KR20000006713A - pressure controller of endotracheal intubation tube cuff - Google Patents

Abstract

PURPOSE: A pressure adjusting device for an incubating tube in a trachea is provided to be used for maintaining a breath of a patient during an operation and for preventing the impurities of a mouth or a pharynx from being absorbed. CONSTITUTION: A pressure adjusting device(10) is made by:an incubating tube(20) containing a cuff elastic tube(22) enabling a cuff(21) to expand and contract; an instrument being installed in one side of an inflating tube(24) being connected to the incubating tube for automatically supplying a certain pressurized air by introducing a check valve(25); an electronic controlling instrument(30) containing a function of operating a driving force transferring instrument(31) for supplying the air; a pressure sensor(36) for automatically controlling a battery(34) for operating the driving force transferring instrument and the pressure of an air supplying hose(35); and a small sized discharging aperture(38) for enabling to optionally adjust the expansion amount of the cuff. The device can be used for maintaining the breath of a patient in an operation and for preventing impurities of a mouth or a pharynx from being absorbed.

Description

Pressure controller of endotracheal intubation tube cuff}

The present invention relates to a pressure regulator of an endotracheal intubation tube cuff that is used as a means for maintaining breathing of a patient under surgery and preventing foreign material inhalation of the oral cavity or pharynx or during artificial respiration. The air is injected by the power transmission means by the operation of the electronic control means by using the power transmission means and the electronic control means which are generally used, and the small discharge port is made in the air supply hose by making a small discharge port. By allowing it to be discharged through a variety of surgery or artificial respiration will be able to use very reasonably.

In general, when performing anesthesia or artificial respiration during surgery, the intubation tube is inserted into the trachea () 管) to supply air or anesthesia, and is used for anesthesia or artificial respiration during surgery.

In general, the conventional endotracheal intubation tube cuff prevents lung aspiration of the esophagus or gastric contents by blocking the outer wall of the cuff between the tube and the airway during respiratory therapy or emergency resuscitation during general anesthesia. Positive pressure ventilation is possible. If the pressure in the cuff is too low, there is a risk of lung aspiration and gas leakage during positive pressure ventilation.If the pressure is too high, the cuff pressure is higher than the perfusion pressure of the engine. Increasing the blood circulation of the tracheal mucosa, there is a problem that causes the complications such as loss of mucosal ciliary, intratracheal ischemia, necrosis, tracheal swallowing, tracheal fistula, sore throat, love.

In recent years, the development of a new tube to prevent the occurrence of such complications has been made continuously, in this case, the pressure in the intubation tube is less than 25 ~ 35mmHg, the perfusion pressure of the mucous membrane of the airway, and 20 ~ to prevent air leakage during positive pressure ventilation It is recommended to inject about 25mmHg.

However, the rational method for injecting the air in the tube while maintaining the ideal pressure has not been developed, and the method of sensibly sensing the appropriate pressure by artificial manipulation or artificially introducing the air to the extent that the tube does not leak through auscultation It depends on the way of injection.

Since the artificial manipulation or auscultation method is accompanied by a problem of extremely low reliability, it may cause a fatal adverse effect in the case of life-threatening patients, so it can reasonably automatically adjust the pressure of the conventional endotracheal intubation tube cuff as described above. There is an urgent need for the development of devices.

The present invention has been made to solve the above problems, the present invention is to modify the power transmission means and electronic control means of the electronic sphygmomanometer generally used, the injection of air by the operation of the electronic control means to the power transmission means By making a small discharge port in the air supply hose, the air over a certain pressure can be discharged through the small discharge port by operating the control valve, so that it can be reasonably used during various operations or artificial respiration. The present invention mainly prevents mild sore throat, love, pain, dysphagia, severe subglottic hematoma, subglottic edema, tracheitis, vocal bleeding, perforated esophageal organs, granulomas, ulcers, etc. It makes it possible to use it reasonably as a pressure regulator of various endotracheal intubation tube cuffs. The.

Looking at the structural features for achieving the above object of the present invention below in configuring the pressure regulator 10 of the endotracheal intubation tube (20) cuff (21), a good elastic cuff at the end (21) is connected, the other side is provided with a supply for anesthetic supply 23, the inside of the intubation tube (20) with a built-in cuff stretch tube 22 to enable the cuff 21 to stretch; Means for attaching a check valve (25) to one side of an inflating tube (24) connected to the intubation tube (20) to automatically supply air of a predetermined pressure; An electronic control means 30 capable of supplying air by operating the power transmission means 31 such as the display 32 and the pump in accordance with the operation of the switch 33; A pressure sensor 36 capable of automatically controlling pressures of the battery 34 and the air supply hose 35 for operating the power transmission means 31; By operating the control valve 37, the appropriate pressure can be automatically discharged to the outside is made of a small discharge port 38 to arbitrarily control the degree of expansion of the cuff (21).

1 is a partial cutaway schematic diagram showing an embodiment of the present invention

2 is a front view illustrating the use state of the present invention;

Explanation of symbols used in the main part of the drawing

10: pressure regulator

20: intubation tube 21: cuff

22: cuff expansion pipe 23: supply unit

24: Inflating tube 25: Check valve

30: electronic control means 31: power transmission means

32: display unit 33: switch

34: battery 35: supply hose

36: pressure sensor 37: control valve

38: small outlet

1 to 2, in the pressure regulator 10 of the cuff 21 of the endotracheal intubation tube 20, as shown in FIGS. 1 and 2, the cuff 21 having good elasticity at the end is provided. Is connected to, the opposite side is provided with a supply unit 23 for supplying an anesthetic, the inside of the intubation tube (20) with a built-in cuff elastic tube 22 to enable the elastic movement of the cuff 21;

A means for attaching a check valve (25) to one side of an inflating tube (24) connected to the intubation tube (20) to automatically supply air of a predetermined pressure;

An electronic control means 30 having a function of supplying air by operating the display unit 32 composed of a circuit and a power transmission means 31 of a pump or the like as the switch 33 is operated;

A pressure sensor 36 capable of automatically controlling pressures of the battery 34 and the air supply hose 35 for operating the power transmission means 31;

By operating the control valve 37, the appropriate pressure is automatically discharged to the outside, characterized in that consisting of a small discharge port (38) for arbitrarily adjusting the degree of expansion of the cuff (21).

Means for adjusting the pressure may be replaced by a pressure regulator 10 for the purpose of the present invention while maintaining a proper pressure by mounting a separate elastic means using a common glass syringe.

In other words, by mounting elastic means such as a spring or a rubber band having a proper elastic force on the outer end of the glass syringe piston and the glass syringe body, it may be able to maintain the appropriate pressure by identifying the scale displayed on the surface of the glass syringe body.

The present invention, which can be configured as described above, mainly maintains the breathing of the patient in operation, and is used as a means for preventing the inhalation of foreign substances in the oral cavity or pharynx or the endotracheal intubation tube 20 used during artificial respiration. Regarding the pressure regulator (10) of the (21), a feature of the present invention is that the air by the operation of the electronic control means 30 using the power transmission means 31 and the electronic control means 30 that are generally used Is injected by the power transmission means 31, the small discharge port 38 is made in the air supply hose (35) so that the air over a predetermined pressure can be discharged through the small discharge port (38) for various surgery or artificial It will be able to use very reasonably when breathing, it will be described how to use and effect of the present invention according to the above configuration of the present invention.

In using the present invention, when the intubation tube 20 connected to the cuff 21 is first inserted through the oral cavity of the patient, the inflating tube 24 connected thereto is embedded in the intubation tube 20. Since the cuff stretch tube 22 is integrally connected, the cuff 21 connected to the end of the intubation tube 20 enters the internal organ of the oral cavity.

When the operator operates the switch 33 in this state, the display unit 32 and the power transmission unit 31 connected to the battery 34 operate, and the power transmission unit 31 is a pump or the like. Since the pump of the power transmission means 31 is operated by the input circuit of the electronic control means 30 composed of a circuit, it is forced to supply air such as oxygen to the air supply hose 35 side.

When the pressure sensor 36 operates according to the pressure of the air and the pressure value is displayed on the display unit 32, the operator operates the control valve 37 to adjust the pressure in consideration of the value of the display unit 32. It can be.

That is, when the pressure of the air supply hose 35 is excessively increased and the value of the display unit 32 is high, the control valve 37 is operated so that the air supplied through the small discharge port 38 is discharged to the outside. By doing so, the pressure in the air supply hose 35 can be kept constant at all times.

And when the pressure of the air supply hose 35 is low to operate the control valve 37 to close or only slightly open the small discharge port 38 it is possible to always maintain a constant pressure of the air supply hose (35).

The present invention operates as described above because the current of the battery 34 is able to operate the electronic control means 30, the power transmission means 31 and the pressure sensor 36, etc., when the switch 33 is pressed Each component is organically operated so that the pressure of the air supply hose 35 is kept constant at all times so that it can be supplied to the engine.

When the necessary air such as oxygen is supplied to the inflating tube 24 through the check valve 25 while maintaining a constant pressure by the operation of the control valve 37 in the above process the inflating tube (inflating tube) 24 is integrally embedded in the cuff expansion tube 22 inside the intubation tube 20 is connected to the cuff 21, so the air such as oxygen supplied as described above is the cuff expansion tube in the intubation tube 20 It is supplied to the inside of the cuff 21 via the (22) to inflate the cuff 21.

As the cuff 21 is inflated as described above, the cuff 21 is kept in close contact with the inside of the trachea while maintaining a proper pressure to prevent lung aspiration of the esophagus or gastric contents as well as to enable positive pressure ventilation in the airways. Do it.

In the case of supplying the air as described above, the anesthetic may be simultaneously supplied through the supply unit 23 mounted at the tip of the intubation tube 20. In this case, the anesthetic supply line is shown in FIG. 2. By connecting to the supply unit 23 to be supplied to the inside of the intubation tube 20, except for the cuff expansion tube 22, it can be supplied into the engine separately from the air.

At this time, by connecting the check valve 25 to the tip of the inflating tube 24 as a means for preventing the back flow of the air supplied into the engine to prevent the back flow by the operation of the check valve 25 The pressure supplied to the trachea may be kept constant, and the pressure of the air supplied to children, adults, or the elderly may be maintained since the desired pressure may always be maintained accurately by the value identified by the display unit 32 from the outside. If they need to be different from each other, it becomes possible to carry out a very reasonable modification.

In addition, as described above, air and anesthetics are supplied as necessary during surgery, and when not necessary, the pressure regulator 10 and the anesthetics supply line are easily separated by separation, in particular for simple artificial respiration rather than surgery. In this case, the air volume of the small discharge port 38 can be adjusted by operating the control valve 37 according to the value of the display unit 32 by connecting only the pressure regulator 10 as described above. It is possible to supply air to the inside.

The above operation is automatically performed by the operation of the switch 33, as well as such operation is simply performed by the input circuit of the electronic control means 30, the power transmission of the pump or the like by the battery 34 Since the means 31 can be operated, it is possible to expect an effect such that the ease of use is further improved without any waste of energy.

Hereinafter, the present invention will be described according to an embodiment.

Example 1

(Object and Method)

Clinical trials were conducted in 60 patients with grades 1 and 2 of the American Society of Anesthesiologists in their 20s and 60s who were scheduled for surgery due to general anesthesia requiring tracheal intubation.

In general, after anesthesia treatment and induction of anesthesia, which were widely used, intubation was performed using a high-capacity low-pressure intubation tube (20). The pilot balloon was felt by hand and the cuff 21 was inflated to 4-7 ml with room air through a normal syringe.

To 20 patients in Group 2, an elastic means such as a rubber band or a spring, which is connected to a 10cc glass syringe, is connected so that air is automatically injected along the tension of the elastic means by the tension of the elastic means, and the tension of the elastic means. The tension was adjusted in advance so that the pressure in the cuff 21 and the pressure in the cuff 21 were equal to 20 to 25 mmHg, and the injection of air was automatically stopped at that time.

The pressure regulator 10 according to the present invention manufactured by separately injecting air of a predetermined pressure by modifying the power transmission means 31 and the electronic control means 30 included in a general electronic blood pressure monitor to 20 patients corresponding to the third group. Air was injected through.

Since each pressure was measured with a pressure (Sphygmomanometer). Statistical analysis was performed using analysis of variance [ANOVA (ANOVA), and it was determined that the P value was less than 0.05.

(conclusion)

Complications that can usually be caused by intubation of the intubation tube 20 in the trachea are mildly from the sore throat, sexuality, pain, dysphagia, subarachnoid hematoma, subglottic edema, tracheitis, vocal bleeding, and perforation of the esophagus. , Granulomas, ulcers, and so on.

Studies on the causative agents of these complications and studies on prevention methods have been conducted in the anesthesiology area. Among these causative factors, the cuff 21 connected to the distal end of the intubation tube 20 was devised to enable positive pressure ventilation by preventing gas leakage and preventing lung aspiration, but in the past, in the case of low-volume high-pressure tubes, the cuff was expanded by an expanded cuff. It caused a lot of airway damage. Subsequent use of high pressure low pressure tubing could reduce the incidence of complications due to the low internal pressure of the cuff 21.

However, an increase in the pressure in the cuff 21 may cause an increase in the pressure in the cuff 21 in patients with high airway pressures or in patients with high mechanical pressure or in the case of long-term anesthesia with N ₂ O gas. It may be accompanied by damaging problems.

In the experiment of Revennas, when the air is injected into the cuff 21 or more than 20 mmHg, the pressure inside the cuff 21 is increased by nitrous oxide during anesthesia, resulting in overexpansion of the cuff 21. It is said to be the main risk factor that damages the mucous membrane of the inner wall. When the pressure in the cuff 21 is 30mmHg or more in Nodin's animal experiment, it causes necrosis of the airway mucosa, so the pressure in the cuff 21 is 20mmHg or less. Rader's research indicates that the internal pressure of the cuff 21 causes damage to the internal wall of the trachea.

The arterial pressure of blood vessels in the adult airway wall is about 30 mmHg (42 cmH ₂ O) or 25-35 torr, and the capillary venous pressure is about 18 mmHg (24 cmH ₂ O). The perfusion pressure of this airway mucosa is similar to the airway pressure normally reached during positive pressure ventilation, and in addition, the inflated cuff 21 puts pressure on the airway wall, thereby reducing or blocking blood flow in the tracheal wall. If it is more than 30mmHg, necrosis of the tracheal mucosa is said to occur.

Counting blank (Seegobin) is the pressure in the cuff _{(21) 30cmH 2 O (22mmHg} ) from the blood flow was reduced in the mucous membranes of the organs of cartilage, 50cmH ₂ O (37mmHg) the proof of using the endoscopic photography and that the blood flow is completely blocked It was.

During anesthesia, N ₂ O diffuses about 34 times faster than N ₂ , so the volume and pressure of cuff 21 during anesthesia show a clear increase with time. Afterwards, the 50% N ₂ O-use group increased above the perfusion pressure after 90 minutes, while the 70% N ₂ O-use group of the concentration similar to the anesthesia gas used remained unchanged below the perfusion pressure during the whole period.

As a method for preventing airway damage due to fluctuations in internal pressure of the cuff 21, a method of intermittently removing gas in the cuff 21, a method of injecting saline in the cuff 21, or a pressure in the tube itself can be adjusted. There is a way to control the pressure using a built-in device or a rediffusion system.

However, in the method of injecting air in the cuff 21 as described above, in spite of many studies that excessive expansion of the cuff 21 causes airway mucosal damage, most anesthesiologists inject air through a general syringe. Although pressure is predicted subjectively through a small pilot balloon, this is not an accurate method of pressure evaluation.

In clinical practice, there is no simple device to inflate air at this pressure, and even some injectors are overexpanded due to anxiety in endotracheal suction and fear of leaking air during positive pressure ventilation.

In this regard, the present inventors studied two methods and used two methods that can be clinically applied. One method is to prevent the injection of pressure over a certain pressure by using the tension of elastic means such as rubber or spring. Bars were a bit cumbersome but were successful for the desired input injection and did not cause any positive pressure ventilation.

Another method is to modify the power transmission means 31 built in the general electronic sphygmomanometer as the present invention and to inject air through the pressure sensor 36 to produce a separate mechanism to enter the air only up to a desired constant pressure through the pressure sensor 36. As a result of using it was able to reach the ideal pressure in the cuff 21 more easily than the previous method.

Accordingly, all of the above methods could exclude subjectiveness of the operator and showed satisfactory response to users.

In conclusion, the present invention was able to minimize the possibility of causing damage to the airway mucosa due to the easy injection of the desired pressure compared to the previous method, and this has the advantage that can be easily used in the clinic. To prevent bronchial mucosal damage of the perforated tube or to reduce the incidence of airway obstruction by the cuff 21 of the endotracheal intubation tube 20, You can see that it can be used as a way to reduce it.

As described in detail above, the present invention converts the power transmission means 31 and the electronic control means 30 of the electronic blood pressure monitor which is generally used, and the injection of air by the operation of the electronic control means 30 is a power transmission means. (31) to make a small discharge port 38 in the air supply hose, the air over a predetermined pressure can be discharged through the small discharge port 38 by operating the control valve 37 to perform a variety of surgery or artificial ventilation It can be used very reasonably, in particular, the present invention, as described above, mainly due to minor sore throat, love, pain, dysphagia that occurs when the intubation tube 20 is inserted into the trachea, the subglottic bloody, glottic It is very suitable as a pressure regulator 10 of various endotracheal intubation tubes 20 and cuffs 21, which can prevent inferior edema, tracheitis, vocal cord bleeding, esophageal organ perforation, granulomas, ulcers, and the like. It is an effect such as can generally be expected that the addition is a very excellent value of invention.

Claims (1)

In constructing the pressure regulator 10 of the endotracheal intubation tube 20, the cuff 21, a cuff 21 having good elasticity is connected to the end thereof, and an anesthetic supply supply 23 is provided on the opposite side. Is provided, the inside of the intubation tube 20 is built in the cuff elastic tube 22 to enable the elastic movement of the cuff 21; Means for attaching a check valve (25) to one side of an inflating tube (24) connected to the intubation tube (20) to automatically supply air of a predetermined pressure; An electronic control means 30 capable of supplying air by operating the power transmission means 31 such as the display 32 and the pump in accordance with the operation of the switch 33; A pressure sensor 36 capable of automatically controlling pressures of the battery 34 and the air supply hose 35 for operating the power transmission means 31; Intra-tubal intubation tube cuff, characterized in that it consists of a small discharge port (38) to allow the appropriate pressure is automatically discharged to the outside by operating the control valve 37 to arbitrarily adjust the degree of expansion of the cuff (21) Pressure regulator.