CN111228619A - Tracheal cannula with bag upper suction - Google Patents
Tracheal cannula with bag upper suction Download PDFInfo
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- CN111228619A CN111228619A CN202010179558.6A CN202010179558A CN111228619A CN 111228619 A CN111228619 A CN 111228619A CN 202010179558 A CN202010179558 A CN 202010179558A CN 111228619 A CN111228619 A CN 111228619A
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- 238000002627 tracheal intubation Methods 0.000 claims abstract description 35
- 239000012465 retentate Substances 0.000 claims abstract description 13
- 238000004804 winding Methods 0.000 claims abstract description 4
- 206010035664 Pneumonia Diseases 0.000 abstract description 14
- 210000003437 trachea Anatomy 0.000 abstract description 11
- 238000009423 ventilation Methods 0.000 abstract description 3
- 230000009286 beneficial effect Effects 0.000 abstract description 2
- 239000000463 material Substances 0.000 abstract description 2
- 210000002409 epiglottis Anatomy 0.000 description 14
- 210000000214 mouth Anatomy 0.000 description 14
- 210000004704 glottis Anatomy 0.000 description 12
- 208000009470 Ventilator-Associated Pneumonia Diseases 0.000 description 11
- 210000003811 finger Anatomy 0.000 description 6
- 210000003128 head Anatomy 0.000 description 6
- 210000004513 dentition Anatomy 0.000 description 4
- 238000000034 method Methods 0.000 description 4
- 230000036346 tooth eruption Effects 0.000 description 4
- 238000010586 diagram Methods 0.000 description 3
- 210000004072 lung Anatomy 0.000 description 3
- 238000005399 mechanical ventilation Methods 0.000 description 3
- 210000001519 tissue Anatomy 0.000 description 3
- 230000000845 anti-microbial effect Effects 0.000 description 2
- 238000007675 cardiac surgery Methods 0.000 description 2
- 210000004247 hand Anatomy 0.000 description 2
- 210000004283 incisor Anatomy 0.000 description 2
- 210000000867 larynx Anatomy 0.000 description 2
- 210000003041 ligament Anatomy 0.000 description 2
- 210000004935 right thumb Anatomy 0.000 description 2
- 230000028327 secretion Effects 0.000 description 2
- 210000003813 thumb Anatomy 0.000 description 2
- 210000002396 uvula Anatomy 0.000 description 2
- 206010002091 Anaesthesia Diseases 0.000 description 1
- 206010036790 Productive cough Diseases 0.000 description 1
- 238000010521 absorption reaction Methods 0.000 description 1
- 230000037005 anaesthesia Effects 0.000 description 1
- 239000008280 blood Substances 0.000 description 1
- 210000004369 blood Anatomy 0.000 description 1
- 210000003736 gastrointestinal content Anatomy 0.000 description 1
- 230000006698 induction Effects 0.000 description 1
- 238000003780 insertion Methods 0.000 description 1
- 230000037431 insertion Effects 0.000 description 1
- 230000002265 prevention Effects 0.000 description 1
- 230000002035 prolonged effect Effects 0.000 description 1
- 230000002685 pulmonary effect Effects 0.000 description 1
- 210000003802 sputum Anatomy 0.000 description 1
- 208000024794 sputum Diseases 0.000 description 1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
- A61M16/04—Tracheal tubes
- A61M16/0402—Special features for tracheal tubes not otherwise provided for
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
- A61M16/0003—Accessories therefor, e.g. sensors, vibrators, negative pressure
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
- A61M16/04—Tracheal tubes
- A61M16/0463—Tracheal tubes combined with suction tubes, catheters or the like; Outside connections
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Abstract
本发明公开了一种带囊上吸引的气管插管，是在气管插管上气囊的部位设置有导管，导管的进口对应气囊底部设置，通过导管引流出气囊上的滞留物。导管的外部并列设置有导丝，通过导丝对导管进行牵引和支撑。气管插管上装配有固定块，固定块的外侧设有卡槽用于导管的固定，固定块的左右侧设置有凹槽用于导丝的缠绕固定。导管的下端设置有连接头，导管通过连接头连接注射器用于气囊上滞留物的引流。有益效果：对气管插管呼吸机辅助通气患者，进行积极的气囊上滞留物清除，能够明显降低呼吸机相关肺炎的发生、呼吸机使用时间，进而极大的降低患者住院费用。
The invention discloses a tracheal intubation tube with suction on the trachea tube. A catheter is arranged at the position of the airbag on the tracheal intubation tube. A guide wire is juxtaposed on the outside of the catheter, and the catheter is pulled and supported by the guide wire. The tracheal intubation tube is equipped with a fixing block, the outer side of the fixing block is provided with a slot for fixing the catheter, and the left and right sides of the fixing block are provided with grooves for winding and fixing the guide wire. The lower end of the catheter is provided with a connecting head, and the catheter is connected to the syringe through the connecting head for the drainage of the retentate on the balloon. Beneficial effects: For patients with tracheal intubation and ventilator-assisted ventilation, active removal of residual material on the airbag can significantly reduce the occurrence of ventilator-related pneumonia and the use time of ventilator, thereby greatly reducing the hospitalization cost of patients.
Description
技术领域technical field
本发明涉及一种气管插管，特别涉及一种带囊上吸引的气管插管。The present invention relates to a tracheal intubation, in particular to a tracheal intubation with suction on a balloon.
背景技术Background technique
目前，随着呼吸机特别是有创呼吸机的应用普及，在应用有创呼吸机时，如何管理好气道，避免呼吸机相关性肺炎(VAP)的发生，越来越成为在呼吸机应用中的一个焦点问题。VAP的发生可导致患者呼吸机通气时间延长，病死率的增加，给患者无论从身体上还是经济上都带来极大伤害。因此，加强气道管理迫在眉睫。导致VAP发生的因素很多，其中气管插管上的气囊上的滞留物回吸到肺组织是一个重要因素。At present, with the popularization of ventilators, especially invasive ventilators, how to manage the airway well and avoid the occurrence of ventilator-associated pneumonia (VAP) when using invasive ventilators has become more and more important in ventilator applications. a focal issue. The occurrence of VAP can lead to prolonged ventilator ventilation time, increase the mortality rate, and bring great harm to patients both physically and economically. Therefore, it is urgent to strengthen airway management. There are many factors that lead to the occurrence of VAP, of which the resorption of the retentate on the balloon on the endotracheal tube into the lung tissue is an important factor.
对于VAP来讲预防重于治疗，临床上普通气管插管无法进行气囊上滞留物的回吸，容易使气囊上的滞留物如痰液、血液、甚至胃内容物等进入肺组织中，导致VAP发生。For VAP, prevention is more important than treatment. In clinical practice, common endotracheal intubation cannot carry out the re-absorption of the retentate on the airbag, and it is easy for the retentate on the airbag to enter the lung tissue, such as sputum, blood, and even stomach contents, resulting in VAP. occur.
发明内容SUMMARY OF THE INVENTION
本发明的目的是为了解决气管插管上的气囊滞留物进入肺组织中从而导致的VAP时有发生的问题，而提供的一种带囊上吸引的气管插管。The purpose of the present invention is to provide a tracheal cannula with suction on the tracheal intubation in order to solve the problem that VAP occurs when the airbag retentate on the tracheal intubation enters into the lung tissue.
本发明提供的带囊上吸引的气管插管是在气管插管上气囊的部位设置有导管，导管的进口对应气囊底部设置，通过导管引流出气囊上的滞留物。The tracheal intubation tube with suction on the bag provided by the present invention is provided with a catheter at the position of the airbag on the tracheal intubation tube, the inlet of the catheter is set corresponding to the bottom of the airbag, and the retentate on the airbag is drained out through the catheter.
导管的外部并列设置有导丝，通过导丝对导管进行牵引和支撑。A guide wire is juxtaposed on the outside of the catheter, and the catheter is pulled and supported by the guide wire.
气管插管上装配有固定块，固定块的外侧设有卡槽用于导管的固定，固定块的左右侧设置有凹槽用于导丝的缠绕固定。The tracheal intubation tube is equipped with a fixing block, the outer side of the fixing block is provided with a slot for fixing the catheter, and the left and right sides of the fixing block are provided with grooves for winding and fixing the guide wire.
导管的下端设置有连接头，导管通过连接头连接注射器用于气囊上滞留物的引流。The lower end of the catheter is provided with a connecting head, and the catheter is connected to the syringe through the connecting head for the drainage of the retentate on the balloon.
本发明的使用方法及使用原理：Using method and using principle of the present invention:
经口腔明视气管内：借助喉镜在直视下暴露声门后，将导管经口腔插入气管内，具体步骤如下：Transoral vision into the trachea: After exposing the glottis under direct vision with a laryngoscope, insert the catheter into the trachea through the oral cavity. The specific steps are as follows:
(1)、将病人头后仰，双手将下颌向前、向上托起以使口张开，或以右手拇指对着下齿列、食指对着上齿列，借旋转力量使口腔张开。(1) Tilt the patient's head back, hold the lower jaw forward and upward with both hands to open the mouth, or place the right thumb against the lower dentition and the index finger against the upper dentition, and open the mouth by rotating force.
(2)、左手持喉镜柄将喉镜片由右口角放入口腔，将舌体推向侧后缓慢推进，可见到悬雍垂。将镜片垂直提起前进，直到会厌显露。挑起会厌以显露声门。(2) Hold the laryngoscope handle with the left hand and put the laryngoscope blade into the oral cavity from the right corner of the mouth, push the tongue body to the side and then slowly push it forward, and the uvula can be seen. Lift the lens vertically forward until the epiglottis is exposed. Raise the epiglottis to reveal the glottis.
(3)、如采用弯镜片插管则将镜片置于会厌与舌根交界处(会厌谷)，用力向前上方提起，使舌骨会厌韧带紧张，会厌翘起紧贴喉镜片，即显露声门。如用直镜片插管，应直接挑起会厌，声门即可显露。(3) If a curved lens is used for intubation, place the lens at the junction of the epiglottis and the base of the tongue (the epiglottis valley), and lift it forward and upward with force to make the hyoid epiglottis ligament tense, and the epiglottis is raised and close to the laryngeal lens, that is, the glottis is exposed. . If a straight lens is used for intubation, the epiglottis should be directly provoked, and the glottis can be exposed.
(4)、以右手拇指、食指及中指如持笔式持住导管的中、上段，由右口角进入口腔，直到导管接近喉头时再将管端移至喉镜片处，同时双目经过镜片与管壁间的狭窄间隙监视导管前进方向，准确轻巧地将导管尖端插入声门。借助管芯插管时，当导管尖端入声门后，应拔出管芯后再将导管插入气管内。导管插入气管内的深度成人为4-5cm，导管尖端至门齿的距离约18-22cm。(4) Hold the middle and upper sections of the catheter with the thumb, index finger and middle finger of the right hand as if holding a pen, enter the oral cavity from the right corner of the mouth, and move the end of the tube to the laryngeal blade when the catheter is close to the larynx. The narrow gap between the walls of the tube monitors the direction of catheter advancement, and inserts the catheter tip into the glottis accurately and lightly. When intubating with a stylet, after the tip of the catheter has entered the glottis, the stylet should be pulled out and then inserted into the trachea. The depth of catheter insertion into the trachea is 4-5 cm for adults, and the distance from the catheter tip to the incisors is about 18-22 cm.
(5)、插管完成后，要确认导管已进入气管内再固定。固定时放置导管在气管插管的一侧，并留有一定活动空隙。(5) After the intubation is completed, it is necessary to confirm that the catheter has entered the trachea and then fix it. When fixed, place the catheter on the side of the tracheal intubation, and leave a certain space for movement.
(6)、当需要清除气囊上滞留物时，从气管插管上的固定块处卸下导管，通过注射器连接导管下端的连接头，以一定的负压吸出气囊上的滞留物。操作完成后，重新在气管插管上固定好导管。(6) When it is necessary to remove the residue on the balloon, remove the catheter from the fixing block on the tracheal intubation tube, connect the connector at the lower end of the catheter through a syringe, and suck out the residue on the balloon with a certain negative pressure. After the operation is complete, re-fix the tube on the endotracheal tube.
(7)、当导管发生堵塞或者气囊上滞留物过大时，可以通过导管或者导丝置入较粗的备用导管代替原有导管，完成气囊上滞留物清除任务。(7) When the catheter is blocked or the residue on the balloon is too large, a thicker spare catheter can be placed through the catheter or guide wire to replace the original catheter to complete the task of removing the residue on the balloon.
本发明的有益效果：Beneficial effects of the present invention:
本发明提供的带囊上吸引的气管插管采用气流冲击法进行气囊上滞留物清除配合吸痰术能够有效清理患者气道分泌物，缩短患者的呼吸机使用时间，减少肺部并发症。通过比较采用气囊上滞留物清除试验组患者VAP的发生率为36.7％，不采用对照组VAP的发生率为56.7％。试验组患者平均住ICU时间比对照组缩短3.53天，两组患者呼吸机的使用时间：试验组(7.4O±2.34)天，对照组(10.93±3.12)天，缩短了患者的呼吸机使用时间。The tracheal intubation with suction on the bag provided by the present invention adopts the airflow impact method to remove the residue on the bag and suction, which can effectively clear the airway secretions of the patient, shorten the use time of the patient's ventilator, and reduce pulmonary complications. By comparing the incidence of VAP in the experimental group with retentate removal on the balloon, the incidence rate was 36.7%, and the incidence of VAP in the control group was 56.7%. The average ICU stay time of the patients in the experimental group was 3.53 days shorter than that in the control group, and the use time of the ventilator in the two groups was (7.40±2.34) days in the experimental group and (10.93±3.12) days in the control group, which shortened the use time of the patient’s ventilator. .
通过临床应用对需要机械通气48小时的患者进行声门下分泌物抽吸(ASS)。并评估了所有心脏手术后患者常规应用ASS的影响，比较了应用ASS前后呼吸机获得性肺炎(VAP)的发生率、机械通气天数和抗菌药物的成本。干预前和干预后的结果(每1000天)为:VAP发生率，23.92vs 16.46(P＝0.04)；抗菌素费用：563，934元人民币比501，223元人民币(P＝0.002)；机械通气天数分别为507.5天和377.5天(P＝0.009)。进而建议从麻醉诱导的那一刻起，所有接受大型心脏手术的患者都应常规接受ASS。Clinical application of subglottic secretion aspiration (ASS) in patients requiring mechanical ventilation for 48 hours. The impact of routine use of ASS in all post-cardiac surgery patients was assessed, and the incidence of ventilator-acquired pneumonia (VAP), days of mechanical ventilation, and antimicrobial costs were compared before and after ASS use. Pre- and post-intervention outcomes (per 1000 days) were: VAP incidence, 23.92 vs 16.46 (P=0.04); antimicrobial costs: RMB 563,934 vs RMB 501,223 (P=0.002); days of mechanical ventilation 507.5 days and 377.5 days, respectively (P=0.009). It is further recommended that all patients undergoing major cardiac surgery should receive ASS routinely from the moment of induction of anesthesia.
通过以上临床研究表明，对气管插管呼吸机辅助通气患者，进行积极的气囊上滞留物清除，能够明显降低呼吸机相关肺炎的发生、呼吸机使用时间，进而极大的降低患者住院费用。The above clinical studies have shown that for patients with tracheal intubation and ventilator-assisted ventilation, active removal of residual material on the airbag can significantly reduce the occurrence of ventilator-related pneumonia and the duration of ventilator use, thereby greatly reducing the hospitalization costs of patients.
附图说明Description of drawings
图1为本发明所述气管插管整体结构示意图。Figure 1 is a schematic diagram of the overall structure of the endotracheal intubation according to the present invention.
图2为本发明所述气管插管上固定块部位结构示意图。FIG. 2 is a schematic structural diagram of the position of the fixing block on the tracheal intubation tube according to the present invention.
图3为本发明所述气管插管使用状态示意图。Fig. 3 is a schematic diagram of the use state of the endotracheal intubation according to the present invention.
上图中的标注如下：The annotations in the figure above are as follows:
1、气管插管 2、气囊 3、导管 4、导丝 5、固定块 6、卡槽1.
7、凹槽 8、连接头。7.
具体实施方式Detailed ways
请参阅图1至图3所示：Please refer to Figures 1 to 3 as shown:
本发明提供的带囊上吸引的气管插管是在气管插管1上气囊2的部位设置有导管3，导管3的进口对应气囊2底部设置，通过导管3引流出气囊2上的滞留物。The tracheal cannula with suction provided by the present invention is provided with a
导管3的外部并列设置有导丝4，通过导丝4对导管3进行牵引和支撑。A
气管插管1上装配有固定块5，固定块5的外侧设有卡槽6用于导管3的固定，固定块5的左右侧设置有凹槽7用于导丝4的缠绕固定。The tracheal intubation tube 1 is equipped with a
导管3的下端设置有连接头8，导管3通过连接头8连接注射器用于气囊2上滞留物的引流。The lower end of the
本发明的使用方法及使用原理：Using method and using principle of the present invention:
经口腔明视气管内：借助喉镜在直视下暴露声门后，将导管3经口腔插入气管内，具体步骤如下：Transoral vision into the trachea: After exposing the glottis under direct vision with the help of a laryngoscope, insert
(1)、将病人头后仰，双手将下颌向前、向上托起以使口张开，或以右手拇指对着下齿列、食指对着上齿列，借旋转力量使口腔张开。(1) Tilt the patient's head back, hold the lower jaw forward and upward with both hands to open the mouth, or place the right thumb against the lower dentition and the index finger against the upper dentition, and open the mouth by rotating force.
(2)、左手持喉镜柄将喉镜片由右口角放入口腔，将舌体推向侧后缓慢推进，可见到悬雍垂。将镜片垂直提起前进，直到会厌显露。挑起会厌以显露声门。(2) Hold the laryngoscope handle with the left hand and put the laryngoscope blade into the oral cavity from the right corner of the mouth, push the tongue body to the side and then slowly push it forward, and the uvula can be seen. Lift the lens vertically forward until the epiglottis is exposed. Raise the epiglottis to reveal the glottis.
(3)、如采用弯镜片插管则将镜片置于会厌与舌根交界处(会厌谷)，用力向前上方提起，使舌骨会厌韧带紧张，会厌翘起紧贴喉镜片，即显露声门。如用直镜片插管，应直接挑起会厌，声门即可显露。(3) If a curved lens is used for intubation, place the lens at the junction of the epiglottis and the base of the tongue (the epiglottis valley), and lift it forward and upward with force to make the hyoid epiglottis ligament tense, and the epiglottis is raised and close to the laryngeal lens, that is, the glottis is exposed. . If a straight lens is used for intubation, the epiglottis should be directly provoked, and the glottis can be exposed.
(4)、以右手拇指、食指及中指如持笔式持住导管3的中、上段，由右口角进入口腔，直到导管3接近喉头时再将管端移至喉镜片处，同时双目经过镜片与管壁间的狭窄间隙监视导管3前进方向，准确轻巧地将导管3尖端插入声门。借助管芯插管时，当导管3尖端入声门后，应拔出管芯后再将导管3插入气管内。导管3插入气管内的深度成人为4-5cm，导管3尖端至门齿的距离约18-22cm。(4) Hold the middle and upper sections of the
(5)、插管完成后，要确认导管3已进入气管内再固定。固定时放置导管3在气管插管1的一侧，并留有一定活动空隙。(5) After the intubation is completed, it is necessary to confirm that the
(6)、当需要清除气囊2上滞留物时，从气管插管1上的固定块5处卸下导管3，通过注射器连接导管3下端的连接头8，以一定的负压吸出气囊2上的滞留物。操作完成后，重新在气管插管1上固定好导管3。(6), when it is necessary to remove the residue on the
(7)、当导管3发生堵塞或者气囊2上滞留物过大时，可以通过导管3或者导丝4置入较粗的备用导管3代替原有导管3，完成气囊2上滞留物清除任务。(7) When the
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| CN2728530Y (en) * | 2003-05-30 | 2005-09-28 | 梁树立 | Trachea capnula with path for preventing suction of residual liquor |
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| CN202961303U (en) * | 2012-12-21 | 2013-06-05 | 郝玉梅 | Trachea cannula convenient and fast sputum suction device |
| CN204193243U (en) * | 2014-09-30 | 2015-03-11 | 杨杰 | Disposable multifunction tracheal intubation |
| CN207429490U (en) * | 2017-04-14 | 2018-06-01 | 遵义医学院附属医院 | A kind of tracheal cannula digital intelligent seal wire |
| CN212416602U (en) * | 2020-03-16 | 2021-01-29 | 吉林大学 | Endotracheal tube with suction on the cuff |
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| Publication number | Priority date | Publication date | Assignee | Title |
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| JPH09173466A (en) * | 1995-12-27 | 1997-07-08 | Nippon Zeon Co Ltd | Guiding catheter |
| CN2728530Y (en) * | 2003-05-30 | 2005-09-28 | 梁树立 | Trachea capnula with path for preventing suction of residual liquor |
| CN200945299Y (en) * | 2006-09-08 | 2007-09-12 | 房磊 | Intubation for tracheotomy |
| CN201618279U (en) * | 2009-12-18 | 2010-11-03 | 蔡强 | Multifunctional combined cannula for full respiratory tract trachea |
| CN102335023A (en) * | 2010-07-16 | 2012-02-01 | 泰尔茂株式会社 | Aspiration catheter |
| CN102198295A (en) * | 2011-05-11 | 2011-09-28 | 许庆林 | Nasotracheal phlegm sucker |
| CN202961303U (en) * | 2012-12-21 | 2013-06-05 | 郝玉梅 | Trachea cannula convenient and fast sputum suction device |
| CN204193243U (en) * | 2014-09-30 | 2015-03-11 | 杨杰 | Disposable multifunction tracheal intubation |
| CN207429490U (en) * | 2017-04-14 | 2018-06-01 | 遵义医学院附属医院 | A kind of tracheal cannula digital intelligent seal wire |
| CN212416602U (en) * | 2020-03-16 | 2021-01-29 | 吉林大学 | Endotracheal tube with suction on the cuff |
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