates that the blood oxygen saturation is greater than the preset blood oxygen threshold and the inhaled oxygen concentration is less than the preset inhaled oxygen threshold, a second oxygen detection result is obtained.

9. The readable storage medium as claimed in claim 8, characterized in that, The step of performing spontaneous breathing detection on the target object and obtaining breathing detection results includes: Obtain the inhaled oxygen concentration and positive end-expiratory pressure corresponding to the target object, as well as the spontaneous inhalation threshold and spontaneous exhalation threshold; Compare the inhaled oxygen concentration with the spontaneous inhalation threshold, and compare the positive end-expiratory pressure with the spontaneous expiratory threshold; When the inhaled oxygen concentration is less than or equal to the spontaneous inhalation threshold and the positive end-expiratory pressure is less than or equal to the spontaneous exhalation threshold, spontaneous breathing detection is performed on the target subject to obtain breathing detection results.

10. The readable storage medium as claimed in claim 9, characterized in that, The step of performing spontaneous breathing detection on the target object and obtaining breathing detection results includes: The triggering mode of the ventilator operating in the preset ventilation mode will be automatically switched to gas flow triggering or gas pressure triggering. Within a second preset duration, the ventilator continuously triggers a preset number of ventilation tests at the same intervals, and when all the ventilation tests are passed, a respiratory detection result indicating that the spontaneous breathing test has been passed is obtained.

11. The readable storage medium as claimed in claim 8, characterized in that, The step of performing a tolerance test on the target object and ending mechanical ventilation when the tolerance test is passed includes: Obtain the tolerance parameters corresponding to the target object, and perform anomaly detection on the tolerance parameters to obtain the parameter detection results; When the parameter detection results indicate that the tolerance parameter is abnormal, the mechanical ventilation of the target object should be reassessed. When the test results of the parameters indicate that the tolerance parameters are normal, the tolerance test is deemed to have passed, and mechanical ventilation is terminated.

12. The readable storage medium as claimed in claim 8, characterized in that, The acid-base detection results include a first acid-base detection result and a second acid-base detection result; The step of performing pH value detection on the target object to obtain pH detection results includes: Obtain the acid-base detection value of the target object, and compare the acid-base detection value with the preset acid-base range; When the acid-base detection value is less than the minimum value of the preset acid-base range, a first acid-base detection result is obtained, and the respiratory rate, tidal volume, or positive end-expiratory pressure is increased so that the acid-base detection value increases to be within the preset acid-base range. When the acid-base detection value is greater than the maximum value of the preset acid-base range, a second acid-base detection result is obtained, and the respiratory rate, tidal volume, or positive end-expiratory pressure is reduced so that the acid-base detection value is reduced to within the preset acid-base range.

13. The readable storage medium as claimed in claim 8, characterized in that, The blood oxygen detection results include a first blood oxygen detection result and a second blood oxygen detection result; The step of detecting blood oxygen saturation in the target object to obtain blood oxygen detection results includes: Obtain the blood oxygen saturation of the target object and compare the blood oxygen saturation with the preset blood oxygen threshold; When the blood oxygen saturation is less than or equal to the preset blood oxygen threshold, a first blood oxygen detection result is obtained, and the inhaled oxygen concentration is increased so that the blood oxygen saturation is greater than the preset blood oxygen threshold. When the blood oxygen saturation is greater than the preset blood oxygen threshold, a second blood oxygen detection result is obtained.

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