CN103007421B - A kind of honeycomb duct for intercostal nerve block - Google Patents
A kind of honeycomb duct for intercostal nerve block Download PDFInfo
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- CN103007421B CN103007421B CN201210567834.1A CN201210567834A CN103007421B CN 103007421 B CN103007421 B CN 103007421B CN 201210567834 A CN201210567834 A CN 201210567834A CN 103007421 B CN103007421 B CN 103007421B
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- conduit
- intercostal
- nerve block
- honeycomb duct
- incision
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Abstract
The invention discloses a kind of honeycomb duct for intercostal nerve block, by main pipe being arranged three conduits, upper respectively to parietal pleura incision, below each intercostal nerves and incision on the upside of the 2nd, the 2nd of 3 intercostal nervess and downside, 3, 4 intercostal nervess effectively block, each intercostal nerves one by one of otch upper and lower sides directly can carry out anesthetic action by a middle conduit, without the need to offering the leakage micropore at this place again on upper and lower two conduits, avoid occurring medicinal liquid to be strayed into thoracic cavity and cause to otch up and down each root distance occur from the problem that the intercostal nerve block that otch is nearest is insufficient, by adopting three conduits, ensure that 7 intercostal nervess below parietal pleura all can obtain effective narcotic analgesic, reduce the postoperative pain of sufferer, avoid the generation of other complication, reduce the cost of seeking medical advice of patient.
Description
Technical field
The invention belongs to chest open surgery medical instruments field, be specifically related to a kind of honeycomb duct for intercostal nerve block.
Background technology
Thorax operration incision pain is very violent, and it is maximum in all surgical operations that reported literature Thorax operration is used for narcotic consumption needed for pain relieving.Owing to having an intense pain, the deep breathing of limiting patient and cough, reduce Pulmonary Function, severe patient can cause the rising of the complication such as pulmonary atelectasis, pneumonia, arrhythmia.In western countries such as the U.S., post-thoracotomy pain is usually considered to a kind of more serious complication and keeps a close eye on.For a long time, clinician is seeking one Analgesic techniques safely and effectively always, and at present conventional analgesia method comprises that intramuscular injection, intravenous injection or oral analgesic, Duragesic, vein or the pain relieving of dura mater Puncture Tube automatic-control pain-relieving pump, intercostal nerves are freezing, intercostal nerve block etc.These analgesia methods respectively have its pluses and minuses, as Duragesic is difficult to reach requirement of effectively easing pain; Traditional Thorax operration intramuscular injection pethidine hydrochloride is the most general, but its medication interval time is long, blood concentration fluctuation is large, effective analgesic time is limited, usually can not pain relieving in time, be difficult to for patient provides satisfied analgesic effect, and strengthen analgesic dosage and may cause respiration inhibition, the side reaction such as drowsiness, and the long-term patient widely applied there is addiction may.The analgesia of vein analgesic pump is a kind of Analgesic techniques comparatively generally applied at present, comparatively lasting and stable blood drug level can be provided thus reach good analgesic effect, but usually cause nausea, vomit, urine retention, dizziness, drowsiness, even respiration inhibition, its clinically consumption be generally no more than 2 ~ 3 days, after removing pump, the pain of patient often increases the weight of.Dura mater Puncture Tube injection analgesic often can obtain comparatively satisfied analgesic effect, the goldstandard of current Thorax operration analgesia therapy, but also there is complicated operation, risk that the complication such as level of anesthesia is wayward, analgesic effect is unstable, have hypotension, urine retention, restoration of gastrointestinal function are slow is possible.The apparatus that the freezing needs of intercostal nerves are special, although effectively can alleviate Thorax operration patient Short-term Pain, can increase medium-long term pain and the sense of discomfort of postoperative wound in quite a few patient, and it is promoted and application is severely limited.
Intercostal nerve block comprises single retardance, is interrupted retardance and continuous block three kinds of methods.Single retardance generally refers to closes the intercostal nerves place liquid medicine injection of front below the capitulum costae place of otch and upper and lower intercostal thereof, to block intercostal nerves and the branch thereof at this place.Clinically from bringing into use in World War II, use till today always, suffice to show that the prosperity of its vitality, generally believe its have simple to operate, pain relieving rapidly, exact analgesic effect, local application is little to systemic effects, the advantage of the gastrointestinal tract such as apnea suppression, Nausea and vomiting and whole body toxicity.But existing problems to be injected once in art, and action time is short, and analgesia duration is generally no more than 24h; As maintained effect, then needing repeatedly to inject from thoracic cavity after surgery, may occur the risk of the complication such as hemothorax, pneumothorax and effect is no longer definite, is that patient or doctor can not accept.Therefore in the recent decade about Thorax operration single intercostal nerve block application and report fewer and feweri, be also only exist as a kind of auxiliary methods as carried out.
Abroad in Recent Years has carried out the research by pipe laying, the retardance of postoperative intermittent infusion bupivacaine under parietal pleura in art, the curative effect better or more similar than anesthesia analgesia pump can be obtained, unit is also had to carry out the research of ultrasound guidance thoracic wall puncture nerve block, because of complicated operation or technical immature, also cannot obtain approval widely at present clinically and generally carry out.But the good analgesic effect that intercostal nerve block shows and less whole body toxicity should be able to remind us should search out more suitably approaches and methods to the due status in improving intercostal nerve block and easing pain after surgery.
If a certain special device can be utilized reliably to imbed a conduit under parietal pleura, realize the continuous block of postoperative intercostal nerves after connecting micro pump, greatly will extend the analgesic effect of analgesia time, improvement.The Nausea and vomiting that this local application exists because of systemic administration in generally there will not be vein and Epidural Analgesia Pump to use, hypotension, urine retention, dizziness, drowsiness, the even possibility of the complication such as respiration inhibition; On the other hand, the existence of vein and Epidural Analgesia Pump dosage large and gastrointestinal tract and urinary tract side reaction, the time limiting its Postoperative Analgesia After is generally no more than 48h, and intercostal nerve block local anesthetic use amount is few, direct retardance, analgesia high efficiency, can obviously after lengthening service time reach more than one week, the worry no longer including pain after making many operation in patients is frightened, and after being more conducive to operation in patients early ambulation and leave hospital early, Economy type medicine spends; And can realize Thorax operration analgesia by the recurrence of taking as the leading factor with Anesthetist to taking as the leading factor with operative doctor, this measure likely will be subject to great welcome at thoracic surgery clinically, is promoted rapidly.
The domestic unit carried out the research of intercostal nerve block analgesic is little, the analgesia method of current Thorax operration is still taken as the leading factor with the vein of Anesthetist's use and Epidural Analgesia Pump, fragmentary several sections are only had to the report of Continuous intercostal nerve block method, current domestic without tube-placing device under special pleura, the conduit that all units conducted a research use forms by surgeon's scene catheter, deep venouspuncture or epidural catheter transformation on operating-table, our unit is also carrying out this research, and the conduit used is exactly the deep venouspuncture through oneself perforate.Therefore be badly in need of carrying out this research, plug a gap, for patient seeks the well-being of.
There is other continuous block device (patent No.: 201120301333.X) of vertebra of a chest open surgery at present, mention by adopting the walk help effect of a head hollow needle to make two microbore catheter can enter between parietal pleura and thoracic wall in this patent document, by supravasal micropore, medicinal liquid is entered intercostal nerves place to anaesthetize, due in parietal pleura incision, cut off a wherein root bone, the intercostal nerves of these rib both sides flows into medicinal liquid by micropore equally and anaesthetizes, and because the intercostal nerves at this place is near incision, because thoracic cavity exists the problem of negative pressure, medicinal liquid easily enters in thoracic cavity by otch, cause anaesthetic effect undesirable, medicinal liquid enters the generation that thoracic cavity easily causes other complication, the pain of patient can not well be controlled.
Therefore, be necessary to propose a kind of can effectively anesthesia the intercostal nerves of incision, avoid micropore leakage to enter in thoracic cavity simultaneously, play effective analgesic effect, reduce the generation of complication.
Summary of the invention
In view of this, the invention provides a kind of effectively to the honeycomb duct for intercostal nerve block that the intercostal nerves of incision is anaesthetized, micropore leakage can being avoided simultaneously to enter in thoracic cavity, play effective analgesic effect, reduce the generation of complication.
A kind of honeycomb duct for intercostal nerve block that object according to the present invention proposes, it is characterized in that, comprise main pipe and in order to stretch into the conduit between parietal pleura and thoracic wall, described conduit is divided into the ascending branch conduit extended upwardly into through described parietal pleura incision and descending the conduit stretched into through described parietal pleura incision downwards, and props up conduit for stretching into the upper and lower two interneural centres of intercostal of described parietal pleura incision;
Described ascending branch conduit is for benumbing the intercostal nerves above parietal pleura incision, and described descending conduit is for benumbing the intercostal nerves below parietal pleura incision, and conduit is propped up for benumbing upper and lower two intercostal nervess of parietal pleura incision in described centre;
The front end of described each conduit all offers the micropore of multiple fluid.
Preferably, the junction of described main pipe and described conduit is provided with the transparent joint being convenient to observe described each catheter position, and described each conduit, by the parallel front end being distributed in described main pipe of described transparent joint, makes described each conduit fluid even.
Preferably, the front end of described each conduit is provided with and is convenient to a described conduit and moves and the balancing weight of locating.
Preferably, described mozzle also comprises the seal wire driving described each conduit movement.
Preferably, described balancing weight rear end offers groove, and described seal wire front end is provided with the projection with described groove match.
Preferably, described balancing weight is aluminium block or lead.
Preferably, described main pipe also offers the side opening passed for liquid medicine injection or the described seal wire of confession.
Preferably, described centre is propped up conduit and is stretched into 2cm under sympathetic nerve.
Preferably, described each catheter proximal end 4cm place is distributed with micropore.
Preferably, described ascending branch conduit and described descending catheter length are 10-12cm, and it is 6-8cm that catheter length is propped up in described centre.
Compared with prior art, the advantage of honeycomb duct for intercostal nerve block of the present invention is: by main pipe being arranged three conduits, upper respectively to parietal pleura incision, below each intercostal nerves and incision on the upside of the 2nd, the 2nd of 3 intercostal nervess and downside, 3, 4 intercostal nervess effectively block, each intercostal nerves one by one of otch upper and lower sides directly can carry out anesthetic action by a middle conduit, without the need to offering the leakage micropore at this place again on upper and lower two conduits, avoid occurring medicinal liquid to be strayed into thoracic cavity and cause to otch up and down each root distance occur from the problem that the intercostal nerve block that otch is nearest is insufficient, by adopting three conduits, ensure that 7 intercostal nervess below parietal pleura all can obtain effective narcotic analgesic, reduce the postoperative pain of sufferer, avoid the generation of other complication, reduce the cost of seeking medical advice of patient.
Accompanying drawing explanation
In order to be illustrated more clearly in the embodiment of the present invention or technical scheme of the prior art, be briefly described to the accompanying drawing used required in embodiment or description of the prior art below, apparently, accompanying drawing in the following describes is only some embodiments of the present invention, for those of ordinary skill in the art, under the prerequisite not paying creative work, other accompanying drawing can also be obtained according to these accompanying drawings.
Fig. 1 is the structural representation of a kind of honeycomb duct for intercostal nerve block disclosed by the invention.
Fig. 2 is the structural representation of seal wire in a kind of honeycomb duct for intercostal nerve block disclosed by the invention.
Structural representation when Fig. 3 is a kind of honeycomb duct for intercostal nerve block use disclosed by the invention.
The title of the numeral in figure or the corresponding component representated by letter:
1, conduit 5, rib 6, intercostal nerves 7, micropore 8, transparent joint 9, side opening 10, balancing weight 11, groove 12, infusion pump 13, flow control valve 14, seal wire 15, projection 16, sympathetic nerve A, otch are propped up in main pipe 2, ascending branch conduit 3, descending conduit 4, centre
Detailed description of the invention
The other continuous block device of the vertebra adopted in prior art comprises microbore catheter more than two, in use easily there is medicinal liquid leaking hunting in incision, medicinal liquid is caused to flow into thoracic cavity, cause anaesthetic effect undesirable, medicinal liquid enters the generation that thoracic cavity easily causes other complication, makes the problems such as the pain of patient can not well control.
The present invention is directed to deficiency of the prior art, a kind of honeycomb duct for intercostal nerve block proposed, by arranging three conduits on main pipe, two intercostal nervess of otch upper and lower sides directly can carry out anesthetic action by a middle conduit, without the need to offering the leakage micropore at this place again on upper and lower two conduits, avoid occurring that medicinal liquid is strayed into the problem generation in thoracic cavity, by adopting three conduits, ensure that the intercostal nerves below parietal pleura all can obtain effective narcotic analgesic, reduce the postoperative pain of sufferer, avoid the generation of other complication, reduce the cost of seeking medical advice of patient.
Please also refer to Fig. 1 and Fig. 3, Fig. 1 is the structural representation of a kind of honeycomb duct for intercostal nerve block disclosed by the invention.Fig. 2 is the structural representation of seal wire in a kind of honeycomb duct for intercostal nerve block disclosed by the invention.Structural representation when Fig. 3 is a kind of honeycomb duct for intercostal nerve block use disclosed by the invention.A kind of honeycomb duct for intercostal nerve block, comprise main pipe 1 and in order to stretch into the conduit between parietal pleura and thoracic wall, prop up conduit and be divided into the ascending branch conduit 2 extended upwardly into through parietal pleura otch A place and descending the conduit 3 stretched into through parietal pleura otch A place downwards, and prop up conduit 4 for the centre stretched between parietal pleura otch upper and lower sides two intercostal nervess 6; Ascending branch conduit 2 is for benumbing the intercostal nerves above parietal pleura incision, and descending conduit 3 is for benumbing the intercostal nerves below parietal pleura incision, and a middle conduit 4 is for benumbing two intercostal nervess of parietal pleura incision; Two intercostal nervess of incision directly carry out anesthetic action by a middle conduit, without the need to offering the leakage micropore at this place again on upper and lower two conduits, avoid occurring medicinal liquid to be strayed into thoracic cavity and cause to otch up and down each root distance occur from the problem that the intercostal nerve block that otch is nearest is insufficient, by adopting three conduits, ensure that the intercostal nerves below parietal pleura all can obtain effective narcotic analgesic, reduce the postoperative pain of sufferer, avoid the generation of other complication, reduce the cost of seeking medical advice of patient.
The front end of each conduit all offers the micropore 7 of multiple fluid.Micropore 7 is mainly used in the medicinal liquid in a conduit to spill to benumb intercostal nerves.Multiple micropore is helically line distribution on a conduit, is convenient to all directions fluid simultaneously on a conduit, and in addition, micropore also in yi word pattern distribution mode or other distribution modes etc. on a conduit, specifically can not limit.
Wherein, ascending branch conduit 2 is 10-12cm with the length of descending conduit 3, and middle conduit 4 length is 6-8cm.Micropore 7 is distributed in each catheter proximal end 4cm position, and a middle conduit stretches into sympathetic nerve 16 times 2cm, ensures the useful effect to each intercostal nerves.
Main pipe 1 is provided with the junction of a conduit the transparent joint 8 being convenient to observe each catheter position, main pipe 1 is effectively connected with three conduits, each conduit is by the parallel front end being distributed in main pipe 1 of transparent joint 8, make each conduit fluid even, facilitate the solution in main pipe 1 to flow in three conduits uniformly, medicinal liquid disperse to each intercostal nerves place spilt through micropore acts on simultaneously.
The front end of each conduit is provided with to be convenient to conduit and to move and the balancing weight 10 of locating.Being convenient to the movement of a conduit by arranging balancing weight, meanwhile, when a conduit moves to certain position, by the effect of this balancing weight gravity, being convenient to its effective location and being fixed between parietal pleura and thoracic wall.Wherein balancing weight can be aluminium block or lead.To prop up conduit stretches between parietal pleura and thoracic wall behind location, is fixed on health the front end of a conduit by the mode sewed up.
Mozzle also comprises the seal wire 14 driving each conduit movement.Balancing weight 10 rear end offers groove 11, and seal wire 14 front end is provided with the projection 15 matched with groove 11.
Main pipe 1 also offers side opening 9, and the effect of side opening 9 is, when strengthening dose according to sick human needs, and can through side opening 9 to liquid medicine injection in main pipe 1; Also can for seal wire through carrying out a traction conduit, seal wire is stretched in one of them conduit through side opening, make the groove match on the projection of front end and balancing weight, a conduit is driven to move forward to corresponding position between parietal pleura and thoracic wall, in thoracic cavity, pin an end of conduit through pleura hands extracted out by seal wire, the storing of another two conduits is carried out in gradation.Leakage is avoided by sealing cap capping plug in the end of side opening 9.
Because this mozzle is used in open surgery, therefore stretch into position without the need to what arrange on each conduit that index aperture also can determine a conduit.
The other continuous block device of a kind of vertebra, comprises infusion pump 12 and honeycomb duct for intercostal nerve block, main pipe is also provided with flow control valve 13.
The operation principle of this device is as follows:
Front is closed at open chest surgery, first according to the radian of thorax, seal wire 14 is carried out bending, seal wire 14 stretches into a middle conduit 4 through side opening 9, make the projection of seal wire 14 front end and the groove match of balancing weight, sympathetic nerve 16 times 2cm are stretched into through incision by a conduit 4 between silk-guiding strip disorder of internal organs, to otch A place up and down each intercostal nerves carry out retardance and control, pin middle catheter proximal end, seal wire extracted out.
Seal wire will carry out bending according to the radian of upper thorax, seal wire 14 stretches into ascending branch conduit 2 through side opening 9, ascending branch conduit is driven upwards to insert through otch A place, undermining dissection under parietal pleura, upwards form one and cross over 2 intercostals, " pocket " that formed between the parietal pleura that Open Side Down and thoracic wall, acts on the 2nd, 3 intercostal nerves above otch, pin ascending branch catheter proximal end, seal wire is extracted out.
Seal wire will carry out bending according to the radian of lower thorax, seal wire 14 stretches into descending conduit 3 through side opening 9, descending conduit is driven to insert through otch A place downwards, undermining dissection under parietal pleura, 3 intercostals are crossed in downward formation one, " pocket " that formed between the parietal pleura of opening upwards and thoracic wall, acts on suitable order the 2nd, 3,4 three intercostal nervess; Pin descending catheter proximal end, seal wire is extracted out.
After the end of each conduit is sewn on health; By controlling infusion pump 12, medicinal liquid is entered between parietal pleura and thoracic wall by main pipe 1 and each conduit afterwards.
Main pipe 1 is provided with flow control valve 13.By arranging flow control valve, effectively can control the amount of infusion in the infusion pump unit interval, also can adjust etc. according to the body constitution difference of individual, easy to use.
The invention discloses a kind of honeycomb duct for intercostal nerve block, by main pipe being arranged three conduits, upper respectively to parietal pleura incision, below each intercostal nerves and incision on the upside of the 2nd, the 2nd of 3 intercostal nervess and downside, 3, 4 intercostal nervess effectively block, each intercostal nerves one by one of otch upper and lower sides directly can carry out anesthetic action by a middle conduit, without the need to offering the leakage micropore at this place again on upper and lower two conduits, avoid occurring medicinal liquid to be strayed into thoracic cavity and cause to otch up and down each root distance occur from the problem that the intercostal nerve block that otch is nearest is insufficient, by adopting three conduits, ensure that 7 intercostal nervess below parietal pleura all can obtain effective narcotic analgesic, reduce the postoperative pain of sufferer, avoid the generation of other complication, reduce the cost of seeking medical advice of patient.
To the above-mentioned explanation of the disclosed embodiments, professional and technical personnel in the field are realized or uses the present invention.To be apparent for those skilled in the art to the multiple amendment of these embodiments, General Principle as defined herein can without departing from the spirit or scope of the present invention, realize in other embodiments.Therefore, the present invention can not be restricted to these embodiments shown in this article, but will meet the widest scope consistent with principle disclosed herein and features of novelty.
Claims (8)
1. a honeycomb duct for intercostal nerve block, it is characterized in that, comprise main pipe and in order to stretch into the conduit between parietal pleura and thoracic wall, described conduit is divided into the ascending branch conduit extended upwardly into through described parietal pleura incision and descending the conduit stretched into through described parietal pleura incision downwards, and props up conduit for stretching into the upper and lower two interneural centres of intercostal of described parietal pleura incision;
Described ascending branch conduit is for benumbing the intercostal nerves above parietal pleura incision, and described descending conduit is for benumbing the intercostal nerves below parietal pleura incision, and conduit is propped up for benumbing upper and lower two intercostal nervess of parietal pleura incision in described centre;
The 4cm place, front end of described each conduit all offers the micropore of multiple fluid; Described centre is propped up conduit and is stretched into 2cm under sympathetic nerve.
2. honeycomb duct for intercostal nerve block as claimed in claim 1, it is characterized in that, the junction of described main pipe and described conduit is provided with the transparent joint being convenient to observe described each catheter position, described each conduit, by the parallel front end being distributed in described main pipe of described transparent joint, makes described each conduit fluid even.
3. honeycomb duct for intercostal nerve block as claimed in claim 1, is characterized in that, the front end of described each conduit is provided with to be convenient to a described conduit and to move and the balancing weight of locating.
4. honeycomb duct for intercostal nerve block as claimed in claim 3, it is characterized in that, described mozzle also comprises the seal wire driving described each conduit movement.
5. honeycomb duct for intercostal nerve block as claimed in claim 4, it is characterized in that, described balancing weight rear end offers groove, and described seal wire front end is provided with the projection with described groove match.
6. honeycomb duct for intercostal nerve block as claimed in claim 3, it is characterized in that, described balancing weight is aluminium block or lead.
7. honeycomb duct for intercostal nerve block as claimed in claim 4, is characterized in that, described main pipe also offers the side opening passed for liquid medicine injection or the described seal wire of confession.
8. honeycomb duct for intercostal nerve block as claimed in claim 1, it is characterized in that, described ascending branch conduit and described descending catheter length are 10-12cm, and it is 6-8cm that catheter length is propped up in described centre.
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| Application Number | Priority Date | Filing Date | Title |
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| CN201210567834.1A CN103007421B (en) | 2012-12-24 | 2012-12-24 | A kind of honeycomb duct for intercostal nerve block |
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| CN201210567834.1A CN103007421B (en) | 2012-12-24 | 2012-12-24 | A kind of honeycomb duct for intercostal nerve block |
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| CN103007421A CN103007421A (en) | 2013-04-03 |
| CN103007421B true CN103007421B (en) | 2015-08-19 |
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| CN107096113A (en) * | 2017-06-27 | 2017-08-29 | 朱辉 | A kind of postoperative anesthesia stays pipe with putting |
| CN108992736A (en) * | 2018-08-02 | 2018-12-14 | 张震 | It is a kind of miniature micro to exempt from infusion pump of making up a prescription |
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| CN202223715U (en) * | 2011-08-18 | 2012-05-23 | 苏州大学附属第一医院 | Continuous paravertebral blocking device for thoracoscopic surgery |
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| CN102614086A (en) * | 2011-08-10 | 2012-08-01 | 山东峰源医用材料有限公司 | Gastrointestinal nutrition drainage tube |
| CN203001642U (en) * | 2012-12-24 | 2013-06-19 | 苏州大学附属第一医院 | Drainage catheter for intercostal nerve block |
Family Cites Families (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN201098452Y (en) * | 2007-11-28 | 2008-08-13 | 步星耀 | Practical brain tissue washing drainage tube |
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Patent Citations (5)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN201263832Y (en) * | 2008-09-27 | 2009-07-01 | 中国人民解放军第二军医大学 | Forfication type skidproof intrahepatic bile duct drainage tube |
| CN102614086A (en) * | 2011-08-10 | 2012-08-01 | 山东峰源医用材料有限公司 | Gastrointestinal nutrition drainage tube |
| CN202223715U (en) * | 2011-08-18 | 2012-05-23 | 苏州大学附属第一医院 | Continuous paravertebral blocking device for thoracoscopic surgery |
| CN202355676U (en) * | 2011-08-18 | 2012-08-01 | 苏州大学附属第一医院 | Paravertebral continuous blockage device for chest open surgery |
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