JP2006061573A - Operational field heating device - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To suppress temperature drop of a whole body by preventing an operation field from being cooled during coronary bypass surgery, suppress the reduction of immune function of a living body, and aim at shortening of the recovery period after surgery. <P>SOLUTION: A blower 2 for sending air and a heater 3 for heating the air sent from this blower 2 are stored in a casing 6. A duct 4 is connected to the air outlet of the casing 6. The blower 2 and the heater 3 are controlled by a control device 7, and the air at the temperature higher than the room temperature at an operating room is supplied to the operational field Y using the duct 4, thereby the biological tissue such as the heart A exposed to the operational field Y is heated. <P>COPYRIGHT: (C)2006,JPO&NCIPI

Description

  The present invention relates to a surgical field heating apparatus that warms a living tissue exposed to a surgical field.

  Conventionally, for example, when a part of the coronary artery distributed in the heart is narrowed or occluded and the blood flow to the peripheral side of the coronary artery is insufficient, blood is transferred to the periphery of the coronary artery using a graft blood vessel. Coronary artery bypass surgery that flows to the side is performed (see, for example, Patent Document 1). When performing this coronary artery bypass surgery, the front chest is incised longitudinally, then the sternum is cut and the thoracotomy is performed. The opened portion serves as a surgical field, and the surgeon performs an anastomosis of the graft blood vessel on the heart exposed to the surgical field.

In general, when performing the above operation, if the amount of sweating by the operator performing the operation increases, the operation is hindered, so the room temperature in the operating room is such that the amount of sweating by the operator can be suppressed. It is set low. In addition, fresh air always flows into the operating room for the operator.
Japanese Patent Laid-Open No. 10-234738 (first page)

  However, when an operation such as that of Patent Document 1 is performed in an operating room in which air whose temperature is adjusted to a low level as described above always flows, it is avoided that a flow of air lower than the body temperature of the living body hits the operative field. In other words, the heart and other living tissue exposed in the surgical field are cooled. When the living tissue is cooled, the temperature of the blood flowing through the living tissue is lowered, and this blood flows through the whole body, so that the temperature of the whole body is lowered. As a result, the energy of the living body is used and lost for increasing the temperature of the whole body, so that less energy is required for recovery after the operation, and recovery is delayed correspondingly. In addition, when the surgical field is cooled, immune functions are reduced and infection with pathogens is likely to occur, which may cause a delay in recovery after surgery.

  The present invention has been made in view of such points, and an object of the present invention is to prevent the temperature of the whole body during the operation from being reduced by preventing the operation field from being cooled during the operation, and It is to reduce the recovery period after surgery by suppressing the decrease in immune function.

  In order to achieve the above object, in the present invention, the surgical field is heated with air heated to a temperature higher than the room temperature of the operating room.

  Specifically, in the first aspect of the present invention, the air blowing means for blowing air, the duct for supplying the air blown by the air blowing means to the living surgical field, and the duct is supplied to the living surgical field. A heating unit that heats the air; and a control unit that is connected to the heating unit and controls the heating unit so that the temperature of the air supplied to the surgical field is higher than the room temperature of the operating room. The configuration.

  According to this configuration, air that has been heated to a temperature higher than the room temperature of the operating room is supplied to the living surgical field during surgery, so that the living tissue exposed to the surgical field is heated. As a result, the blood flowing through the living tissue exposed to the operative field is not cooled and the temperature of the whole body is avoided from being lowered, and the immune function caused by the cooling of the operative field is avoided and the living body may be infected with the pathogen. This can be reduced.

  According to a second aspect of the present invention, in the first aspect of the present invention, a filter medium for filtering air supplied to a living surgical field is provided.

  According to this configuration, since the air filtered by the filter medium is supplied to the surgical field, the surgical field is cleaned when air is actively sent to the surgical field to warm the living tissue exposed to the surgical field. It becomes possible to keep on.

  According to a third aspect of the present invention, in the first or second aspect of the present invention, a humidifying means for humidifying the air supplied to the operative field of the living body is provided.

  According to this configuration, since the air humidified by the humidifying means is supplied to the surgical field, it is possible to prevent the living tissue exposed in the surgical field from being dried.

  In the invention of claim 4, in the invention of claim 3, the humidifying means comprises a humidifier that generates water vapor, and the water vapor outlet of the humidifier is connected to the air flow upstream side of the air outlet of the duct, Between the connection point of the steam outlet in the duct and the air outlet, there is provided a drain portion for discharging water generated by condensation of the steam blown out from the steam outlet into the duct. The configuration.

  According to this configuration, water vapor blows into the duct from the water vapor outlet of the humidifier, and the air flowing through the duct is humidified by this water vapor and supplied to the surgical field. When the water vapor blown into the duct from the water vapor outlet is condensed on the inner surface of the duct due to the temperature of the inner surface of the duct, and water is generated in the duct, the water in the duct is discharged from the drain portion to the outside of the duct. Is done.

  According to the invention of claim 1, since air having a temperature higher than the room temperature of the operating room is supplied to the surgical field, a temperature drop of the whole body can be avoided and there is a risk of infection with a pathogen. It can be lowered and the recovery period after surgery can be shortened.

  According to the invention of claim 2, since the air filtered by the filter medium can be supplied to the surgical field, it can be heated while keeping the surgical field clean, and the living body may be infected with a pathogen. Can be further reduced.

  According to the invention of claim 3, since the air humidified by the humidifying means can be supplied to the surgical field, it is possible to prevent the living tissue exposed in the surgical field from being dried. As a result, when the incision is anastomosed at the end of the operation, the living tissues are easily attached to each other, and the recovery period can be further shortened.

  According to the invention of claim 4, when the air in the duct is humidified by the humidifier, water generated by condensation of water vapor in the duct is scattered in the living tissue of the operative field and obstructs the operator's procedure. This can be prevented beforehand.

  Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings.

  FIG. 1 shows a usage state of an operative field heating apparatus 1 according to an embodiment of the present invention. The surgical field heating device 1 includes a blower 2 as a blowing means for blowing air, a heater 3 as a heating means for heating the air blown by the blower 2, and air heated by the heater 3. A duct 4 supplied to the surgical field Y and a humidifier 5 as humidifying means for humidifying the air flowing in the duct 4 are provided. Further, the surgical field heating apparatus 1 includes a control device 7 as a control unit that controls the blower 2, the heater 3, and the humidifier 5.

  The blower 2 and the heater 3 are accommodated in a casing 6. Although not shown, the blower 2 includes a fan and a motor that rotationally drives the fan. A blower control unit 8 provided in the control device 7 is connected to the motor, and current is supplied from the blower control unit 8. The blower control unit 8 is configured to be able to change the amount of current flowing through the motor by an operator's operation, and the rotational speed of the motor is changed due to the change in the amount of current, so that the amount of blown air is changed. And the air introduced from the air inlet (not shown) formed in the casing 6 by rotating the fan with the motor described above is sent to the heater 3 disposed on the downstream side of the air flow of the blower 2. It is designed to be blown.

  The heater 3 is constituted by a heating wire, and a heater control unit 9 provided in the control device 7 is connected to the heater 3 so that a current is supplied from the heater control unit 9. . The heater control unit 9 is configured so that the amount of current flowing through the heater 3 can be changed by an operator's operation, and the amount of heat generated by the heater 3 is changed by the change in the amount of current. The air blown by the blower 2 is heated by the heater 3, and the air that has passed through the heater 3 is directed to an air outlet (not shown) formed in the casing 6. In addition, you may comprise the heater 3 with heat generating bodies other than a heating wire.

  The duct 4 is formed in a substantially cylindrical shape, has a bellows shape, and can be bent and held in an arbitrary shape. The inner diameter of the duct 4 is set in a range of about 40 mm to 65 mm from the upstream end to the downstream end of the air flow, and the upstream end is connected to the air outlet of the casing 6. The air flow downstream end of the duct 4 is an air outlet 4a, and a filter medium 10 for detaching the air blown from the air outlet 4a is detachably attached to the peripheral edge of the air outlet 4a. The filter medium 10 is formed in a shape that covers the entire air outlet 4a, and is a well-known one that is used at medical sites, pharmaceutical manufacturing sites, and the like. Specifically, the filter medium 10 is a HEPA filter used to construct a class 100 clean room in the US Aerospace Standard biological clean room standard.

  The humidifier 5 includes a tank 11 that stores sterilized physiological saline, an ultrasonic generator 12 that vaporizes the physiological saline in the tank 11, and water vapor generated by the ultrasonic generator 12. And a fan 13 for pressure-feeding. The ultrasonic generator 12 is a well-known one used in a general ultrasonic humidifier. The tank 11, the ultrasonic generator 12 and the fan 13 are accommodated in a casing 14. A humidifier controller 19 provided in the control device 7 is connected to the ultrasonic generator 12 and the fan 13. The humidifier controller 19 controls the ultrasonic generator 12 and the fan 13 to generate steam. The amount can be changed. The tank 11 may store sterilized water.

  Further, the humidifier 5 includes a conduit 15 that guides the water vapor generated by the ultrasonic generator 12 into the duct 4. The water vapor flow downstream end of the conduit 15 is a water vapor outlet 15a. The water vapor outlet 15a is connected to a location about 600 mm to 700 mm away from the air outlet 4a in the duct 4 on the upstream side of the air flow. Thus, by supplying water vapor to the location away from the air outlet 4a in the duct 4 to the upstream side of the air flow, the water vapor supplied into the duct 4 is well mixed with the air before reaching the air outlet 4a. It becomes like this. Thereby, it becomes possible to make the humidity of the whole air which blows off from the air blower outlet 4a substantially uniform. In addition, you may comprise the humidifier 5 in the heating type which generates water vapor | steam by heating water, for example, without using the ultrasonic generator 12. FIG.

  A drain portion 16 is provided at the lower end portion of the duct 4 in the vicinity of the air outlet 4a. The drain portion 16 includes an opening (not shown) formed in the peripheral wall portion of the duct 4 and a hose 17 connected to the opening. A container (not shown) is disposed near the outlet of the hose 17.

  In the coronary artery bypass surgery of this embodiment, the blower device 20 that blows off blood at the anastomosis portion when the graft blood vessel G is anastomosed is used. As shown in FIG. 1, the blower device 20 includes a cylinder 21 filled with carbon dioxide gas. A tube 22 is connected to the cylinder 21, and a nozzle 23 is provided at the tip of the tube 22. ing. The opening diameter at the tip of the nozzle 23 is significantly smaller than the air outlet 4 a of the duct 4. The tube 22 is provided with a pressure regulator 24 and a flow rate adjusting valve 25 for adjusting the pressure, and the flow rate of the carbon dioxide gas blown from the nozzle 23 is set to about 3 liters / minute.

  Next, a case where the surgical field heater 1 configured as described above is used for human coronary artery bypass surgery will be described. In this embodiment, the coronary artery bypass surgery under pulsation performed while the heart A exposed to the surgical field Y is pulsated is taken as an example. Further, as shown in FIG. Of the three main coronary arteries distributed on the surface, that is, the left anterior descending branch B, the left turning branch C, and the right coronary artery D, the case where the stenosis E is formed in the left anterior descending branch B is targeted. Further, this operation is performed in an operating room whose room temperature is set in a range of about 20 ° C. to 22 ° C., and fresh air adjusted to the above temperature flows into the operating room from above the operator. Therefore, the air flow adjusted to about 20 ° C. to 22 ° C. hits the surgical field Y.

  In this operation, the graft blood vessel G for bypass formation is a free graft such as the great saphenous vein. One end of the graft blood vessel G is anastomosed to the base of the aorta above the heart A, and the other end is anastomosed to the distal side of the stenosis E of the left anterior descending branch B.

  First, as shown in FIG. 1, the air outlet 4a of the duct 4 is positioned obliquely above the heart A and the surgical field is warmed up until the anastomosis of the graft blood vessel G is started after the anterior chest is opened. The apparatus 1 is operated to start blowing. The distance between the air outlet 4a of the duct 4 and the surface of the heart A is about 300 to 400 mm. By securing a distance of 300 mm or more between the air outlet 4a and the surface of the heart A in this way, a sufficient space for the operator to perform a procedure on the heart A is obtained, and the operative field heating apparatus 1 is installed. It becomes possible to eliminate the influence on the surgical technique. Reference symbol F indicates the thoracic cavity.

  Further, by operating the control device 7, the rotational speed of the motor is set so that the wind speed of the air blown from the air outlet 4a of the duct 4 is about 1 m / s to 4 m / s in the vicinity of the air outlet 4a. The amount of heat generated by the heater 3 is set so that the temperature of the blown-out air is about 40 ° C. to 50 ° C. near the air outlet 4a. The reason why the temperature of the air in the vicinity of the air outlet 4a is significantly higher than the human body temperature is that the air blown out from the outlet 4a entrains the surrounding air before reaching the surgical field Y. This is because the temperature drops.

  Since the air blowing temperature is set as described above, and the distance between the air outlet 4a and the heart A surface is 400 mm or less as described above, the temperature of the air when reaching the surgical field Y is operated. It becomes possible to set to about 30 ° C. to 37 ° C., which is higher than the room temperature of the room, and the surgical field Y is heated by this air. Further, since the inner diameter of the duct 4 is secured to 45 mm or more and the wind speed of the blown air is set to 1 m / s or more, an air volume capable of heating the surgical field Y in a wide range is obtained.

  Thereby, it is possible to prevent the heart A exposed to the surgical field Y and the living tissue around the heart A from being cooled by the air flowing into the operating room, and flow through the living tissue of the surgical field Y. It is possible to avoid a decrease in the temperature of the whole body of a person who is undergoing surgery because the blood is not cooled. As a result, for those undergoing surgery, less energy is used to raise the body temperature during surgery, and energy for recovery after surgery can be secured. Furthermore, since the surgical field Y is heated as described above, it is possible to avoid a decrease in the immune function of a person undergoing surgery and to reduce the possibility of being infected with a pathogen. By these things, the recovery period after an operation can be shortened.

  In addition, by using this surgical field heating apparatus 1, the heart A can be prevented from being cooled and the temperature state of the heart A can be maintained at a temperature close to the human deep body temperature. Can also be prevented.

  In addition, since the living tissue such as the skin of the incised portion is always heated, the living tissues are easily attached to each other after the incised portion is anastomosed. For this reason, it is not necessary to heat the living tissue of the incision part with, for example, warmed physiological saline or a heating material before anastomosing the incision part, and it is possible to simplify the operation process, The operation time can be shortened.

  Furthermore, by operating the humidifier 5 by operating the control device 7, water vapor is supplied to the duct 4, and the air in the duct 4 is humidified by this water vapor. The humidification amount at this time is set so that the humidity of the air blown out from the air outlet 4a of the duct 4 is about 55% to about 70% in the vicinity of the air outlet 4a. By supplying this humidified air to the surgical field Y, it is possible to avoid drying the surface of the heart A during the operation. As a result, when the incision is anastomosed at the end of the operation, biological tissues such as skin are easily attached to each other, and the recovery period can be further shortened.

  When water vapor is generated by condensation of the water vapor supplied into the duct 4 due to the temperature of the inner surface of the duct 4 or the like, the water is discharged from the drain portion 16 of the duct 4 to the outside of the duct 4 and collected in the container. Thereby, it is possible to prevent the water in the duct 4 from scattering from the air outlet 4a to the operative field Y and obstructing the surgeon's procedure.

  Furthermore, since the filter medium 10 is disposed in the duct 4, the air filtered by the filter medium 10 can be supplied to the surgical field Y. Thereby, even if air is actively sent to the surgical field Y and heated as described above, the surgical field Y can be kept clean, and the possibility of being infected with a pathogen can be further reduced.

  Further, when the graft blood vessel G is anastomosed to the left anterior descending branch B, as shown in FIG. 2, the left anterior descending branch B is incised to form an incision H, and the graft blood vessel G is anastomosed to the periphery of the incision H I will do it. At this time, since the heart A is kept beating, blood is flowing in the left anterior descending branch B even though the stenosis E is formed. It becomes difficult to confirm the anastomosis part. For this reason, the blower device 20 is used to blow carbon dioxide to the anastomosis portion to blow off blood. Although the surgical field Y may be cooled by the blowing of carbon dioxide gas by the blower device 20, air having a temperature higher than the room temperature of the operating room is blown from the surgical field warming device 1 as described above. Since the field Y is heated, it is possible to prevent the surgical field Y from being cooled by the blower device 20.

  In addition, in the said embodiment, although the heater 3 is arrange | positioned in the air flow downstream of the air blower 2, you may arrange | position the heater 3 in the air flow upstream of the air blower 2. FIG.

  Moreover, in the said embodiment, although the filter medium 10 is attached to the air blower outlet 4a periphery of the duct 4, the position which attaches the filter medium 10 is in the air flow direction middle part of the duct 4, and the casing 6. Also good. Moreover, you may provide the filter medium whose eyes are coarser than the said filter medium 10 in the air inlet of the casing 6. FIG.

  The surgical field heating apparatus 1 can also be used for operations involving incisions other than coronary artery bypass surgery, such as cesarean section in obstetrics and gynecology, prostatectomy in urology, and orthopedics. It can be used for various operations, laparotomy, lung surgery and the like.

  As described above, the surgical field heating apparatus according to the present invention can be used, for example, for coronary artery bypass surgery for the heart.

It is a figure explaining the use condition of the operative field heating apparatus which concerns on embodiment of this invention. It is the schematic which looked at the heart which performs coronary artery bypass surgery from the thoracotomy part.

Explanation of symbols

1 Surgery field heating device 2 Blower 3 Heater (heating means)
4 Duct 4a Air outlet 5 Humidifier (humidifying means)
7 Control device (control means)
10 Filter medium 15a Water vapor outlet 16 Drain part Y

Claims (4)

Air blowing means for blowing air;
A duct for supplying air blown by the blowing means to the living field;
Heating means for heating the air supplied to the living surgical field by the duct;
And a control means for controlling the heating means so that the temperature of the air supplied to the surgical field is higher than the room temperature of the operating room. Temperature device. In the surgical field heating apparatus according to claim 1,
An operative field heating apparatus comprising a filter medium for filtering air supplied to a operative field of a living body. In the surgical field heating apparatus according to claim 1 or 2,
A surgical field heating apparatus comprising a humidifying means for humidifying air supplied to a biological surgical field. In the surgical field heating apparatus according to claim 3,
The humidifying means consists of a humidifier that generates water vapor,
The steam outlet of the humidifier is connected to the air flow upstream side of the air outlet of the duct,
Between the connection point of the steam outlet in the duct and the air outlet, there is provided a drain portion for discharging water generated by condensation of the steam discharged from the steam outlet into the duct. Surgical field heating device characterized by that.

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