CN112546378B - Intubation plasticity method for fitting laryngoscope - Google Patents

Intubation plasticity method for fitting laryngoscope Download PDF

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Publication number
CN112546378B
CN112546378B CN202011461202.8A CN202011461202A CN112546378B CN 112546378 B CN112546378 B CN 112546378B CN 202011461202 A CN202011461202 A CN 202011461202A CN 112546378 B CN112546378 B CN 112546378B
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arc
bending
laryngoscope
point
alpha
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CN112546378A (en
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刘海贝
孙小惠
曾小淇
朱涛
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West China Hospital of Sichuan University
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West China Hospital of Sichuan University
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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
    • A61M16/021Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes operated by electrical means
    • A61M16/022Control means therefor
    • A61M16/024Control means therefor including calculation means, e.g. using a processor

Abstract

The invention relates to the technical field of tracheal tubes, and aims to provide a plastic method for fitting a visual laryngoscope, wherein the plastic angle and the plastic position of a main focus of tracheal tube shaping under the guidance of the visual laryngoscope are used, the successful placement of the catheter can be influenced by the plastic position and the bending radian of the catheter under the guidance of the visual laryngoscope, but the optimal bending position is not given in the current literature.

Description

Intubation plasticity method for fitting laryngoscope
Technical Field
The invention relates to the technical field of endotracheal intubation, in particular to an intubation plasticity method for fitting a laryngoscope.
Background
Airway management has long been a major and difficult task in anesthesia management. The visual laryngoscope images the glottis structure, shows the glottis and guide intubation through the image on the video, does not need the overlapping of mouth, pharynx, larynx axis and does not need to lift the laryngoscope up by force and just can be fine expose the glottis, has not only solved difficult air flue difficult problem, also can alleviate the relevant damage of intubate to conventional air flue. However, just as the visual laryngoscope does not require overlapping of the oral, pharyngeal and laryngeal axes as a direct laryngoscope, the shape of the visual laryngoscope lens is more curved, making it easy to expose the glottis of the visual laryngoscope but difficult to guide the tip of the endotracheal tube into the glottis, which has plagued anesthesiologists, especially beginners. The more curved lens also makes the laryngoscope guide the endotracheal tube more dependent on the plastic shape of the endotracheal tube.
The plastic mode of the tracheal catheter commonly used in clinic is to insert the plastic core into the lumen of the tracheal catheter and bend the plastic core once at a certain position of the tracheal catheter to form a shape of a hockey stick. Whether the endotracheal tube is bentBoth the position and the angle of the bend can affect the successful placement of the catheter. The current research only explores the optimal plastic angle, and reports on the position of the optimal bending are lacking. The shapes of the visual laryngoscope lenses of different manufacturers are different, and the same manufacturer also has differences for the visual laryngoscope lenses of different models of different ages. The best plasticity angle reported in the current research is mainly aimed atVisual laryngoscopes lack shaping methods suitable for use with different shapes of visual laryngoscopes.
Therefore, in order to solve the problem of shaping the endotracheal tube by guiding the intubation by the visual laryngoscope, there is a need for a plastic method of the endotracheal tube for the visual laryngoscope lens with different shape parameters, which can guide the anesthesiologist to find the optimal bending position and bending angle of the endotracheal tube for different shapes of the visual laryngoscope lens.
Disclosure of Invention
The invention aims to overcome the defects of the prior art, provides a method for fitting the intubate plasticity of a laryngoscope, and obtains a complete set of calculation method for bending the tracheal catheter through mathematical modeling, so that the laryngoscope is highly matched with the tracheal catheter, and the accuracy rate during intubatton is greatly improved.
The method is realized by the following technical scheme: the utility model provides a intubate plasticity method of fitting laryngoscope, the shape of tracheal catheter is matchd through the arc lens shape of laryngoscope when visual laryngoscopy, and the laryngoscope is including display, main part and arc lens, the main part is connected with the arc lens through connecting portion, the inside shaping tube core that has still been placed of tracheal catheter includes the following step:
step 1: selecting a laryngoscope to be matched and an endotracheal tube to be fitted, wherein the central angle arc degree theta of the arc lens is obtained, the unit is degree, and the step 2 is executed;
step 2: after fitting a plastic tube 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 the central angle arc degree alpha between the bending point and the connecting part, wherein the unit is degree, and the radius of the arc lens is R, and executing the step 3;
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 tracheal catheter shape with the highest fitting degree with the laryngoscope lens is obtained.
Preferably, the fitting method in the step 2 is one-time bending, specifically, after the tail end of the tracheal catheter is overlapped with the tail end of the arc lens to be matched, determining a bending point and a bending angle through calculation, and bending the plastic tube core to obtain the tracheal catheter with corresponding bending.
Preferably, the step 3 further includes placing the arc-shaped lens into the patient's mouth, aligning the end of the arc-shaped lens with the glottis, placing the bent tracheal catheter along the laryngoscope lens, moving the tracheal catheter by observing the display, so that the extending end of the tracheal catheter coincides with the end of the arc-shaped lens, taking out the molding tube core, and completing the extending of the tracheal catheter.
Preferably, the calculation process of the bending point and the bending angle with the highest fitting degree is as follows:
S1=π*R 2 *(θ/360)
S2=(1/2)*R 2 *(sinα+sin(θ-α))
S=S1-S2=π*R 2 *(θ/360)-(1/2)*R 2 *(sinα+sin(θ-α))
dS/dα=-(1/2)*R 2 (cosα-cos(θ-α))
wherein, the arc lens is used as an arc to obtain a point E with a circle center, one end of the arc lens is a point C, the connecting part of the other end is a point A, the bending point is a point B, the radius of the circle E is R, R=EC=EA, the radius is cm, the point B is on the circle E, S1 is the area of a sector AEC, S2 is the area of a quadrilateral ABCE, cos (x) is a decreasing function, 0 < alpha < theta < pi,
when alpha < theta-alpha (alpha < theta/2), dS/dalpha <0,S decreases as alpha increases,
when a=θ -a (a=θ/2), dS/dα=0,
when alpha > theta-alpha (alpha > theta/2), dS/dalpha >0,S increases as alpha increases,
so a=θ/2, s is minimized, the angle ABC is (pi- θ/2), and BC is 2Rsin (θ/2).
Preferably, the end of the arc lens is further provided with a signal transmitting device, the end of the tracheal catheter 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 tracheal catheter during intubation include:
step 51: after the laryngoscope is placed in the throat of a patient, the tracheal catheter with the bent plastic tube core 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 lens on the arc-shaped lens sends the captured laryngeal image to the display for displaying, the movement of the tracheal catheter is observed through the display, and step 53 is executed;
step 53, when the tip of the tracheal catheter is aligned with the glottis, taking out the shaping tube core and the laryngoscope, continuously feeding the tracheal catheter, and executing step 54;
step 54: the processor processes and calculates the distance from the tail end of the tracheal catheter to the tail end of the arc lens, when the calculated distance falls into a distance standard threshold interval, the distance is displayed as a normal signal on the display, when the calculated distance is smaller than the minimum value of the standard threshold interval, the distance is displayed as a first early warning signal on the display, and when the calculated distance is larger than the maximum value of the standard threshold interval, the distance is displayed as a second early warning signal on the display.
Preferably, the feeding of the endotracheal tube is stopped when a normal signal is shown on the display.
Preferably, the minimum value of the standard threshold interval is 6.5cm, and the maximum value of the standard threshold interval is 13cm.
The beneficial effects of the invention are as follows:
(1) The plastic position and the angle of the tracheal catheter can be accurately calculated, so that the tracheal catheter can be smoothly inserted into the glottis by subsequent medical staff;
(2) The method can be suitable for arc laryngoscopes with different shapes, and different bending conditions of the air tube guide tube are obtained aiming at the arc laryngoscopes with different shapes.
Drawings
FIG. 1 is a block diagram of the visual laryngoscope of the invention;
FIG. 2 is a schematic diagram of one embodiment of the present invention;
FIG. 3 is a schematic view of a laryngoscope according to an embodiment of the invention;
fig. 4 is a view showing an embodiment of the present invention when the endotracheal tube is inserted.
Reference numerals: 1. an arc lens; 2. a display; 3. and a connecting part.
Detailed Description
The following description of the embodiments of the present invention will be made clearly and fully with reference to the accompanying drawings 1 to 3, in which it is evident that the embodiments described are only some, but not all embodiments of the present invention. Based on the embodiments of the present invention, one of ordinary skill in the art would obtain all other implementations that may be obtained without undue burden.
In the description of the present invention, it should be understood that the terms "counterclockwise," "clockwise," "longitudinal," "transverse," "upper," "lower," "front," "rear," "left," "right," "vertical," "horizontal," "top," "bottom," "inner," "outer," and the like indicate orientations or positional relationships based on the orientation or positional relationships shown in the drawings, are merely for convenience in describing the present invention, and do not indicate or imply that the devices or elements referred to must have a specific orientation, be configured and operated in a specific orientation, and therefore should not be construed as limiting the present invention.
Examples:
the utility model provides a intubate plasticity method of fitting visual laryngoscope, the shape through the endotracheal tube matches the arc lens 1 shape of laryngoscope when visual laryngoscopy, and the laryngoscope is including display 2, main part and arc lens 1, the main part passes through connecting portion 3 and arc lens 1 fixed connection, the inside shaping tube core that has still placed of endotracheal tube includes the following step:
step 1: selecting a laryngoscope to be matched and an endotracheal tube to be fitted, wherein the number of central angle radians of the arc-shaped lens 1 is obtained, the unit is degree, and the step 2 is executed;
step 2: after fitting a plastic tube of an endotracheal tube to be fitted with an arc lens 1, calculating a bending point and a bending angle, taking the arc lens 1 as an arc, obtaining the central angle arc degree between the bending point and a connecting part 3, wherein the unit is degree, the radius of the arc lens 1 is R, and executing the step 3;
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 shape with the highest fitting degree with the laryngoscope lens is obtained.
It should be noted that, the fitting method in the step 2 is one-time bending, specifically, after the tail end of the tracheal catheter is overlapped with the tail end of the arc lens 1 to be matched, the bending point and the bending angle are determined through calculation, and the bending plastic tube core is bent to obtain the tracheal catheter with corresponding bending.
It should be noted that, the step 3 further includes placing the arc lens 1 into the patient's mouth, so that the end of the arc lens 1 is aligned with the glottis, placing the bent tracheal catheter along the laryngoscope lens, moving the tracheal catheter by observing the display 2, so that the extending end of the tracheal catheter coincides with the end of the arc lens 1, taking out the shaping tube core, completing the extending of the tracheal catheter, wherein the shaping tube core is a light bendable steel wire in the embodiment for supporting the tracheal catheter, avoiding the closing deformation of the tracheal catheter, and the shaping tube core is convenient for plasticity, because the tracheal catheter is a soft colloidal product, and cannot be plastic alone.
It should be noted that referring to fig. 2, the calculation process of the bending point and the bending angle with the highest fitting degree is as follows: s1=pi×r 2 *(θ/360)
S2=(1/2)*R 2 *(sinα+sin(θ-α))
S=S1-S2=π*R 2 *(θ/360)-(1/2)*R 2 *(sinα+sin(θ-α))
dS/dα=-(1/2)*R 2 (cosα-cos(θ-α))
Wherein, the arc lens is used as an arc to obtain a point E with a circle center, one end of the arc lens is a point C, the connecting part of the other end is a point A, the bending point is a point B, the radius of the circle E is R, R=EC=EA, the radius is cm, the point B is on the circle E, S1 is the area of a sector AEC, S2 is the area of a quadrilateral ABCE, cos (x) is a decreasing function, 0 < alpha < theta < pi,
when alpha < theta-alpha (alpha < theta/2), dS/dalpha <0,S decreases as alpha increases,
when a=θ -a (a=θ/2), dS/dα=0,
when alpha > theta-alpha (alpha > theta/2), dS/dalpha >0,S increases as alpha increases,
so a=θ/2, s is minimized, the angle ABC is (pi- θ/2), and BC is 2Rsin (θ/2).
It should be noted that, the end of the arc-shaped lens is further provided with a signal transmitting device, the end of the tracheal catheter is also provided with a signal receiving end, the invention is preferably arranged at the end of the tracheal catheter, and another embodiment is arranged at the end of the plastic tube core, but considering that a certain distance is needed to be extended after reentry into the glottis, the signal receiving end is arranged at the end of the tracheal catheter, the processor in the display is also provided with a distance standard threshold interval, and the specific steps of the tracheal catheter after plasticity when performing intubation include:
step 51: after the laryngoscope is placed in the throat of a patient, the tracheal catheter with the bent molding core is inserted;
step 52: the tail end of the tracheal catheter is placed along the arc-shaped lens of the laryngoscope, the lens on the arc-shaped lens sends the captured laryngeal image to the display for displaying, 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 feeding the shaping tube core into the tracheal catheter.
Step 54: the processor processes and calculates the distance from the tail end of the tracheal catheter to the tail end of the arc lens, when the calculated distance falls into a distance standard threshold interval, the distance is displayed as a normal signal on the display, when the calculated distance is smaller than the minimum value of the standard threshold interval, the distance is displayed as a first early warning signal on the display, and when the calculated distance is larger than the maximum value of the standard threshold interval, the distance is displayed as a second early warning signal on the display.
It is worth to say that, the minimum value of the standard threshold interval is 6.5cm, the maximum value of the standard threshold interval is 13cm, the signal transmitting end and the signal receiving end selected in this embodiment are miniature ultrasonic detection kit in the prior art, the kit material is harmless to human body, the heat generated during operation is low, the response is fast, and the laser displacement sensor with proper measuring range in ZLDS10X series is preferred.
It is worth to say that the general working principle of the visual laryngoscope guiding trachea cannula is 1. The supine position, the shoulder bolster and the open oral cavity. 2. The left hand laryngoscope is slowly inserted along the bending degree of the back of the tongue until the glottis is exposed at the tongue root. The right hand endotracheal tube is aimed at the glottis. The tube core is pulled out, and the tracheal catheter is continuously sent until the cuff completely enters the glottis, the bite block is placed, and the laryngoscope is withdrawn. 3. Checking whether the air is discharged along with the respiration at the outer opening of the tracheal catheter or whether the respiration sound of the lung at the two sides of auscultation is consistent. After confirming the intubate is correct, the intubate is fixed together with the bite-block. The balloon at the front end of the endotracheal tube was filled with 5ml of air to close the space between the tube and the tracheal wall.
In summary, the low matching rate of the plastic shape of the tracheal catheter and the laryngoscope can reduce the success rate of one time, increase the operation times, increase the risk of hypoxia of the patient and cause soft tissue injury. By the fitting method, the position of the bending point and the bending curvature of the tracheal catheter with the best fitting degree for the circular arc-shaped visual laryngoscope lenses with different shapes can be obtained, thereby helping medical staff to perform tracheal catheter plasticity, improving the primary success rate and reducing the occurrence rate of airway adverse events in the perioperative period.

Claims (2)

1. The utility model provides a plastic method of intubate of fitting laryngoscope, matches the arc lens shape of laryngoscope through endotracheal tube shape, and the laryngoscope is including display, main part and arc lens, the main part is connected with the arc lens through connecting portion, the inside shaping tube core that has still been placed of endotracheal tube, its characterized in that includes following step:
step 1: selecting a laryngoscope to be matched and an endotracheal tube to be fitted, wherein the central angle of the arc lens is obtained, the unit is degree, and the step 2 is executed;
step 2: after fitting the molding tube core of the tracheal catheter to be fitted with the arc-shaped lens, calculating a bending point and a bending angle, taking the arc-shaped lens as an arc, obtaining the central angle between the bending point and the connecting part, wherein the unit is the degree, and the radius of the arc-shaped lens is R, and executing the step 3;
step 3: when the bending angle is (pi-theta/2), and the distance between the bending point and the end point of the tracheal catheter is 2Rsin (theta/2), the tracheal catheter with the highest fitting degree with the laryngoscope is obtained;
the calculation process of the bending point and the bending angle with the highest fitting degree is as follows:
S1=π*R 2 *( θ/360)
S2=(1/2)* R 2 *(sin α+ sin (θ-α))
S=S1-S2=π* R 2 *( θ/360) -(1/2)* R 2 *(sin α+ sin (θ-α))
dS/dα=-(1/2)* R 2 (cos α- cos (θ-α))
wherein, the arc lens is used as an arc to obtain a point E with a circle center, one end of the arc lens is a point C, the connecting part of the other end is a point A, the bending point is a point B, the radius of the circle E is R, R=EC=EA, the radius is cm, the point B is on the circle E, S1 is the area of a sector AEC, S2 is the area of a quadrilateral ABCE, cos (x) is a decreasing function, 0 < alpha < theta < pi,
when alpha < theta-alpha (alpha < theta/2), dS/dalpha <0, S decreases as alpha increases,
when a=θ -a (a=θ/2), dS/dα=0,
when alpha > theta-alpha (alpha > theta/2), dS/dalpha >0, S increases as alpha increases,
so α=θ/2, S reaches a minimum, the degree of angle ABC is (pi- θ/2), and BC is 2Rsin (α/2).
2. The method according to claim 1, wherein the fitting method in step 2 is a bending, specifically, after the end of the shaping tube core coincides with the end of the arc lens to be matched, determining the bending point and the bending angle by calculation, and bending the shaping tube core to obtain the tracheal catheter with corresponding bending.
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