CN111803773A - Double-visual double-positioning tracheal intubation set with combination of visual laryngoscope and visual guide core - Google Patents

Double-visual double-positioning tracheal intubation set with combination of visual laryngoscope and visual guide core Download PDF

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CN111803773A
CN111803773A CN202010840687.5A CN202010840687A CN111803773A CN 111803773 A CN111803773 A CN 111803773A CN 202010840687 A CN202010840687 A CN 202010840687A CN 111803773 A CN111803773 A CN 111803773A
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visual
guide core
laryngoscope
trachea
glottis
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黄加庆
王金领
王莹
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Priority to EP21857687.4A priority patent/EP4183437A4/en
Priority to JP2023512401A priority patent/JP2023538122A/en
Priority to PCT/CN2021/113131 priority patent/WO2022037595A1/en
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES 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
    • A61M16/00Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04Tracheal tubes
    • A61M16/0402Special features for tracheal tubes not otherwise provided for
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00002Operational features of endoscopes
    • A61B1/00043Operational features of endoscopes provided with output arrangements
    • A61B1/00045Display arrangement
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/04Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/267Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for the respiratory tract, e.g. laryngoscopes, bronchoscopes
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES 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
    • A61M16/00Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04Tracheal tubes
    • A61M16/0488Mouthpieces; Means for guiding, securing or introducing the tubes
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES 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
    • A61M16/00Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04Tracheal tubes
    • A61M16/0488Mouthpieces; Means for guiding, securing or introducing the tubes
    • A61M16/049Mouthpieces
    • A61M16/0493Mouthpieces with means for protecting the tube from damage caused by the patient's teeth, e.g. bite block

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Abstract

The utility model provides a two visual, two location trachea cannula suit of visual laryngoscope and visual guide core combination, carries out tracheal cannula with tracheal catheter cover on visual guide core during trachea cannula, can guide glottis position fast through visual laryngoscope, and rethread visual guide core camera device carries out accurate ground glottis secondary positioning, can adopt visual guide core alone to carry out trachea cannula to the patient of part opening a mouthful difficulty. The invention adopts double-visual and double-positioning technology, can overcome the defects of the prior trachea cannula technology, realizes the whole-course visualization of the trachea cannula process, is easy to operate, has high cannula speed and high success rate of one-time cannula, does not have the risk of mistakenly inserting into the esophagus, is particularly suitable for the quick cannula of a patient with difficult airways, can quickly determine whether a tracheal catheter is positioned in the trachea and whether the insertion depth of the tracheal catheter is proper or not through the visual guide core, greatly improves the operability and safety of the trachea cannula, reduces medical risks, and is suitable for clinical popularization and application.

Description

Double-visual double-positioning tracheal intubation set with combination of visual laryngoscope and visual guide core
Technical Field
The invention relates to the technical field of medical instruments, in particular to a double-visual and double-positioning tracheal intubation set combining a visual laryngoscope and a visual guide core, which is particularly suitable for the rapid intubation of patients with difficult airways.
Background
Clinically, critical patients, particularly patients with respiratory arrest and general anesthesia need to be subjected to tracheal intubation to help patients breathe. The trachea cannula is a technology for placing a special trachea catheter into a trachea through a glottis, and the technology can provide optimal conditions for smooth air passage, ventilation and oxygen supply, respiratory tract suction, prevention of aspiration and the like. For some critical patients, general anesthesia patients, tracheal intubation is an essential means for maintaining respiratory function, and medical staff must deliver the tracheal tube into the trachea of the patient in a short time to provide respiratory support, so how to quickly and effectively perform tracheal intubation becomes a key problem for patient treatment. The trachea cannula is too long in time or even fails due to the adoption of a common trachea cannula method, so that the patient loses the best rescue opportunity, the patient is seriously injured or even dies, and medical risks are brought to a hospital.
The current common tools for clinical trachea intubation are: direct-view laryngoscopes, visual guide cores, bronchoscopes, optical rods and the like, but all of the tools have certain limitations and disadvantages in clinical use. Despite adequate techniques, it is often difficult to complete intubation of the trachea and even failure of intubation for difficult airways, especially for physicians with less experience in endotracheal intubation, due to anatomical variations and individual differences, and due to various reasons such as the inability of the physician to see the situation around the glottis.
Firstly, a direct-view laryngoscope: the direct-vision laryngoscope is also called a direct laryngoscope, a fiber optic laryngoscope or a common laryngoscope, and has low cost, and is durable. Although used in large quantities in clinic, there are some limitations and disadvantages in clinical use: 1. the patient position is required to be certain, the patient is required to adopt a smell level with the back head facing backwards in a supine position during intubation, and the three axes of the oral axis, the pharyngeal axis and the laryngeal axis of the patient are the same line; for a few patients with difficult airways, such as patients with short distance between the nail and the chin, small mandible, prominent incisors, large tongue body, high larynx, obesity, thick neck, limited mandible movement, limited cervical vertebra movement and other special body types or patients with difficult airways, such as patients with cervical vertebra injury and the like, who cannot lean backwards due to head injury, the glottis cannot be seen frequently in the trachea intubation process and only can be inserted blindly when the three axes are in one line; the blind probing intubation has certain probing property, local mucosal hemorrhage, edema, even larynx spasm, glottis closure and the like can be caused by multiple stimulation to the throat part, the damage to the airway is large, and the difficulty of endotracheal intubation is further increased; the blind probe intubation is easy to be inserted into the esophagus by mistake, causing aspiration complications, and the intubation success rate is low or even the intubation fails; 2. in order to realize the three-axis and one-line function of the direct-view laryngoscope to expose the glottis, the oral and pharyngeal parts are often required to be excessively exposed, the lifting force of the laryngoscope handle is required to be increased, and the lips, the teeth, the tongue and the pharynx are easily damaged; 3. the direct-vision laryngoscope needs to forcibly lift the laryngoscope in order to expose the glottis, and the lifting laryngoscope is easy to generate cardiovascular reaction in the intubation process; 4, the lens of the direct-vision laryngoscope has larger thickness, the openness must be larger (generally more than 3 cm) to be placed in the oral cavity, and the direct-vision laryngoscope is not suitable for patients with limited openness (the openness is less than 3 cm).
Secondly, a visible laryngoscope: the clinical use of the visual laryngoscope comprises 2 types, the curvature of the first lens is similar to that of a direct-viewing laryngoscope, but a visual device is additionally arranged, the intubation method and the direct-viewing laryngoscope are similar to require a three-axis line or a line close to the three-axis line, but the visual device is beneficial to the observation of a doctor on the glottis, and has the advantages and the disadvantages similar to those of the direct-viewing laryngoscope; in addition, the curvature of the lens of the visual laryngoscope is larger, the visual laryngoscope conforms to the physiological bending of the oropharynx, the visual angle is rotated forwards by about 60 degrees (the design angles of different manufacturers are inconsistent), the viewpoint moves forwards, the glottis can be exposed without excessively backward tilting of the head and the neck during tracheal intubation, and the glottis can be exposed without three axes of the mouth, the pharynx and the larynx in one line, the glottis exposure is simple, multiple researches show that the visual laryngoscope can improve the glottis exposure of a difficult airway by 1-2 levels or even 3 levels compared with a direct-view laryngoscope, the problem of tracheal intubation of most difficult airways of general anesthesia is solved, and most of the visual laryngoscopes used clinically belong to the laryngoscope. Visual laryngoscopes make it easier to expose the glottis, but there are also certain limitations and disadvantages in clinical use: 1. the visual laryngoscope is easy to expose the glottis but the intubation tube is more complicated and difficult to enter the glottis than the visual laryngoscope, because the curvature of the lens is larger and the corresponding bending angle of the front end of the tracheal catheter must be larger in order to avoid the lens being blocked by the front section of the lens and the lens being blocked by the tube when the catheter enters the lens; when the tracheal catheter is inserted into the glottis, the three axes of the mouth, the pharynx and the larynx are not in the same line but are bent at a large angle, the tip of the tracheal catheter firstly pushes the front wall of the lower glottis chamber of the glottis forwards and then can enter the glottis and the trachea after being bent downwards, the resistance of the tracheal catheter is large, the tip of the tracheal catheter can slide out of the glottis due to the resistance of the tracheal catheter, and the tracheal catheter can not be placed into the glottis smoothly even if the tip adjustable guide core is used; when the direct-viewing laryngoscope is used for intubation, eyes are outside the mouth, the sight of the eyes looks at the tip of the catheter and is directly inserted into the glottis, the visible laryngoscope moves the eyes to the display screen, the eyes are not consistent with the visual field, and the vision is visible and unobtainable after parallax error occurs, so that although the glottis visual field is easier to see, the relationship between the tip of the tube and the glottis is more difficult to judge, and intubation difficulty and even mistaken insertion into the esophagus are easily caused; 2. the curvature of the visual laryngoscope lens is larger, the glottis is easy to expose but the intubation is difficult, so the visual laryngoscope guide core generally adopts a harder guide wire or a special hard guide core, and the excessively hard guide core is easy to cause accidental injury to the pharynx, the larynx and the vocal cords; 3. the visual laryngoscope can only observe the position of the oral cavity and the glottis, and when the tracheal catheter enters the glottis during tracheal intubation, the tracheal catheter often blocks the lens of the visual laryngoscope, so that the visual effect cannot be completely achieved, and the tracheal catheter can be inserted into the esophagus by mistake; 4. patients with a large amount of oral secretion have unclear sight due to the adhesion of secretion to the lens, so that the intubation success rate is low; 5. the visual laryngoscope is the same as a direct-viewing laryngoscope, the thickness of the lens is larger, the openness must be larger (generally more than 3 cm) to be placed in the oral cavity, and the visual laryngoscope is not suitable for patients with limited openness (the openness is less than 3 cm).
Thirdly, a visual guide core: the invention discloses a visible guide core for clinical application, which has a plurality of names, such as a visible tube core, a video optical rod, a catheter type visible laryngoscope and the like. The common visual guide core used in clinic comprises a plastic visual guide core and a hard non-plastic visual guide core; the hard non-moldable visible guide core is generally molded in advance according to the physiological bending of the oropharynx, and can not be individualized and re-molded when in use, the hard non-moldable visible guide core has the advantages that the guide core is hard, the guide core can not be deformed when in intubation, the guide core is not easy to damage because the guide core is not repeatedly bent and molded, and the hard visible guide core has the defects that the individualized and re-molded can not be performed, and the hard guide core is easy to damage tissues such as oral mucosa, epiglottis, periphery of glottis, vocal cords and the; the advantages and disadvantages of the shapeable visual guide core are opposite. When the trachea cannula is performed, the left thumb catches the lower incisor of the patient and lifts the lower jaw and the tongue body upwards to enlarge the pharyngeal cavity gap, the visual guide core is held by the right hand and inserted into the oral cavity to perform the trachea cannula, and an assistant can assist in supporting the lower jaw of the patient to facilitate an operator to find the glottis exposure behind the epiglottis when necessary. The visual guide core has low requirements on the openness, can solve the problem of trachea cannula of most patients with difficult airways with too small openness, but also has certain limitations and disadvantages in clinical use: 1. the method of buckling the lower incisor of the patient by the thumb of the left hand and lifting up the lower jaw and the tongue body to expand the pharyngeal cavity gap is required to be carried out on the premise that the patient does not have the occlusion capacity, but in the actual clinical work, particularly, the emergency intubation patients often do not have full anesthesia and muscle relaxation due to the illness state, the patient throws away the patient to keep the autonomous respiration and the occlusion capacity, and at the moment, the thumb cannot be stretched into the mouth of the patient to ensure that the visual core guiding intubation method cannot be applied; 2. the method of grasping and buckling the lower incisors of the patient by the left thumb and lifting the lower jaw and the tongue body upwards is adopted to expose the epiglottis and the glottis, meanwhile, the general anesthesia or the patient without spontaneous respiration aggravates the difficulty degree of exposing the epiglottis and the glottis further by aggravating the tongue tenesmus due to the muscle relaxation, the visual guide core is narrow in inserting visual field, the path is blocked, sometimes even no sufficient space enters the guide core, at this time, even if an assistant assists in supporting the lower jaw of the patient to facilitate the operator to expose the epiglottis and the glottis of the patient, the epiglottis and the glottis are often not fully exposed, and the intubation operation is difficult; 3. when the visual guide core is used for tracheal intubation, the glottis cannot be displayed due to the obstruction of the epiglottis, and the glottis needs to be bypassed or downwards crossed by the epiglottis, so that the intubation operation difficulty is high, the intubation time is long, the tracheal intubation cannot be completed quickly, and even the intubation failure occurs; 4. the plastic visual guide core is often difficult to insert a tube because the guide core is too soft and is easy to deform; the hard non-moldable visible guide core is often not suitable for partial patients due to the fact that the guide core is not moldable, and meanwhile, the guide core is too hard, so that tissues such as oral mucosa, epiglottis, periglottis, vocal cords and the like are easily damaged during operation, bleeding or edema is caused, and the difficulty degree of tracheal intubation is increased.
Fourthly, a light bar: the glottis position is judged by the light transmitting intensity of the light stick, the light stick is completely a blind insertion, the injury of the lip, the tooth, the tongue, the pharynx, the glottis, the trachea and other parts is likely to be caused, the injury to a human body is large, the glottis is not accurately judged by the throat brightness, the inserting into the esophagus by mistake is likely to happen, and the success rate of inserting the tube is low.
Fifthly, fiber bronchoscopy: can be used for tracheal intubation of various difficult airways, but has certain limitations and disadvantages in clinical use: 1. the tube is soft, time and labor are wasted when the direction is adjusted in the oral cavity, the operation difficulty is high, abundant clinical operation experience is required, the operation time is long, and the trachea cannula can not be quickly finished frequently during emergency treatment; 2, the bronchofiberscope is not suitable for emergency trachea cannula for rescuing patients because the bronchofiberscope has soft tube, great operation difficulty and long operation time and often needs the clear-headed cooperation of the patients; 3. the fiber bronchoscope is complex and expensive in equipment, large in size, complex in disinfection and high in application cost, and most departments of the hospital are not equipped with the fiber bronchoscope.
In summary, the above various trachea intubation methods often cause difficulty in completing trachea intubation in a short time or even failure of trachea intubation on difficult airways of patients with special body types, and may cause injury to patients or even cause the patients to lose rescue opportunities if the trachea intubation methods are not operated properly, so that the existing intubation tools need to be further improved to meet clinical needs, improve intubation speed and intubation success rate, and reduce medical risks.
After successful intubation of the trachea, two problems are involved: 1. whether the endotracheal tube is located within the trachea; 2. whether the insertion depth of the tracheal catheter is proper or not.
The following methods are commonly used to confirm the endotracheal tube in the clinic:
first, gold standard-end-tidal carbon dioxide waveform and values: after the trachea cannula, the carbon dioxide exhaled by the first four times of exhalation energy absorption is continuously monitored, so that the trachea cannula is credible. But also has certain limitations and disadvantages in clinical use: 1. most monitors are not provided with the end-tidal carbon dioxide monitoring device in a conventional way, and long time is needed for checking the waveform of the end-tidal carbon dioxide after the end-tidal carbon dioxide monitoring device is installed and 4 times of respiration, and serious and irreparable consequences can be caused if the monitors are inserted into the esophagus by mistake; 2. if the ventilator performs assisted ventilation according to the frequency of 12 times per minute, 20 seconds are needed for checking the waveform of the carbon dioxide at the end of 4 breaths, if the esophagus is inserted by mistake, the catheter is pulled out, and the mask of the ventilator performs assisted ventilation, the time is longer, and the oxygen is not supplied for the patient with serious and serious hypoxia, which can cause serious and irreparable consequences; 3. some patients with cardiac arrest, even if the catheter is in the trachea, cannot show a carbon dioxide waveform or the carbon dioxide pressure is low because there is no gas exchange; 4. under the conditions of rupture or obstruction of the tracheal catheter, non-inflation or rupture of an air bag of the tracheal catheter, blockage or leakage or rupture or non-connection of a carbon dioxide sampling tube, severe bronchospasm and the like, the tracheal catheter can not display carbon dioxide waveforms or has very low carbon dioxide pressure even in the trachea; 5. if mouth-to-mouth artificial respiration or balloon mask assisted ventilation is available, exhaled air can be blown into the stomach of a patient, or the patient takes a medicine or food containing carbonate in a short time, carbon dioxide waveforms can appear in ventilation for several times before the tracheal catheter inserted into the esophagus is sampled, or false positives can appear in a color development method detection device, and certainly if the waveforms are checked, the waveforms are not consistent with the waveforms in the trachea of the tracheal catheter, but the waveforms can be judged within a certain time; 6. it is important to note that this method does not allow a determination of whether the endotracheal tube insertion depth is appropriate.
II, secondly: the trachea catheter breathes regularly water mist, and if the trachea catheter is inserted into the esophagus, the mist does not move regularly along with the breathing. However, in the actual clinical work, the fact that the tracheal catheter is unreliable in the trachea is judged by covering the catheter with water vapor, and if the flatulence is obvious, the mist sometimes moves along with the breathing rule if the tracheal catheter is inserted into the esophagus; furthermore, if the temperature difference between the temperature of the exhaled air and the room temperature in the endotracheal tube is small due to a high room temperature or the airway of the patient is dry, the endotracheal tube often has no or little water mist with the breathing regularity.
Thirdly, the method comprises the following steps: listening to breath sound, and listening to the contrast of the upper abdomen, wherein the lung breath sound is strong, and the upper abdomen has weak conduction sound; when breathing the breath, the user cannot listen to the chest only, and should pay more attention to the alveolar sound, the breath sound in the airway is easier to conduct, and even if the user inserts one main bronchus, the user can always hear the breath sound in both lungs, but the alveolar sound is certainly inaudible. But also has certain limitations and disadvantages in clinical use: 1. if the patient has spontaneous breathing, the alveolar sound can be heard even if the tracheal catheter is inserted into the esophagus by mistake; 2. if the tracheal catheter is inserted into the esophagus by mistake, if the stethoscope is close to the tracheal catheter, the breathing sound can be heard sometimes, and the tracheal catheter is mistaken for being inserted into the trachea; 3. if the patient has obvious emphysema or serious pulmonary lesion, the respiratory sound is often not obvious, the alveolar sound is often not heard, and even the respiratory sound is not understood; 4. critical patients often hear the wet rale in the lungs due to cardiac insufficiency or pulmonary infection, and the wet rale auscultation in the lungs can seriously interfere with the judgment of alveolar sounds.
Fourthly, the method comprises the following steps: advanced techniques such as direct bronchofiberscope viewing of the tracheal rings and carina are reliable indicators of the endotracheal tube being located, and visual laryngoscope viewing of the endotracheal tube between the vocal cords is also very reliable. However, the fiber bronchoscope is complex and expensive in equipment, large in size, complex in disinfection and high in application cost, and most departments of the hospital are not equipped with the fiber bronchoscope; the oral cavity is often a place without enough positions for placing the video laryngoscope after the patient inserts the tracheal catheter and fixes the bite-block, and even if the visual laryngoscope is placed in the oral cavity, the tracheal catheter is difficult to clearly see between the vocal cords due to the shielding of soft tissues around the vocal cords, so that the video laryngoscope can not be applied to confirm that the tracheal catheter is in the trachea under most conditions.
The depth of tracheal intubation for adults should be about 3-5 cm above the carina, with too deep a tube potentially displacing inward into the bronchi for some reason, such as the abdominal compression of the diaphragm during laparoscopic gynecological surgery, with some finding a maximum possible displacement of 3-5 cm. The over-shallow air bag may be stuck in the glottis to cause glottis injury, and the tube may also slide out of the glottis due to head and neck rotation or buckling. Therefore, the depth positioning needs to consider whether the patient moves the position of the head and neck, influences the position of the diaphragm and the like.
With respect to whether the insertion depth of the endotracheal tube is appropriate, the following methods are commonly used clinically:
firstly, the method comprises the following steps: according to the rough measurement of the height, there are many methods such as measuring a large predetermined length along the face of the patient with a tube, or measuring the distance from the tip of the nose to the earlobe plus half the length, etc., and such measurement is performed by approximately inserting about 23cm into the male at 170 as the middle. The female inserts about 21cm with 160 as the median.
II, secondly: based on the anatomical data of the head and face, the formula is calculated.
Thirdly, the method comprises the following steps: the distance from the individual's palpebral fissure to the suprasternal notch is used as the actual intubation depth for each individual. The patient was left without the bolster in the horizontal position, the eyes were closed, and the length of the above-mentioned interval was measured with a ruler.
Fourthly, the method comprises the following steps: it is suitable for children. The height of the child should also be proportional to the data of certain anatomical landmarks on its body surface, and it is not certain whether the above method is also suitable. The child, the depth required for insertion can be estimated using the following formula: the depth of the catheter = [ age +2] ÷ 12, but even at the same age, the height of the child varies greatly, and therefore the depth of the catheter should be determined according to the condition of each child. For young children, the tube can easily be removed or entered into the bronchus due to the short length of the trachea. Some people propose that the intubation tube is intentionally inserted into the bronchus too deep to one side, then the tube is retreated while the breathing sound is auscultated, and the tube is retreated by 1-2 cm (according to the height) when the symmetrical breathing sound of the two lungs is heard.
The four methods described above are empirical and there is often an inappropriate depth of tracheal insertion due to individual variation. Therefore, the following method is more commonly used clinically.
Fifthly: if the respiratory sounds of the left lung are reduced after intubation, the right main bronchus may be inserted and slowly withdrawn from the tracheal catheter until the respiratory sounds of both sides are symmetrically auscultated (i.e. the left and right lungs are symmetrically).
Sixthly, the method comprises the following steps: after intubation, the patient's lungs were examined by chest fluoroscopy and the radiopaque marker wire tip on the endotracheal tube was confirmed to be in the mid-trachea, not in the left and right main bronchi. However, fluoroscopy is not reliable for identifying whether the esophagus is inserted.
Seventhly, the method comprises the following steps: the lung CT has high accuracy, if the lung CT is CT, the tracheal catheter can be clearly positioned in the trachea, and the insertion depth of the tracheal catheter can be determined at the same time, but the CT is used for examining the position and the depth of the tracheal catheter, and the CT is not used for determining the position and the depth of the tracheal catheter clinically.
Eighthly: the bronchofiberscope with the fixed tracheal intubation depth is the best, but the bronchofiberscope is complex and expensive in equipment, large in size, complex in disinfection and high in application cost, and most departments of a hospital are not equipped with the bronchofiberscope.
The above methods for determining whether the endotracheal tube is located in the trachea and whether the insertion depth of the endotracheal tube is proper have certain disadvantages, and if the insertion depth of the endotracheal tube is not proper or even if the endotracheal tube is mistakenly inserted into the esophagus, serious injury can be caused to the patient and the patient can die. Therefore, the prior intubation tool needs to be further improved, whether the tracheal catheter is positioned in the trachea or not and whether the insertion depth of the tracheal catheter is proper or not are better determined, the clinical requirement is met, and the medical risk is reduced.
Disclosure of Invention
In order to improve the existing intubation tool, improve the intubation speed and the intubation success rate and reduce the medical risk, the invention provides the double-visual and double-positioning tracheal intubation set combining the visual laryngoscope and the visual guide core to overcome the defects of the prior art, which is particularly suitable for the quick intubation of the difficult airway, so that the tracheal intubation operation is simpler and more convenient, a beginner can quickly master the tracheal intubation, and simultaneously, whether the tracheal catheter is positioned in the trachea and whether the insertion depth of the tracheal catheter is proper can be quickly determined. The operation of the suit is easy to master, the suit is convenient to popularize among medical care personnel, the defects of the prior art can be overcome, and the medical risk is reduced.
The suit is characterized in that: the combination comprises two parts, namely a visual laryngoscope 1 and a visual guide core 2.
The visual laryngoscope 1 comprises a display screen 11, a handle 12, a laryngoscope lens 13 and a camera device 14.
The visual laryngoscope display screen 11 can receive images transmitted by the visual laryngoscope 1 and the visual guide core 2 simultaneously or independently; according to different models and different application scenes, the display screen 11 can be fixed on the visual laryngoscope handle 12 or can be separately arranged outside the handle 12 for convenient viewing, and if the display screen 11 is separately arranged outside the handle 12, the display screen can be connected with the handle 12 through wireless devices such as WiFi or Bluetooth for image transmission.
The visual laryngoscope handle 12 is provided with a switch, a data line interface, a power supply module and an integrated circuit; the data line interface is connected with the power supply device or the display screen through a data line; if the display screen 11 is separately disposed outside the handle 12, the handle 12 incorporates a wireless device such as WiFi or bluetooth to transmit the image of the camera to the display screen 11.
The tail part of the laryngoscope blade 13 of the visible laryngoscope is provided with a camera device 14, the side of the camera device is provided with a lighting lamp, a data cable of the camera device passes through the inside of the laryngoscope blade 13, enters the inside of the handle 12, is connected with the integrated circuit and transmits an image to the display screen 11 through the integrated circuit; the laryngoscope lens 13 is a lens which is bent according to the physiological curvature of the oropharynx part. The invention relates to a laryngoscope for a laryngoscope, which is characterized in that a common visual laryngoscope adopts a double-visual and double-positioning method to avoid that the front section of the lens partially shields a lens and a tube shields the lens when a catheter enters the lens, the visual laryngoscope aims to expose a glottis, the observation of the catheter entering the glottis mainly depends on a visual guide core when the trachea is intubated, and the condition that the tube shields the lens when the catheter enters the lens is not considered, so that the curvature of the laryngoscope is smaller than that of the common visual laryngoscope, a smell level of back-facing of the back-lying position can be adopted when the trachea is intubated, and at the moment, three axes of a patient's mouth axis, a throat axis and a throat axis are one-line, so that the problems that the visual laryngoscope is easy to expose the glottis but the intubation.
The visual guide core 2 can be divided into a plastic guide core and a hard non-plastic guide core according to different models and different application scenes; the guide core comprises a handle 21, hollow pipes (22, 23), a limiter 24 and a camera device 26
One end of the visual guide core handle 21 is connected with the handle end 22 of the hollow pipe; a switch, a data line interface, an integrated circuit and a power module are arranged in the handle 21, and the data line interface is connected with a power supply device or a display screen through a data line; according to different models and different application scenes, the handle 21 and the visual laryngoscope display screen 11 are connected through a data line to carry out image transmission or carry out image transmission through wireless devices such as WiFi and Bluetooth; in the case of wireless connection, the handle 21 incorporates a wireless device such as WiFi or bluetooth for transmitting an image of the camera to the display 11.
The hollow tubes (22, 23) can be divided into plastic hollow tubes and hard non-plastic hollow tubes according to different models and different application scenes; the hollow tube camera device end 23 is provided with a camera device 26, the camera device side is provided with an illuminating lamp, and a data cable 25 of the camera device on the hollow tube penetrates through the hollow tube and the handle 21 to be connected with an integrated circuit and transmits images to the display screen 11; and a stopper 24 is sleeved on the peripheral surface of the hollow pipe.
The stopper 24 is in a circular truncated cone shape, the large end of the stopper is close to the handle 21, the distance between the outer end face of the hollow tube and the outer end face of the endotracheal tube is always kept about 10mm by the stopper, the camera device 26 is not exposed out of the endotracheal tube, and the patient is prevented from being damaged.
The visual laryngoscope that clinical commonly used at present uses the lens curvature great, carries out trachea cannula and need not the excessive back-facing of neck, exposes the glottis easy simple, nevertheless because design problem, visual laryngoscope exposes the glottis easy and clear in clinical use, but the intubate gets into the glottis more complicated difficulty than the direct-view laryngoscope. The invention adopts a double-visual and double-positioning method, the visual laryngoscope aims at exposing the glottis, the observation of the catheter entering the glottis during tracheal intubation mainly depends on the visual guide core, and the tube blocks the lens when the catheter enters the lens is not considered, so the curvature of the laryngoscope lens is smaller than that of a common visual laryngoscope, the olfactory position can be adopted during tracheal intubation, the three axes of the oral axis, the pharyngeal axis and the laryngeal axis are the same when intubation is carried out, the resistance of the intubation tube is small during tracheal intubation, even if the glottis cannot be seen due to the secretion adhering to the lens of the camera device, the descending tracheal intubation can be seen directly, and the problems that the visual laryngoscope is easy to expose the glottis but the intubation is more complicated and difficult to enter the glottis than the direct viewing laryngoscope and the glottis cannot be seen due to the secretion adhering.
The laryngoscope lens of the visible laryngoscope accords with the physiological bending of the oropharynx, so that the visual angle is rotated forward by about 60 degrees, the viewpoint moves forward, the olfactory position of a small part of patients with special difficult airways does not need to be emphasized excessively, and the glottis can be exposed without one line of three axes of the mouth, the pharynx and the larynx The three-axis angle difference of the pharyngeal axis and the laryngeal axis reduces the difficulty of tube feeding during trachea intubation. The invention can fully utilize the advantages of the visible laryngoscope and the direct-viewing laryngoscope, simultaneously avoid the defects of the visible laryngoscope and the direct-viewing laryngoscope, obviously improve the success rate of intubation and reduce the complications.
The invention adopts a double-visual and double-positioning method, adopts the visual laryngoscope to expose the glottis, and mainly relies on the visual guide core to observe the entrance of the catheter into the glottis during the tracheal intubation, thereby solving the problem that the visual laryngoscope is difficult to judge the relationship between the tip of the tracheal catheter and the glottis; the invention adopts the visual laryngoscope to expose the glottis, and solves the problems that the thumb needs to be extended into the mouth of a patient when the visual guide core is used for inserting the trachea and the tube and the epiglottis and the glottis are difficult to expose; the invention adopts the visual laryngoscope to expose the glottis, the visual laryngoscope pushes the tongue body away when the trachea is intubated, and the visual guide core has larger space to enter the oral cavity to reduce the damage and increase the success rate of intubatton.
The invention can separately adopt the visual guide core to perform tracheal intubation on partial patients with difficult mouth opening, and solves the problem of tracheal intubation of the patients with difficult mouth opening.
The invention can determine whether the tracheal catheter is positioned in the trachea and whether the insertion depth of the tracheal catheter is proper or not through the shapeable visual guide core, and solves the problems that whether the tracheal catheter is positioned in the trachea and whether the insertion depth of the tracheal catheter is proper or not after the tracheal intubation clinically at present.
The tracheal intubation can be carried out according to the following steps:
1. after the visual guide core is lubricated, the tracheal catheter is sleeved on the visual guide core, the position limiter on the visual guide core is adjusted to enable the tube head of the visual guide core to be kept at a position about 1cm away from the tip end of the tracheal catheter, so that parts such as a camera device and the like cannot be exposed to damage mucosa tissues of a patient, and meanwhile, the contact with pollutants such as sputum and saliva and the like can be avoided to a certain extent, and the image effect is influenced.
2. And turning on the power supplies of the visual laryngoscope and the visual guide core to ensure that the images transmitted by the visual laryngoscope and the visual guide core can be simultaneously seen on the display screen.
3. The patient adopts the smelly thing position of supine position back head facing backward, need not excessively emphasize triaxial one line to a small number of difficult air flue patients of special physique such as first chin distance is short, little lower jaw, incisor protrusion, the tongue body is fat, high larynx, obesity, neck thick and short, lower jaw activity is limited, cervical vertebra activity is limited or cervical vertebra injury reason such as can't face backward, holds visual laryngoscope with the left hand, shows three anatomical landmarks in proper order with the help of visual laryngoscope: uvula, epiglottis, glottis.
4. The handheld cover in right side has visual guide core endotracheal tube, inserts endotracheal tube into the oral cavity, and visual guide core camera device shows the inside condition image in oral cavity on the display screen in real time, supplies operator's secondary glottis location, sees the glottis and pushes away endotracheal tube in the trachea with the trend, takes out visual guide core, adjusts the endotracheal tube degree of depth, fixed endotracheal tube, and the intubate is accomplished.
5. After the intubation is finished and the bite-block is fixed, the breathing machine can assist in ventilation and the plastic visual guide core can be used for determining whether the tracheal catheter is positioned in the trachea and whether the insertion depth of the tracheal catheter is proper.
6. When a patient suffers from restlessness, shortness of breath, blood oxygen saturation reduction and the like during the auxiliary ventilation of the breathing machine, the problems of whether the tracheal catheter is positioned in the trachea, whether the insertion depth of the tracheal catheter is proper, whether the air sac hernia of the tracheal catheter exists, whether main bronchus sputum exists or not and the like to cause main bronchus blockage can be determined through the plastic visual guide core again while the auxiliary ventilation of the breathing machine is carried out.
7. For the patients with partial mouth opening difficulty, if the visual laryngoscope can not be placed, the visual guide core can be independently adopted for tracheal intubation without the use of the laryngoscope. After the visual guide core is lubricated, the tracheal catheter is sleeved on the visual guide core, and a limiter on the visual guide core is adjusted; turning on the power supply of the visual guide core and the display screen, and determining that the image transmitted by the visual guide core can be seen on the display screen; put the position, insert the oral cavity with the endotracheal tube that the cover has visual guide core, camera device shows the display screen with the inside condition image in oral cavity in real time on, supply the operator to find the glottis, because the visual characteristics of guide core, put it under the epiglottis alright find the glottis, see that the glottis is opened and is followed the situation and push away the endotracheal tube in the trachea, take out visual guide core, the adjustment endotracheal tube degree of depth, fixed endotracheal tube, the intubate is accomplished. The method has low requirement on the degree of opening, and the difficult airway trachea cannula with the degree of opening of about 0.5 cm becomes simple and accurate.
The invention adopts a double-visual and double-positioning method combining the visual laryngoscope and the visual guide core, can quickly guide the camera device of the visual laryngoscope to the glottic position through the positioning of the visual laryngoscope, and then carries out precise secondary positioning of the glottic through the camera device of the visual guide core, quickly carries out tracheal intubation on a patient, ensures the success rate of the tracheal intubation, and can clearly determine whether the tracheal catheter is positioned in a trachea and whether the insertion depth of the tracheal catheter is proper through the visual guide core. The visual guide core can be independently used for tracheal intubation for patients with partial mouth opening difficulty. This two visual, two location trachea cannula suit can realize the whole visual of trachea cannula process, can not have the risk that the esophagus was inserted to the mistake, makes things convenient for the doctor to the degree of depth and the definite of position of trachea cannula, has greatly improved trachea cannula's maneuverability and security, reduces medical risk.
Advantageous effects
1. The invention adopts a double-visual and double-positioning method, can quickly guide the visual laryngoscope camera device to the glottic position through the visual laryngoscope positioning, and then carries out accurate glottic secondary positioning through the visual guide core camera device, thereby realizing the whole course real-time visual guide in the operation process of the tracheal intubation, being easy to operate, having high intubation speed, high success rate of one-time intubation, no risk of mistaken insertion into the esophagus, greatly improving the operability and safety of the tracheal intubation, effectively improving the timeliness of the intubation, reducing the medical risk, being beneficial to the new approach, and being suitable for clinical popularization and application.
2. The invention can determine whether the tracheal catheter is positioned in the trachea and whether the insertion depth of the tracheal catheter is proper or not through the shapeable visual guide core, and solves the problems that whether the tracheal catheter is positioned in the trachea and whether the insertion depth of the tracheal catheter is proper or not after the tracheal intubation clinically at present.
3. The general visual laryngoscope prevents the lens from being partially shielded by the front section of the lens and prevents the tube from blocking the lens when the tracheal catheter enters the lens, so the curvature of the lens is larger; the invention adopts a double-visual and double-positioning method, the visual laryngoscope aims at exposing the glottis, the observation of the tube entering the glottis during the tracheal intubation mainly depends on the visual guide core, and the tube blocks the lens when the tube enters the lens is not considered, so the curvature of the laryngoscope lens is smaller than that of a common visual laryngoscope, the olfactory position of the back head of a patient in a supine position can be adopted during the tracheal intubation, and at the moment, the three axes of the oral axis, the pharyngeal axis and the laryngeal axis of the patient are the same, thereby solving the problem that the visual laryngoscope is easy to expose the glottis, but the intubation is more complicated and difficult to enter the glottis than a direct-viewing laryngoscope.
4. Because can adopt and smell the thing position during trachea cannula, so if there is secretion adhesion camera lens to cause the glottis unclear also can look directly down trachea cannula, solved secretion adhesion camera lens and caused the problem of the glottis unclear.
5. When the direct-viewing laryngoscope with the straighter laryngoscope lens is used for intubation, eyes are outside the mouth, the tip of the catheter is directly inserted into the vocal tract while the sight looks at the tip of the catheter, the visual laryngoscope moves the eyes to the display screen, the eyes are not consistent with the visual field, and the visual parallax is generated, so that the relationship between the tip of the tube and the vocal tract is not easily judged, and the intubation difficulty and even the mistaken insertion into the esophagus are easily caused; the invention adopts a double-visual and double-positioning method, the visual laryngoscope aims at exposing the glottis, and the observation of the catheter entering the glottis during the tracheal intubation mainly depends on the visual guide core, thereby solving the problem that the visual laryngoscope is difficult to judge the relationship between the tip of the tracheal catheter and the glottis.
6. The laryngoscope lens of the visual laryngoscope adopts the curvature which is in accordance with the physiological bending of the oropharynx, so that the visual angle is forwards rotated by about 60 degrees, the viewpoint is forwards moved, and the exposure of the glottis is facilitated, therefore, when a few patients with difficult airways are encountered, such as special body types with short distance between the nail and the chin, small mandible, prominent incisor teeth, large tongue body, high larynx, obesity, thick and short neck, limited jaw movement, limited cervical vertebra movement and the like, or cervical vertebra injury and head backward bending failure and the like, the three axes of the oral axis, the pharyngeal axis and the laryngeal axis of the patient are not in a line, but because the visual angle of the laryngoscope lens is forwards rotated by about 60 degrees, the viewpoint is forwards moved, the glottis can still be displayed, and the problems that the glottis of the direct-viewing laryngoscope is difficult to expose and.
7. The invention can find the glottis by placing the guide core under the epiglottis due to the visual characteristic of the guide core, and the tracheal catheter can be inserted when the glottis is opened, so that the glottis can be visually intubated without fully exposing the glottis by using a laryngoscope, thereby solving the problem of tracheal intubation of difficult airway patients that few visual laryngoscopes can not display the glottis.
8. The invention adopts the visual laryngoscope to expose the glottis, and solves the problems that the thumb needs to be extended into the mouth of a patient when the visual guide core is used for inserting the trachea and the tube and the epiglottis and the glottis are difficult to expose.
9. The invention adopts the visual laryngoscope to expose the glottis, the visual laryngoscope pushes the tongue body away when the trachea is intubated, and the visual guide core has larger space to enter the oral cavity to reduce the damage and increase the success rate of intubatton.
10. The visual guide core can be independently adopted for trachea intubation for the patients with partial mouth opening difficulty, so that the problem of trachea intubation for the patients with mouth opening difficulty is solved.
Drawings
FIG. 1 is a schematic structural diagram of the present invention. In fig. 1, a visual laryngoscope; 11. a display screen; 12. a visible laryngoscope handle; 13. a visible laryngoscope lens; 14. a visible laryngoscope camera device; 2. a visual guide core; 21. a visual guide core handle; 22. a handle end of the hollow tube; 23. a hollow tube camera end; 24. a stopper; 25. a data cable of the visual guide core camera device; 26. visual guide core camera device.
Detailed Description
The visual laryngoscope and the visual guide core combined double-visual and double-positioning tracheal intubation set can adopt different tracheal intubation methods according to different conditions of patients.
The first mode is that for most patients who can clearly expose the difficult airway of glottis with a direct-view laryngoscope, the olfactory level of the back head of the supine position can be adopted during tracheal intubation, and the three axes of the oral axis, the pharyngeal axis and the laryngeal axis are the same during intubation: 1. after the visual guide core is lubricated, the tracheal catheter is sleeved on the plastic visual guide core, the limiter on the visual guide core is adjusted and the visual guide core is shaped, and the tube head of the plastic guide core is kept at a position which is about 1cm away from the tip of the tracheal catheter, so that parts such as a camera device and the like cannot be exposed to damage mucosa tissues of a patient, and meanwhile, the tracheal catheter can be prevented from contacting with dirt such as sputum saliva and the like to a certain extent to influence the image effect; 2. turning on the power supply of the visual laryngoscope and the visual guide core, and determining that the images transmitted by the visual laryngoscope and the visual guide core can be simultaneously seen on the display screen; 3. the visual laryngoscope is used under the position of smelling the thing, with the help of the change of head, position, makes oral axis, pharynx axis, larynx axis triaxial overlap, holds visual laryngoscope in the left hand at this moment and shows three anatomical landmarks in proper order: the trachea cannula can also be used for directly seeing the descending trachea cannula if the glottis is unclear due to the fact that secretions adhere to the lens; 4. inserting the tracheal catheter sleeved with the visual guide core into the oral cavity by the right hand, displaying the condition image inside the oral cavity on a display screen in real time by a camera device of the visual guide core so that an operator can accurately find the glottis for the second time, pushing the tracheal catheter into the trachea by seeing that the glottis is opened, drawing out the plastic guide core, adjusting the depth of the tracheal catheter, fixing the tracheal catheter and completing intubation; 5. after the intubation is finished, fixing a bite block, connecting a breathing machine for auxiliary ventilation, and then determining whether the tracheal catheter is positioned in the trachea and whether the insertion depth of the tracheal catheter is proper through the plastic visual guide core while the breathing machine for auxiliary ventilation is used; 6. when a patient suffers from restlessness, shortness of breath, blood oxygen saturation reduction and the like during the auxiliary ventilation of the breathing machine, the problems of whether the tracheal catheter is positioned in the trachea, whether the insertion depth of the tracheal catheter is proper, whether the air sac hernia of the tracheal catheter exists, whether main bronchus sputum exists or not and the like to cause main bronchus blockage can be determined through the plastic visual guide core again while the auxiliary ventilation of the breathing machine is carried out.
And in the second mode, for a few patients with difficult airways, such as patients with short distance between the nail and the chin, small mandible, prominent incisor teeth, enlarged tongue body, high larynx, obesity, thick and short neck, limited mandible movement, limited cervical vertebra movement and other special body types or patients with cervical vertebra injury and the like who cannot lean backwards due to head bending, the direct-view laryngoscope cannot clearly expose the glottis, and the first line of three axes does not need to be emphasized: 1. after the visual guide core is lubricated, the tracheal catheter is sleeved on the plastic visual guide core, the limiter on the visual guide core is adjusted and the visual guide core is shaped, and the tube head of the plastic guide core is kept at a position which is about 1cm away from the tip of the tracheal catheter, so that parts such as a camera device and the like cannot be exposed to damage mucosa tissues of a patient, and meanwhile, the tracheal catheter can be prevented from contacting with dirt such as sputum saliva and the like to a certain extent to influence the image effect; 2. turning on the power supply of the visual laryngoscope and the visual guide core, and determining that the images transmitted by the visual laryngoscope and the visual guide core can be simultaneously seen on the display screen; 3. if the patient condition allows, the patient can adopt a sniffing object position during trachea intubation, even if the standard sniffing object position cannot be achieved, the three axes of the mouth, the pharynx and the larynx can not reach the same line, the body position of the patient is also arranged, the angle difference of the three axes of the mouth axis, the pharynx axis and the larynx axis is reduced, and the tube feeding difficulty during trachea intubation is reduced; but if the patient can not adopt the sniffing object position due to cervical vertebra injury and the like, the safe body position of the patient is kept; 4. the left-handed visual laryngoscope sequentially reveals three anatomical landmarks: the mouth cavity is inserted with the trachea catheter sleeved with the visual guide core in the right hand, the image of the condition inside the mouth cavity is displayed on a display screen in real time by a camera device of the visual guide core, so that an operator can accurately find the glottis for the second time, the trachea catheter is pushed into the trachea by seeing the opening of the glottis, the plastic guide core is drawn out, the depth of the trachea catheter is adjusted, the trachea catheter is fixed, and the intubation is completed; 5. after the intubation is finished, fixing a bite block, connecting a breathing machine for auxiliary ventilation, and then determining whether the tracheal catheter is positioned in the trachea and whether the insertion depth of the tracheal catheter is proper through the plastic visual guide core while the breathing machine for auxiliary ventilation is used; 6. when a patient suffers from restlessness, shortness of breath, blood oxygen saturation reduction and the like during the auxiliary ventilation of the breathing machine, the problems of whether the tracheal catheter is positioned in the trachea, whether the insertion depth of the tracheal catheter is proper, whether the air sac hernia of the tracheal catheter exists, whether main bronchus sputum exists or not and the like to cause main bronchus blockage can be determined through the plastic visual guide core again while the auxiliary ventilation of the breathing machine is carried out.
Mode three, to the difficult air flue patient that few visual laryngoscope also can not clearly expose the glottis, as long as the patient condition allows, also put the patient position, reduce oral axis, pharynx axis, the triaxial angle difference of larynx axis, send out the degree of difficulty of pipe when reducing trachea cannula: 1. after the visual guide core is lubricated, the tracheal catheter is sleeved on the plastic visual guide core, the limiter on the visual guide core is adjusted and the visual guide core is shaped, and the tube head of the plastic guide core is kept at a position which is about 1cm away from the tip of the tracheal catheter, so that parts such as a camera device and the like cannot be exposed to damage mucosa tissues of a patient, and meanwhile, the tracheal catheter can be prevented from contacting with dirt such as sputum saliva and the like to a certain extent to influence the image effect; 2. turning on the power supply of the visual laryngoscope and the visual guide core, and determining that the images transmitted by the visual laryngoscope and the visual guide core can be simultaneously seen on the display screen; 3. if the patient's condition allows, even if the patient's condition can not reach the standard smelling material level, can not reach the same line of the three axes of the mouth, the pharynx and the larynx, the patient's body position is also arranged, the angle difference of the three axes of the mouth axis, the pharynx axis and the larynx axis is reduced, and the difficulty of tube feeding during the tracheal intubation is reduced; but if the patient can not adopt the sniffing object position due to cervical vertebra injury and the like, the safe body position of the patient is kept; 4. the uvula and the epiglottis are sequentially exposed by holding the visual laryngoscope by the left hand, the glottis or even the uvula and the epiglottis cannot be exposed by the patients of the type, and the intubation tube is confirmed to enter the glottis and mainly depends on the visual guide core; the right hand holds the tracheal catheter sleeved with the visual guide core and inserts into the oral cavity, the camera device of the visual guide core displays the condition image in the oral cavity on a display screen in real time, an operator can find the glottis, if the glottis cannot be displayed due to the obstruction of the epiglottis, the visual guide core needs to bypass from the side of the epiglottis or downwards cross the epiglottis, due to the visual characteristic of the guide core, the glottis can be found by placing the visual guide core under the epiglottis, the glottis does not need to be fully exposed by a laryngoscope, the tracheal catheter is pushed into the tracheal catheter by seeing the opening of the glottis, the plastic guide core is drawn out, the depth of the tracheal catheter is adjusted, the tracheal catheter is; if the glottis cannot be displayed due to the fact that the plastic guide core is too soft, the hard non-plastic guide core is used for completing the tracheal intubation; 5. after the intubation is finished, the bite block is fixed and is connected with a breathing machine for auxiliary ventilation, and then whether the tracheal catheter is positioned in the trachea or not and whether the insertion depth of the tracheal catheter is proper or not can be determined through the plastic visual guide core while the breathing machine is used for auxiliary ventilation; 6. when a patient suffers from restlessness, shortness of breath, blood oxygen saturation reduction and the like during the auxiliary ventilation of the breathing machine, the problems of whether the tracheal catheter is positioned in the trachea, whether the insertion depth of the tracheal catheter is proper, whether the air sac hernia of the tracheal catheter exists, whether main bronchus sputum exists or not and the like to cause main bronchus blockage can be determined through the plastic visual guide core again while the auxiliary ventilation of the breathing machine is carried out.
Mode four, to the difficult air flue patient that visual laryngoscope can't be put into to part mouth opening difficulty, then can not use the laryngoscope to adopt visual guide core alone to carry out trachea cannula, can adopt during trachea cannula and smell the thing position, need not excessively emphasize to the special difficult air flue patient of minority part and smell the thing position, nevertheless should reduce as far as possible oral axis, pharynx axis, the triaxial angle difference of larynx axis, send the degree of difficulty of tub when reducing trachea cannula: 1. after the visual guide core is lubricated, the tracheal catheter is sleeved on the plastic visual guide core, the limiter on the visual guide core is adjusted and the visual guide core is shaped, and the tube head of the plastic guide core is kept at a position which is about 1cm away from the tip of the tracheal catheter, so that parts such as a camera device and the like cannot be exposed to damage mucosa tissues of a patient, and meanwhile, the tracheal catheter can be prevented from contacting with dirt such as sputum saliva and the like to a certain extent to influence the image effect; 2. turning on a power supply of the visual guide core and a power supply of the display screen, and determining that the image transmitted by the visual guide core can be seen on the display screen; 3. if the patient condition allows, the patient can adopt a sniffing object position during trachea intubation, even if the standard sniffing object position cannot be achieved, the three axes of the mouth, the pharynx and the larynx can not reach the same line, the body position of the patient is also arranged, the angle difference of the three axes of the mouth axis, the pharynx axis and the larynx axis is reduced, and the tube feeding difficulty during trachea intubation is reduced; but if the patient can not adopt the sniffing object position due to cervical vertebra injury and the like, the safe body position of the patient is kept; 4. when tracheal intubation is carried out, the left thumb catches and buckles the lower incisors of a patient and lifts the lower jaw and the tongue body upwards to enlarge the pharyngeal cavity gap, the tracheal catheter sleeved with the visible guide core is inserted into the oral cavity by hand, the assistant can assist in supporting the lower jaw of the patient to be beneficial to an operator to find the exposure of the glottis after the epiglottis, the glottis cannot be displayed due to the obstruction of the epiglottis, the glottis needs to be bypassed from the side of the epiglottis or downwards cross the epiglottis, the glottis can be found by placing the guide core under the epiglottis due to the visible characteristic of the guide core, the glottis does not need to be fully exposed by a laryngoscope, the glottis is opened to push the tracheal catheter into the trachea, the plastic visible guide core is extracted, the; if the glottis cannot be displayed due to the fact that the plastic visual guide core is too soft, the hard non-plastic visual guide core is used for completing the tracheal intubation; 5. after the intubation is finished, fixing a bite block, connecting a breathing machine for auxiliary ventilation, and then determining whether the tracheal catheter is positioned in the trachea and whether the insertion depth of the tracheal catheter is proper through the plastic visual guide core while the breathing machine for auxiliary ventilation is used; 6. when a patient suffers from restlessness, shortness of breath, blood oxygen saturation reduction and the like during the auxiliary ventilation of the breathing machine, the problems of whether the tracheal catheter is positioned in the trachea, whether the insertion depth of the tracheal catheter is proper, whether the air sac hernia of the tracheal catheter exists, whether main bronchus sputum exists or not and the like to cause main bronchus blockage can be determined through the plastic visual guide core again while the auxiliary ventilation of the breathing machine is carried out. The method has low requirement on the degree of opening, and the difficult airway trachea cannula with the degree of opening of about 0.5 cm becomes simple and accurate.
The invention is not limited to the specific embodiments described above, but extends to various modifications that nevertheless fall within the scope of the appended claims. It will be understood by those skilled in the art that various modifications and equivalent arrangements may be made without departing from the spirit and scope of the present invention, which is to be covered by the appended claims.

Claims (7)

1. The utility model provides a trachea cannula suit which characterized in that: the trachea cannula suit comprises a visual laryngoscope and a visual guide core.
2. The endotracheal intubation kit according to claim 1, wherein: the suit adopts a double-visual and double-positioning tracheal intubation technology combining a visual laryngoscope and a visual guide core.
3. The endotracheal intubation kit according to claim 1, wherein: the visual laryngoscope of this suit includes display screen, handle, laryngoscope piece, camera device.
4. The endotracheal intubation kit according to claim 1, wherein: the visual laryngoscope blade of the suit adopts the curvature which accords with the physiological bending of the oropharynx, and the curvature of the blade of the laryngoscope is smaller than that of the common visual laryngoscope so as to facilitate the tracheal intubation when the olfactory object is adopted.
5. The endotracheal intubation kit according to claim 1, wherein: the display screen set can be fixed on the visible laryngoscope handle or independently arranged outside the visible laryngoscope handle so as to be convenient for watching, and if the display screen is independently arranged outside the visible laryngoscope handle, the display screen set can be connected with the handle through wireless devices such as WiFi or Bluetooth to transmit images; the visual guide core handle and the display screen are connected through a data line to carry out image transmission or carry out image transmission through wireless devices such as WiFi and Bluetooth, and if the visual guide core handle is in wireless connection, the visual guide core handle is internally provided with the wireless devices such as WiFi and Bluetooth so as to send images of the camera device to the display screen.
6. The endotracheal intubation kit according to claim 1, wherein: the visual guide core of this suit includes handle, hollow tube, stopper, camera device, and visual guide core can be divided into visual guide core of mouldable and the visual guide core of the not mouldable of stereoplasm according to different models, different application scenes.
7. The endotracheal intubation kit according to claim 1, wherein: and (3) adopting a shapeable visual guide core to determine whether the endotracheal tube is positioned in the trachea or not and whether the insertion depth of the endotracheal tube is proper or not.
CN202010840687.5A 2020-08-20 2020-08-20 Double-visual double-positioning tracheal intubation set with combination of visual laryngoscope and visual guide core Pending CN111803773A (en)

Priority Applications (5)

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CN202010840687.5A CN111803773A (en) 2020-08-20 2020-08-20 Double-visual double-positioning tracheal intubation set with combination of visual laryngoscope and visual guide core
US18/022,139 US20240008732A1 (en) 2020-08-20 2021-08-17 Dual-visible and dual-positioning endotracheal intubation set with visual laryngoscope and visual guide core
EP21857687.4A EP4183437A4 (en) 2020-08-20 2021-08-17 Visual laryngoscope/visual guide core-combined dual-visualization and dual-positioning tracheal intubation set
JP2023512401A JP2023538122A (en) 2020-08-20 2021-08-17 Double visible, double positioning tracheal intubation set combining laryngoscope and endoscopic guide core
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Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN112546378A (en) * 2020-12-08 2021-03-26 四川大学华西医院 Intubation plasticity method of fitting laryngoscope
WO2022037595A1 (en) * 2020-08-20 2022-02-24 黄加庆 Visual laryngoscope/visual guide core-combined dual-visualization and dual-positioning tracheal intubation set

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2022037595A1 (en) * 2020-08-20 2022-02-24 黄加庆 Visual laryngoscope/visual guide core-combined dual-visualization and dual-positioning tracheal intubation set
CN112546378A (en) * 2020-12-08 2021-03-26 四川大学华西医院 Intubation plasticity method of fitting laryngoscope
CN112546378B (en) * 2020-12-08 2023-09-29 四川大学华西医院 Intubation plasticity method for fitting laryngoscope

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