CN115252078B

CN115252078B - Pericardium puncture needle

Info

Publication number: CN115252078B
Application number: CN202210898174.9A
Authority: CN
Inventors: 储慧民
Original assignee: Individual
Current assignee: Individual
Priority date: 2022-07-28
Filing date: 2022-07-28
Publication date: 2024-04-26
Anticipated expiration: 2042-07-28
Also published as: CN115252078A

Abstract

The invention provides a pericardial puncture needle, which belongs to the technical field of puncture needles and comprises a guide assembly, a puncture assembly, a positioning pacing assembly and a three-dimensional modeling assembly, wherein the puncture assembly is arranged on one side of the guide assembly, the puncture assembly can move along the length direction of the guide assembly to puncture the pericardium, the positioning pacing assembly is arranged at the ends of the guide assembly and the puncture assembly and is used for pacing when the pericardium punctures, and the three-dimensional modeling assembly is electrically connected with the positioning pacing assembly and is used for judging the relative position of the puncture assembly compared with the pericardium and cardiac muscle according to the position of the positioning pacing assembly. Compared with the prior art, the embodiment of the invention effectively solves the problem that the needle point is difficult to accurately position in real time in the pericardial puncture process, greatly improves the safety of the operation, and simultaneously plays a role in doubly preventing the needle point from damaging cardiac muscle.

Description

Pericardium puncture needle

Technical Field

The invention belongs to the technical field of puncture needles, and particularly relates to a pericardial puncture needle.

Background

Access to the epicardial space is a cornerstone for many cardiac interventional procedures, such as epicardial radio frequency ablation, which refers to an interventional procedure that involves parallel ablation through pericardial puncture, access to the epicardial space, and mapping and ablation of the epicardium, with the main path being percutaneous subxiphoid or apex puncturing of the pericardium, establishing an operative passageway through which the catheter is passed into the pericardial cavity. Similarly, the technique is applicable to any other type of supraventricular arrhythmia requiring epicardial ablation after failure of endocardial route radio frequency ablation, such as atrial premature, atrial tachycardia, atrial flutter, and atrioventricular bypass. Other applications that are currently rare also include: epicardial left atrial appendage occlusion, esophageal protection, epicardial pacing electrode implantation, etc., but may have bright application prospects in the future. Particularly, in recent years, radio frequency ablation treatment of atrial fibrillation has rapidly progressed, which currently accounts for more than half of the total arrhythmia interventional therapy, the success rate of primary ablation is about 70-80%, and at least 10% of recurrent patients are related to epicardial lesions, so that active epicardial intervention may be required.

The pericardium is a layer of connective tissue membrane structure tightly wrapped around the periphery of the heart, and when performing an extracardiac ablation operation, a passage must be manually opened through a pericardial puncture needle to enable the ablation device to enter between the outer wall of the heart and the pericardium for ablation.

The traditional pericardial puncture technology is performed under the guidance of X-rays, but because the technology is a two-dimensional technology, the positions of a needle tip and pericardium are close at a certain angle, but are possibly not close at other angles, that is, the optimal tangential position is difficult to find, the puncture failure is often caused by the fact that the needle is not in place in clinical operation, and the myocardium is punctured due to the fact that the needle is too deep. Moreover, since the myocardial edge is sometimes unclear under the X-ray due to the fact that one layer of fat is arranged on the surface of the heart, the heart is harder to master when beating, serious consequences of damaging the epicardial surface coronary artery are more likely to occur, and pericardium puncture has certain difficulty, when the traditional technique is operated, the radiation quantity is larger, only a puncture needle point is arranged in the traditional puncture device, pacing cannot be performed during puncture, the potential of a target position cannot be accurately recorded, and the position and the direction of the needle point relative to the pericardium and epicardium cannot be accurately judged, so that myocardial damage is likely to be caused.

Disclosure of Invention

Aiming at the defects of the prior art, the technical problem to be solved by the embodiment of the invention is to provide a pericardial puncture needle.

In order to solve the technical problems, the invention provides the following technical scheme:

a pericardial puncture needle comprises a guiding component, a puncture component, a positioning pacing component and a three-dimensional modeling component,

The puncture assembly is arranged at one side of the guide assembly, the puncture assembly can move along the length direction of the guide assembly to perform pericardial puncture,

The positioning pacing component is arranged at the end parts of the guide component and the puncture component and is used for pacing when the pericardium punctures,

The three-dimensional modeling component is electrically connected with the positioning pacing component and is used for judging the relative position of the puncture component compared with the pericardium and the cardiac muscle according to the position of the positioning pacing component.

As a further improvement of the invention: the puncture assembly comprises a core bar and a puncture needle point arranged at one end of the core bar.

As a further improvement of the invention: the guide assembly comprises a sleeve, and one end of the core rod extends into the sleeve and is in telescopic fit with the sleeve.

As a further improvement of the invention: the positional pacing assembly includes a first electrode and a second electrode,

The first electrode is arranged at the tip position of the puncture needle tip, the second electrode is arranged at the end part of the sleeve,

The three-dimensional modeling component is electrically connected with the first electrode and the second electrode.

As a still further improvement of the invention: the three-dimensional modeling component is electrically connected with the first electrode and the second electrode through connecting cables.

As a still further improvement of the invention: a holding part is arranged at one end of the sleeve pipe far away from the second electrode,

One side of the holding part is provided with a push rod, and one end of the push rod extends into the sleeve and is connected with the core rod.

As a still further improvement of the invention: a channel communicated with the puncture needle point is arranged inside the core rod,

The holding part is also provided with a water injection part on one side, and the water injection part is communicated with the channel inside the core rod and is used for injecting physiological saline or contrast agent into the core rod.

As a still further improvement of the invention: the surface of the core rod and the surface of the sleeve are both provided with insulating coatings.

As a still further improvement of the invention: the sleeve outer wall is provided with scales along the length direction.

As a still further improvement of the invention: one side of the holding part is also provided with a connecting cable port which is coated outside the connecting cable.

Compared with the prior art, the invention has the beneficial effects that:

1. The needle tip and the electrode form a pacing system, which can pace while puncturing and judge the position change of the puncturing needle while monitoring the change of the ventricular beating frequency.

2. Through the arrangement of the double-electrode system, the needle point can record the potential change from pericardium to epicardium while puncturing, and the position reached by the needle point is judged through the potential change.

3. The double-electrode system is arranged, so that the puncture cannula and the needle point can be subjected to three-dimensional modeling, and the model can be changed in real time along with the position movement of the needle point, so that the relative position of the needle point can be judged.

The three points effectively solve the problem that in the prior art, the needle point is difficult to accurately position in real time in the pericardial puncture process, greatly improve the safety of the operation, and simultaneously play a role in doubly preventing the needle point from damaging cardiac muscle.

Drawings

FIG. 1 is a schematic diagram of the structure of the present invention;

FIG. 2 is a schematic diagram of the puncture of the left front position according to the invention;

FIG. 3 is a schematic illustration of the present invention with a center bag pierced;

fig. 4 is a schematic view of the puncture according to the present invention at a left front view of 45 degrees.

Detailed Description

The technical scheme of the patent is further described in detail below with reference to the specific embodiments.

Embodiments of the present patent are described in detail below, examples of which are illustrated in the accompanying drawings, wherein the same or similar reference numerals refer to the same or similar elements or elements having the same or similar functions throughout. The embodiments described below by referring to the drawings are exemplary only for explaining the present patent and are not to be construed as limiting the present patent.

Referring to fig. 1, this embodiment provides a pericardium puncture needle, including direction subassembly, puncture subassembly, location pacing component 3 and three-dimensional modeling component, puncture subassembly sets up direction subassembly one side, puncture subassembly can be followed direction subassembly length direction removes in order to carry out the pericardium puncture, location pacing component 3 sets up direction subassembly with puncture subassembly tip for carry out the pace-making when the pericardium puncture, three-dimensional modeling component with location pacing component 3 electric connection is used for according to location pacing component 3's position judgement puncture subassembly is compared with pericardium, myocardial relative position.

When puncturing is carried out, the puncture assembly moves compared with the guide assembly, one end of the puncture assembly pierces the pericardium, and pacing is carried out by positioning the pacing assembly 3 in the process, so that the ventricular beating frequency is driven to change, and further the puncture assembly is judged to pierce in place; the positioning pacing component 3 is positioned by the three-dimensional modeling component so as to judge the relative position of the puncture component compared with the pericardium and the cardiac muscle.

Referring to fig. 1, in one embodiment, the piercing assembly includes a core pin 2 and a piercing tip 4 disposed at one end of the core pin 2.

During puncturing, the core bar 2 drives the puncturing needle point 4 to move, and the puncturing needle point 4 punctures the pericardium.

Referring to fig. 1, in one embodiment, the guide assembly includes a sleeve 1, and one end of the core rod 2 extends into the sleeve 1 and is telescopically engaged with the sleeve 1.

Through the telescopic fit of the sleeve 1 and the core rod 2, the guide effect is provided for the movement of the core rod 2, and the core rod 2 can be ensured to move stably.

In another embodiment, the guide assembly may further include a guide rod, and a collar is fixedly disposed on one side of the core rod 2, and is slidably sleeved on the outside of the guide rod.

The sliding fit between the ring sleeve and the guide rod piece ensures that the movement of the core rod 2 can be kept stable.

Referring to fig. 1, in one embodiment, the positioning pacing assembly 3 includes a first electrode and a second electrode, the first electrode is mounted at the tip of the puncture needle tip 4, the second electrode is mounted at the end of the cannula 1, and the three-dimensional modeling assembly is electrically connected to the first electrode and the second electrode.

A pacing system is formed by the first electrode and the second electrode, and can pace at the same time during puncture, and a fixed pacing frequency can be set, preferably, the pacing frequency is 100 times/min; when the puncture needle tip 4 is positioned in the sleeve 1 and the first electrode is flush with the second electrode, the three-dimensional modeling component can be positioned to position information, when the puncture needle tip 4 punctures, the puncture needle tip 4 gradually moves out of the sleeve 1, the first electrode and the second electrode are separated by a distance, the three-dimensional modeling component can be positioned to position information of the two electrodes, modeling can be performed by the three-dimensional modeling component according to the moving distance (the distance between the two electrodes), the shape, the position and the direction of the whole puncture needle tip 4 and the sleeve 1 are simulated, and the relative positions of the puncture needle tip 4, the pericardium and the cardiac muscle can be judged.

Referring to fig. 1, in one embodiment, the three-dimensional modeling component is electrically connected to the first electrode and the second electrode through a connection cable 9.

Referring to fig. 1, in one embodiment, a holding portion 7 is disposed at an end of the sleeve 1 away from the second electrode, a push rod 10 is disposed at one side of the holding portion 7, and one end of the push rod 10 extends into the sleeve 1 and is connected to the core rod 2.

During puncturing, the push rod 10 is pushed to drive the core rod 2 to move along the inside of the sleeve 1, so as to drive the puncture needle tip 4 to move out of the inside of the sleeve 1 and puncture the pericardium.

Referring to fig. 1, in one embodiment, a channel communicating with the puncture needle tip 4 is provided inside the core rod 2, a water injection portion 6 is further provided at one side of the holding portion 7, and the water injection portion 6 is communicated with the channel inside the core rod 2, and is used for injecting physiological saline or contrast agent into the core rod 2, and the physiological saline or contrast agent is delivered into the body from the puncture needle tip 4.

In one embodiment, the holding part 7 is further provided with a connecting cable opening 8 wrapping the connecting cable 9, and the connecting cable 9 can be protected by the arrangement of the connecting cable opening 8.

In one embodiment, the surface of the core rod 2 and the surface of the sleeve 1 are both provided with insulating coatings, and the outer wall of the sleeve 1 is provided with scales along the length direction so as to judge the length of the needle, and also can judge the distance between the first electrode on the puncture needle tip 4 and the second electrode at the end part of the sleeve 1.

The specific workflow of the embodiment of the invention is as follows:

1. Preparation work before surgery; 2. modeling a ventricle under a three-dimensional system; 3. the puncture device connecting cable is connected with the three-dimensional equipment, and the shape, the position and the direction of the puncture device can be established under three-dimensional mapping; 4. selecting a puncture position, wherein the puncture position selects a left front position; 5. beginning pericardium puncture and pacing at the same time; 6. the needle tip is sent out of the sleeve, pericardial puncture is started, and the potential can be displayed when the needle tip contacts the pericardium; 7. continuing to puncture, simultaneously observing the direction of the needle point and the change of the distance from the needle point to the epicardium through three-dimensional equipment during puncture; 8. the needle tip slowly moves forwards, when the needle tip contacts the cardiac muscle, the needle tip can record the potential change of the cardiac muscle, the ventricular beating frequency is changed, and the three-dimensional equipment can display that the needle tip reaches the cardiac muscle, and the puncture is stopped at the moment; 9. the puncture guide wire is fed for puncture, and the guide wire definitely enters the pericardium when the guide wire takes the shape along the transparent belt.

Specifically, in step 1, for the preparation work before the operation, surgical instruments such as a puncture guide wire, a pericardial puncture needle, a Y-valve, a syringe, and the like are prepared. First, before insertion, the puncture guide wire is passed through the puncture needle, and whether the guide wire can smoothly pass through the puncture needle without obstruction and whether the shape of the puncture guide wire is normal or not is confirmed. And then, heparin physiological saline is injected into the puncture needle through the Y-shaped valve, and the puncture needle tube is thoroughly flushed. And thirdly, retracting the puncture guide wire into the puncture needle tube.

Specifically, in step 4, for puncture position selection, a suitable puncture position and a suitable needle insertion angle are selected by analyzing the heart, diaphragm, xiphoid process, sternal anatomy and X-ray imaging characteristics. The left anterior position (LAO) can clearly determine the left and right diaphragmatic muscles, preferably 40-50 degrees, more preferably 45 degrees, of the left anterior position. The puncture of this body position can avoid the puncture to damage the diaphragm, the front and back positions of the puncture point can be easily judged, the transparent belt at the bottom of the heart can be easily observed, and simultaneously, the coronary artery injury can be avoided, and the frequent body position change is avoided, as shown in fig. 2.

Specifically, in step 5, it includes: first, a skin penetration point was confirmed, and a surgical knife was used to cut 2mm to 3mm under the xiphoid process. Secondly, the puncture needle is inserted from the skin incision and the spine at an included angle of 20-40 degrees, and definitely above the left diaphragm, and the needle tip of the puncture needle gradually approaches to the transparent belt in the needle insertion process. The puncture point is adjusted to be positioned between 1/4 and 2/5 of the left heart image, preferably, the puncture point is adjusted to be positioned about 1/3 of the left heart image, the sleeve body is pushed until the sleeve distal end is blocked, at the moment, the sleeve body distal end is judged to contact the pericardium, as shown in fig. 3, and at the moment, the needle point plane is exactly parallel to the outer surface of the pericardium. Preferably, the needle is advanced from the skin incision at an angle of 30 ° to the spine.

Fig. 4 shows a pericardial puncture according to a preferred embodiment of the present invention. As shown in fig. 4, the puncture is performed at a view angle of 45 degrees from the left front, so that the puncture is prevented from damaging the diaphragm, the front and rear positions of the puncture point are easily judged, the transparent belt at the bottom of the heart is easily observed, and the coronary artery injury is avoided.

In the embodiment of the invention, the second electrode is arranged on the sleeve and drives the first electrode with the puncture needle tip to form a double-electrode system, on one hand, when the puncture needle tip gradually moves from the pericardium to the epicardium, the potential can be monitored in real time when the puncture needle tip punctures, and when the puncture needle tip contacts the cardiac muscle, the potential can be monitored to change by the puncture needle tip; on the other hand, the puncture needle tip and the second electrode on the sleeve can form a pacing system, in the process of puncturing, the pacing frequency is 100 times/min, and when the pacing drives the ventricle, the ventricular beat frequency changes, so that the puncture needle is further judged to be in place. In addition, the double electrodes formed by the first electrode and the second electrode can be positioned in real time under a three-dimensional system, and the positions and directions of the sleeve and the puncture needle tip can be accurately displayed. The position change of the puncture needle can be accurately and effectively judged by the judging method, and the safety of the operation is greatly improved.

While the preferred embodiments of the present patent have been described in detail, the present patent is not limited to the above embodiments, and various changes may be made without departing from the spirit of the present patent within the knowledge of those skilled in the art.

Claims

1. A pericardial puncture needle is characterized by comprising a guiding component, a puncture component, a positioning pacing component and a three-dimensional modeling component,

The puncture assembly is arranged inside the guide assembly, the puncture assembly can move along the length direction of the guide assembly to perform pericardial puncture,

The three-dimensional modeling component is electrically connected with the positioning pacing component and is used for judging the relative position of the puncture component compared with the pericardium and the cardiac muscle according to the position of the positioning pacing component,

The puncture assembly comprises a core bar and a puncture needle point arranged at one end of the core bar,

The guide component comprises a sleeve, one end of the core rod extends into the sleeve and is in telescopic fit with the sleeve,

The positional pacing assembly includes a first electrode and a second electrode,

2. The pericardial puncture needle according to claim 1, wherein the three-dimensional modeling component is electrically connected to the first electrode and the second electrode via a connecting cable.

3. A pericardial puncture needle according to claim 2, wherein the end of the sleeve remote from the second electrode is provided with a grip portion,

4. A pericardial puncture needle according to claim 3, wherein the core rod is provided with a passage inside which communicates with the puncture needle tip,

5. A pericardial puncture needle according to claim 1, wherein the core rod surface and the cannula surface are provided with an insulating coating.

6. A pericardial puncture needle according to claim 1, wherein the outer wall of the cannula is provided with graduations along the length direction.

7. A pericardial puncture needle according to claim 3, wherein the holding part is further provided with a connecting cable port which is covered on the outside of the connecting cable.