JP2009125184A - Double lumen tube for differential lung ventilation - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To certainly perform differential lung ventilation by simple operation and to prevent the shift or falling-off of an instrument during operation. <P>SOLUTION: The port members 20 and 21 of a double lumen tube 10 has a common port 36 positioned in the most downstream side, the first port 32 communicating with the common port 36 on a straight line and the second port 34 arranged orthogonally to the common port 36 and the first port 32. An expansible and contractible balloon 51 is arranged in a pipe body 30 of the second port 34 and connected to an inflation line 41. A pilot balloon 42 having a one-way valve 43 attached to its leading end is connected to the other end of the inflation line 41. <P>COPYRIGHT: (C)2009,JPO&INPIT

Description

  The present invention relates to a double lumen tube for use in isolated lung ventilation.

  Separate lung ventilation, which ventilates the left and right lungs separately, is performed during thoracoscopic-assisted surgery, thoracic aortic aneurysm replacement, radical surgery for esophageal cancer, and single lung ventilation for pulmonary resection. In order to ventilate the left and right lungs separately, a double lumen tube having a double tube structure or a bronchial blocker is used.

  As described in Non-Patent Document 1, Broncocas (registered trademark) that hardly damages the tracheal mucosa is often used in the double lumen tube.

  For bronchial blockers, improvements such as those disclosed in Patent Document 1 and Patent Document 2 have been proposed.

  FIG. 6 is a view showing an example of a conventional double lumen tube for separation lung ventilation. The separated lumen ventilation double lumen tube (hereinafter simply referred to as “double lumen tube”) shown in FIG. 6 is a so-called Broncocas (registered trademark).

  As shown in FIG. 6, the double lumen tube 100 is attached to a main body 11 having a double lumen type pipe and an upstream side (upper side in FIG. 6) of the main body 11 and branches the two pipes of the main body 11. It has the member 12 and the two sleeve members 13 and 14 attached to the further upstream of the branch member 12. As shown in FIG.

  On the downstream side of the main body, a tracheal cuff 15 that closes the trachea by inflating as will be described later, and further on the downstream side, communicates with one pipe of the main body 11, and anesthesia gas, air, etc. in the right lung Or a right lung opening 17 for degassing the inside of the right lung, and a left bronchus extension 18 extending further downstream.

  The left bronchial extension 18 is provided with a bronchial cuff 16 that closes the left bronchus by expanding, and an anesthetic gas, air, or the like is supplied to the left lung at the forefront, or left for degassing the left lung A lung opening 19 is provided.

  Further, port members 220 and 221 having three input / output ports are attached to the upstream ends of the sleeve members 13 and 14, respectively. In each of the port members 220 and 221, lids 223 and 224 for closing the openings are provided at the most upstream (upper side in FIG. 6) openings. In addition, the ports 225 and 226 that extend in the vertical direction in the port members 220 and 221 are formed of an elastically deformable material. Therefore, the ports 225 and 226 are sandwiched between clamps (not shown). Can be closed.

  In the double lumen tube 100 shown in FIG. 6, the right lung opening 17 and the port member 221 communicate with each other, and the left lung opening 19 and the port member 220 communicate with each other.

  Tubes (not shown) are connected to the tips of the vertical ports 225 and 226 extending vertically from the port members 220 and 221, respectively. These tubes are connected to an anesthetic gas supply device for supplying anesthetic gas and a ventilator.

  A first inflation line 22 that communicates with the bronchial cuff 16 extends from the main body 11, and a first pilot balloon 24 with a one-side valve attached to the distal end is connected to the end of the first inflation line 22. The

  Further, a second inflation line 23 communicating with the tracheal cuff 15 extends from the main body 11, and a second pilot balloon 25 having a one-valve attached to the tip is provided at the end of the second inflation line 23. Connected. When the doctor presses the pilot balloons 25 and 26, air passes through the first inflation line 22 and the second inflation line, respectively, and the bronchial cuff 16 and the tracheal cuff 15 are inflated.

  To perform isolated lung ventilation, the double lumen tube 100 is intubated into the trachea by a physician. With the tracheal cuff 15 reaching a predetermined position of the trachea and the bronchial cuff 16 reaching a predetermined position of the left bronchus, the pilot balloons 24 and 25 are pressed to operate the bronchial cuff 16 and The tracheal cuff 15 is inflated.

  When the bronchial cuff 16 is expanded, the left bronchus is closed, and air or the like is supplied to the left lung through the left lung opening 19. On the other hand, when the trachea cuff 15 and the bronchial cuff 16 are inflated, the trachea and the left bronchus are also closed, and air or the like is supplied to the right lung through the right lung opening 17. .

  In the conventional double lumen tube 100, the case where the ventilation of one lung is stopped and the lung is deflated will be described. When only the right lung is ventilated and the left lung is deflated, the vertical port 225 of the port member 220 communicating with the left bronchus is closed by a clamp (not shown). Next, the left lung air is discharged by opening the lid 223 disposed on the upper part of the port member 220. This can deflate the left lung.

  The doctor closes the lid 223 and removes the clamp, so that the left lung is ventilated again.

In the case of the right lung, the same operation is performed on the port member 221 for the right lung.
Japanese Association for Acute Medicine, Glossary of Medical Terms “Separated Lung Ventilation”, Japan Emergency Medicine Association website, [on line], February 2007, [searched November 6, 2007], Internet <URL: http://www.jaam.jp/html/report/dictionary/word/0419.htm> JP 2004-154268 A JP 2002-113101 A

  When a conventional double lumen tube is used, the doctor involves opening and closing the lids 223 and 224 of the port members 220 and 221 and closing the vertical ports 225 and 226 of the port members 220 and 221 using a clamp. That is, the two actions of closing the lid and closing the vertical port by clamping must be performed almost simultaneously.

  In addition, since the clamp is heavy and large, the double lumen tube may be displaced by the weight of the clamp when the clamp closes the vertical ports 225 and 226 during the operation. Furthermore, since the clamp is large, a doctor or a nurse may touch the clamp and the clamp may fall off.

  It is an object of the present invention to provide a double-lumen tube for separating lung ventilation that allows a doctor to reliably perform separated lung ventilation with a simple operation and that prevents the device from being displaced or dropped during surgery. Objective.

The object of the present invention is to provide a main body with two double lumen type pipes,
A branching member attached to an upstream end of the main body and branching two pipes of the main body;
Two port members with three input / output ports attached further upstream of the branch member;
A tracheal cuff attached to the downstream side of the main body for closing the trachea;
A first opening located on the downstream side of the tracheal cuff, communicating with one tube of the main body, supplying anesthesia gas or air to one lung, and degassing one lung And
An extension extending further downstream from the first opening, the bronchial cuff closing the bronchus connected to the other lung by expansion, and the other lung located at the most distal end on the downstream side An anesthetic gas or air, and an extension having a second opening for degassing the other lungs;
A first air supply member for supplying air to the trachea cuff;
A second lumen tube for supplying air to the bronchial cuff, and a double lumen tube,
The port members are respectively
A common port located on the most downstream side;
A first port connected in a straight line with the common port;
The common port and the first port; and a second port arranged at a predetermined angle;
A connecting portion for connecting the first port, the second port and the common port;
An inflatable and deflateable balloon disposed within the tube of the second port;
An inflation line that reaches the tube at the downstream end and is connected to the balloon at the end;
Attached to the other end of the inflation line, air is supplied to the balloon via the inflation line, the balloon is inflated to close the tubular body, the balloon is deaerated, and the balloon is deflated. And a second port closing / opening member that opens the tube body, and is achieved by a double lumen tube for separating lung ventilation.

  In a preferred embodiment, the tube of the second port is at least translucent, and the balloon is colored in a color different from that of the tube.

  In another preferred embodiment, the second port closing / opening member is attached to a pilot balloon for supplying air to the balloon via the inflation line, and is attached to an end of the pilot balloon. A one-way valve configured to be shut off to prevent the outflow of air to the outside and to be opened by a certain operation.

  In still another preferred embodiment, the upper side or the lower side of the balloon is partially bonded to the upper inner wall or the lower inner wall of the tube, and the deflated balloon is connected to the upper or lower side of the tube. It will be in the state which almost adhered to.

  According to the present invention, there is provided a double lumen tube for separation lung ventilation that allows a doctor to reliably perform separation lung ventilation with a simple operation and that can prevent displacement and dropout of an instrument during surgery. It becomes possible.

  Embodiments of the present invention will be described below with reference to the accompanying drawings. FIG. 1 is a perspective view showing a configuration example of a double lumen tube for separation lung ventilation according to an embodiment of the present invention. In the present specification, the side connected to the ventilator or the anesthesia apparatus is referred to as the upstream side, and the side inserted into the trachea or bronchus is referred to as the downstream side.

  As shown in FIG. 1, the double lumen tube includes a main body 11 having a double lumen type pipe, a branch member 12 attached to the upstream side of the main body 11 and branching the two pipes of the main body 11, and a branch member 12. And two sleeve members 13 and 14 attached to the further upstream side.

  On the downstream side of the main body, a tracheal cuff 15 that closes the trachea by inflating as will be described later, and further on the downstream side, communicates with one pipe of the main body 11, and anesthesia gas, air, etc. in the right lung Or a right lung opening 17 for degassing the inside of the right lung, and a left bronchus extension 18 extending further downstream.

  The left bronchial extension 18 is provided with a bronchial cuff 16 that closes the left bronchus by expanding, and an anesthetic gas, air, or the like is supplied to the left lung at the forefront, or left for degassing the left lung A lung opening 19 is provided.

  The double lumen tube shown in FIG. 1 is for the left bronchus. Of course, it may be a double lumen tube for the right bronchus. In this case, the configuration shown in FIG.

  A first inflation line 22 that communicates with the bronchial cuff 16 extends from the main body 11, and a first pilot balloon 24 having a one-way valve 26 attached to the distal end is connected to the end of the first inflation line 22. Is done.

  Also, a second inflation line 23 communicating with the tracheal cuff 15 extends from the main body 11, and a second pilot balloon 25 having a one-way valve 27 attached to the tip is provided at the end of the second inflation line 23. Are concatenated. When the doctor presses the pilot balloons 24 and 25, air passes through the first inflation line 22 and the second inflation line, respectively, and the bronchial cuff 16 and the tracheal cuff 15 are inflated. The bronchial cuff 16 and the tracheal cuff 15 are contracted by pushing back the normally closed opening provided at the distal ends of the one-way valves 26 and 27 with an instrument having a thin distal end to reverse the air. be able to.

  As shown in FIG. 1, port members 20 and 21 having three input / output ports are attached to the upstream ends of the sleeve members 13 and 14, respectively.

  In the double lumen tube 10 shown in FIG. 1, the right lung opening 17 and the port member 21 communicate with each other, and the left lung opening 19 and the port member 20 communicate with each other.

  In each of the port members 20 and 21, a tube (not shown) is connected to the tip of a second port (vertical port) (for example, the second port 34 in FIG. 2). These tubes are connected to an anesthetic gas supply device for supplying anesthetic gas and a ventilator.

  Further, as shown in FIG. 1, in the present embodiment, hollow inflation lines 41 and 44 extend from the second port (vertical port) in each of the port members 20 and 21. A pilot balloon 42 having a one-way valve 43 attached to the tip is connected to the end of the inflation line 41. A pilot balloon 45 to which a one-way valve 46 is attached is connected to the end of the inflation line 44.

  2 and 3 are a front view and a right side view of the port member 20 according to the present embodiment, respectively. In this embodiment, two port members 20 and 21 are used, but since these are the same, only the port member 20 will be described.

  As shown in FIGS. 2 and 3, the main body 30 of the port member 20 has three ports: a first port 32, a second port (vertical port) 34, and a common port 36. The tips of the first port 32, the second port 34, and the common port 36 are opened (see reference numerals 33, 35, and 37), respectively.

  The first port 32 and the common port 36 are arranged to form a straight line, and the second port 34 is arranged to be orthogonal to the first port 32 and the common port 36.

  Inside the connecting portion 40 of the first port 32, the second port 34 and the common port 36, the passage of the common port 36, the passage of the first port 32 and the passage of the second port 34 are connected.

  As shown in FIG. 2, the inflation line 41 reaches the tube 50 of the second port 34 at the downstream end, and the end is connected to the balloon 51. A pilot balloon 42 is attached at the upstream end of the inflation line 41, and the doctor presses the pilot balloon 42, whereby air is supplied to the balloon 51 through the inflation line 41.

  In a state where air is not supplied (that is, in a contracted state), it is desirable that the balloon 51 is accommodated in a state of being in close contact with the upper portion of the tubular body 50 as shown in FIGS. For example, the upper side of the balloon 51 is partially bonded to the upper inner wall of the tube body 50. As a result, the deflated balloon 51 is in close contact with the upper portion of the tubular body 50. Here, adhesion includes attachment by an adhesive and adhesion by pressure (crimping).

  The balloon is made of, for example, polyvinyl chloride or silicon rubber. However, it goes without saying that the present invention is not limited to these materials.

  4A and 4B are cross-sectional views showing the tubular body 50 and the balloon 51 in more detail. As shown in FIG. 4A, in the first state in which air is not supplied (that is, deaerated), the tube body 50 is contracted so as to be in close contact with the upper portion of the tube body 50. It becomes a state of communication.

  On the other hand, as shown in FIG. 4B, in the second state in which air is supplied to the balloon 51 (that is, the balloon 51 is inflated), the tube body 50 is blocked by the inflated balloon 51. Peeling and air communication is hindered.

  In the present embodiment, the balloon 51 is colored in a color different from that of the tube body 50 to clarify whether the balloon 51 is inflated or deflated. Since the tubular body 50 is generally translucent white, the balloon 51 may be colored blue or orange.

  FIG. 5 is a schematic cross-sectional view showing a configuration example of the one-way valve according to the present embodiment. On the other hand, the valve 43 has a shaft 61 located at the center of the tube. An enlarged portion 62 having a radius larger than that of the shaft 61 is provided on the upstream side of the shaft 61. The enlarged portion 62 is located near the upstream end of the one-way valve 43. Therefore, it is possible to press the end portion of the enlarged portion 62 with a rod-like member that is thinner than the radius of the tubular body.

  In addition, on the upstream side of the central portion 63 of the one-way valve 43, an upstream side regulation member 65 having a portion protruding in the radial direction of the tubular body is disposed. Further, a downstream side regulating member 66 having a portion protruding in the radial direction of the tubular body is also arranged on the downstream side of the central portion 63.

  The shaft 19 is provided with a disc-shaped blocking member 64 that comes into contact with the protruding portion of the upstream-side regulating member 65. With the upstream regulating member 65 and the blocking member 64 in close contact with each other, the flow path is blocked, thereby preventing air communication in the one-way valve 43.

  A spring 67 is disposed around the shaft 19 on the downstream side of the blocking member 64. The spring 67 is located between the downstream regulating member 66 and the blocking member 64, and biases the blocking member 64 upstream (in the direction of the arrow in FIG. 5) by its elastic force. Therefore, normally, the upstream regulating member 65 and the blocking member 64 are in close contact with each other by the biasing force of the spring.

  In order to perform separated lung ventilation, the double lumen tube 10 according to the present embodiment is intubated into the trachea by a doctor. With the tracheal cuff 15 reaching a predetermined position of the trachea and the bronchial cuff 16 reaching a predetermined position of the left bronchus, the pilot balloons 24 and 25 are pressed to operate the bronchial cuff 16 and The tracheal cuff 15 is inflated.

  When the bronchial cuff 16 is expanded, the left bronchus is closed, and air or the like is supplied to the left lung through the left lung opening 19. On the other hand, when the trachea cuff 15 and the bronchial cuff 16 are inflated, the trachea and the left bronchus are also closed, and air or the like is supplied to the right lung through the right lung opening 17. .

  In the port members 20 and 21 of the double lumen tube 10 according to the present embodiment, initially, the lids 47 and 48 are closed and the balloon 51 is deflated. As a result, the common port 36 and the second port 34 communicate with each other (FIG. 4A). Thus, both lungs can be ventilated because they are in communication with an anesthetic gas supply and a ventilator.

  In the present embodiment, a case where the ventilation of one lung is stopped and the lung is deflated will be described. When only the right lung is ventilated and the left lung is deflated, the doctor opens the cover 47 of the port member 20 communicating with the left bronchus and presses the pilot balloon 42 to inflate the balloon 51. Then, the tube body 50 is closed to a second state (FIG. 4B). As a result, the common port 36 and the first port 32 communicate with each other, so that the left lung air is discharged. In this way, the left lung can be deflated.

  When the left lung is ventilated again, the doctor closes the lid 47 and presses the enlarged portion 62 of the shaft 61 of the one-valve 43 attached to the end of the pilot balloon 42 with an instrument having a thin tip. . As a result, the blocking member 64 moves downstream against the biasing force of the spring 67, and a gap is formed between the blocking member 64 and the upstream regulating member 65. Therefore, the air from the balloon 51 is discharged to the outside through the one-way valve 43, and the balloon 51 is in a first state in which it is deflated. The common port 36 and the second port 34 communicate with each other by the deflation of the balloon 51, and the ventilation of the left lung is resumed.

  Here, in the present embodiment, the balloon 51 is colored in a color different from that of the tubular body 50 in the second ports 34 of the port members 20 and 21. Therefore, when the balloon 51 is in the inflated second state, it can be visually recognized that the tube body 50 is blocked by the balloon 41 of a different color.

  Therefore, the doctor can immediately and intuitively know whether the second port 34 communicates with the common port 36 or is blocked, and can prevent erroneous connection of the ports. It becomes.

  Moreover, in order to confirm the insertion position of the double lumen tube 10, a bronchoscope (not shown) may be inserted into the tube. The diameter of the bronchoscope and its tube are substantially the same as the diameter of the opening 33 of the first port 32 of the port members 20, 21.

  When the bronchoscope is inserted, the pilot balloon 42 is pushed and the balloon 51 is inflated to close the tube body 50, the common port 36 and the first port 32 are communicated, The bronchoscope and its tube may be fed from the opening 33.

  As described above, according to the present embodiment, it is only necessary to use the clamp and press the pilot balloon 42 in order to inflate the balloon 51 when inserting the bronchoscope.

  The present invention is not limited to the above embodiments, and various modifications can be made within the scope of the invention described in the claims, and these are also included in the scope of the present invention. Needless to say.

  For example, in the embodiment described above, the second port 34 is disposed so as to be orthogonal to the first port 32 and the common port 36. However, the orientation of the second port is not limited to this, and the second port only needs to be arranged at a predetermined angle with respect to the first port 32 and the common port 36.

  In the embodiment, the upper side of the balloon 51 is partially bonded to the upper inner wall of the tube body 50, and the deflated balloon 51 is in close contact with the upper portion of the tube body 50. However, the present invention is not limited to this, and the lower side of the balloon is partially bonded to the lower inner wall of the tube, and the inflation line 41 communicates with the balloon 51 from the lower side. It may be in a state of being in close contact with each other.

FIG. 1 is a perspective view showing a configuration example of a double lumen tube for separation lung ventilation according to an embodiment of the present invention. FIG. 2 is a front view of the port member according to the present embodiment. FIG. 3 is a right side view of the port member according to the present embodiment. 4A and 4B are cross-sectional views showing the tube body and the balloon according to the present embodiment in more detail. FIG. 5 is a schematic cross-sectional view showing a configuration example of the one-way valve according to the present embodiment. FIG. 6 is a perspective view showing an example of a conventional double lumen tube for separating lung ventilation.

Explanation of symbols

DESCRIPTION OF SYMBOLS 11 Main body 12 Branch member 13 Sleeve member 14 Sleeve member 15 Tracheal cuff 16 Bronchial cuff 17 Right lung opening 18 Left bronchial extension 19 Left lung opening 20, 21 Port member 22, 23 Inflation line 24, 25 Pilot Balloons 26 and 27 One-way valve 30 Port member main body 32 First port 33 First port opening 34 Second port 35 Second port opening 36 Common port 37 Common port opening 40 Connection portions 41 and 44 Inflation lines 42 and 45 Pilot balloon 43 46 One-way valve 47, 48 Lid 50 Tube 51 Balloon 61 Shaft 62 Enlarged part 63 Central part 64 Shut-off member 65 Upstream restriction member 66 Downstream restriction member 67 Spring

Claims (4)

A body with two double-lumen pipes,
A branching member attached to an upstream end of the main body and branching two pipes of the main body;
Two port members with three input / output ports attached further upstream of the branch member;
A tracheal cuff attached to the downstream side of the main body for closing the trachea;
A first opening located on the downstream side of the tracheal cuff, communicating with one tube of the main body, supplying anesthesia gas or air to one lung, and degassing one lung And
An extension extending further downstream from the first opening, the bronchial cuff closing the bronchus connected to the other lung by expansion, and the other lung located at the most distal end on the downstream side An anesthetic gas or air, and an extension having a second opening for degassing the other lungs;
A first air supply member for supplying air to the trachea cuff;
A second lumen tube for supplying air to the bronchial cuff, and a double lumen tube,
The port members are respectively
A common port located on the most downstream side;
A first port connected in a straight line with the common port;
The common port and the first port; and a second port arranged at a predetermined angle;
A connecting portion for connecting the first port, the second port and the common port;
An inflatable and deflateable balloon disposed within the tube of the second port;
An inflation line that reaches the tube at the downstream end and is connected to the balloon at the end;
Attached to the other end of the inflation line, air is supplied to the balloon via the inflation line, the balloon is inflated to close the tubular body, the balloon is deaerated, and the balloon is deflated. And a second port closing / opening member for opening the tube body, wherein the double lumen tube for separating lung ventilation is provided.   2. The double lumen for separating lung ventilation according to claim 1, wherein the tubular body of the second port is at least translucent, and the balloon is colored in a color different from that of the tubular body. tube.   The second port closing / opening member is attached to a pilot balloon for supplying air to the balloon via the inflation line, and an end of the pilot balloon, and normally prevents outflow of air from the pilot balloon to the outside. The double-lumen tube for separating lung ventilation according to claim 1, further comprising: a one-way valve configured to be shut off and opened by a certain operation.   The upper or lower side of the balloon is partially bonded to the upper inner wall or the lower inner wall of the tubular body, and the deflated balloon is in a state of being in close contact with the upper or lower part of the tubular body. The double lumen tube for separation lung ventilation according to any one of claims 1 to 3.

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