JP2013176466A - Mask for non-invasive positive-pressure ventilation coping with endoscope - Google Patents

Mask for non-invasive positive-pressure ventilation coping with endoscope Download PDF

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JP2013176466A
JP2013176466A JP2012042291A JP2012042291A JP2013176466A JP 2013176466 A JP2013176466 A JP 2013176466A JP 2012042291 A JP2012042291 A JP 2012042291A JP 2012042291 A JP2012042291 A JP 2012042291A JP 2013176466 A JP2013176466 A JP 2013176466A
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endoscope
mask
nppv
port
cable
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JP2012042291A
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Japanese (ja)
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Saori Miyagawa
沙織 宮川
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Kitasato Institute
学校法人北里研究所
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Abstract

The present invention provides a gastrostomy as a method for constructing a gastrostoma while confirming the surgical position with an endoscope for a patient who has progressed in reducing respiratory muscle strength, and is capable of performing surgery while providing respiratory assistance without giving pain. A mirror-compatible non-invasive positive pressure ventilation therapy (NPPV) mask is provided.
An endoscope comprising a breathing tube connecting port of an artificial respirator and an endoscope insertion port, hermetically covering a nose and a mouth, and being inserted into the stomach from the endoscope insertion port, and An endoscope-compatible NPPV mask in which the cable passes smoothly through the insertion port at the time of insertion and the airtightness between the endoscope cable and the endoscope insertion port is maintained when the endoscope reaches the stomach.
[Selection] Figure 1

Description

  The present invention relates to an endoscope-compatible non-invasive positive pressure ventilation mask used at the time of gastrostomy construction. More specifically, maintain nutritional status while confirming the surgical position with an endoscope while providing respiratory assistance to patients who are unable to take food orally due to weakness of the pharyngeal muscles (respiratory muscles). The present invention relates to an endoscopic-compatible noninvasive positive pressure ventilation mask used when performing gastrostomy for the purpose.
  Patients with progressive generalized muscle atrophy, such as motor neuron disease, gradually become unable to take food orally due to weakness of the pharyngeal muscles. A gastrostoma may be constructed for the purpose of maintaining a nutritional state. In this case, the gastrostomy is constructed transendoscopically percutaneously. When performing surgery endoscopically, sedation is performed for the purpose of endoscopic operation itself and for pain relief associated with surgery. Also have. Therefore, respiratory suppression occurs when a sedative is used in patients who exhibit respiratory muscle weakness. It is necessary to use a sufficient amount of sedative to relieve pain and pain, but it is difficult to use a sufficient amount of sedative, and depending on the patient, even if a very small amount of sedative is used, breathing The condition worsened, and gastrostomy had to be stopped.
Up to now, gastrostomy construction method (abbreviated as endoscopic construction method) under observation with endoscope in patients with advanced respiratory muscle weakness, (1) Mask that covers only nose (nasal mask) In some cases, an endoscopic method is used, and (2) an endoscopic construction method that uses only a local anesthetic under the skin without using a intravenous sedation.
It is difficult to say that the nasal mask of (1) leaks air from the mouth and allows sufficient ventilation, and the use of local anesthetics under the skin of (2) causes insufficient pain relief. It was happening.
Furthermore, there are reports of gastrostomy (radiologically-guided gastrostomy) using radiation, but there are drawbacks such as limited puncture sites and easy tube removal, and it is not a method that can be performed in normal facilities (European Journal of Neurology 2012, 19: 360-375; Non-Patent Document 1).
European Journal of Neurology 2012, 19: 360-375
  The object of the present invention is to construct a gastrostoma while confirming the surgical position with an endoscope for a patient who has progressed in reducing respiratory muscle strength, making it safer and less painful and performing surgery while providing respiratory assistance It is an object of the present invention to provide an endoscopic-compatible noninvasive positive pressure ventilation mask (hereinafter sometimes abbreviated as an endoscopic-compatible NPPV mask) for carrying out the method of performing the above. .
Non-invasive positive pressure ventilation (NPPV), which is used as an artificial respiration therapy for patients who have developed respiratory muscle weakness, has a mask made so that it can be sealed as much as possible. It is a method of covering a face so as to cover and breathing assistance of a patient by sending positive pressure air from a respiratory assistance device (respiratory device), but the present inventor is using an endoscope while using this respiratory assistance device. Therefore, if gastrostomy for maintaining nutritional status was confirmed while confirming the surgical position, it was considered that it would be effective even in patients expected to have respiratory depression during the operation.
The current NPPV mask is only provided with a hole (respirator connection port) for connecting a tube through which air is fed, and is not compatible with an endoscope. Therefore, a hole for endoscope (endoscope insertion port) is opened separately in an NPPV mask made of silicon or plastic so that positive pressure air does not leak as much as possible when inserting and operating the endoscope and its cable. The present invention was completed by devising.
That is, the present invention provides the following endoscope-compatible NPPV mask.
1. An endoscopic-compatible non-invasive positive pressure ventilation (NPPV) mask that includes a breathing tube connection port of an artificial respirator and an endoscope insertion port and covers the nose and mouth in an airtight manner.
2. 2. The endoscope-compatible NPPV mask according to item 1 above, which airtightly covers the vicinity of the nose tip, the vicinity of the nasal bone, both cheeks and the mouth.
3. A soft vinyl chloride resin that is bonded to the body of the hard plastic selected from vinyl chloride resin, styrene resin, methacrylic resin, polycarbonate, and polysulfone and the hem of the main body, and does not create a gap, and has a low density. 3. The endoscope-compatible NPPV mask according to item 1 or 2, comprising a material selected from polyethylene and silicone rubber.
4). The endoscope inserted into the stomach from the endoscope insertion port and its cable pass smoothly through the insertion port when inserted, and when the endoscope reaches the stomach, the endoscope cable and the endoscope insertion port The endoscope-compatible NPPV mask according to any one of the preceding items 1 to 3, wherein airtightness is maintained (the interior is maintained at a positive pressure state).
5. The endoscope insertion port of the ventilator is made of a stretchable material, and the endoscope and its cable can be inserted smoothly, and when the endoscope reaches the stomach, the endoscope cable and the endoscope. The endoscope-compatible NPPV mask according to item 4, wherein airtightness with the insertion port is ensured.
6). The stretchable material is rubber, the endoscope through which the endoscope and its cable pass, and a hole having a diameter smaller than the outer diameter of the cable, the endoscope, its cable and mask, 6. The endoscope-compatible NPPV mask according to 5 above, which maintains the airtightness of the endoscope.
7). The endoscope according to item 5 above, wherein the stretchable material is rubber, and a cut is made through the endoscope and the cable through the rubber material to maintain airtightness between the endoscope and the cable and the mask. Compatible NPPV mask.
8). 8. The endoscope-compatible NPPV mask according to any one of the preceding items 1 to 7, wherein a breathing tube connection port and an endoscope insertion port of the ventilator are separately provided.
9. 8. The endoscope-compatible NPPV mask according to any one of the preceding items 1 to 7, wherein the mask is fixed by a gripping member and the patient's face and the mask are kept airtight.
10. 10. The endoscope-compatible NPPV mask according to 9 above, wherein the gripping member is a belt that fixes the mask to the face.
11. The endoscope-compatible NPPV mask according to item 9, wherein the gripping member is a strap attached to the mask.
  Use the endoscope-compatible noninvasive positive pressure ventilation (NPPV) mask of the present invention, which has an inhalation tube connection port and an endoscope insertion port of a ventilator and covers the nose and the mouth in an airtight manner Accordingly, it is possible to safely perform percutaneous transendoscopic gastrostomy for a patient with amyotrophic lateral sclerosis in which respiratory muscle paralysis has progressed.
It is a perspective view of an example of the NPPV mask for endoscopes of the present invention. It is a perspective view of an NPPV mask.
Hereinafter, an endoscope-compatible NPPV mask of the present invention will be described with reference to the accompanying drawings.
The endoscopic-compatible NPPV mask of the present invention is a mask having only a respiratory assistance port that has been used to perform non-invasive positive pressure ventilation therapy (NPPV) in patients whose respiratory muscle strength has been reduced so far. The endoscope is characterized in that it has a hole (endoscope insertion port) through which an endoscope for observing the inside of the stomach when performing gastrostomy and its cable are inserted and operated while maintaining a positive pressure state.
  FIG. 2 shows an example of an off-the-shelf NPPV mask that has a breathing assist device connection port on the front surface, and is attached to both sides (5a, 5b) and the top (6) with a gripping member belt (7) that fixes the mask to the face. It is a perspective view.
  FIG. 1 shows the cross section of the patient's nose tip, nasal bone region, both cheeks, and the mouth, which is hermetically covered in a dome shape, and is connected to the breathing tube connection port (1) of the ventilator and the endoscope. 1 is a perspective view of an example of an endoscope-compatible non-invasive positive pressure ventilation (NPPV) mask according to the present invention having a mirror insertion opening (2). FIG.
  In this example, the air inlet in front of the NPPV mask at the patient's nose and mouth in FIG. 2 is used as the endoscope and its cable inlet, and the breathing tube connection port of the ventilator is used as the mask. Separately provided on the side.
  Mask material does not cause irritation (pain) to the patient at the contact surface when fixed to the face, is kept airtight, and is easy to process when drilling holes to connect the breathing tube of the ventilator Any material can be used, and the same material as the mask for noninvasive positive pressure ventilation therapy can be used.
  As such a material, for example, an outer shape selected from transparent hard plastics such as vinyl chloride resin, styrene resin, methacrylic resin, polycarbonate, polysulfone, etc. is joined to the oval main body and the hem of the main body and the patient's face And those made of soft vinyl chloride resin, low-density polyethylene, silicone rubber, etc. that are in close contact with each other and do not generate gaps.
  The endoscope and its cable inserted into the stomach through the endoscope insertion port can be smoothly inserted without air leakage, and the endoscope cable and the internal cable can be inserted during the insertion and the operation of observing the stomach with the endoscope. The airtightness with the endoscope insertion port needs to be maintained. As shown in FIG. 1, the present inventors fitted a rubber finger bag (3) in a place that was an air insertion port of an NPPV mask, and tightened (reinforced) the fitting portion with a rubber ring (4). By opening a small hole (not shown) in the tip of the finger bag and inserting the endoscope and its cable from there, the gastrostomy can be successfully performed as shown in the examples described later. It was. As another method of maintaining the airtightness, for example, a thick rubber material is fitted into the air insertion port in front of the NPPV mask, and a cut is made through the endoscope and its cable, or the rubber material is cut into the rubber material. A method of providing a hole having a diameter smaller than the outer diameter of the endoscope and its cable is also mentioned.
The gastrostomy for the patient under observation with an endoscope is performed as follows.
The breathing tube connection port of the endoscope-compatible NPPV mask of the present invention is connected to a ventilator and covered with a mask so as to cover a predetermined position (nose and mouth) of the patient's face, thereby maintaining airtightness. The patient's head is fixed by a gripping member. The endoscope and its cable are inserted into a hole in a rubber member fitted in the insertion port in front of the NPPV mask, the endoscope is inserted into the patient's stomach, and gastrostomy is performed while observing with the endoscope. As described in the Examples, 27 patients with Amyotrophic Lateral (ALS) with advanced respiratory muscle paralysis were used for percutaneous transendoscopic gastrostomy using the mask of the present invention. However, with the exception of one example, it was confirmed that treatment could be performed safely and that a sufficient sedative effect was obtained.
The Amyotrophic Lateral (ALS) treatment guidelines recommend that gastrostomy be established before the% vital capacity (% VC) falls below 50%, and the risk of gastrostomy Is considered moderate when% VC is 30-50% and high when 30% or less.
Therefore, using the mask of the present invention, an attempt was made to perform gastrostomy with NPPV in combination with respiratory function at the time of gastrostomy for ALS patients and patients with reduced respiratory function of ALS.
Fit the rubber finger bag into the air insertion port of the NPPV mask, reinforce the fitting part with a rubber ring, make a small hole at the tip of the finger bag, and insert the endoscope and its cable from there A mask was prepared and used at the time of gastrostomy for patients with moderate risk of gastrostomy (% VC 30-50%) or less. Gastrostomy was performed in 37 ALS patients (14 males, 23 females, age: 57.9 ± 13.5 years).
Measurement of preoperative respiratory function (ventilatory function test, blood gas test, nasal inspiratory pressure (SNIP), subjective symptoms, night SpO 2 (percutaneous arterial oxygen saturation) monitor) for each patient, and intraoperative safety And pain management (confirmation of blood pressure / pulse / SpO 2 , subjective symptoms and consciousness).
Among 37 cases,% VC> 50% 11 cases, 30% <% VC <50% 13 cases,% VC <30% 4 cases (2 cases incapable of measurement, 7 cases without data) . For PaCO 2 (carbon dioxide partial pressure, normal value is 35 to 45 mmHg), PaCO 2 <45 mmHg 22 cases, 45 mmHg <PaCO 2 <50 mmHg 9 cases, PaCO 2 > 50 mmHg 6 cases, and guidelines for gastrostomy 37% of the cases satisfying 50% or more of the above standard% VC, and 59% of the total of PaCO 2 45 mmHg or less, and 9 out of 37 NPPV-free patients satisfying both were NPPV. There were 27 cases that met the criteria for combined use. Of these, 16 patients used NPPV prior to surgery, and 11 patients used NPPV only during gastrostomy. Among them, the former 8 cases and the latter 4 cases had a decrease in SpO 2 during operation (<88%), but the deviation could be handled safely by adjusting oxygen administration and IPAP (inspiratory positive airway pressure).
  As described above, except for one case that caused aspiration in the pretreatment, in all cases including 4 cases of% VC30% or less, effective ventilation without leakage was obtained by using the mask of the present invention. We were able to safely perform gastrostomy without pain while applying sedation.
DESCRIPTION OF SYMBOLS 1 Tube connection port for exhalation 2 Endoscope insertion port 3 Rubber finger bag 4 Rubber ring 5a, 5b Mask side surface 6 Mask top 7 Belt

Claims (11)

  1.   An endoscopic-compatible non-invasive positive pressure ventilation (NPPV) mask that includes a breathing tube connection port of an artificial respirator and an endoscope insertion port and covers the nose and mouth in an airtight manner.
  2.   The endoscope-compatible NPPV mask according to claim 1, wherein the vicinity of the nose tip, the vicinity of the nasal bone portion, both cheeks, and the mouth are hermetically covered.
  3.   Soft vinyl chloride resin, low density that adheres to the patient's face and does not create gaps between the main body made of hard plastic selected from vinyl chloride resin, styrene resin, methacrylic resin, polycarbonate and polysulfone and the hem of the main body The NPPV mask for endoscope according to claim 1 or 2, comprising a material selected from polyethylene and silicone rubber.
  4.   The endoscope inserted into the stomach from the endoscope insertion port and its cable pass smoothly through the insertion port when inserted, and when the endoscope reaches the stomach, the endoscope cable and the endoscope insertion port The endoscope-compatible NPPV mask according to claim 1, wherein the airtightness of the endoscope is maintained (the inside is maintained in a positive pressure state).
  5.   The endoscope insertion port of the ventilator is made of a stretchable material, and the endoscope and its cable can be inserted smoothly, and when the endoscope reaches the stomach, the endoscope cable and the endoscope. The endoscope-compatible NPPV mask according to claim 4, wherein airtightness with the insertion port is ensured.
  6.   The stretchable material is rubber, the endoscope through which the endoscope and its cable pass, and a hole having a diameter smaller than the outer diameter of the cable, the endoscope, its cable and mask, The endoscope compatible NPPV mask according to claim 5, wherein the airtightness of the endoscope is maintained.
  7.   The endoscope according to claim 5, wherein the stretchable material is rubber, and a cut is made through the rubber material to pass the endoscope and the cable thereof to maintain airtightness between the endoscope and the cable and the mask. NPPV mask for mirror.
  8.   The NPPV mask for endoscope according to any one of claims 1 to 7, wherein a tube connection port for exhalation of an artificial respirator and an endoscope insertion port are separately provided.
  9.   The NPPV mask for endoscope according to any one of claims 1 to 8, wherein the mask is fixed by a gripping member to hold the patient's face and the mask in an airtight manner.
  10.   The endoscope compatible NPPV mask according to claim 9, wherein the gripping member is a belt for fixing the mask to the face.
  11.   The endoscope compatible NPPV mask according to claim 9, wherein the gripping member is a strap attached to the mask.
JP2012042291A 2012-02-28 2012-02-28 Mask for non-invasive positive-pressure ventilation coping with endoscope Pending JP2013176466A (en)

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Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2011085427A1 (en) * 2010-01-13 2011-07-21 Borody Thomas J A mask for use with a patient undergoing a sedated endoscopic procedure
WO2011127660A1 (en) * 2010-04-15 2011-10-20 深圳市安保科技有限公司 Face mask for endoscopy

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2011085427A1 (en) * 2010-01-13 2011-07-21 Borody Thomas J A mask for use with a patient undergoing a sedated endoscopic procedure
JP2013517016A (en) * 2010-01-13 2013-05-16 トーマス・ジュリアス・ボロディ Mask used for patients undergoing sedation endoscopic procedures
WO2011127660A1 (en) * 2010-04-15 2011-10-20 深圳市安保科技有限公司 Face mask for endoscopy
JP2013523355A (en) * 2010-04-15 2013-06-17 アンビュランク (シェンチェン) テック. カンパニー リミテッド Endoscope face mask

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