CN104955389A - 支气管内导管装置 - Google Patents

支气管内导管装置 Download PDF

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CN104955389A
CN104955389A CN201380071314.4A CN201380071314A CN104955389A CN 104955389 A CN104955389 A CN 104955389A CN 201380071314 A CN201380071314 A CN 201380071314A CN 104955389 A CN104955389 A CN 104955389A
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electrode
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李文正
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Medtronic Xomed LLC
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Restore Medical Inc
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Abstract

本文所提出的概念包括用于监测患者的喉部肌肉的EMG信号的装置。该装置包括具有外部表面和两个腔的支气管内导管用于提供换气。导电油墨电极被形成在该支气管内导管的外部表面上。该导电油墨电极被配置为当该支气管内导管被置于患者的气管中时接收来自该喉部肌肉的EMG信号。至少一个导体被耦合至该导电油墨电极并且被配置为将由该导电油墨电极接收的EMG信号传送到处理装置。

Description

支气管内导管装置
背景技术
支气管内导管(也被称为双腔气管内导管)在手术期间提供开放气道以供患者换气。具体而言，支气管内导管被用于在手术过程期间对个人的肺分别提供换气。当前支气管内导管包括第一气管腔和第二支气管腔。每个腔包括相关联的可充气套囊(inflatable cuff)，与气管腔相关联的套囊被放置在气管内而与支气管腔相关联的套囊被放置在其中一个支气管内。
发明内容
本文所示的概念包括用于监测患者的喉部肌肉的EMG信号的装置。该装置包括具有外部表面和两个腔的支气管内导管用于提供换气。导电油墨电极被形成在该支气管内导管的外部表面上。该导电油墨电极被配置为当气管内导管被置于患者的气管中时接收来自喉部肌肉的EMG信号。至少一个导体被耦合至导电油墨电极并且被配置为将由导电油墨电极接收的EMG信号传送到处理装置。
附图说明
图1是EMG支气管内导管的示意图。
图2A和2B是支气管内导管的不同侧视图。
图2C是如图2A所示的支气管内导管的截面视图。
图3是具有电极套囊的支气管内导管的部分侧视图。
具体实施方式
图1示出由挤压的聚合物制成的EMG支气管内导管100。支气管内导管100包括实芯线102、支气管配件104、气管配件106、y连接器108、支气管套囊充气导管110、气管套囊充气导管112、挤压的聚合物导管114、电极116、支气管套囊120以及气管套囊122。在互连124处，实芯线102被连接至电极116。导管114向肺传输气体并且从肺传输气体。具体而言，导管114限定了从支气管配件104延伸至开口128即支气管套囊120远端的第一支气管腔126以及从气管配件106延伸至开口132即气管套囊122远端的第二气管腔130。Y连接器108将支气管配件104和气管配件106分别地流体地耦合至支气管腔126和气管腔130。
配件106和106被配置为连接至呼吸机(未示出)以便将空气注入到肺中以及从肺中收回空气。套囊充气导管110和112被配置为连接至压缩空气源(未示出)以便给套囊120和122充气。套囊充气导管110与位于导管114的壁中的一腔相通，而该腔与支气管套囊120相通。同样地，气管套囊充气导管112与位于导管114的壁中的一腔相通，而该腔与气管套囊122相通。在使用期间，其中一个配件(例如支气管配件104)被配置为将空气注入一个肺而另一个配件(例如气管配件106)被配置为将空气注入另一个肺。例如，套囊120可被放置在左支气管内而套囊122被放置在气管内。在此情况下，开口126被放置以将空气从支气管配件104导向至左肺，而开口132被放置以将空气从气管配件106导向至右肺。选择性地，空气可被提供至配件104、106中的仅一个以便将空气提供至仅单个肺并且使另一个肺塌陷。在这样的情况下，外科医生可临近塌陷的肺或在塌陷的肺上动手术。在支气管内导管100被插入患者的气管后，电极116感测EMG信号，这些EMG信号经由实芯线102被输出到EMG处理机，比如神经完整性监测(NIM)装置140。模切(Die cut)胶带可被用于把导管114粘在患者的嘴部以固定该导管并保持它被适当地放置。
在一个实施例中，NIM 140被配置为确定何时电极116与声带接触，并且被配置为当失去这样的接触时向外科医生提供警告。在一个实施例中，NIM 140也被配置为基于接收到的信号确定电极116是否与肌肉或组织接触。
在一个实施例中，导管114是编织导管，它比传统固体聚合物导管更加柔韧并且减少了扭结(kinking)。根据一个实施例的导管114是由编织聚合物或镍钛合金形成在薄壁导管内，并且在声带处降低或消除导管的旋转，同时允许导管的近端部分旋转。
图2A示出具有四个电极116的支气管内导管114的第一侧视图(后部侧)。图2B示出图2A所示的支气管内导管114的第二侧视图(由图2A所示的视图旋转90度)。图2C是示出图2A和2B所示的支气管内导管114的截面视图的图。
电极116包括四个电极116A-116D，被形成为围绕导管114的圆周并且在导管114的纵向方向上延伸。电极116A和116B被完整地放置在导管114的后部侧并且在本文中也被称为后部电极116A和116B。电极116C和116D被完整地放置在导管114的前部侧并且也被称为前部电极116C和116D。导管114的前部侧是图2C所示的导管114的下半部分，而导管114的后部侧是图2C所示的导管114的上半部分。每个电极116A-116D被耦合至各自的迹线(trace)150A-150D(迹线150D在图中不可见)。迹线150A-150D被放置在导管114的保护(遮掩)区域152。后部电极116A和116B被放置在导管114的暴露(未遮掩)区域154。前部电极116C和116D被放置在导管114的暴露(未遮掩)区域156。
在一个实施例中，每个电极116A-116D具有大约一英寸的长度，并且围绕导管的圆周横向地延伸了对应于大约60度的角160的距离(即每个电极116A-116D具有导管的总圆周的大约百分之16.67的宽度)。这些电极围绕该导管的圆周被横向地隔开了对应于大约30度的角160的距离(即在每个电极116A-116D之间的横向间隔是该导管的总圆周的大约百分之8.333)。后部电极116A和116B与前部电极116C和116D在纵向上偏移或位移。后部电极116A和116B比前部电极116C和116D更加接近导管114的远端(图2A和2B的右侧)放置，而前部电极116C和116D比后部电极116A和116D更加接近导管114的近端(图2A和2B的左侧)放置。
导管114包括重叠区域166，其中，后部电极116A和116B的近端部分与前部电极116C和116D的远端部分纵向地重叠。电极116没有物理地相互重叠，因为它们横向地互相偏移。在一个实施例中，重叠区域166大约0.1英寸长，从前部电极116C和116D的近端到后部电极116A和116B的远端的总长度为大约1.9英寸。在另一个实施例中，重叠区域166大约0.2英寸长，从前部电极116C和116D的近端到后部电极116A和116B的远端的总长度为大约1.8英寸。导管114被配置为放置成使患者的声带被放置在重叠区域166。因此，电极116在声带上面的配置不同于在声带下面的配置。后部电极116A和116B被配置为主要放置在声带下面，而前部电极116C和116D被配置为主要放置在声带上面。在一个实施例中，电极116A和116C被用于第一EMG信道，而电极116B和116D被用于第二EMG信道。
在替代实施例中，所有四个表面印刷电极112A、112B、112C和112D在长度上相等。这将允许放置成品时不需要担心旋转对齐。
如图2C所示，导管110和112被形成在导管114的厚度内以将压缩空气分别传送到支气管套囊120和气管套囊122。另外，在导管114内部形成支气管腔126和气管腔130。在使用期间，腔126和130中的一个可被用于将气体注入特定肺，而另一个腔被密封以免将气体注入相反的肺。
参见图3，另一个实施例包括邻近气管套囊122放置的电极套囊170。在图3的实施例中，套囊122与图1-2C所示的套囊是不同的形状。对于套囊112和170可使用其他形状。电极116被直接应用在电极套囊170上并且与以上所讨论的相似。依尺寸制造套囊122和170从而当被提供在充气导管110内的加压流体充气时既在气管和套囊122之间提供密封又提供与患者的声带接触的电极套囊170的适合的顺应性。充气后，气管套囊122具有比电极套囊170的直径D2更大的直径D1。在一些实施例中，直径D2被选择为大约一半的直径D1。在一个示例中，D1为大约20毫米，而D2为大约9毫米。在又一实施例中，D1为大约27毫米，而D2为大约14毫米。此外，套囊170的长度L1被选择为大于套囊122的长度L2。在一个实施例中，L1为大约1.875英寸。在另一个实施例中，L1在从大约1.5英寸到2.5英寸的范围内。在又一实施例中，D1：L1的比率被选择为在从大约15：100到30：100的范围内。
此外，套囊170的顺应性被选择以便防止由套囊170接触患者的声带而引起的创伤。在一个实施例中，套囊170被形成为半顺应气囊。对于气囊从标称压力到额定涨裂压力，半顺应气囊在直径上将增加大约百分之10到20。在又一实施例中，套囊170由顺应气囊形成，使得从气囊的标称压力到额定涨裂压力，该气囊在直径上将增加百分之20到200。在又一个实施例中，套囊170由比为套囊122所选择的材料具有更大顺应性的顺应材料形成。在一个实施例中，套囊122具有顺应性，被定义为从标称压力到额定涨裂压力，套囊122在直径上增加大约百分之20到200。
充气导管110沿着导管114的长度延伸至电极套囊170并且继续延伸至气管套囊122。由于套囊122的170的相关顺应性，套囊122被配置为当被放置时流体地密封一患者的气管，而电极套囊170充气以接触该患者的声带从而防止由套囊170与声带之间的接触而引起的创伤的发生。此外，通过选择套囊122和170的直径D1和D2，调节了施加在每个套囊的外部表面上的张力。在一个实施例中，套囊122和170的厚度和直径被选择使得套囊122将在套囊170上吸收压力和降低压力。在此配置中，套囊170可顺从声带的形状并且确保电极112与声带之间充分的电接触而不通过在声带上施加过多压力而引起刺激性。
虽然已参考优选实施例对本公开进行描述，但是本领域的技术人员将认识到可作形式或细节上的改变而不背离本公开的精神和范围。

Claims (12)

1.一种用于监测患者的喉部肌肉的肌电图信号的装置，包括：
支气管内导管，其限定了第一和第二腔；
第一套囊，其耦合至所述支气管内导管并且邻近第一开口而放置，所述第一开口与所述第一腔流体地耦合，依尺寸制造的所述第一套囊被放置在所述患者的支气管内；
第二套囊，其耦合至所述支气管内导管并且邻近第二开口而放置，所述第二开口与所述第二腔流体地耦合，所述第二套囊被配置为放置在所述患者的气管内；以及
导电油墨电极，其放置在所述支气管内导管的外部表面上并且邻近近端套囊。
2.如权利要求1所述的装置，其特征在于，所述电极包括围绕所述外部表面的圆周而放置的四个电极。
3.如权利要求1所述的装置，进一步包括耦合至所述支气管内导管的Y连接器，所述Y连接器使第一和第二配件分别流体地耦合至第一和第二腔。
4.如权利要求1所述的装置，进一步包括耦合至所述导管的互连和将电极与所述互连电连接的导电迹线。
5.如权利要求1所述的装置，进一步包括分别流体地耦合至所述第一和第二套囊的第一和第二充气导管。
6.如权利要求5所述的装置，其特征在于，所述外部表面包括流体地耦合至所述第二充气导管并且具有放置在其上的所述导电油墨电极的电极套囊。
7.一种用于监测患者的喉部肌肉的肌电图信号的方法，包括：
提供限定第一和第二腔的支气管内导管，所述支气管内导管包括放置在其外部表面上的导电油墨电极；
放置一支气管套囊在所述患者的支气管内，所述支气管套囊被耦合至所述支气管内导管；
放置一气管套囊在所述患者的气管内，所述气管套囊被耦合至所述支气管内导管；以及
使用所述导电油墨电极来测量所述患者的信号。
8.如权利要求7所述的方法，其特征在于，所述电极包括围绕所述外部表面的圆周而放置的四个电极。
9.如权利要求7所述的方法，进一步包括：
将Y连接器耦合至所述支气管内导管，所述Y连接器将第一和第二配件分别流体地耦合至所述第一和第二腔。
10.如权利要求7所述的方法，进一步包括在所述支气管内导管上用导电迹线将所述电极电连接至一互连。
11.如权利要求7所述的方法，进一步包括：
使用第一和第二充气导管分别给所述第一和第二套囊充气。
12.如权利要求11所述的方法，进一步包括：
提供流体地耦合至所述第二充气导管的电极套囊；以及
在所述电极套囊上提供所述导电油墨电极。
CN201380071314.4A 2013-11-27 2013-11-27 支气管内导管装置 Pending CN104955389A (zh)

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