JP3590705B2 - Emergency resuscitation esophageal airway - Google Patents

Description

[0001]
TECHNICAL FIELD OF THE INVENTION
The present invention relates to an airway used to secure an airway required for breathing of a patient. More specifically, patients without general use of an endotracheal tube or face mask, under general anesthesia or in a coma, or who are unable to maintain their airways and have difficulty keeping their upper airways open (myasthenia) And paralyzed patients) to secure an airway from the larynx to the trachea and lungs, and from the oral cavity to the throat where air or oxygen or anesthetic gas can be easily inhaled or exhaled. The present invention relates to a medical airway securing device through which intermittent pressurized respiration can be performed.
[0002]
[Prior art]
2. Description of the Related Art Conventionally, medical instruments for securing an airway for anesthesia, emergency resuscitation, or management of critically ill patients include endotracheal tubes, oral and nasal airways, esophageal-tracheal airways (Combi-tube), and Laryngeal mask (LM). Esophageal closed airway (EOA), esophagogastric tube-equipped airway (EGTA), and the like.
[0003]
By inserting the endotracheal tube orally or nasally into the patient's trachea and connecting it to an anesthesia machine, a ventilator, and a resuscitation device, the airway is secured and the endotracheal suction can be performed appropriately. It has been most widely used because reflux from the stomach and esophagus is isolated from the respiratory tract, and pressurized respiration can be performed without any trouble as needed.
[0004]
However, if this method is to be performed reliably in an emergency for the purpose of emergency lifesaving, the operation of endotracheal intubation with direct laryngeal expansion is likely to cause serious complications such as occurrence of arrhythmia, reflux of gastric contents, This is a high-risk, highly invasive medical procedure that is difficult for a physician who is proficient in this operation to actually perform, depending on the environment, patient's position, etc. Stimulation of the villous epithelium on the inner surface of the trachea by the endotracheal tube or its cuff may cause side effects such as foreign body sensation and sputum difficulty, and may cause serious complications such as glottic edema and tracheitis. It is a serious drawback that it is a serious medical need to avoid foreign objects in the larynx or trachea for the purpose of securing the airway for ventilation. In other words, endotracheal intubation is desirable only in cases where it is necessary or unavoidable, such as thoracotomy and upper cervical surgery, and if there is a reliable alternative to an endotracheal tube, it is no exception.
[0005]
Oral airways and nasal airways, on the other hand, have been widely used for many years, but they simply support the tongue base mechanically at the tip of the inserted airway and try to help prevent airway obstruction by subsidence. In many cases, it cannot be used sufficiently because it cannot support the periphery of the distal end, does not prevent reflux from the esophagus to the trachea, and is required to hold the face mask airtight by hand when performing artificial respiration Is a major drawback, and generally limits the range of cases that can be used and the available time. However, it is an important advantage that it can be widely used by nurses and rescue workers, as well as doctors who are skilled in handling such endotracheal tubes.
[0006]
Further, a device capable of performing ventilation by selecting an air supply route regardless of whether it is intubated into the esophagus or the trachea is disclosed in JP-A-5-269204, US Pat. No. 4,688,568, and JP-A-7-213614. Have been. Even if this device is inserted into either the esophagus or trachea, if the insertion location can be confirmed, the air supply route can be selected and ventilation can be performed, but if the confirmation is incorrect and the air supply route is incorrect, ventilation will not be possible Therefore, it is necessary to quickly and accurately confirm and diagnose whether the patient has been inserted into the esophagus or trachea. Also, like the endotracheal tube, if it is inserted into the trachea, there is a high possibility that serious complications will occur, and it may be difficult to do this unless a physician who is skilled in this operation is practical. On the other hand, the paramedics use this device as a tool to secure the airway, but the fact is that paramedics are not allowed to be inserted into the trachea. Also, when inserting into the esophagus, the length is adjusted to the tracheal bifurcation, so it does not reach the deep part of the esophagus. Because of the curved shape of the esophagus, it is easy to damage the anterior esophagus, and it is particularly dangerous to perform resuscitation by closed heart massage.
[0007]
In addition, a rubber cushion (mask) invented by Doctor Brain of London, UK (UK Patent No. 2,111,394) is attached to the laryngeal opening with a large diameter arcuate tube attached. What is called a laryngeal mask (LM) used in recent years has been introduced in Japan in recent years, and is used for anesthesia and emergency resuscitation. In Japan, 1983 Br. J. Anaesth. Of Brain's Laryngeal mask, which was published in 1989 by Amaga et al. In the journal "Anesthesia". This invention was developed by suctioning or siphoning the liquid remaining in the mask area. Is disclosed in JP-A-2-283378, but is not yet commercially available in this form.
[0008]
With LM, there is no need to insert a foreign body into the trachea, and if inserted correctly, it is convenient for general anesthesia under spontaneous breathing except for prone position, and can be used without any postoperative complications. Has attracted worldwide attention. The drawback is that, when inserted without spontaneous breathing, it is not possible to immediately observe the ventilation state to determine whether it is in the proper position, and the cushion (mask) requires directionality, but may not settle in the correct use position. This is not always easy, and there is a risk that the cushion (mask) may be displaced when the patient is repositioned or transported, and the cushion (mask) which is greatly expanded may obstruct the airway. In addition, since there is not enough pressure to press the cushion (mask) tightly against the larynx and mouth in the throat, gas leaks around the cushion when the airway pressure exceeds a certain level (approximately 20 cmH2O or more) during pressurized artificial respiration. It is difficult to perform sufficient pressurized artificial respiration, and the degree of closure of the upper esophagus is insufficient, so that it is inevitable that the contents of the stomach regurgitate and flow into the trachea (ingestion). In Japan, not only doctors but also nurses and paramedics can use LM. However, for emergency resuscitation, there is a limit to pressurization of positive pressure artificial respiration, and it is difficult to determine the correct insertion depth and position. In some cases, misalignment occurs during transportation at an emergency site or an ambulance.
[0009]
Furthermore, there is no need to perform laryngeal expansion as in the case of endotracheal intubation, and it is inserted blindly and quickly into the esophagus, and the balloon attached near the tip of the tube is inflated in the esophagus to adhere to the esophageal wall, Close the lower esophagus with the tip of the tube, which is a blind end, to prevent reflux of the stomach contents and ensure airtightness.Push gas from the side hole of the tube into the upper esophagus, then to the larynx and trachea. The esophageal closed airway (EOA), which pushes in and ventilates, and the end of the tube is opened so that the contents of the stomach can be aspirated with the attached stomach tube. An esophagogastric tube-equipped airway (EGTA) that passes through the periphery to the esophagus → larynx → trachea is widely used for paramedics.
[0010]
However, this method has a drawback that airtightness cannot be maintained unless the face mask is held in close contact with the patient's face with both hands at the same time as artificial respiration, and thus there is a drawback that pressurized artificial respiration cannot be sufficiently performed in a traveling ambulance. Recently, a strap has been attached to the mask to improve the adhesion to the face. Further, due to its structure, it has been pointed out that it is difficult to discharge carbon dioxide from a patient because the dead space of ventilation gas is larger than that of an endotracheal tube, laryngeal mask, or the like.
[0011]
In addition, Japanese Patent Application Laid-Open No. 6-142205 and Japanese Patent Application No. 7-177436 disclose a device in which these drawbacks of the closed esophagus airway are improved and the mask is replaced with a pharyngeal balloon. These do not require fixation of the mask, and the dead space is smaller than that of the mask type. However, there was a possibility that the tube was erroneously inserted into the trachea because the tube cross section was circular. In addition, the balloons, including the esophagus-tracheal airway, must be inflated two by two individually, and the operation is complicated, and there is a risk that the air injection amount of each may be wrong.
[0012]
[Problems to be solved by the invention]
The present invention has been made in view of the above circumstances, and has no fear of being inserted into the trachea, can be used by being inserted into the esophagus, does not require the use of a face mask, and is airtight in both the stomach direction and the oral direction. To provide an emergency esophageal airway for emergency resuscitation that can adjust the insertion depth while maintaining the satisfactorily, facilitate balloon inflation operation, and can easily and quickly perform resuscitation by pressurized artificial respiration. With the goal.
[0013]
[Means for Solving the Problems]
SUMMARY OF THE INVENTION In order to solve the above problems, the present invention provides a respiratory tube curved in an arc shape except for a portion near a distal end thereof, and a rubber for closing a lower esophagus provided on a periphery near a distal end portion of the respiratory tube. A first balloon made of an elastic elastomer film or a synthetic resin film, and a second balloon made of a synthetic resin thin film for closing a pharynx provided from the base end side at the periphery of the breathing tube. A first balloon inflation tube and a second balloon inflation tube for inflating the first balloon and the second balloon, respectively, and a suction tube opened at the tip of the respiration tube. The tube has a first lumen communicating with the first balloon, a second lumen communicating with the second balloon, a third lumen opening at the distal end, the first balloon and the second balloon. A fourth lumen communicating with the outside of the respiratory tube through a side hole provided on a side surface between the balloon and the balloon, the respiratory tube having a horizontally long elliptical cross-sectional shape, It is characterized in that the side holes are provided only on the inner peripheral side and the side surface of the curve.
Also, in this emergency resuscitation esophageal airway, the volume of the inner space between the second balloon and the respiratory tube is such that the volume of air within the balloon increases the internal pressure of the balloon to 20 to 40 cm water column pressure. The size may be substantially full.
Further, the side holes for gas flow for breathing may be formed in an elliptical shape elongated in the longitudinal direction of the breathing tube, and may be arranged in a plurality of rows so as to be mutually shifted.
Also, an insertion position mark may be provided between the connection position of the balloon inflation tube and the suction tube to the breathing tube and the second balloon.
The long diameter of the distal end of the respiratory tube is 13 mm or more for adults, 8 mm or more for children, and 5 mm or more for infants. It has a size and shape that allows it to be inserted only into the esophagus without being inserted into the trachea. It may be.
[0014]
BEST MODE FOR CARRYING OUT THE INVENTION
Hereinafter, the present invention will be specifically described with reference to the drawings. 1A and 1B show an airway in an esophagus for emergency resuscitation according to one embodiment of the present invention, wherein FIG. 1A is a side view, and FIG. FIGS. 2A and 2B show an esophagus airway for emergency resuscitation according to another embodiment of the present invention, wherein FIG. 2A is a side view, and FIG.
[0015]
As shown in FIG. 1, the respiratory tube (1) is an elliptical tube having a horizontally long cross section that is curved in an arcuate shape and inserted into the esophagus from the oral cavity. The proximal end is open, and the distal end is the suction lumen (19). ) Is closed and the distal end (8) distal to the first balloon (2) extends straight without being curved so that it can be easily inserted along the posterior wall of the esophagus; The distal end of the breathing tube (1) is formed diagonally so that the tip end is on the outer peripheral side of the curve. At the open end of the base end, a connector (15) (usually determined to have a diameter of 15 mm and a taper of 1/40 both internationally and domestically) is attached so that a resuscitator or the like can be directly connected. I have. A first balloon (2) for closing the esophagus is attached adjacent to the distal end (8), while a flexible second for closing the pharynx near the proximal side. A balloon (3) is attached. As shown in FIG. 1 (b), the cross-sectional shape of the respiratory tube (1) is an elliptical shape that is long in the horizontal direction and short in the vertical direction so that the distal end of the tube is difficult to enter the vertically long and narrow laryngeal opening so as not to be inserted into the trachea. Four lumens are formed on the tube wall: a ventilation lumen (16), a first balloon inflation lumen (17), a second balloon inflation lumen (18), and a suction lumen (19). I have. The esophagus is originally flat and oblong before and after, and it expands and contracts as needed, so it can be said that it makes sense to insert a flat oval tube horizontally. Since the ventilation lumen (16) is open at the base end and has a ventilation connector (15) attached and the distal end is sealed, it can be sent from the resuscitation device connected to the ventilation connector (15). The inspired air passes from the ventilation lumen (16) through the respiratory gas flow side hole (4) between the first balloon (2) and the second balloon (3), from the esophagus to the laryngeal cavity, into the trachea. The air in the trachea is sent to the resuscitator from the ventilation lumen (16) through the respiratory gas flow side hole (4) as expiration. The first balloon inflation lumen (17) is connected to a first balloon inflation tube (5) having a pilot balloon (11) with a one-way valve (12) at the distal end, and the distal end is sealed. On the other hand, air injected from the valve (12) passes through the first balloon inflation lumen (17), and flows out into the first balloon (2) from a side hole opened in the first balloon (2). You. The second balloon inflation lumen (18) is connected to a second balloon inflation tube (6) with a pilot balloon (13) with a three-way cock (14) at the distal end, and the distal end is sealed. The air injected from the three-way cock (14) passes through the second balloon inflation lumen (18) and flows out into the second balloon (3) from a side hole opened in the second balloon (3). You. The suction lumen (19) is connected to a suction tube (7) with a connector (15) at the distal end, and the distal end side is open to the outside.
[0016]
Further, from FIG. 2 showing another embodiment, the respiratory tube (31) is an elliptical tube whose cross section curved in an arc shape and long in a horizontal direction is inserted from the oral cavity into the flat esophagus back and forth. The end side is open, and the distal end side is closed with lumens other than the suction lumen (45). To facilitate insertion into the esophagus, the distal end ( 37) extends straight without being curved, and the tip of the respiratory tube (31) is formed obliquely so that the tip end is on the outer peripheral side of the curve. At the open end of the base end, a connector (38) made of synthetic resin (determined to have a diameter of 15 mm and a taper of 1/40 both internationally and domestically) is attached so that a resuscitator or the like can be directly connected. I have. A first balloon (32) for closing the esophagus is attached adjacent to the distal end (37), while a flexible second balloon (close to the proximal side for closing the pharynx). 33) is attached. As shown in FIG. 2 (b), the cross-sectional shape of the breathing tube (31) has an elliptical shape that is long in the horizontal direction and short in the vertical direction so that the distal end of the tube is not easily inserted into the long laryngeal opening so as not to be inserted into the trachea. The tube wall is formed with three lumens: a ventilation lumen (43), first and second balloon inflation lumens (44), and a suction lumen (45). The ventilation lumen (43) is open at the distal end, is fitted with a ventilation connector (38), is sealed at the distal end, and the intake air sent from the resuscitator connected to the ventilation connector (38) is used for ventilation. From the lumen (43), it is sent into the trachea through the respiratory gas circulation side hole (34) between the first balloon (32) and the second balloon (33), and the air in the trachea is respired as expiration gas. It is sent from the ventilation lumen (43) to the resuscitator through the circulation side hole (34). The first and second balloon inflation lumens (44) are connected to the first and second balloon inflation tubes (35) having a pilot balloon (40) with a three-way cock (41) at the distal end, and the distal end is connected to the first and second balloon inflation lumens (44). The air that is sealed and injected through the three-way cock (41) passes through the first and second balloon inflation lumens (44) and opens into the first balloon (32) and the second balloon (33). It flows out of the side holes into the first balloon (32) and the second balloon (33). The suction lumen (45) is connected to a suction tube (36) with a connector (42) on the base end side, and is open on the tip end side.
[0017]
The breathing tubes (1) and (31) are formed to have an appropriate size length and thickness to fit the patient's physique, and have appropriate flexibility and elasticity at normal room temperature and body temperature. As the material, generally, a synthetic resin such as a soft vinyl chloride resin, silicone rubber, or polyurethane is preferably used. The tip portions (8) and (37) extend straight without being curved, and the tip portion is formed diagonally so that the tip end is on the outer peripheral side of the curve. 13 mm or more. The distal ends (8) and (37) are usually formed integrally with the respiratory tubes (1) and (31), but may be plug-like parts as separate members. It may be different from the material of forming the breathing tubes (1) and (31). Insertion position marks (10), (39) between the connection position of the balloon inflation tubes (5), (6), (35) and the suction tubes (7), (36) and the second balloon. May be provided to facilitate checking the insertion depth of the airway in the esophagus for emergency resuscitation.
[0018]
The first balloon inflation tube (5), the second balloon inflation tube (6), and the first and second balloon inflation tubes are made of synthetic resin such as soft vinyl chloride resin, silicone rubber, polyurethane, polyethylene, etc., and have a small diameter. Is formed. Pilot balloons (11), (13) and (40) are provided at their ends to check the degree of inflation of the balloon due to the injected air outside the body. Generally, a suitable material for forming the pilot balloon is a synthetic resin such as a soft vinyl chloride resin, silicone rubber, polyurethane, polyethylene, or polyester. Further, a backflow preventing means, such as a check valve, a stopcock or a stopcock, is attached to those ends so that the injected air does not flow backward. Example In FIG. 1, one valve (12) is operated on the side of the first balloon (2) having a small capacity, and air is added and deaerated on the side of the second balloon (3) having a large capacity without removing the syringe. Shown is a three-way cock (14) attached as possible.
[0019]
A large number of side holes (4) and (34) for breathing gas flow formed in the tube walls of the breathing tubes (1) and (31) are provided with the first balloons (2) and (32) and the second balloon. When (3) and (33) are inflated to airtightly close the lower esophagus and pharynx, respectively, between the first balloons (2) and (32) and the second balloons (3) and (33) Open to the space inside the esophagus where you can. Accordingly, the respiratory gas circulation side holes (4) and (34) are just inserted into the esophagus because the rescue esophageal airway is inserted into the esophagus from the oral cavity such that the tracheal entrance is located between the two balloons. It is drilled near the position where it is inserted into the pharynx from above, but it does not have to be. At the same time, the respiratory gas flow side holes (4) and (34) are usually circular or circular so that the flow of the respiratory gas is ensured without resistance even if a part of the side hole hits the esophageal wall or is blocked by mucus. A large number of elongated holes of appropriate size, e.g., elliptical, are formed in a plurality of rows, especially on the inside and sides of the curved inner circumference. The size and arrangement of the holes (zigzag arrangement) so that the breathing tubes (1) and (31) do not easily bend or flatten due to the side holes (4) and (34) for breathing gas flow. Need to be devised.
[0020]
The first balloons (2) and (32) are for hermetically closing the lower part of the esophagus. To improve airtightness, the first balloons (2) and (32) are made of a rubber-like elastic material such as natural rubber, isoprene rubber, silicone rubber, urethane rubber, ethylene, or the like. -It is formed in a cylindrical shape using synthetic rubber such as propylene rubber, synthetic resin such as soft vinyl chloride resin or elastomer. However, the expansion of the first balloon (32) may be stiffer than that of the second balloon, and it is preferable to select a material whose inflation diameter is restricted to about the esophageal diameter of about 30 mm and further hardly inflates. . When the membrane is inserted without internal pressure, it is important that the membrane adheres to the wall of the respiratory tube and does not hinder the insertion into the esophagus. The second balloons (3) and (33) hermetically close this portion along the wall extending from the upper part of the pharynx to the oral cavity, and follow the complicated shape of the pharynx when inflated. It is formed in a cylindrical shape using a relatively soft resin such as a synthetic resin, for example, polyethylene, polyester, soft vinyl chloride resin, silicone resin, or polyurethane, so as not to strongly press the wall while being in close contact with the resin.
[0021]
The second balloons (3), (33) are rubbery-elastic compared to the first balloons (2), (32) so that when inflated, they do not compress the pharyngeal wall and damage the pharyngeal wall tissue. When the intermittent pressurized respiration is performed up to the internal pressure, the internal pressure of the soft and large balloons (3) and (33) is not defeated by the positive airway pressure. The balloon is deformed. Each time the positive pressure of the intermittent ventilation reaches its peak, it is slightly distorted and the gas does not leak but does not shift. Therefore, the second balloons (3) and (33) are formed so as to expand more in the longitudinal and lateral directions than the first balloons (2) and (32) in order to improve airtightness and fixability. I have. The volume of the space between the second balloons (3), (33) and the breathing tubes (1), (31) was determined by the physique from the second balloon inflation tubes (6), (35). It is sized to be just full when a volume of air is injected at a pressure of 20-40 cmH2O. Although not limited, the amount of air at a pressure of 20 to 40 cmH2O injected into the second balloon is, for example, 50 to 150 ml for an adult and 30 to 60 ml for a child.
[0022]
The suction tubes (7) and (36) are connected to suction lumens (19) and (45) provided on the tube walls of the breathing tubes (1) and (31), and through these, the breathing tubes (19) and (45). 1) and (31) are open at the tip. The suction tubes (7) and (36) are made of the same synthetic resin as the balloon inflation tubes (5), (6) and (35) and have a small diameter, and the base end is usually connected to suction means. Means: Connectors (15) and (42) are provided. The opening positions of the suction lumens (19) and (45) to the tube wall are not particularly limited as long as they are formed on the base end side of the insertion position mark.
[0023]
【The invention's effect】
By using the resuscitation esophageal airway of the present invention, there is no need to insert into the trachea, and since the tube has a horizontally long elliptical shape, there is no danger of being accidentally inserted into a vertically long laryngeal opening, and from the oral cavity to the esophagus It can be easily inserted to the deep part, selectively or simultaneously inflating the balloon, the lower part closes the esophagus, the upper part closes the oral and nasal passages with the pharynx, and can perform ventilation operation, it is safe, secure, whole body It is a tool for securing the airway that is easy to use during anesthesia, etc., and is also extremely useful as an artificial respiration tool that can be easily inserted for use in an emergency.
[Brief description of the drawings]
FIG. 1 is a view showing a structure of an airway in an esophagus for emergency resuscitation according to an embodiment of the present invention, in which (a) is a side view and (b) is a cross-sectional view.
FIG. 2 is a view showing a structure of an airway in an esophagus for emergency resuscitation according to another embodiment of the present invention, in which (a) is a side view and (b) is a cross-sectional view.
[Explanation of symbols]
1, 31 Respiratory tube 2, 32 First balloon 3, 33 Second balloon 4, 34 Respiratory gas flow side hole 5 First balloon inflation tube 6 Second balloon inflation tube 35 First, second Tubes for balloon inflation 7, 36 Tubes for suction 8, 37 Tip 9, 38 Connectors 10, 39 Insertion position mark 11, 13 Pilot balloon 40 Pilot balloon 12 One-way valve 14, 41 Three-way cock 15, 42 Connector 16, 43 Ventilation Lumen 17 First balloon inflation lumen 18 Second balloon inflation lumen 44 First and second balloon inflation lumens 19, 45 Suction lumen

Claims (5)

It consists of a respiratory tube curved in a bow shape except for the vicinity of the distal end , and a rubber-like elastic film or a synthetic resin film for closing a lower esophagus provided on the periphery near the distal end of the respiratory tube. A first balloon, a second balloon made of a synthetic resin thin film for closing the pharynx provided on the periphery of the respiratory tube from the proximal end side, and the first balloon and the second balloon. A first balloon inflation tube and a second balloon inflation tube for inflation, and a suction tube opened at the tip of the respiratory tube, respectively.
A first lumen communicating with the first balloon, a second lumen communicating with the second balloon, a third lumen opening at the distal end, and the first balloon, A fourth lumen communicating with the outside of the respiratory tube via a side hole provided on a side surface between the second balloon and the second balloon;
The respiratory resuscitation esophagus airway, wherein the respiratory tube has a horizontally long elliptical cross-sectional shape, and the side hole is provided only on a curved inner peripheral side and a side surface. 2. The second balloon is sized so that the volume of the inner space between the second balloon and the respiratory tube is substantially full of air sufficient to raise the balloon internal pressure to 20-40 cm water column pressure. The airway in the esophagus for emergency resuscitation according to any of the above. The airway in the esophagus for emergency resuscitation according to claim 1 or 2, wherein the side holes for gas flow for breathing are formed in an oval shape elongated in the longitudinal direction of the breathing tube, and are arranged in a plurality of rows so as to be mutually shifted. The airway in the esophagus for emergency resuscitation according to any one of claims 1 to 3, wherein an insertion position mark is provided between a position where the balloon inflation tube and the suction tube are connected to the breathing tube and the second balloon. The major diameter of the distal end of the respiratory tube is 13 mm or more for adults, 8 mm or more for children, and 5 mm or more for infants. The esophagus airway for emergency resuscitation according to any one of claims 1 to 4.

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