JP2007117115A - Intubation assistance device and intubation assistance apparatus - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a highly safe intubation assistance device permitting easy and secure intubation by a simple operation, and an intubation assistance apparatus equipped with the intubation assistance device. <P>SOLUTION: The intubation assistance apparatus 1 comprises an apparatus body 2, and an intubation assistance device 3 detachably attached to the apparatus body 2. The intubation assistance device 3 has a long insertion part 4 to be inserted into the trachea or the peripheral region of a patient from the mouth of the patient. A groove 43 for guiding an intubation tube 200 into the trachea of the patient and a scope guide hole 44 in which a scope 5 with a CCD and a white LED is stored are formed in the insertion part 4 of the intubation assistance instrument 3. In addition, a sheet-like tongue piece 42 with translucency, projecting toward the distal end, is disposed in the distal end 41 of the insertion part 4. The tongue piece 42 is raised from the edge on the inner side of the insertion part 4 in the bending direction. <P>COPYRIGHT: (C)2007,JPO&INPIT

Description

  The present invention relates to an intubation support tool and an intubation support device used for inserting the distal end of an intubation tube into a trachea.

  For example, there is a case where artificial respiration has to be performed as a primary lifesaving treatment for a patient presenting with consciousness disorder due to an accident or the like. This artificial respiration may be performed without using a device, but may be performed using a ventilator.

  When performing artificial respiration using a ventilator, an intubation tube whose proximal end is connected to the ventilator is inserted into the patient's trachea, and air is sent from the ventilator to the trachea via the intubation tube.

  By the way, when a patient loses consciousness, the muscles of the pharynx and larynx are relaxed and the lower jaw is depressed due to gravity, resulting in tongue root depression, thereby blocking the airway.

  Therefore, when inserting the intubation tube into the trachea (target site) as described above (hereinafter referred to as “intubation work”), first, the tongue is pushed up to open the obstructed airway to secure the airway. I need it.

  An instrument used to secure the airway is called an oral airway (see, for example, Patent Document 1).

  This oral airway is a long member whose front end is curved. For example, the oral airway is inserted from the mouth of a patient with impaired consciousness, and a predetermined portion on the front end abuts on the tongue base of the patient. The airway is secured by lifting up.

  However, the oral airway is only a device for securing the airway, and the pharynx or larynx (and glottis inside the larynx) cannot be observed by the oral airway. For this reason, it is difficult to perform the intubation work in a state where the oral airway is used.

A video laryngoscope is known as an intubation aid for securing the airway.
This video laryngoscope displays a bar-like insertion part used to secure the airway, an image sensor such as a CCD provided at the tip of the insertion part, and an image captured by this image sensor Image display means such as a display.

  That is, the video laryngoscope has both an intubation assist function for securing the airway and a function for observing the pharynx or larynx.

  Therefore, the video laryngoscope can be used to observe the pharynx or larynx, which makes intubation easier to some extent, but it is difficult to insert an intubation tube made of a flexible material into the trachea from a small glottic fissure. Technology is required.

  Thus, it is difficult for the conventional instrument to easily and reliably perform the intubation operation regardless of the user.

  In addition, in the intubation work using a video laryngoscope, the intubation tube cannot be inserted unless the patient's jaw is protruded (the cervical vertebra is bent) and the oral cavity to the glottic fissure are made substantially straight. In the case of a patient who suffers from a contusion (a patient with a difficult intubation case), the video laryngoscope cannot be used because the cervical vertebra cannot be bent.

JP-A-8-322937

  An object of the present invention is to provide an intubation support device that can easily and surely perform an intubation operation with a simple operation and has high safety, and an intubation support device including such an intubation support device.

Such an object is achieved by the present inventions (1) to (19) below.
(1) An intubation support device having a long insertion portion to be inserted in or near a patient's trachea,
The insertion portion guides the intubation tube to the patient's trachea when intubating the intubation tube into the patient's trachea, and guide means capable of detaching the intubation tube with the insertion portion inserted;
An installation unit in which at least a part of image light acquisition means for acquiring image light of an observation site from the distal end of the insertion unit is installed;
A plate-like projecting portion provided at the distal end portion of the insertion portion and projecting toward the distal end direction;
An intubation support tool, wherein at least the protruding portion of the insertion portion has light permeability.

  Thereby, the intubation operation | work to a patient's trachea can be performed easily and reliably by simple operation, and the intubation assistance tool with high safety | security is obtained.

  In particular, since it has a guide means, when inserting the intubation tube into the trachea, there is no need to bend the patient's cervical vertebrae and stick the jaws out, so patients with contusion to the cervical vertebrae ( Intubation can be easily and reliably performed on patients who have difficulty intubation.

  In addition, since the distal end portion of the insertion portion has a plate-like protrusion, the patient's epiglottis can be lifted by this protrusion, thereby ensuring the patient's airway easily and reliably.

  In addition, since the image light acquisition means is installed, the image light acquisition means is installed, so that, for example, the vicinity of the distal end of the insertion portion, the glottic cleft that is the entrance of the trachea, and the intubation tube Since the intubation work can be performed while observing the positional relationship, the intubation work can be performed more easily and reliably. In addition, since the protrusion at the distal end of the insertion part is light-transmitting, when the patient's epiglottis is lifted by the protrusion, the epiglottis can be observed through the protrusion, which facilitates the epiglottis. And it can be lifted reliably.

(2) The insertion part has a curved part curved in the middle,
The intubation support tool according to (1), wherein the protruding portion is erected from an extension of an inner surface of the bending portion at a distal end portion of the insertion portion.
Thereby, intubation work can be performed more easily.

  (3) The installation portion is a lumen formed along a longitudinal direction of the insertion portion, and at least a part of the image light acquisition unit is stored in the lumen. Intubation aid.

  Thereby, compared with the case where an image light acquisition means is installed in the outer side of an insertion part, intubation work can be performed easily.

  (4) At least the tip of the lumen is sealed in a liquid-tight manner, and at least the tip of the image light acquisition means housed in the lumen is configured not to be exposed to the outside ( The intubation support tool according to 3).

  Thereby, the penetration | invasion of the liquid (for example, saliva) from the front-end | tip part of an insertion part into a lumen | bore can be prevented.

  (5) The intubation support tool according to (4), wherein the insertion portion has a closed portion that has a light-transmitting property and seals a distal end portion of the lumen in a liquid-tight manner.

  Thereby, the penetration | invasion of the liquid (for example, saliva) from the front-end | tip part of an insertion part into a lumen | bore can be prevented.

(6) The intubation assistance tool according to any one of (1) to (5), wherein the shape of the protrusion in plan view is a substantially square shape.
Thereby, a patient's epiglottis can be lifted more easily by a protrusion part.

(7) The intubation assistance tool according to any one of (1) to (6), wherein a length (A) in the protruding direction of the protruding portion is 10 to 40 mm.
Thereby, a patient's epiglottis can be lifted still more easily by a protrusion part.

  (8) The intubation support tool according to any one of (1) to (7), wherein a shape of the distal end portion of the insertion portion in a cross section is substantially square.

  As a result, a space of a certain amount or more can be secured in the oral cavity, so that a non-observed object such as a tongue can be removed from the captured image, and a target site such as glottis can be observed reliably.

  (9) The dimension in the cross section of the front-end | tip part of the said insertion part is 15-40 mm in the length (B) of a horizontal direction, and the length (C) of a vertical direction is 10-30 mm as described in said (8). Intubation aid.

  As a result, a space of a certain amount or more can be secured in the oral cavity, so that a non-observed object such as a tongue can be removed from the captured image, and a target site such as glottis can be observed reliably.

  (10) The intubation assistance tool according to any one of (1) to (9), further including at least one through hole or groove provided along a longitudinal direction of the insertion portion.

  Thereby, for example, a suction tube or forceps can be provided in the through-hole or groove. For example, the foreign substance having fluidity such as saliva and sputum can be sucked and removed by the suction tube, and the solid foreign substance can be removed by the forceps, for example.

  (11) The intubation support tool according to (10), wherein the through hole or groove is provided for providing a suction tube or forceps.

  Thus, for example, a foreign substance having fluidity such as saliva and sputum can be sucked and removed by a suction tube provided in the through-hole or groove, and, for example, a solid (solid) ) Can be removed.

  (12) The intubation support tool according to any one of (1) to (11), wherein the guide means is configured by a groove provided along a longitudinal direction of the insertion portion.

  Thereby, the intubation tube can be guided accurately, and the intubation work can be performed more easily.

(13) The intubation aid according to any one of (1) to (12) above,
An apparatus main body to which the intubation support tool is attached;
An intubation support apparatus comprising: image light acquisition means for acquiring image light of an observation site from a distal end portion of the insertion portion of the intubation support tool.

  Thereby, the intubation operation | work to a patient's trachea can be performed easily and reliably by simple operation, and the intubation assistance apparatus with high safety | security is obtained.

  In particular, since the insertion part of the intubation support tool has a guide means, when inserting the intubation tube into the trachea, it is not necessary to bend the patient's cervical vertebra and project the jaw. Intubation work can be performed easily and reliably even for patients who have contusions (patients with difficult intubation cases).

  In addition, since the distal end portion of the insertion portion has a plate-like protrusion, the patient's epiglottis can be lifted by this protrusion, thereby ensuring the patient's airway easily and reliably.

  In addition, since it has image light acquisition means, for example, it is possible to perform intubation work while observing the positional relationship between the glottal crevice, which is the entrance of the trachea, and the intubation tube, near the distal end of the insertion section. Intubation work can be performed more easily and reliably. In addition, since the protrusion at the distal end of the insertion part is light-transmitting, when the patient's epiglottis is lifted by the protrusion, the epiglottis can be observed through the protrusion, which facilitates the epiglottis. And it can be lifted reliably.

  (14) The intubation support device according to (13), wherein the intubation support tool is detachably attached to the device main body.

  Thereby, it is not necessary to perform cleaning, disinfection, sterilization, etc. by exchanging the intubation support tool every time it is used, and labor can be reduced.

  (15) The intubation assistance apparatus according to (13) or (14), wherein a portion of the image light acquisition unit that is installed in the installation unit is detachable from the insertion unit.

  Thereby, it is possible to replace only the intubation support tool while leaving the image light acquisition means on the apparatus main body side.

  (16) The above (13) to (15) configured to be inclined with respect to the central axis at the distal end portion of the insertion portion so that the center line of the visual field of the image light acquisition means faces the intubation tube side. ) Intubation support apparatus according to any of the above.

  Thereby, in the intubation work, the positional relationship between the glottic cleft that is the entrance of the trachea and the distal end portion of the intubation tube can be grasped very easily based on the image light acquired by the image light acquisition means.

  (17) The intubation assistance apparatus according to any one of (13) to (16), further including an image display unit that is provided in the apparatus main body and displays an image based on the image light acquired by the image light acquisition unit.

  Thereby, since the confirmation of the image light acquired by the image light acquisition means becomes easier, the intubation work can be performed more easily and reliably.

  (18) When the intubation tube is drawn out from the distal end portion of the insertion portion, the intubation tube is configured to advance toward the substantially central portion on the image displayed by the image display means ( 17) The intubation assistance apparatus according to 17).

  Thereby, in the intubation work, the positional relationship between the glottic cleft that is the entrance of the trachea and the distal end portion of the intubation tube can be grasped very easily by looking at the image displayed by the image display means.

(19) The intubation assistance device according to any one of (13) to (18), further including an illumination unit that illuminates the observation site.
Thereby, the image light acquisition means can acquire clearer image light.

  According to the present invention, since the intubation tube is guided to the trachea by the guide means without using other instruments, the intubation operation can be performed easily and reliably. In particular, since it has a guide means, when inserting the intubation tube into the trachea, there is no need to bend the patient's cervical vertebrae and stick the jaws out, so patients with contusion to the cervical vertebrae ( Intubation can be easily and reliably performed on patients who have difficulty intubation.

  In addition, since the intubation tube can be detached (separated) from the insertion portion with the insertion portion inserted, the insertion portion can be removed (withdrawn) after the intubation operation has been completed while the intubation tube is inserted into the trachea. it can.

  In addition, since the distal end portion of the insertion portion has a plate-like protrusion, the patient's epiglottis can be lifted by this protrusion, thereby ensuring the patient's airway easily and reliably.

  Also, by acquiring the image light of the observation site by the image light acquisition means, for example, performing the intubation work while observing the positional relationship between the glottal crevice, which is the entrance of the trachea, and the intubation tube, for example. As a result, the intubation work can be performed more easily and reliably. In addition, since the protrusion at the distal end of the insertion part is light-transmitting, when the patient's epiglottis is lifted by the protrusion, the epiglottis can be observed through the protrusion, which facilitates the epiglottis. And it can be lifted reliably.

  Moreover, the time required for intubation can be shortened, and the burden on the patient can be reduced.

  Hereinafter, an intubation support tool and an intubation support device of the present invention will be described in detail based on preferred embodiments shown in the accompanying drawings.

  1 is a perspective view showing an embodiment of an intubation support device of the present invention and an intubation support device provided with such an intubation support device, FIG. 2 is a perspective view of a device main body of the intubation support device shown in FIG. 4 is a perspective view of the intubation support device of the intubation support device shown in FIG. 1, and FIG. 5 is a cross-sectional view of a connection portion (coupling portion) between the apparatus main body and the intubation support device of the intubation support device shown in FIG. 6 is a side view and a front view of the scope of the intubation support device shown in FIG. 1, and FIG. 7 is a rear view of the distal end portion of the intubation support tool of the intubation support device shown in FIG.

  In the following, for convenience of explanation, in principle, the lower side in FIGS. 1, 3, 4 and 7 is referred to as “tip” and the upper side is referred to as “base end”. However, since the insertion portion of the intubation support tool is curved in the middle, the distal direction changes accordingly. Further, the left side of FIGS. 5 and 6 is the “tip”, and the right side is the “base end”.

  The intubation support apparatus 1 shown in these drawings includes an apparatus main body 2 and an intubation support tool 3 that is detachably attached to the apparatus main body 2.

  As will be described later, the intubation support device 1 is used in combination with an intubation tube 200 that is inserted into the trachea of the patient through the patient's mouth (oral cavity).

  As shown in FIG. 1, the intubation tube 200 has a substantially circular cross section and is made of a flexible material such as elastomer or rubber.

  The apparatus main body 2 is equipped with an intubation support tool 3 having an insertion portion 4 having functions described later in addition to functions similar to those provided in a general oral airway.

  This insertion part 4 is comprised by a long (long shape) member, and is inserted in the trachea which is a patient's target site | part, or its vicinity from a patient's mouth (oral cavity). For example, the insertion unit 4 is used by being inserted from the mouth of a patient with impaired consciousness or a general anesthesia patient, and lifts the patient's epiglottis with a tongue piece (protrusion) 42 described later on the distal end side of the insertion unit 4. The patient's airway is secured by bringing a predetermined portion on the distal end side of the insertion portion 4 into contact with the tongue base portion of the patient.

  As shown in FIGS. 3 and 4, the insertion portion 4 has a curved portion 40 that is curved in the middle of the longitudinal direction so that the distal end side faces upward in FIG. 3. Is approximately 90 °. Moreover, although the insertion part 4 (intubation support tool 3) has light transmittance as a whole in this embodiment, it is not limited to this, and only a necessary part (part) has light transmittance. Just do it.

  A groove (guide means) 43 is provided on the left side surface in FIG. 3 of the insertion portion 4 from the proximal end portion to the distal end portion 41 of the insertion portion 4, that is, along the longitudinal direction of the insertion portion 4. Yes. Moreover, the general usage method of the intubation support apparatus 1 is that the user is intubated so that the user is first positioned on the upper side of the lying patient and faces the user side in a state in which the display 71 described later is stored. A support device 1 is provided. When the user, the patient, and the intubation support apparatus 1 are in this positional relationship (positional relationship during use), the groove 43 is provided on the right side (right hand side) for the user of the insertion unit 4.

  The groove 43 has a function of guiding the intubation tube 200 inserted from the patient's mouth to the patient's trachea when the airway is secured by the insertion portion 4. Further, since the guide means is the groove 43, the intubation tube 200 can be easily detached in a state where the insertion portion 4 is inserted into the patient.

  When the airway is secured by the insertion portion 4, the intubation tube 200 is introduced (inserted) into the groove 43 from the proximal end portion of the insertion portion 4 and is drawn out toward the distal end portion 41 of the insertion portion 4. At this time, the intubation tube 200 advances by sliding in the groove 43 while being guided by at least the side wall of the groove 43 (in this embodiment, the entire inner wall of the groove 43). Then, the distal end of the intubation tube 200 is fed out from the distal end portion 41 of the insertion portion 4 toward the glottic fissure behind the larynx. In this case, since the groove 43 is provided on the right side for the user of the insertion portion 4, the user can operate the intubation tube 200 with the right hand which is the same technique as the video laryngoscope.

  The cross-sectional shape of the groove 43 is substantially semicircular. The width (maximum width), that is, the diameter of the groove 43 is set to be slightly larger than the outer diameter of the intubation tube 200. In addition, the cross-sectional shape of the groove | channel 43 is not restricted to semicircle shape, For example, U shape, U-shape etc. are mentioned, for example. Further, the guide means is not limited to the groove, and may be a hole or the like, for example.

  Further, ribs (projections) are provided on the edges of the left and right side walls in FIG. 4 of the groove 43 as stoppers (drop-off preventing means) of the intubation tube 200 over the entire length of the groove 43, respectively. 431 is provided. The rib 431 provided at the edge of the left side wall protrudes toward the edge of the right side wall, and the rib 431 provided at the edge of the right side wall protrudes toward the edge of the left side wall. That is, one rib 431 protrudes toward the other rib 431.

  Due to the ribs 431, the width of the opening of the groove 43 (length W in FIG. 4) is smaller than the width of the portion inside the opening of the groove 43. That is, the width of the opening of the groove 43 is smaller than the outer diameter of the intubation tube 200. Thereby, the intubation tube 200 inserted into the groove 43 is prevented from dropping from the opening of the groove 43.

  Further, the distal end portion 41 of the insertion portion 4 is provided with a plate-like tongue piece (projection portion) 42 that protrudes toward the distal end direction and has optical transparency. The tongue piece 42 is erected on an extension of the inner side surface of the bending portion 40 of the distal end portion 41. During the intubation work, the tongue piece 42 can lift the epiglottis of the patient, thereby ensuring the patient's airway easily and reliably.

  The shape of the tongue piece 42 in a plan view is substantially rectangular. Moreover, each corner | angular part of the tongue piece 42 is roundish, and the safety | security at the time of insertion improves by this. Note that the shape of the tongue piece 42 in a plan view is not limited to a quadrangle, and examples thereof include a semi-elliptical shape and a semi-circular shape.

  Here, the length A in the protruding direction of the tongue piece 42 shown in FIG. 4 is preferably about 10 to 40 mm, and more preferably about 20 to 30 mm.

  When the length A of the tongue piece 42 exceeds the upper limit value, it becomes an obstacle during intubation work, and the strength becomes insufficient when the thickness of the tongue piece 42 is small.

  Further, when the length A of the tongue piece 42 is less than the lower limit value, it is difficult to lift the patient's epiglottis during the intubation work.

  Moreover, it is preferable that the thickness (thickness) of the tongue piece 42 is about 1-2 mm at the tip portion and about 3-5 mm at the root portion.

  When the thickness of the tongue piece 42 exceeds the above value, it becomes difficult to lift the patient's epiglottis during intubation work.

If the thickness of the tongue piece 42 is less than the above value, the strength may be insufficient depending on the material.
Moreover, the shape in the cross section of the front-end | tip part 41 of the insertion part 4 has comprised the substantially square shape. Moreover, the dimension in the cross section of the front-end | tip part 41 of the insertion part 4 is the length of the horizontal direction (length in the direction substantially perpendicular to the thickness direction of the tongue piece 42) B shown in FIG. Preferably, the length is about 25 to 30 mm, and the length C in the vertical direction (length in the thickness direction of the tongue piece 42) is preferably about 10 to 30 mm. More preferably, it is about 20 mm.

  When the lateral length B and the longitudinal length C in the transverse section of the distal end portion 41 of the insertion portion 4 exceed the upper limit, it becomes difficult to insert the insertion portion 4 into the patient during intubation work, The burden on the patient increases.

  Further, when the lateral length B and the longitudinal length C are less than the lower limit value, the tongue piece 42 is plate-shaped. When it is brought into contact with (pressed against) the tongue base portion, the patient's tongue hangs to the side of the distal end portion 41 of the insertion portion 4, and the visual field of the CCD 53 described later is narrowed by the tongue.

  In addition, the shape in the cross section of the front-end | tip part 41 of the insertion part 4 is not restricted to a rectangle, For example, elliptical shape, semi-elliptical shape, circular shape, semicircle shape etc. are mentioned.

  In addition, the insertion portion 4 is an installation portion in which at least a part (the whole in the present embodiment) of a scope 5 (image light acquisition means) to be described later is installed, extending from the proximal end portion to the distal end portion 41, that is, A scope guide hole (lumen) 44 is formed along the longitudinal direction of the insertion portion 4. In this case, the distal end portion of the scope guide hole 44 (in the present embodiment, the entire scope guide hole 44) is unevenly distributed in the width direction of the tongue piece 42 (direction of arrow b in FIG. 4). That is, when the user, the patient, and the intubation assistance device 1 are in the positional relationship during use, the scope guide hole 44 is unevenly distributed on the left side (left hand side) for the user.

  The scope guide hole 44 has a substantially circular cross section and is open (opened) at the proximal end of the insertion portion 4. As will be described later, the proximal end side of the scope guide hole 44 is sealed in a liquid-tight (air-tight) manner with the intubation support tool 3 attached to the apparatus main body 2.

  In addition, the distal end portion of the scope guide hole 44 (the distal end portion 41 of the insertion portion 4) is provided with a light-transmitting blocking portion 45 (fixed). The closed portion 45 is sealed in a liquid-tight (air-tight) manner. Note that the closing portion 45 may be formed integrally with the insertion portion 4.

  As shown in FIGS. 1 and 5, the scope 5 is accommodated (removably provided) in the scope guide hole 44. In this case, the distal end portion of the scope 5 is disposed at the distal end portion of the scope guide hole 44. As described above, since the distal end portion of the scope guide hole 44 is sealed by the closing portion 45, the distal end portion (image light acquisition means and illumination means) of the scope 5 housed in the scope guide hole 44 is It is not exposed to the outside (does not touch the outside air). This scope 5 is an apparatus that serves both as image light acquisition means (imaging means) for acquiring (imaging) image light (subject image) of an observation site from the distal end portion 41 of the insertion portion 4 and illumination means for illuminating the observation site ( Means) and has a waterproof structure. As the waterproof structure of the scope 5, for example, various conventionally known structures (configurations) can be adopted.

  As shown in FIGS. 5 and 6, the scope 5 includes a flexible main body 51 having a long shape and a connector 52 provided at the base end of the main body 51. . The scope 5 is detachably mechanically connected to a connector part 61 (described later) of the apparatus main body 2 by a connector part 52. As a result of this connection, the scope 5 and the apparatus body 2 are also electrically connected.

  A CCD (imaging device) 53 and a white LED (light emitting diode) 55 as a light source are installed inside the tip of the main body 51. Further, one or more imaging lenses (lens groups) having an objective lens 54 are installed on the distal end side of the CCD 53 of the main body 51, and an illumination lens 56 is installed on the distal end side of the white LED 55. Yes. In the following, one or more imaging lenses (lens group) having the objective lens 54 are simply referred to as “objective lens 54”.

  Specifically, two holes (not shown) opened (opened) at the tip are formed at the tip of the main body 51, and the CCD 53 and the objective lens 54 are installed in one of the holes. The tip of the hole is liquid-tightly sealed with a window portion 57 having light permeability. The white LED 55 and the illumination lens 56 are installed in the other hole, and the tip of the hole is sealed in a liquid-tight manner by a window part 58 having light permeability. The illumination lens 56 may be omitted, and the window portion 58 may also serve as the illumination lens. The CCD 53 and the objective lens 54, the white LED 55 and the illumination lens 56 are installed in different holes, and the separate windows 57 and 58 are provided, so that the CCD 53 and the objective lens 54, the white LED 55 and the illumination lens 56 are provided. , The light emitted from the white LED 55 can be prevented from adversely affecting the CCD 53. The main body 51 fixes the positional relationship between the CCD 53 and the objective lens 54, the positional relationship between the white LED 55 and the illumination lens 56, and the positional relationship between the CCD 53 and the objective lens 54, the white LED 55 and the illumination lens 56, respectively. It has a function.

  The control lines and signal lines of the CCD 53 and the signal lines of the white LED 55 pass through the inside of the main body 51 and are connected to predetermined terminals of the connector 52. The CCD 53 and the objective lens 54 constitute image light acquisition means, and the white LED 55 and the illumination lens 56 (window portion 58) constitute illumination means.

  In this scope 5, the reflected light (image light) from the observation part which is the part where the distal end part 41 of the insertion part 4 is located or the vicinity thereof is connected onto the light receiving surface (imaging surface) of the CCD 53 by the objective lens 54. The subject image (image light) is picked up by the CCD 53. That is, the observation region is imaged by the CCD 53. Specifically, for example, when the CCD 53 lifts the patient's epiglottis with the tongue piece 42 of the insertion unit 4, the CCD 53 captures (acquires) at least a subject image of the patient's epiglottis and the vicinity thereof. When secured, it is possible to capture a subject image of at least the glottal fissure of the patient and its vicinity (the larynx or glottic fissure).

  Further, when the white LED 55 emits light, the light emitted from the white LED 55 is irradiated to the observation site from the distal end portion 41 of the insertion portion 4 via the illumination lens 56, and the observation site is illuminated. Thereby, the observation site can be illuminated with sufficient brightness.

  The number of white LEDs 55 is one in the illustrated example, but is not limited thereto, and may be two or more depending on the F number of the objective lens 54 and the sensitivity characteristics of the CCD 53.

  Here, as shown in FIG. 7, the distal end portion of the scope guide hole 44 is inclined toward the intubation tube 200 (groove 43). That is, the scope guide hole 44 has an insertion portion so that the center line 59 of the visual field of the CCD 53 (image light acquisition means) of the scope 5 accommodated in the scope guide hole 44 faces the intubation tube 200 (groove 43). 4 is formed so as to be inclined with respect to the central axis 47 at the tip portion 41.

  That is, in the intubation work, when the intubation tube 200 is drawn out from the distal end portion 41 of the insertion portion 4, the intubation tube 200 advances toward the substantially central portion of the image on the image displayed on the display 71 described later. It is configured.

  Thereby, in the intubation work, the positional relationship between the glottic cleft that is the entrance of the trachea and the distal end portion of the intubation tube 200 can be grasped very easily by looking at the image displayed on the display 71.

  The configuration of the image light acquisition unit is not limited to the above. As another configuration of the image light acquisition unit, the image light acquisition unit may be configured by, for example, an image guide and a CCD (imaging device) provided on the base end side of the image guide. The image guide includes, for example, a fiber bundle and an objective lens provided on the tip side of the fiber bundle. The fiber bundle is formed by bundling a plurality of optical fibers made of, for example, quartz, multicomponent glass, plastic, or the like. In the image light acquisition means having this configuration, the image guide captures the reflected light (image light) from the observation site with the objective lens, and transmits the captured image light (subject image) to the CCD via the fiber bundle. Captures the subject image. In this configuration example, the image guide constitutes means for guiding the image light (subject image) of the observation site to the image sensor. Note that the imaging element may be provided in the apparatus main body 2 or may be provided in the intubation support tool 3. Moreover, it is good also as a structure which observes an observation site | part with the naked eye by providing an eyepiece instead of CCD.

  Moreover, the structure of an illumination means is not limited to the said thing. As another configuration of the illuminating unit, the illuminating unit may be composed of, for example, a light guide and a white LED (light source) provided on the base end side of the light guide. The light guide includes, for example, a fiber bundle and an illumination lens provided on the distal end side of the fiber bundle. The fiber bundle may be made of the same material as the fiber bundle of the image guide. In the illumination means having this configuration, the light guide guides the light emitted from the white LED, and irradiates the observation site from the distal end portion 41 of the insertion portion 4 for illumination. In this configuration example, the light guide constitutes means (light guiding means) for guiding light from the light source to the distal end portion 41 of the insertion portion 4. The light source may be provided in the apparatus main body 2 or may be provided in the intubation support tool 3.

  In addition, a through hole 46 is formed in the insertion portion 4 from the base end portion to the distal end portion 41, that is, along the longitudinal direction of the insertion portion 4. In this case, the tip of the through hole 46 is located between the groove 43 and the scope guide hole 44 and on the tongue piece 42 side, and the base end of the through hole 46 is located on the groove 43 side. The through hole 46 has a substantially circular cross section.

  Inside the through hole 46, for example, a suction tube or forceps (not shown) is provided. The suction tube and forceps may be detachably provided inside the through hole 46 or may be fixed. With the suction tube, for example, fluid foreign substances such as saliva and sputum can be sucked and removed. The forceps can remove, for example, solid foreign matters.

  The number of through holes 46 is one in the illustrated example, but is not limited thereto, and may be two or more.

  Further, one or more grooves may be formed in place of the through hole 46, and one or more through holes 46 and one groove may be formed.

  As shown in FIGS. 1, 2, and 5, the apparatus main body 2 includes a casing 21 and has a waterproof structure. In addition, about the waterproof structure of the apparatus main body 2, conventionally well-known various structures (structure) are employable, for example.

  As shown in FIG. 5, the casing 21 includes a case main body 22 and an annular attachment portion 23 provided on the distal end side of the case main body 22. The case main body 22 and the attachment portion 23 are fixed by bolts (male screws) 27. In this case, as described above, the case main body 22 and the attachment portion 23 are sealed in a liquid-tight (air-tight) manner by, for example, a seal member (seal means) such as packing (not shown). Note that the case main body 22 and the attachment portion 23 may be integrally formed.

  An annular operation ring 24 is installed on the outer peripheral side of the mounting portion 23 so as to be rotatable (rotatable) in both forward and reverse directions. Further, the operation ring 24 is prevented from being detached from the attachment portion 23 by the pressing member 25. A screw 241 is formed on the inner peripheral surface of the distal end portion of the operation ring 24.

  On the other hand, on the outer peripheral surface of the base end portion 31 of the intubation support tool 3, a screw 311 that is screwed with the screw 241 of the operation ring 24 is formed.

  Further, a groove 231 is formed on the outer peripheral surface of the mounting portion 23, and a seal member (seal means) 26 such as packing is installed inside the groove 231.

  When the intubation support tool 3 is attached (fixed) to the apparatus main body 2, the proximal end portion 31 of the intubation support tool 3 is inserted between the attachment portion 23 of the casing 21 of the apparatus main body 2 and the operation ring 24, and the operation is performed. The ring 24 is rotated (rotated) in a predetermined direction. Thereby, the intubation support tool 3 moves in the proximal direction with respect to the apparatus main body 2, and the intubation support tool 3 is attached to the apparatus main body 2.

  In a state in which the intubation support tool 3 is mounted on the apparatus main body 2, the seal member 26 seals the space between the attachment portion 23 of the apparatus main body 2 and the proximal end portion 31 of the intubation support tool 3 in a liquid-tight (air-tight) manner. Thus, the proximal end side of the scope guide hole 44 of the insertion portion 4 of the intubation support tool 3 is sealed in a liquid-tight (air-tight) manner. Thereby, the entire scope guide hole 44 is hermetically sealed (airtight), and contamination of the scope 5 accommodated in the scope guide hole 44 can be reliably prevented.

  Moreover, when removing the intubation assistance tool 3 from the apparatus main body 2, the operation ring 24 is rotated in the reverse direction. As a result, the intubation support tool 3 moves in the distal direction with respect to the apparatus main body 2, the screw 241 and the screw 311 are unscrewed, and the intubation support tool 3 is detached from the apparatus main body 2.

  Thus, when the intubation support tool 3 is detachable from the apparatus main body 2, the intubation support tool 3 can be replaced every time it is used, and infection (secondary infection) due to bacteria of the patient is prevented. Can be high safety.

  Further, the removed intubation support tool 3 may be reused again after cleaning, disinfection, sterilization, etc., but those that are discarded after one use are preferable. Thereby, a secondary infection can be prevented more reliably.

  In addition, the method of attaching (fixing) the intubation support tool 3 to the apparatus main body 2, that is, the method of connecting (coupling) the intubation support tool 3 and the apparatus main body 2 is not limited to the above-described configuration (screw mount type), In addition, various methods such as a method (method) using a ratchet mechanism, a bayonet mount method, a cam method, a method using a locking claw, and a magnetic force (magnetism) method can be employed.

  As shown in FIGS. 1 and 2, a display (image display means) 71 for image display is provided at the base end portion of the apparatus body 2 so as to be rotatable (displaceable) about a shaft 72. Yes. In this case, the display 71 may be configured to be manually rotated by the user, or may be configured to be automatically rotated by the driving force of a driving source such as a motor.

  The display 71 includes, for example, a liquid crystal display element, an organic EL display element, and the like. The display 71 includes an image based on the image light acquired by the image light acquisition unit, that is, an image of the observation site captured by the CCD 53. (Electronic image) is displayed.

  In addition, the display 71 includes, for example, a target mark for specifying the position of the glottal fissure in order to facilitate the insertion of the distal end portion of the intubation tube 200 into the trachea from the glottic fissure, and a battery (battery) of a power supply unit described later. Indicator to show the remaining amount of battery, battery warning mark to warn of battery replacement when the battery is depleted, time taken for intubation work so that the apnea state of the patient does not become long (intubation time) from the start of intubation work, etc. Is displayed.

  Since the display 71 is rotatable with respect to the apparatus main body 2, the display 71 can be directed in a desired direction regardless of the direction in which the insertion portion 4 faces. Therefore, the image displayed on the display 71 can be easily seen regardless of the patient's body position or the user's standing position, and the intubation work can be easily and reliably performed.

  The display 71 may be configured to be detachably attached to the apparatus main body 2.

  Further, a detection unit that detects a rotation angle (rotation amount) of the display 71 with respect to the apparatus main body 2 may be provided, and an image displayed on the display 71 may be reversed based on the detection result.

  Further, the display 71 is not limited to the one-axis direction, and may be rotatable in, for example, a biaxial direction and a triaxial direction.

  Further, the intubation support tool 3 may be rotatable (displaceable) with respect to the apparatus main body 2. In this case, the intubation support tool 3 may be configured to be manually rotated by the user, or may be configured to be automatically rotated by the driving force of a driving source such as a motor. Good.

  Further, as shown in FIG. 5, a connector portion 61 that is connected to the connector portion 52 of the scope 5 is provided at a position corresponding to the mounting portion 23 inside the apparatus main body 2. Further, inside the apparatus main body 2, a circuit unit connected to the connector unit 61 and the display 71, and a power supply unit and an input / output unit (both not shown) connected to the circuit unit are provided. ing.

  The circuit unit includes an LED drive circuit (illumination drive circuit) that drives the white LED 55, a CCD drive circuit (image pickup device drive circuit) that drives the CCD 53, and image processing that performs image processing on image data output from the CCD 53. A circuit, an image display circuit that converts image data output from the image processing circuit into image data corresponding to the display 71 and displays an image on the display 71, and a storage unit (storage means) that stores (stores) the image data And a central processing circuit.

  A battery is detachably installed in the power supply unit, and power is supplied from the power supply unit to each unit such as a circuit unit.

  Further, a lid (not shown) is installed at a predetermined portion of the casing 21 of the apparatus main body 2, and the battery is opened and removed by opening the lid. In this case, the lid and the casing 21 are provided with a lock mechanism (not shown) so that the lid does not open or close inadvertently. The lid and the casing 21 are sealed in a liquid-tight (air-tight) manner by, for example, a seal member (seal means) such as packing (not shown).

The power supply unit may be configured to be detachably attached to the apparatus main body 2.
The input / output unit includes an external power input terminal for inputting (supplying) power (power) from the outside, an external monitor output terminal for outputting image data to an external monitor, for example, an SD card, a CF card, etc. And a memory terminal for image storage connected to a memory card (detachable memory device).

  As shown in FIG. 2, a lid 73 is installed on the left side surface of the casing 21 of the apparatus main body 2 in FIG. 2, and the external power input terminal, the external monitor output terminal, and the memory for image storage are provided. Connection to the terminals is performed by opening the lid 73, respectively. Moreover, it is comprised so that the lid | cover 73 can be opened and closed only with a special instrument so that the lid | cover 73 cannot be opened and closed carelessly. The lid 73 and the casing 21 are sealed in a liquid-tight (air-tight) manner by, for example, a sealing member (sealing means) such as packing (not shown).

  Note that some or all of the external power input terminal, the external monitor output terminal, and the memory terminal for image storage may be provided in the battery chamber of the power supply unit, for example.

Next, an example of a usage method (action) of the intubation support device 1 will be described.
The intubation support device 1 is used, for example, when the patient loses consciousness and it becomes necessary to insert the intubation tube 200 into the trachea.

  [1] First, when inserting the intubation tube 200, the intubation support device 1 is assembled.

  In this case, first, the connector part 52 of the scope 5 is connected to the connector part 61 of the apparatus body 2. Further, if necessary, for example, a suction tube or the like is inserted into the through hole 46 of the insertion portion 4 of the intubation support tool 3 and installed.

  Next, the scope 5 is inserted into the scope guide hole 44 of the insertion portion 4 of the intubation support tool 3, and the base of the intubation support tool 3 is interposed between the attachment portion 23 of the casing 21 of the apparatus body 2 and the operation ring 24. The end 31 is inserted, the operation ring 24 is rotated in a predetermined direction, and the intubation support tool 3 is attached to the apparatus main body 2.

  [2] Next, each part (white LED 55, CCD 53, display 71, etc.) of the intubation assistance apparatus 1 is driven by operating a switch (not shown), and the insertion part 4 of the intubation assistance tool 3 is moved from the patient's mouth to the patient's trachea. Insert toward.

  Specifically, the insertion portion 4 is inserted into the patient's mouth while keeping the inside of the curved portion of the insertion portion 4 along the tongue base. Then, while viewing and confirming the image displayed on the display 71, the patient's epiglottis is lifted to the tongue base side with the tongue piece 42 of the insertion portion 4, and a predetermined portion on the distal end side of the insertion portion 4 is applied to the tongue base portion of the patient. Make contact. Thereby, an airway is secured.

  In this case, since the tongue piece 42 (insertion portion 4) is light-transmitting, when the patient's epiglottis is lifted to the base of the tongue by the tongue piece 42, the epiglottis is imaged by the CCD 53 via the tongue piece 42. Since the tongue piece 42 has a plate shape, the epiglottis can be lifted easily, quickly and reliably by the tongue piece 42. Easy, quick and reliable, can ensure the airway.

  [3] Next, when the distal end of the insertion portion 4 secures the airway, the intubation tube 200 is inserted into the groove 43 from the proximal end portion of the insertion portion 4 and the intubation tube 200 is pushed forward. As a result, the intubation tube 200 is guided by the groove 43 and advances along the groove 43.

  Then, while viewing the image (including the image of the distal end portion of the intubation tube 200) displayed on the display 71, the distal end portion of the intubation tube 200 protruding from the groove 43 is inserted into the glottis and allowed to reach the trachea.

  Here, the groove 43 is formed so that the distal end portion of the intubation tube 200 naturally proceeds toward the glottic fissure, whereby the intubation tube 200 is naturally guided to the glottic fissure. .

  In this manner, the intubation tube 200 can be inserted into the trachea from the glottic fissure while viewing the image displayed on the display 71, and the intubation tube 200 is naturally guided to the glottic fissure by the groove 43. Therefore, the intubation tube 200 can be easily, quickly and reliably inserted into the trachea.

  [4] Next, in a state where the intubation tube 200 is inserted into the trachea, the intubation tube 200 is deformed, and the intubation tube 200 is detached from the groove 43.

  [5] Next, while maintaining this state, the insertion portion 4 is removed (extracted) from the patient's mouth.

In this way, the intubation tube 200 can be intubated into the patient's trachea.
As described above, according to the intubation assisting apparatus 1, since the tongue piece 42 has light transmittance, when the patient's epiglottis is lifted by the tongue piece 42, the epiglottis is placed via the tongue piece 42. Thus, the patient's airway can be secured easily, quickly and reliably. Moreover, since the insertion part 4 of the intubation support tool 3 has the groove | channel 43 which guides the intubation tube 200, the intubation operation | work of the intubation tube 200 can be performed easily and reliably. In particular, since the intubation tube 200 can be guided by the groove 43, it is not necessary to bend the patient's cervical vertebra and protrude the jaw during the intubation operation. The intubation work can be easily and reliably performed on a patient who is difficult to intubate.

  Moreover, since this groove | channel 43 hold | maintains the intubation tube 200 so that separation | separation is possible (separable) in the state which inserted the insertion part 4 from the patient's mouth, the intubation tube 200 was inserted in the patient's trachea after the intubation operation completion | finish. In the state, the insertion part 4 can be removed from the patient's mouth.

  In addition, since the plate-like tongue piece 42 is provided at the distal end portion 41 of the insertion portion 4, the patient's epiglottis can be lifted by the tongue piece 42, thereby ensuring the patient's airway easily and reliably. be able to.

  Further, since the intubation support device 1 includes the scope 5 and the display 71, the user can observe, for example, the vicinity of the distal end portion 41 of the insertion portion 4, the pharynx, the larynx, and the like of the patient, at the entrance of the trachea. The positional relationship between a certain glottic fissure and the distal end portion of the intubation tube 200 can be grasped, so that the intubation operation can be performed more easily and reliably.

  Moreover, since the intubation support tool 3 is detachable with respect to the apparatus main body 2, it can be replaced | exchanged for every use, can prevent the infection (secondary infection) by a patient's bacteria, etc., and is safe. High nature. In particular, since the scope guide hole 44 in which the scope 5 is accommodated is sealed in a liquid-tight (air-tight) manner with the intubation support tool 3 attached to the apparatus main body 2, the intubation support tool is replaced every time it is used. By doing so, it is not necessary to perform cleaning, disinfection, sterilization, etc., and labor can be reduced.

  Moreover, according to the intubation assistance apparatus 1, the time required for intubation work can be shortened, and the burden on the patient can be reduced.

  In addition, the intubation tube 200 has a proximal end connected to the ventilator, and air is fed into the trachea from the ventilator through the intubation tube 200 inserted into the trachea from the glottic fissure.

  As described above, the intubation support tool and the intubation support device of the present invention have been described based on the illustrated embodiment. However, the present invention is not limited to this, and the components constituting the intubation support tool and the intubation support device are the same. It can be replaced with any structure that can exhibit the above function. Moreover, other arbitrary components may be added.

  For example, the apparatus main body 2 may include an electronic data transmission apparatus that transmits image data to a hospital that is a patient transport destination via a wireless communication network. Thereby, the patient can be prepared for treatment in the hospital while the patient is being transported by an ambulance or the like.

  In the embodiment, the intubation support tool 3 is detachably attached to the apparatus main body 2. However, in the present invention, the intubation support tool is fixed (adhered) to the apparatus main body. May be.

It is a perspective view showing an embodiment of an intubation support device of the present invention and an intubation support device provided with such an intubation support device. It is a perspective view of the apparatus main body of the intubation assistance apparatus shown in FIG. It is a perspective view of the intubation assistance tool of the intubation assistance apparatus shown in FIG. It is a perspective view of the intubation assistance tool of the intubation assistance apparatus shown in FIG. It is sectional drawing of the connection part (coupling | bond part) of the apparatus main body of the intubation assistance apparatus shown in FIG. 1, and an intubation assistance tool. It is the side view and front view of a scope of the intubation assistance apparatus shown in FIG. It is a rear view of the front-end | tip part of the intubation assistance tool of the intubation assistance apparatus shown in FIG.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Intubation assistance apparatus 2 Apparatus main body 21 Casing 22 Case main body 23 Attaching part 231 Groove 24 Operation ring 241 Screw 25 Holding member 26 Seal member 27 Bolt 3 Intubation support tool 31 Base end part 311 Screw 4 Insertion part 40 Bending part 41 Tip part 42 Tongue piece 43 Groove 431 Rib 44 Scope guide hole 45 Blocking part 46 Through hole 47 Central axis 5 Scope 51 Body part 52 Connector part 53 CCD
54 Objective lens 55 White LED
56 Illumination lens 57, 58 Window 59 Center line 61 Connector 71 Display 72 Axle 73 Lid 200 Intubation tube

Claims (19)

An intubation support device having a long insertion portion to be inserted in or near a patient's trachea,
The insertion portion guides the intubation tube to the patient's trachea when intubating the intubation tube into the patient's trachea, and guide means capable of detaching the intubation tube with the insertion portion inserted;
An installation unit in which at least a part of image light acquisition means for acquiring image light of an observation site from the distal end of the insertion unit is installed;
A plate-like projecting portion provided at the distal end portion of the insertion portion and projecting toward the distal end direction;
An intubation support tool, wherein at least the protruding portion of the insertion portion has light permeability. The insertion part has a curved part curved in the middle,
The intubation support tool according to claim 1, wherein the protruding portion is erected from an extension of an inner side surface of the bending portion at a distal end portion of the insertion portion.   The intubation support tool according to claim 1, wherein the installation portion is a lumen formed along a longitudinal direction of the insertion portion, and at least a part of the image light acquisition unit is accommodated in the lumen.   The at least tip portion of the lumen is sealed in a liquid-tight manner, and at least the tip portion of the image light acquisition means housed in the lumen is configured not to be exposed to the outside. Intubation support tool.   The intubation support tool according to claim 4, wherein the insertion portion has a blocking portion that seals a distal end portion of the lumen in a liquid-tight manner and has light permeability.   The intubation assistance tool according to any one of claims 1 to 5, wherein a shape of the protruding portion in a plan view is a substantially square shape.   The intubation assistance tool according to any one of claims 1 to 6, wherein a length (A) of the protruding portion in the protruding direction is 10 to 40 mm.   The intubation assistance tool according to any one of claims 1 to 7, wherein a shape of the distal end portion of the insertion portion in a cross section is substantially a square.   The intubation support tool according to claim 8, wherein the dimensions of the distal end portion of the insertion portion in the cross section are 15 to 40 mm in the lateral length (B) and 10 to 30 mm in the longitudinal length (C).   Furthermore, the intubation assistance tool in any one of Claim 1 thru | or 9 which has at least one through-hole or groove | channel provided along the longitudinal direction of the said insertion part.   The intubation support tool according to claim 10, wherein the through-hole or groove is provided for providing a suction tube or forceps.   The intubation support tool according to any one of claims 1 to 11, wherein the guide means includes a groove provided along a longitudinal direction of the insertion portion. The intubation assistance tool according to any one of claims 1 to 12,
An apparatus main body to which the intubation support tool is attached;
An intubation support apparatus comprising: image light acquisition means for acquiring image light of an observation site from a distal end portion of the insertion portion of the intubation support tool.   The intubation support apparatus according to claim 13, wherein the intubation support tool is detachably attached to the apparatus main body.   The intubation assistance apparatus according to claim 13 or 14, wherein a portion of the image light acquisition unit that is installed in the installation unit is detachable from the insertion unit.   The center line of the visual field of the image light acquisition means is configured to be inclined with respect to the central axis at the distal end portion of the insertion portion so as to face the intubation tube side. Intubation support device.   The intubation assistance apparatus according to claim 13, further comprising an image display unit that is provided in the apparatus main body and displays an image based on the image light acquired by the image light acquisition unit.   The said intubation tube is comprised so that the said intubation tube may advance toward the substantially center part on the image displayed by the said image display means, when the said intubation tube is drawn | fed out from the front-end | tip part of the said insertion part. Intubation support device. The intubation assistance apparatus according to claim 13, further comprising an illumination unit that illuminates the observation site.

Images