CN112546378A - Intubation plasticity method of fitting laryngoscope - Google Patents
Intubation plasticity method of fitting laryngoscope Download PDFInfo
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- CN112546378A CN112546378A CN202011461202.8A CN202011461202A CN112546378A CN 112546378 A CN112546378 A CN 112546378A CN 202011461202 A CN202011461202 A CN 202011461202A CN 112546378 A CN112546378 A CN 112546378A
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- 238000000034 method Methods 0.000 title claims abstract description 23
- 238000002627 tracheal intubation Methods 0.000 title claims abstract description 21
- 238000005452 bending Methods 0.000 claims abstract description 43
- 238000007493 shaping process Methods 0.000 claims abstract description 23
- 238000003780 insertion Methods 0.000 claims abstract 3
- 230000037431 insertion Effects 0.000 claims abstract 3
- 210000004704 glottis Anatomy 0.000 claims description 16
- 238000004364 calculation method Methods 0.000 claims description 5
- 210000003300 oropharynx Anatomy 0.000 claims description 4
- 230000007423 decrease Effects 0.000 claims description 3
- 230000003247 decreasing effect Effects 0.000 claims description 3
- 238000002576 laryngoscopy Methods 0.000 claims description 2
- 238000000465 moulding Methods 0.000 claims 1
- 230000000007 visual effect Effects 0.000 abstract description 17
- 210000000214 mouth Anatomy 0.000 description 4
- 238000010586 diagram Methods 0.000 description 2
- 206010002091 Anaesthesia Diseases 0.000 description 1
- 206010021143 Hypoxia Diseases 0.000 description 1
- 208000037656 Respiratory Sounds Diseases 0.000 description 1
- 208000026137 Soft tissue injury Diseases 0.000 description 1
- 229910000831 Steel Inorganic materials 0.000 description 1
- 230000037005 anaesthesia Effects 0.000 description 1
- 230000009286 beneficial effect Effects 0.000 description 1
- 230000006378 damage Effects 0.000 description 1
- 230000007547 defect Effects 0.000 description 1
- 230000001419 dependent effect Effects 0.000 description 1
- 238000001514 detection method Methods 0.000 description 1
- 238000006073 displacement reaction Methods 0.000 description 1
- 230000007954 hypoxia Effects 0.000 description 1
- 238000007689 inspection Methods 0.000 description 1
- 210000000867 larynx Anatomy 0.000 description 1
- 210000004072 lung Anatomy 0.000 description 1
- 239000000463 material Substances 0.000 description 1
- 210000003800 pharynx Anatomy 0.000 description 1
- 230000029058 respiratory gaseous exchange Effects 0.000 description 1
- 210000005181 root of the tongue Anatomy 0.000 description 1
- 239000010959 steel Substances 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. mouth-to-mouth respiration; Tracheal tubes
- A61M16/021—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes operated by electrical means
- A61M16/022—Control means therefor
- A61M16/024—Control means therefor including calculation means, e.g. using a processor
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Abstract
The invention relates to the technical field of endotracheal tubes, and aims to provide an intubation tube plasticity method for fitting a visual laryngoscope, wherein the main focus of endotracheal tube shaping under the guidance of the visual laryngoscope is at a shaping angle and position, and the successful insertion of the endotracheal tube is influenced by the shaping position and the bending radian of the endotracheal tube under the guidance of the visual laryngoscope, but the best bending position is not given in the current literature.
Description
Technical Field
The invention relates to the technical field of endotracheal tube intubation, in particular to an intubation plasticity method of a fitting laryngoscope.
Background
Airway management has been a major and difficult point in anesthesia management. The visual laryngoscope images the glottis structure, reveals the glottis and guides the intubate through the image on the video, no longer need mouth, pharynx, larynx axis overlap nor need exert oneself and lift the glottis that the laryngoscope just can be fine expose, has not only solved difficult air flue difficult problem, also can alleviate the relevant damage of intubate to conventional air flue. However, just as visual laryngoscopes do not require overlapping oral, pharyngeal, and laryngeal axes as do direct laryngoscopes, the visual laryngoscope lens is more curved in shape, making it easier for the visual laryngoscope to expose the glottis but difficult to guide the endotracheal tube tip into the glottis, a problem that has plagued anesthetists, particularly beginners. The more curved lens also makes the guiding of the endotracheal tube by the visual laryngoscope more dependent on the plastic shape of the endotracheal tube.
The common clinical tracheal catheter plasticity mode is that a plastic tube core is inserted into the lumen of the tracheal catheter and is bent and plasticized at a certain position of the tracheal catheter to form a hockey stick shape. Both the location and angle of the bend in the endotracheal tube can affect the successful placement of the tube. The current research only explores the optimal plastic angle and lacks reports on the location of the optimal bend. The shapes of the visible laryngoscope lenses of different manufacturers are different, and the same manufacturer has different types of visible laryngoscope lenses for different ages. The best plasticity angle reported by the current research is mainly aimed atVisual laryngoscopes lack methods suitable for shaping different shapes of visual laryngoscopes.
Therefore, in order to solve the problem of tracheal catheter shaping of a visual laryngoscope for guiding intubation, a tracheal catheter shaping method aiming at visual laryngoscope lenses with different shape parameters is needed, and an anaesthetist can be guided to find the optimal bending position and bending angle of the tracheal catheter aiming at different visual laryngoscope lens shapes.
Disclosure of Invention
The invention aims to overcome the defects of the prior art and provide an intubation plasticity method for fitting a laryngoscope, and a complete calculation method for bending the tracheal catheter is obtained through mathematical modeling, so that the laryngoscope is highly matched with the tracheal catheter, and the accuracy in intubation is greatly improved.
The method is realized by the following technical scheme: the intubation plasticity method of fitting laryngoscope, the shape of the arc lens of the laryngoscope is matched with that of the endotracheal tube during the visual laryngoscopy, the laryngoscope comprises a display, a main body and the arc lens, the main body is connected with the arc lens through a connecting part, and a shaping tube core is also placed in the endotracheal tube, and the intubation plasticity method comprises the following steps:
step 1: selecting a laryngoscope to be matched and a tracheal catheter to be fitted, wherein the circle center angle arc degree theta of the arc lens is obtained and the unit is degree, and executing the step 2;
step 2: fitting a plastic pipe of the tracheal catheter to be fitted with an arc lens, calculating a bending point and a bending angle, taking the arc lens as an arc, obtaining a circle center angle arc degree alpha between the bending point and the connecting part, wherein the unit is degree, the radius of the arc lens is R, and executing the step 3;
and step 3: when the bending angle is (pi-theta/2), the distance between the bending point and the tail end of the tracheal catheter is 2Rsin (theta/2), and the shape of the tracheal catheter with the highest fitting degree with the laryngoscope lens is obtained.
Preferably, the fitting method in step 2 is a primary bending, specifically, after the tail end of the endotracheal tube is overlapped with the tail end of the arc lens to be matched, a bending point and a bending angle are determined through calculation, and the shaping tube core is bent to obtain the endotracheal tube which is bent correspondingly.
Preferably, the step 3 further includes placing the arc-shaped lens in the mouth of the patient, so that the tail end of the arc-shaped lens is aligned with the glottis, placing the bent endotracheal tube along the laryngoscope lens, moving the endotracheal tube through the observation display, so that the extending end of the endotracheal tube is overlapped with the tail end of the arc-shaped lens, taking out the shaping tube core, and completing the extending of the endotracheal tube.
Preferably, the calculation of the bending point and bending angle with the highest fitting degree is as follows:
S1=π*R2*(θ/360)
S2=(1/2)*R2*(sinα+sin(θ-α))
S=S1-S2=π*R2*(θ/360)-(1/2)*R2*(sinα+sin(θ-α))
dS/dα=-(1/2)*R2(cosα-cos(θ-α))
wherein, the arc lens is taken as an arc, the center of the obtained circle is taken as a point E, one end of the arc lens is taken as a point C, the connecting part of the other end of the arc lens is taken as a point A, the bending point is taken as a point B, the radius of the circle E is R, R is EC and EA, the radius is cm, the point B is on the circle E, S1 is the area of a fan AEC, S2 is the area of a quadrilateral ABCE, cos (x) is a decreasing function in [0, pi ], and alpha is more than 0 and less than theta and less than pi,
when α < θ - α (α < θ/2), dS/d α <0, S decreases as α increases,
when α is θ - α (α is θ/2), dS/d α is 0,
when α > θ - α (α > θ/2), dS/d α >0, S increases with increasing α,
so a is θ/2, S is minimal, angle ABC is (pi- θ/2), and BC length is 2Rsin (θ/2).
Preferably, the tail end of the arc-shaped lens is further provided with a signal transmitting device, the tail end of the tracheal catheter is further provided with a signal receiving end, a processor in the display is further provided with a distance standard threshold interval, and the specific steps of the tracheal catheter after plasticity during intubation comprise:
step 51: after the laryngoscope is placed in the oropharynx of the patient, the tracheal catheter with the shaping tube core bent is inserted, and step 52 is executed;
step 52: the tail end of the tracheal catheter is placed along the arc-shaped lens of the laryngoscope, the captured laryngeal picture is sent to the display through the lens on the arc-shaped lens to be displayed, the movement of the tracheal catheter is observed through the display, and the step 53 is executed;
step 53, when the tip end of the tracheal catheter is aligned with the glottis, taking out the shaping tube core and the laryngoscope, continuously sending into the tracheal catheter, and executing step 54;
step 54: the distance between the tail end of the tracheal catheter and the tail end of the arc-shaped lens is obtained through processing and calculating received signals by the processor, when the calculated distance falls into a distance standard threshold interval, the normal signal is displayed on the display, when the calculated distance is smaller than the minimum value of the standard threshold interval, the first early warning signal is displayed on the display, and when the calculated distance is larger than the maximum value of the standard threshold interval, the second early warning signal is displayed on the display.
Preferably, when a normal signal is displayed on the display, the endotracheal tube is stopped from being fed.
Preferably, the minimum value of the standard threshold interval is 6.5cm, and the maximum value of the standard threshold interval is 13 cm.
The invention has the beneficial effects that:
(1) the plastic position and the angle of the tracheal catheter can be accurately calculated, so that the subsequent medical personnel can smoothly insert the tracheal catheter into the glottis;
(2) the method can be suitable for arc laryngoscopes with different shapes, and can obtain the bending conditions of different endotracheal tubes aiming at the arc laryngoscopes with different shapes.
Drawings
FIG. 1 is a block diagram of a visual laryngoscope arrangement according to the invention;
FIG. 2 is a schematic structural diagram of one embodiment of the present invention;
FIG. 3 is a diagrammatic view of a laryngoscope configuration according to an embodiment of the invention;
fig. 4 is a view showing an example of the endotracheal tube intubation according to the present invention.
Reference numerals: 1. an arc-shaped lens; 2. a display; 3. a connecting portion.
Detailed Description
The technical solutions in the embodiments of the present invention are clearly and completely described below with reference to fig. 1 to 3 of the present invention, and it is obvious that the described embodiments are only a part of the embodiments of the present invention, but not all embodiments. All other implementations made by those of ordinary skill in the art based on the embodiments of the present invention are obtained without inventive efforts.
In the description of the present invention, it is to be understood that the terms "counterclockwise", "clockwise", "longitudinal", "lateral", "up", "down", "front", "back", "left", "right", "vertical", "horizontal", "top", "bottom", "inner", "outer", etc., indicate orientations or positional relationships based on those shown in the drawings, and are used for convenience of description only, and do not indicate or imply that the referenced devices or elements must have a particular orientation, be constructed and operated in a particular orientation, and thus, are not to be considered as limiting.
Example (b):
the utility model provides an intubate plasticity method of visual laryngoscope, visual laryngoscope inspection is through the shape matching laryngoscope's arc lens 1 shape, the laryngoscope includes display 2, main part and arc lens 1, the main part passes through connecting portion 3 and arc lens 1 fixed connection, plastic pipe core has still been placed to endotracheal tube inside, contains the following step:
step 1: selecting a laryngoscope to be matched and an endotracheal tube to be fitted, wherein the circle center angle arc degree of the arc lens 1 is obtained, and the unit is degree, and executing the step 2;
step 2: fitting a shaping tube of the tracheal catheter to be fitted with the arc lens 1, calculating a bending point and a bending angle, taking the arc lens 1 as an arc, obtaining the arc degree of a circle center angle between the bending point and the connecting part 3, wherein the unit is degree, the radius of the arc lens 1 is R, and executing the step 3;
and step 3: when the bending angle is (pi-theta/2), the distance between the bending point and the end point of the tracheal catheter is 2Rsin (theta/2), and the shape of the tracheal catheter with the highest fitting degree with the laryngoscope lens is obtained.
It should be noted that the fitting method in step 2 is a primary bending, specifically, after the end of the endotracheal tube is overlapped with the end of the arc lens 1 to be matched, the bending point and the bending angle are determined by calculation, and the endotracheal tube bent correspondingly is obtained by bending the shaping tube core.
It should be noted that step 3 further includes placing the arc-shaped lens 1 into the patient's mouth, so that the end of the arc-shaped lens 1 is aligned with the glottis, placing the bent endotracheal tube along the laryngoscope lens, moving the endotracheal tube through the observation display 2, so that the extending end of the endotracheal tube coincides with the end of the arc-shaped lens 1, and taking out the shaping tube core, so as to complete the extending of the endotracheal tube, wherein the shaping tube core is a light bendable steel wire in the embodiment for supporting the endotracheal tube, so as to avoid the endotracheal tube from being deformed by closing, and the shaping tube core is convenient for plasticity because the endotracheal tube is a soft gelatinous product and cannot be independently plastic.
Please note thatReferring to FIG. 2, the bending point and bending angle with the highest fitting degree are calculated as follows: s1 ═ pi × R2*(θ/360)
S2=(1/2)*R2*(sinα+sin(θ-α))
S=S1-S2=π*R2*(θ/360)-(1/2)*R2*(sinα+sin(θ-α))
dS/dα=-(1/2)*R2(cosα-cos(θ-α))
Wherein, the arc lens is taken as an arc, the center of the obtained circle is taken as a point E, one end of the arc lens is taken as a point C, the connecting part of the other end of the arc lens is taken as a point A, the bending point is taken as a point B, the radius of the circle E is R, R is EC and EA, the radius is cm, the point B is on the circle E, S1 is the area of a fan AEC, S2 is the area of a quadrilateral ABCE, cos (x) is a decreasing function in [0, pi ], and alpha is more than 0 and less than theta and less than pi,
when α < θ - α (α < θ/2), dS/d α <0, S decreases as α increases,
when α is θ - α (α is θ/2), dS/d α is 0,
when α > θ - α (α > θ/2), dS/d α >0, S increases with increasing α,
so a is θ/2, S is minimal, angle ABC is (pi- θ/2), and BC length is 2Rsin (θ/2).
It should be noted that the end of the arc-shaped lens is further provided with a signal emitting device, and the end of the endotracheal tube is further provided with a signal receiving end, the invention is preferably arranged at the end of the endotracheal tube, another embodiment is arranged at the end of the plastic tube core, but considering that the endotracheal tube needs to extend a distance after entering the glottis, the signal receiving end is arranged at the end of the endotracheal tube, the processor in the display is further provided with a distance standard threshold interval, and the specific steps of the plastic endotracheal tube during intubation include:
step 51: after the laryngoscope is placed in the oropharynx of a patient, the tracheal catheter with the bent plastic tube core is inserted;
step 52: the tail end of the tracheal catheter is placed along the arc-shaped lens of the laryngoscope, the captured laryngeal picture is sent to the display through the lens on the arc-shaped lens to be displayed, and the movement of the tracheal catheter is observed through the display;
and 53, after the tracheal catheter is aligned with the glottis, taking out the shaping tube core, and continuously sending the tube core into the tracheal catheter.
Step 54: the distance between the tail end of the tracheal catheter and the tail end of the arc-shaped lens is obtained through processing and calculating received signals by the processor, when the calculated distance falls into a distance standard threshold interval, the normal signal is displayed on the display, when the calculated distance is smaller than the minimum value of the standard threshold interval, the first early warning signal is displayed on the display, and when the calculated distance is larger than the maximum value of the standard threshold interval, the second early warning signal is displayed on the display.
It should be noted that the minimum value of the standard threshold interval is 6.5cm, the maximum value of the standard threshold interval is 13cm, both the signal transmitting end and the signal receiving end selected in this embodiment are micro ultrasonic detection sets in the prior art, and the set material is harmless to the human body, the heat generated during the operation is low, the response is fast, and a laser displacement sensor with a suitable measuring range in the ZLDS10X series is preferred.
It is worth to be noted that the general working principle of guiding the tracheal intubation by the visual laryngoscope is 1. supine position, bolster under the shoulder, and open the oral cavity. 2. Holding the laryngoscope with the left hand, and inserting the laryngoscope slowly along the curvature of the back of the tongue until the glottis can be exposed at the root of the tongue. The right hand endotracheal tube is aimed at the glottis. The tube core is pulled out, the tracheal catheter is continuously fed until the cuff completely enters the glottis, the bite block is placed, and the laryngoscope is withdrawn. 3. Checking whether gas is discharged along with respiration at the outer opening of the tracheal catheter or whether the respiratory sounds of the lungs on two sides are consistent or not. After the intubatton is confirmed to be correct, the intubatton and the bite block are fixed together. The balloon at the front end of the tracheal catheter is filled with 5ml of air to close the gap between the catheter and the tracheal wall.
In conclusion, the low matching rate of the plastic shape of the tracheal catheter and the laryngoscope can reduce the one-time success rate, increase the operation times, increase the hypoxia risk of the patient and cause soft tissue injury. By the fitting method, the best fitting degree of the arc-shaped visible laryngoscope lens in different shapes of the tracheal catheter bending point position and bending curvature can be obtained, so that medical workers can be helped to perform tracheal catheter plasticity, the one-time success rate is improved, and the perioperative airway adverse event occurrence rate is reduced.
Claims (7)
1. The utility model provides an intubate plasticity method of fitting laryngoscope, passes through endotracheal tube shape matching laryngoscope's arc lens shape during laryngoscopy, and the laryngoscope includes display, main part and arc lens, the main part passes through connecting portion and is connected with the arc lens, moulding die has still been placed to endotracheal tube inside, its characterized in that includes the following step:
step 1: selecting a laryngoscope to be matched and a tracheal catheter to be fitted, wherein the central angle theta of the arc-shaped lens is obtained and the unit is degree, and executing the step 2;
step 2: fitting a shaping tube core of the tracheal catheter to be fitted with an arc lens, calculating a bending point and a bending angle, taking the arc lens as an arc, obtaining a central angle alpha between the bending point and a connecting part, wherein the unit is DEG, and the radius of the arc lens is R, and executing the step 3;
and step 3: when the bending angle is (pi-theta/2), the distance between the bending point and the end point of the tracheal catheter is 2Rsin (theta/2), and the tracheal catheter with the highest fitting degree with the laryngoscope is obtained.
2. The intubation plasticity method of a fitting laryngoscope as claimed in claim 1, wherein the fitting method in step 2 is a primary bending, and specifically, after the end of the shaping tube core is overlapped with the end of the arc-shaped lens to be matched, the bending point and the bending angle are determined by calculation, and the shaping tube core is bent to obtain the tracheal tube with corresponding bending.
3. The intubation plasticity method of a fitted laryngoscope according to claim 2, wherein the step 3 further comprises placing the arc-shaped lens in the oropharynx of the patient such that the distal end of the arc-shaped lens is aligned with the glottis, placing the bent endotracheal tube along the laryngoscope lens, moving the endotracheal tube by observing the display such that the insertion end of the endotracheal tube coincides with the distal end of the arc-shaped lens, and removing the shaped tube core to complete the insertion of the endotracheal tube.
4. A method of fitting laryngoscope intubation plasticity according to claim 3, wherein the bending point and bending angle with the highest degree of fit are calculated as follows:
S1=π*R2*(θ/360)
S2=(1/2)*R2*(sinα+sin(θ-α))
S=S1-S2=π*R2*(θ/360)-(1/2)*R2*(sinα+sin(θ-α))
dS/dα=-(1/2)*R2(cosα-cos(θ-α))
wherein, the arc lens is taken as an arc, the center of the obtained circle is taken as a point E, one end of the arc lens is taken as a point C, the connecting part of the other end of the arc lens is taken as a point A, the bending point is taken as a point B, the radius of the circle E is R, R is EC and EA, the radius is cm, the point B is on the circle E, S1 is the area of a fan AEC, S2 is the area of a quadrilateral ABCE, cos (x) is a decreasing function in [0, pi ], and alpha is more than 0 and less than theta and less than pi,
when α < θ - α (α < θ/2), dS/d α <0, S decreases as α increases,
when α is θ - α (α is θ/2), dS/d α is 0,
when α > θ - α (α > θ/2), dS/d α >0, S increases with increasing α,
so a is θ/2, S is minimal, angle ABC is in degrees (pi- θ/2) and BC length is 2Rsin (θ/2).
5. The intubation plasticity method of a fitting laryngoscope as claimed in claim 4, wherein the distal end of the arc-shaped lens is further provided with a signal emitting device, the distal end of the shaping tube core is further provided with a signal receiving end, the processor in the display is further provided with a distance standard threshold interval, and the specific steps of the plastic endotracheal tube during intubation include:
step 51: after the laryngoscope is placed in the oropharynx of the patient, the tracheal catheter with the shaping tube core bent is inserted, and step 52 is executed;
step 52: the tail end of the tracheal catheter is placed along the arc-shaped lens of the laryngoscope, the captured laryngeal picture is sent to the display through the lens on the arc-shaped lens to be displayed, the movement of the tracheal catheter is observed through the display, and the step 53 is executed;
step 53, when the tip end of the tracheal catheter is aligned with the glottis, taking out the shaping tube core and the laryngoscope, continuously sending into the tracheal catheter, and executing step 54;
step 54: the distance between the tail end of the tracheal catheter and the tail end of the arc-shaped lens is obtained through processing and calculating received signals by the processor, when the calculated distance falls into a distance standard threshold interval, the normal signal is displayed on the display, when the calculated distance is smaller than the minimum value of the standard threshold interval, the first early warning signal is displayed on the display, and when the calculated distance is larger than the maximum value of the standard threshold interval, the second early warning signal is displayed on the display.
6. An intubation plastication method according to claim 4, wherein the endotracheal tube is stopped when a normal signal is displayed on said display.
7. An intubation plasticity method according to claim 4, wherein the minimum value of the standard threshold interval is 6.5cm and the maximum value of the standard threshold interval is 13 cm.
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