CN105813674B - 在吹入器中的维持压力的排烟装置 - Google Patents

在吹入器中的维持压力的排烟装置 Download PDF

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CN105813674B
CN105813674B CN201480053153.0A CN201480053153A CN105813674B CN 105813674 B CN105813674 B CN 105813674B CN 201480053153 A CN201480053153 A CN 201480053153A CN 105813674 B CN105813674 B CN 105813674B
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Y.克特
S.施特格曼
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W.O.M.药物世界有限责任公司
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Abstract

本发明涉及一种用于微创手术的具有排烟装置的吹入器，其如此设计，即在抽排期间腹压在最大程度上保持恒定。吹入器包含：a)具有比例阀的气体接头，b)具有压力测量装置的供给管线，过滤器和在第一套管针上的接头，c)具有抽排软管的第二套管针和过滤器，其连接到一个具有可调节的抽排功率的抽排装置上，和d)电子调节单元，其特征在于，所述电子调节单元依据在供给管线中的压力调节抽排装置。

Description

在吹入器中的维持压力的排烟装置
本发明涉及一种具有排烟装置的吹入器，其如此设计，即在抽排期间腹压在最大程度上保持恒定。要求德国申请DE102013016063.4(申请日2014年9月27日)的优先权。
背景和现有技术
在微创手术，例如诊断或治疗的腹腔镜检查的领域中，在腹部中借助于导入的气体(例如医用二氧化碳(CO2))产生过压，该过压使腹部膨胀，由此存在足够的空间用于目视检查和/或治疗干预。为此使用所谓的吹入器，它借助于调节的气体流在腹部中建立受控制的压力。通过一系列的安全装置保证腹压保持在限度内，由此没有组织受损。
在微创手术的范围中常常使用电外科器械或也使用激光，它们的使用在腹部中产生烟气。该烟气不仅妨碍视线，而且也含有有害物质(在气体，液滴和/或颗粒的形式下)，由此该烟气必须从腹部中去除。这个问题的一个解决方案在于，建立一个简单的出口，烟气通过该出口离开身体。对此一种实现的可能性在US6592543中示出。在此通过手术医生手动地通过打开套管针上的阀控制该抽排。但是通过现今的系统常常产生比在US6592543的申请时间点时较大的烟气量，由此在那里介绍的解决方案如今不再能够应用。
这种被动的系统通过提供抽排装置得到进一步的发展，该抽排装置能够将腹部中的气体包括烟气颗粒在内主动地抽排出去。这种系统例如在US5199944中描述。在此存在问题，即在强烈抽排烟气时腹部中的压力下降，由此腹部可以收缩。治疗医生此时必须一直等待，直到在腹部中重新建立足够大的压力时才继续实施手术。非常清楚的是，这种方法本身带有很多的缺陷。另一方面在过弱的抽排情况下抽排是不足够有效的，由此手术医生由于差的视线受到妨碍而使手术延长。这个方法的一个备选方案在于，抽排出的气体被再次输给病人(循环)。这种系统在专利US4735603中描述。在这种实施方式中也存在问题，即在过高的抽排率（抽排速率）下腹压下降。
在高的抽排功率下，在供给管线上的系统压力强烈升高。依据连接的仪器窄细程度的情况，压力可能较强或较弱地升高。在每种情况下自一个确定的压力极限起，在供给管线内的安全阀打开并且由此已经导致压力下降。此外吹入器不再能够供给附加的二氧化碳，用于补偿可能存在的泄漏。
不仅在带有循环而且在不带有循环的抽排装置中都产生问题，即抽排功率（抽排量）必须匹配于手术的实际条件。如描述的那样，在此处使用的仪器，以及在腹部处的实际的泄漏率起着决定性的作用。
现有技术此外为在设备处的手术医生提供不同等级的抽排功率(例如：低/中/高)。手术医生因此有责任确定最佳的抽排等级。如果抽排功率被过高地调整，那么吹入器不能够维持腹压。这通常在压力已经显著下降时手术医生才注意到。此外手术医生难于预先识别，较高的抽排功率也是可能的和也是需要的。为了不冒压力下降的风险，手术医生可能此时不会选择较高抽排功率。
因此存在对用于微创手术，尤其是腹腔镜检查的装置的需要，该装置允许确定和调整用于从治疗室(尤其是腹部)的烟气的尽可能高的抽排率，由此在所述空间（容积）中不发生显著的压力降低。在此情况下应该可以使用在市场上常见的套管针。该问题的解决通过以下描述的按照本发明的装置保证。
任务的解决
任务的解决通过权利要求的主题来实施，即一种具有集成的抽排泵的吹入器。这种泵举例地在图1中示出。吹入器首先包含通常的在具有气体的压力气体瓶上的接头，该气体适合用于治疗目的，例如二氧化碳。该气体首先经由比例阀和消毒软管供给到套管针。在吹入器内不仅测量管道的压力而且测量管道的气体流(流量)。可选择地还插入一个挡住颗粒物的过滤器。
第二套管针连接到被集成到吹入器中的抽吸泵上。在此，可选择地也中间连接一个过滤器，它可以吸收颗粒物、液滴和/或有毒气体。泵出的吹入气体然后可以排放到大气中。吹入器经由开关单元(控制电路)控制。控制电路尤其以电子方式调节抽吸泵的功率。
本发明因此涉及一种用于微创手术的吹入器，包括
a)具有比例阀的气体接头，
b)具有压力测量装置的供给管线，过滤器和在第一套管针上的接头，
c)具有抽排软管的第二套管针和过滤器，其连接到具有可调节的抽排功率的抽排装置上，
d)电子调节单元，
其特征在于，电子调节单元依据在供给管线中的压力调节抽排装置。
在本发明的一个特别的实施方式中，吹入器的特征在于，如果在供给管线中的压力超过一个阈值，电子调节单元通过控制抽排装置减小抽排率，
和/或
如果在供给管线中的压力低于一个阈值，电子调节单元通过控制抽排装置提高抽排率。
用于减小用于在供给管线中的压力的抽排率的阈值例如可以在60和80mmHg之间。用于提高用于在供给管线中的压力的抽排率的阈值例如可以在0和50mmHg之间。在本发明的特定的实施方式中阈值在吹入器上是可以调整的。
吹入器的最大流量决定性地由在吹入软管上的连接的仪器确定。在与大的仪器组合下使用小的或窄的套管针时，最大吹入功率（吹入流量）可以为4-6 l/min（升/分钟）或较小。在使用大的套管针时最大吹入功率可以为15-20 l/min或甚至更高。
吹入器按照相应的需要调节要再注入的量。当然出于安全原因在供给软管中已经限定一个最大压力，其不允许被超过。该最大压力限制最大气体流量。
再注入二氧化碳的需求通过持久的以及短时间的泄漏产生。插入患者体内的套管针具有与结构类型限定地最小泄漏。此外主动的排烟装置在一定程度上可以看作是持久的泄漏，其必须通过吹入器补偿。
如果例如在手术中存在具有4 l/min的流量的抽排和系统限定的3 l/min的泄漏，那么吹入器必须在注入流中调整出直至7 l/min的流量。为了达到目标流量，吹入器一直提高在供给软管中的压力，直到或者调整出该流量，或者达到最大允许的压力。如果在目标流量达到之前达到最大压力，那么该泄漏不能够通过吹入器补偿。如果这种状态持续较长的时间，那么腹压就会下降。由于这种原因，吹入器在这种情况下必须减小抽排功率。
但是，如果在软管或仪器中存在足够大的容量，那么可以调整出要求的7 l/min的流量，而不达到最大压力。在这种情况下甚至还可以提高抽排功率。
因此，与在吹入期间最大压力的比下的在供给软管中达到的压力是一种尺度，其显示在软管或仪器中还可供使用的容量。
功率的调节可以借助于上面描述的由达到的驱动压力与最大驱动压力的比进行调节。在此情况下可以直接地改变泵的输入电压。
结果，排烟装置的功率针对吹入功率的当前的条件被匹配或优化。由此最大抽排功率被调整，而患者压力不改变。
按照本发明的装置的最大驱动压力一般地为80mmHg。
备选实施方式
本领域的技术人员受本说明的启发也可以通过其它的手段实现本发明的基本构想。因此例如可以通过旁通阀控制抽吸泵(图2)。为此例如可以将泵调整到一定的功率上，该功率在最大程度上是恒定的，并且功率的调节此时通过旁通阀实施。
此外备选地也可以将控制阀直接地定位在抽排管道中(图3)。以这种方式甚至可以使用外部的泵，例如在OP中存在的壁式抽吸装置。吹入器的控制系统此时经由示出的控制阀调节抽排功率。
在本发明的其它的实施方式中，从吹入器到患者的气体供给管线也可以可加热地设计，例如经由一个软管，如其在WO2014/111084中描述的那样。备选地，从吹入器到患者的气体供给管线不仅可以是可加热的而且可以设置用于加湿气体，例如经由一个软管，如其在WO2014/111084中描述的那样。

Claims (12)

1.用于微创手术的吹入器，包含
a)具有比例阀的气体接头，
b)具有压力测量装置的供给管线，过滤器和在第一套管针上的接头，
c)具有抽排软管的第二套管针和过滤器，其连接到具有可调节的抽排功率的抽排装置上，
d)电子调节单元，
其特征在于，电子调节单元依据供给管线中的压力调节抽排装置，其中泵出的吹入气体然后能排放到大气中。
2.按照权利要求1所述的吹入器，其特征在于，
如果在供给管线中的压力超过一个阈值，电子调节单元通过控制抽排装置减小抽排率，
和/或
如果在供给管线中的压力低于一个阈值，电子调节单元通过控制抽排装置提高抽排率。
3.按照权利要求2所述的吹入器，其特征在于，用于减小用于在供给管线中的压力的抽排率的阈值在60和80mmHg之间。
4.按照权利要求2所述的吹入器，其特征在于，用于提高用于在供给管线中的压力的抽排率的阈值在0和50mmHg之间。
5.按照权利要求1所述的吹入器，其特征在于，所述具有可调节的抽排功率的抽排装置由可调节的抽排泵构成。
6.按照权利要求1所述的吹入器，其特征在于，所述具有可调节的抽排功率的抽排装置连接到一个外部的泵上并且抽排功率经由一个可调节的阀控制。
7.按照权利要求1-5中任一项所述的吹入器，其特征在于在0和50 l/min之间的可调节的吹入功率。
8.按照权利要求7所述的吹入器，其特征在于在0和20 l/min之间的可调节的抽排功率。
9.按照权利要求8所述的吹入器，其特征在于在0和10 l/min之间的可调节的抽排功率。
10.按照权利要求1-5中任一项所述的吹入器，其特征在于，在气体供给管线中设有气体加热装置。
11.按照权利要求5所述的吹入器，其特征在于，所述具有可调节的抽排功率的抽排装置由具有可调节的旁通阀的抽排泵构成。
12.按照权利要求5所述的吹入器，其特征在于，所述具有可调节的抽排功率的抽排装置由具有附加的可调节的比例阀的抽排泵构成。
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