JP2015016177A - Medical instrument - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a medical instrument capable of easily securing the airway of a subject without depending upon the skill level of an operator.SOLUTION: A medical instrument according to the present invention is used to secure the airway of a subject, comprising: a tubular member which is inserted through the oral cavity or nasal cavity of the subject such that a tip part thereof is positioned in a specified site of the subject; and a long insertion part which has an imaging unit at the tip part thereof and is inserted into the tubular member slidably relative to the tubular member. The medical instrument is used such that the tip part of the tubular member is delivered to a specified site of the subject in a state in which the medical instrument is assembled with the insertion part inserted into the tubular member.

Description

  The present invention relates to a medical device.

  For example, there is a case where tracheal intubation is performed in which a tube is inserted into a patient's trachea and oxygen is supplied to the lung as a primary lifesaving treatment for a patient who has impaired consciousness due to an accident or the like and whose respiratory function is reduced. In addition, patients who have lost their consciousness have slackening of the pharyngeal and laryngeal muscles and depression due to gravity of the lower jaw, resulting in tongue root depression, which obstructs the airways. For this reason, it may be difficult to insert a tube into the trachea for a patient who has lost consciousness and whose airway is blocked.

  Therefore, when the patient's airway is obstructed in the tracheal intubation procedure, it is necessary to push up the tongue base and pry open the obstructed airway to secure the airway. Therefore, in order to secure the airway, an instrument called a supraglottic device may be used (see, for example, Patent Document 1).

  This supraglottic device is a long member that curves in the middle of the longitudinal direction.For example, it is inserted from the mouth of a patient with impaired consciousness, and a predetermined portion on the tip side is brought into contact with the tongue base portion of the patient. The airway is secured by lifting the tongue base part.

  However, tracheal intubation is a very difficult procedure. For this reason, when such a tracheal intubation procedure is performed by a person with a relatively low level of skill, there is a problem that it takes a long time to secure the airway or insert the tube into a target site of the subject. is there.

JP-A-8-322937

  An object of the present invention is to provide a medical instrument that can easily secure the airway of a subject regardless of the skill level of the operator.

Such an object is achieved by the present inventions (1) to (14) below.
(1) A medical device used to secure a subject's airway,
A tubular member that is inserted so that a distal end portion is located at a predetermined site of the subject via the oral cavity or nasal cavity of the subject;
In the tubular member, it is slidably inserted relative to the tubular member, and has a long insertion part having an imaging part at the tip part,
The medical instrument is used so that the distal end portion of the tubular member reaches a predetermined part of the subject in a state where the insertion portion is inserted into the tubular member and assembled. Medical equipment to do.

  (2) The medical instrument according to (1), wherein a change unit that changes a visual field direction of the imaging unit is provided at a distal end of the insertion unit.

  (3) The medical instrument according to (1) or (2), further including a marker for grasping a rotation angle around the axis of the insertion portion.

(4) Provided on the proximal end side of the insertion portion with a gripping portion for gripping when operating the insertion portion,
The medical instrument according to (3), wherein the marker is provided on the grip portion.

  (5) The medical instrument according to any one of (1) to (4), further including an image display unit that displays an image captured by the imaging unit.

  (6) The medical instrument according to any one of (1) to (5), further including a second imaging unit different from the imaging unit.

  (7) The medical instrument according to (6), wherein the second imaging unit is arranged so that at least a position of the imaging unit can be confirmed.

(8) The image display unit is configured to display a first image captured by the imaging unit and a second image captured by the second imaging unit,
Further, a first display mode for displaying only the first image, a second display mode for displaying only the second image, and both the first image and the second image are displayed. The medical instrument according to (6) or (7), further including display switching means for switching between the third display mode.

(9) The medical instrument may be configured such that the imaging unit is aligned with the distal end portion of the tubular member or is positioned on a proximal side with respect to the distal end portion of the tubular member. The tip is allowed to reach a predetermined site of the subject,
Thereafter, the medical instrument according to any one of (1) to (8), wherein the imaging unit is used so as to protrude from a distal end of the tubular member.

  (10) The medical device according to any one of (1) to (9), further including a diameter-expanding portion that is provided on a distal end side from the tubular member and increases at least in an inner diameter as the distance from the tubular member increases. .

  (11) The medical instrument according to (10), wherein a central axis of the enlarged diameter portion is inclined with respect to a central axis of the tubular member.

  (12) The medical device according to (11), wherein the enlarged-diameter portion includes a cuff portion that can expand and contract at a peripheral portion thereof.

(13) The insertion portion has a substantially circular cross-sectional shape,
The above (1) to (12) satisfying the relationship of 1.2 ≦ X / Y ≦ 10.0, where X is the inner diameter of the tubular member and Y is the outer diameter of the insertion portion. The medical instrument according to any one of the above.

(14) The insertion portion has a substantially circular cross-sectional shape,
The medical instrument according to any one of (1) to (13), wherein an outer diameter of the insertion portion is 1.0 to 4.0 mm.

  According to the present invention, when an airway is secured, a tubular member to be inserted into a predetermined site of a subject is used in a state where an insertion portion having an imaging portion at the distal end portion is inserted. For this reason, by adjusting the positional relationship between the distal end portion of the tubular member and the distal end portion of the insertion portion, it is possible to observe the distal end portion of the tubular member and a predetermined portion of the subject in the image by the imaging unit. Therefore, according to the present invention, the tubular member can be easily inserted into the subject regardless of the skill level of the operator, and thus the airway of the subject can be easily secured. can do.

It is the perspective view which looked at the medical device of a 1st embodiment from the front side. It is the perspective view which looked at the medical instrument shown in FIG. 1 from the back side. It is a side view of the supraglottic device shown in FIG. It is the perspective view which looked at the intubation tube shown in FIG. 1 from the front side. It is a figure ((a) is a front view, (b) is a top view) which shows the front-end | tip part of the scope insertion part with which the scope shown in FIG. 1 is provided. It is a block diagram of the medical device shown in FIG. It is a figure which shows typically the state which inserted the front-end | tip part of the supraglottic device shown in FIG. 1 in the entrance part of the esophagus, and the figure of the display screen displayed on an image display part in that case. It is a figure which shows typically the state which advanced the front-end | tip part of the scope insertion part shown in FIG. 1 to the glottic vicinity, and the figure of the display screen displayed on an image display part in that case. It is a figure which shows typically the state which advanced the front-end | tip part of the scope insertion part shown in FIG. 1 from the glottis, and the figure of the display screen displayed on an image display part in that case. It is a figure which shows typically the state which advanced the front-end | tip part of the scope insertion part shown in FIG. 1 to a bronchial bifurcation part, and the figure of the display screen displayed on an image display part in that case. It is a figure which shows typically the state which advanced the front-end | tip part of the scope insertion part shown in FIG. 1 to the left bronchus, and the figure of the display screen displayed on an image display part in that case. It is a figure which shows typically the state which inserted the front-end | tip part of the supraglottic device in the entrance part of the esophagus. It is the perspective view which looked at the medical device of 3rd Embodiment from the front side. It is a figure of the display screen displayed on an image display part, when the front-end | tip part of the supraglottic device shown in FIG. 13 is inserted in the entrance part of an esophagus. It is a figure of the display screen displayed on an image display part, when the front-end | tip part of the scope insertion part shown in FIG. 13 is advanced to the glottic vicinity. It is a figure of the display screen displayed on an image display part, when the front-end | tip part of the scope insertion part shown in FIG. 13 is advanced behind a glottis. It is a figure ((a) is a front view, (b) is a top view, (c) is a longitudinal cross-sectional view) which shows the front-end | tip part of the scope insertion part with which the medical instrument of 4th Embodiment is provided. It is the perspective view which looked at the supraglottic device with which the medical instrument of a 5th embodiment is provided from the front side. It is the perspective view which looked at the medical instrument of 6th Embodiment from the front side. FIG. 19 is a view (partially cut away) of the laryngoscope blade shown in FIG. 19 (partly cut away) ((a) is a front view and (b) is a top view). It is the figure which shows typically the state which inserted the blade for laryngoscopes shown in FIG. 19 in the larynx, and the figure of the display screen displayed on an image display part in that case. It is the figure which shows typically the state which advanced the nasal intubation tube shown in FIG. 19 to the epiglottis vicinity, and the figure of the display screen displayed on an image display part in that case. It is the figure which shows typically the state which advanced the nasal intubation tube shown in FIG. 19 back from the glottic vicinity, and the figure of the display screen displayed on an image display part in that case.

Hereinafter, the medical device of the present invention will be described in detail based on a preferred embodiment shown in the accompanying drawings.
<First Embodiment>
FIG. 1 is a perspective view of the medical device of the first embodiment as viewed from the front side, FIG. 2 is a perspective view of the medical device shown in FIG. 1 as viewed from the back side, and FIG. FIG. 4 is a perspective view of the intubation tube shown in FIG. 1 as viewed from the front side, and FIG. 5 shows a distal end portion of a scope insertion portion provided in the scope shown in FIG. FIG. 6A is a side view, FIG. 6B is a block diagram of the medical instrument shown in FIG. 1, and FIG. 7 shows the distal end portion of the supraglottic device shown in FIG. FIG. 8 is a diagram schematically showing a state of being inserted into the entrance portion of the esophagus, and a diagram of a display screen displayed on the image display unit at that time, and FIG. 8 shows the glottis of the distal end portion of the scope insertion unit shown in FIG. FIG. 9 is a diagram schematically showing a state of having advanced to the vicinity, and a diagram of a display screen displayed on the image display unit at that time. A diagram showing a state in which advancing the leading end of the scope insertion portion shown in FIG. 1 to the far than glottal schematically, and a diagram of a display screen displayed on the image display unit at that time, FIG. 1 0 a diagram showing a state in which advancing the leading end of the scope insertion portion shown in FIG. 1 to the bronchial branching unit schematically, and is a diagram of a display screen displayed on the image display unit at that time, FIG. 1 1, It is a figure which shows typically the state which advanced the front-end | tip part of the scope insertion part shown in FIG. 1 to the left bronchus, and the figure of the display screen displayed on an image display part in that case.

  In the following, for convenience of explanation, in principle, the lower side in FIGS. 1 to 5 and FIGS. 7 to 11 is referred to as a “tip” and the upper side is referred to as a “base end”. However, since the insertion portion of the medical instrument is curved in the middle, the tip direction changes accordingly.

  The medical instrument 100 shown in these drawings is used when performing an intubation operation for inserting, for example, an intubation tube 2 into a trachea of a subject such as a patient who exhibits consciousness disorder or a subject who has undergone general anesthesia. Is.

  As shown in FIGS. 1 and 2, the medical instrument 100 includes the supraglottic device 1, a scope 3, and an image display device 4 connected to the scope 3.

  Moreover, the medical instrument 100 can be used in combination with the separately prepared intubation tube 2, and the case where the intubation tube 2 is combined with the medical instrument 100 is demonstrated below.

  As shown in FIGS. 1 and 2, the supraglottic device (laringial mask) 1 has a main body portion 11 and a mask portion (expanded diameter portion) 12 provided at the tip of the main body portion 11. . The supraglottic device 1 can be inserted from the subject's mouth and the subject's airway can be secured by lifting the subject's epiglottis or the like with the mask unit 12.

  The main body 11 is composed of a long tubular member. The main body 11 has flexibility by being made of a material such as a soft resin, an elastomer, and rubber, for example. Thereby, when inserting the glottal device 1 from the mouth (oral cavity) of the subject, the main body 11 can be deformed according to the shape of the organ that defines the airway of the subject. Therefore, the glottic device 1 (mask part 12) can be easily and safely inserted up to the intended location (part) of the subject.

  As shown in FIG. 3, the length of the central axis of the main body 11 (the total length of the supraglottic device 1 including the mask 12) L1 is preferably about 200 to 300 mm for adults, In the case of a child, it is preferably about 150 to 250 mm, and in the case of a newborn, it is preferably about 130 to 200 mm.

  As shown in FIGS. 1 and 2, a mask portion 12 is formed integrally with the main body portion 11 at the tip of the main body portion 11. The mask portion 12 has a shape (mortar shape) in which the inner diameter and the outer diameter increase as the distance from the main body portion 11 increases. Thereby, the overall glottal device 1 has a trumpet shape as a whole. Further, the central axis of the mask part 12 is inclined with respect to the central axis of the main body part 11, whereby the opening 122 of the mask part 12 is open to the side of the supraglottal device 1.

  When the mask part 12 is inserted into the subject, the peripheral part (portion surrounding the opening 122) 121 is brought into contact with the epiglottis of the subject and the surrounding tissue, so that the larynx is Can be closed.

  Although the angle (in FIG. 3, angle (theta)) which the center axis | shaft of the mask part 12 and the center axis | shaft of the main-body part 11 make is not specifically limited, It is preferable that it is about 10-100 degrees, It is about 20-90 degrees. Is more preferable. Thereby, the mask part 12 can improve the adhesiveness with respect to a subject's epiglottis and its surrounding tissue.

  From the viewpoint of improving the adhesion of the mask unit 12 to the subject's epiglottis and surrounding tissues, examples of the constituent material of the mask unit 12 (supraglottic device 1) include silicone resins and silicone-based thermoplastic elastomers. Preferably used.

Moreover, the opening area of the opening 122 of the mask part 12 is not particularly limited, but is preferably about 900 to 1900 mm ² . Thereby, the larynx can be more reliably blocked with the mask part 12.

  In such a glottal device 1, as shown in FIG. 1, a guide hole 13 and a through hole 14 are formed along the longitudinal direction thereof.

  The guide hole 13 has a substantially circular cross-sectional shape, a base end that opens to the base end opening 131 of the main body 11, and a tip that opens through the front end opening 132 of the main body 11. Open to 122.

  A scope insertion portion 31 of the scope 3 to be described later is inserted into the guide hole 13 while being inserted into the intubation tube 2.

  When the larynx is blocked by the mask part 12, the airway leading from the larynx to the trachea and the guide hole 13 communicate with each other, so that the scope insertion part 31 and the intubation tube 2 are easily inserted into the larynx, trachea and further into the bronchus. be able to.

  Along the guide hole 13, as shown in FIG. The through hole 14 also has a substantially circular cross-sectional shape, the base end is open to the base end opening 141 of the main body 11, and the tip is open to the tip opening 142 (tip of the mask portion 12). .

  For example, a suction tube or forceps (not shown) is provided in the through hole 14. The suction tube and forceps may be detachable from the main body 11 or may be fixed to the main body 11. For example, a foreign substance having fluidity such as saliva and sputum can be sucked and removed by the suction tube. In addition, for example, solid (solid) foreign matter can be removed by the forceps. The number of through holes 14 is one in the illustrated example, but may be two or more.

  The entire glottic device 1 as described above may be light-transmissive as a whole, or only necessary portions may be light-transmissive.

  As shown in FIG. 1, the intubation tube 2 is inserted into the guide hole 13 of the above supraglottic device 1.

  As shown in FIG. 4, the intubation tube 2 includes a tube main body 21 and a tracheal sealing cuff 23 provided on the distal end side of the tube main body 21.

  The tube body 21 is composed of a single lumen tube whose cross-sectional shape is substantially circular. The tube body 21 is made of a flexible material such as elastomer or rubber.

  The maximum outer diameter of the intubation tube 2 (the diameter of the portion where the tracheal sealing cuff 23 is provided during contraction) is set smaller than the inner diameter of the guide hole 13. Thereby, the intubation tube 2 can be smoothly slid or rotated along the longitudinal direction of the supraglottic device 1 in the guide hole 13.

  Although the maximum outer diameter of this intubation tube 2 is not specifically limited, It is preferable that it is about 2-9 mm, and it is more preferable that it is about 5-8 mm. The length of the tube body 21 is not particularly limited, but is preferably about 180 to 360 mm.

  As shown in FIG. 4, a tracheal seal pilot balloon 231 connected to the tracheal seal cuff 23 is provided on the proximal end side of the tube main body 21.

  A ventilator is connected to the proximal end opening 24 of the tube body 21 after the scope 3 is removed (not shown).

  In the present embodiment, the tube main body 21 is composed of a single lumen tube, but may be composed of, for example, a double lumen tube.

  The supraglottic device 1 and the intubation tube 2 are used in combination with a scope 3 as shown in FIGS. The scope 3 includes a long scope insertion portion 31, a scope grip portion 32 provided on the proximal end side of the scope insertion portion 31, and a scope connection portion 35 that is electrically connected to the image display device 4. ing.

  As shown in FIGS. 1 and 2, the supraglottic device 1, the intubation tube 2, and the scope 3 insert the intubation tube 2 into the guide hole 13 of the supraglottic device 1, and further the scope insertion portion 31 inside the intubation tube 2. Is used in this assembled state.

  As shown in FIGS. 1 and 5, the scope insertion unit 31 includes a long tube body 311, scope imaging means 33 and scope illumination means 34 provided in the tube body 311.

  The tube body 311 is made of, for example, a material such as resin, elastomer, or rubber, and has flexibility. For this reason, the scope insertion part 31 can be deformed flexibly along the deformed (curved) shape of the supraglottic device 1 and the intubation tube 2, the shape of the organ that defines the airway, and the like.

  The cross-sectional shape of the tubular body 311 is substantially circular, but may be, for example, a rectangle such as a rectangle, a square, or a rhombus, a triangle, a hexagon, an octagon, a circle, or an ellipse.

  The outer diameter of the tube body 311 (scope insertion part 31) is set slightly smaller than the inner diameter of the tube body 21. Thereby, the scope insertion part 31 can be smoothly slid along the longitudinal direction in the intubation tube 2.

  The outer diameter of the tubular body 311 is not particularly limited, but is preferably 1.0 to 4.0 mm, and more preferably about 2.5 to 3.5 mm.

  Moreover, the full length of the pipe | tube body 311 (scope insertion part 31) should just be set larger than the full length of the tube main body 21, and although it does not specifically limit, It is preferable that it is about 300-600 mm. Further, since the distal end portion of the scope insertion portion 31 can protrude from the distal end of the intubation tube 2, the positional relationship of the distal end portion of the scope insertion portion 31 with respect to the distal end portion of the supraglottal device 1 and the distal end portion of the intubation tube 2 is adjusted. By doing so, the distal end portion of the supraglottic device 1, the distal end portion of the intubation tube 2, and a predetermined part of the subject can be observed by the scope imaging means 33 described below.

  As shown in FIG. 5, a scope imaging unit 33 and a scope illumination unit 34 are provided inside the tube body 311.

  The scope imaging means 33 is connected to the CCD 331 and an imaging unit 37 including a CCD (moving camera) 331 arranged in order from the base end side of the tube body 311, an objective lens 332 and a light-transmissive window 333. And an image signal cable 334. Specifically, a hole (not shown) is provided at the distal end of the tube 311, and a CCD 331 and an objective lens 332 to which an image signal cable 334 is connected are installed in the hole, and the distal end of the hole is The window 333 is liquid-tightly sealed. In this scope imaging means 33, reflected light (image light) from a predetermined part of the subject where the distal end portion of the scope insertion portion 31 is located forms an image on the light receiving surface (imaging surface) of the CCD 331 by the objective lens 332. The subject image (image light) is picked up by the CCD 331. That is, the CCD 331 images a predetermined part of the subject, the tip part of the supraglottic device 1, and the like.

  The scope illumination unit 34 provided in parallel with the scope imaging unit 33 includes a white LED (light emitting diode) 341, an illumination lens 342, and a light-transmitting window arranged in this order from the proximal end side of the tube 311. The illumination unit 38 including the unit 343 and the illumination signal cable 344 are included. Specifically, a hole (not shown) different from the hole in which the CCD 331 and the objective lens 332 are installed is provided at the tip of the tube 311, and the white LED 341 and the illumination lens 342 are provided in the hole. The tip of the hole is liquid-tightly sealed with a window 343. Thus, by installing the CCD 331 and the white LED 341 in separate holes, it is possible to prevent the occurrence of halation due to the light emitted from the white LED 341.

  As shown in FIGS. 1 and 2, a scope gripping portion 32 that can be gripped by an operator with fingers is provided on the proximal end side of the scope insertion portion 31. When the operator grasps the scope gripping part 32 with fingers and operates the scope 3, the scope insertion part 31 (CCD 331) moves (slides) along the longitudinal direction of the supraglottal device 1 and the intubation tube 2 Or rotate around that axis.

  The cross-sectional shape of the scope gripping part 32 is substantially circular, and a convex part 321 is formed projecting toward the side at the base end part. The convex part 321 has a function as a marker for grasping the rotation amount (rotation angle) around the axis of the scope 3 (scope insertion part 31). The operator can grasp the rotation direction and the rotation amount of the scope insertion unit 31 by confirming the position of the convex portion 321 when the scope holding unit 32 is rotated around the axis. In addition, the shape of the convex part 321 may be any shape. Further, a recess formed in the outer surface of the scope grip 32 may be used as a marker.

  Further, the outer surface of the scope gripping part 32 may be subjected to anti-slip processing for preventing the scope gripping part 32 from sliding down when the scope gripping part 32 is gripped. Examples of the anti-slip process include a process of forming a resin layer on the surface of the scope gripping part 32 and a rough surface process.

  In addition, the scope holding unit 32 is provided with a scope connection unit 35 that connects the scope 3 to the image display device 4. The scope connection unit 35 is provided on the tube 350 in which the image signal cable 334 and the illumination signal cable 344 are disposed inside, and on the opposite side of the scope 350 from the scope grip unit 32. The image signal cable 334, the illumination signal And a connection terminal 351 to which a cable 344 is connected. By connecting the connection terminal 351 to the connection terminal 422 of the image display device 4, the scope 3 and the image display device 4 can be electrically connected.

  Such a scope 3 has a waterproof structure. About this waterproof structure, conventionally well-known various structures (structure) are employable, for example.

  An image display device 4 is electrically connected to the scope 3. The image display device 4 includes a main body 41 and a display 42 provided on the base end side of the main body 41.

  As shown in FIGS. 1 and 2, the main body 41 has a columnar outer shape, and a support member (not shown) is attached to and detached from the main body 41 on the tip side (lower side in FIG. 1). Connected freely.

  Examples of the support member include a stand for supporting the image display device 4 on the floor surface, and a band for attaching the image display device 4 to an operator's arm or wrist.

  By mounting and using such a support member on the main body 41, the operator does not need to hold the image display device 4 when performing the intubation work, and can perform the intubation work in a concentrated manner. .

  The main body 41 has a waterproof structure. About this waterproof structure, conventionally well-known various structures (structure) are employable, for example.

  As shown in FIGS. 1 and 2, a display (image display unit) 42 is provided on the base end side of the main body 41.

  The display 42 is provided so as to be rotatable (displaceable) with respect to the main body 41 around the rotation mechanism 421. The display 42 has a rectangular plate shape, and includes, for example, a liquid crystal display element, an organic EL display element, and the like. In the present embodiment, the display 42 has a vertically long shape, but may have a horizontally long shape, for example.

  A first image captured by the imaging unit 37 of the scope 3 is displayed on the display 42.

  In addition, the display 42 includes, for example, a target mark for specifying the position of the glottal fissure, an indicator display indicating the remaining amount of battery (battery) of the power supply unit 412, a battery warning mark for warning battery replacement when the battery is exhausted, The elapsed time (intubation time) from the start of the intubation work may be displayed.

  As described above, the display 42 can be rotated with respect to the main body 41 by the rotation mechanism 421. Therefore, the display 42 can be directed in a desired direction according to the place where the intubation work is performed, the standing position of the subject, and the like. Therefore, the operator can easily see the image displayed on the display 42 regardless of the situation when performing the intubation work, and can easily and reliably perform the intubation work.

  The display 42 may be configured to be detachably attached to the main body 41. Further, the display 42 is not limited to the uniaxial direction, and may be rotatable in, for example, the biaxial direction and the triaxial direction.

  A connection terminal 422 for electrically connecting the scope 3 is provided on the rotation center axis of the rotation mechanism 421.

  Such an image display device 4 is electrically connected to the scope 3 by connecting the connection terminal 351 of the scope 3 to the connection terminal 422.

  In the medical instrument 100 as described above, as shown in FIG. 6, a control unit (circuit unit) 411 that controls the operation of the display 42 and the scope 3, and a control unit 411 inside the main body 41 of the image display device 4. And a power supply unit 412 for supplying power to each unit and an input / output unit (not shown).

  The control unit 411 includes an LED drive circuit (illumination drive circuit) that drives the white LED 341, a CCD drive circuit (image pickup device drive circuit) that drives the CCD 331, and an image that performs image processing on the image data output from the CCD 331. A processing circuit; an image display circuit for converting the image data output from the image processing circuit to display on the display 42; a storage unit (storage means) for storing the image data; a central processing circuit; .

  A battery is detachably installed in the power supply unit 412, and power is supplied from the power supply unit 412 to each unit such as a control unit. The main body 41 is provided with a lid (not shown), and the battery is opened and removed by opening the lid.

  In addition to the connection terminal 422, 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, And a memory terminal for image storage connected to a memory card (detachable memory device) such as an SD card or a CF card.

  As shown in FIG. 1, a switch 44 for switching the main power source is installed on the right side surface of the main body 41 in FIG. 1. By repeating the pressing operation of the switch 44, driving and stopping of each part (white LED 341, CCD 331, display 42, etc.) of the medical instrument 100 can be repeated.

  Further, a lid 413 is installed on the right side surface of the main body 41 in FIG. 2, and the connection to the external power input terminal, the external monitor output terminal and the memory terminal for image storage is performed on the lid 413, respectively. It is designed to be opened. Further, the lid 413 can be opened and closed only with a dedicated instrument so that the lid 413 cannot be opened and closed carelessly.

Next, an example of a usage method (action) of the medical device 100 will be described.
The medical instrument 100 is used, for example, when the subject loses consciousness and needs to perform an intubation operation for inserting the intubation tube 2 into the trachea.

  [1A] Prior to starting the intubation operation of the intubation tube 2, the medical instrument 100 is assembled.

  First, the connection terminal 351 of the scope 3 is inserted into the connection terminal 422 of the image display apparatus 4 to connect the scope 3 and the image display apparatus 4.

  Next, the scope insertion portion 31 of the scope 3 is inserted into the tube main body 21 of the intubation tube 2, and the intubation tube 2 is inserted into the guide hole 13 of the supraglottic device 1 in this state. At this time, as shown in FIG. 1, the distal end of the intubation tube 2 is positioned in the vicinity of the distal end portion (the distal end opening portion 132) of the body portion 11 of the supraglottic device 1, and the distal end of the scope insertion portion 31 is further inserted into the intubation tube 2. Let it be in a state of slightly projecting from the tip.

  However, it is preferable that the distal end portion of the scope insertion portion 31 (scope 3) is aligned with the distal end portion of the main body portion 11 or is positioned closer to the proximal end side than the distal end portion of the main body portion 11. Thereby, since the scope insertion part 31 and the tube main body 21 do not protrude from the supraglottic device 1, the scope insertion part 31 and the tube main body 21 become an obstacle in the operation for securing the airway in the next step [2A]. There is nothing.

  If necessary, for example, a suction tube or the like may be inserted into the through hole 14 of the main body 11 and installed.

  [2A] Next, the operator operates the switch 44 to drive each part of the medical instrument 100 (white LED 341, CCD 331, display 42, etc.). Accordingly, the first image by the scope 3 (CCD 331) is displayed on the display 42.

  Next, in a state where the supraglottic device 1, the intubation tube 2 and the scope insertion part 31 are collectively grasped, these are inserted from the tip toward the larynx via the mouth of the subject. Specifically, the opening 122 of the mask part 12 is positioned so as to face the epiglottis side of the subject, the intubation tube 2 and the scope insertion part 31 are grasped together with the main body part 11 of the supraglottic device 1, and the airway is defined. The supraglottic device 1 is inserted from the subject's mouth toward the larynx while keeping it along the organ.

  At this time, since the supraglottic device 1, the intubation tube 2 and the scope insertion portion 31 have flexibility, the tip of the supraglottic device 1 is naturally guided toward the larynx along the shape of the organ. Can be inserted.

  When the glottal device 1 is light transmissive, the inside of the oral cavity and the pharynx can be sequentially imaged by the CCD 331 via the main body 11 and the mask 12, and the display 42 The image can be displayed.

  [3A] Next, while confirming the first image, the supraglottic device 1, the intubation tube 2, and the scope insertion portion 31 are pushed forward. Accordingly, the tongue base and epiglottis are lifted by the mask portion 12, and the distal end portion of the mask portion 12 is inserted into the entrance portion of the subject's esophagus as shown in FIG. 7A, and the epiglottis is lifted by the proximal end portion. Maintain the state. Thereby, obstruction | occlusion of an airway can be cancelled | released.

  At this time, it is confirmed by the first image that the distal end portion of the mask portion 12 is inserted into the entrance portion of the esophagus.

  Next, when the distal end portion of the mask portion 12 is inserted into the entrance portion of the esophagus, the operator can finely adjust the position and orientation of the distal end portion of the mask portion 12 while confirming the first image. An operation to move 1 back and forth or an operation to rotate around the axis is performed. Thereby, the peripheral part 121 of the mask part 12 is made into the state (state shown to FIG. 7 (B)) closely_contact | adhered to the surrounding tissue of the larynx.

  At this time, since the distal end portion of the scope insertion portion 31 is positioned on the proximal end side with respect to the distal end portion (the distal end opening portion 132) of the main body portion 11, the peripheral portion 121 of the mask portion 12 and the surrounding tissue of the larynx. Can be confirmed in the first image by the scope 3 (CCD 331). As described above, if the first image confirms that the degree of adhesion between the peripheral portion 121 of the mask portion 12 and the surrounding tissue of the larynx is sufficient, the airway can be more reliably secured, In the next step [4A], the insertion operation of the scope insertion portion 31 into the glottis is facilitated.

  In addition, as described above, since the degree of adhesion between the peripheral portion 121 of the mask portion 12 and the surrounding tissue of the larynx can be confirmed in the first image, even though they are sufficiently adhered to each other. Therefore, there is no possibility that the operator further pushes the supraglottic device 1. That is, the operator can perform the insertion operation of the supraglottic device 1 while controlling the magnitude of the applied force. In this way, there is no need to apply unnecessary force to the supraglottic device 1 during the insertion operation, so that the flexible supraglottic device 1, the intubation tube 2, and the scope insertion portion 31 are unnecessary. It is also possible to suitably prevent bending (buckling).

  For this reason, according to the present invention, regardless of the skill level of the operator, the tip part (mask part 12) of the supraglottic device 1 can be easily and surely inserted into the place targeted by the subject. Can do.

  [4A] Next, when the airway obstruction is released by the supraglottic device 1, the scope insertion portion 31 is moved along the intubation tube 2 in the guide hole 13 while confirming the position of the glottic fissure in the first image. Push forward. As a result, the distal end portion of the scope insertion portion 31 reaches the glottic fissure (trachea) (see FIGS. 8A and 8B) and is inserted into the glottic fissure.

  Note that the guide hole 13 is formed so that the distal end portion of the scope insertion portion 31 and the intubation tube 2 naturally proceeds toward the glottic cleft, so that the distal end portion of the scope insertion portion 31 can be more reliably and securely moved to the glottic fissure. Can be easily guided and inserted further.

  Since the operation of inserting the distal end portion of the scope insertion portion 31 into the glottic fissure (trachea) can be performed while confirming the first image, it can be performed reliably and easily.

  [5A] Next, when the distal end portion of the scope insertion portion 31 is inserted into the trachea, the intubation tube 2 is pushed forward along the scope insertion portion 31 to protrude from the distal end (opening 122) of the supraglottic device 1 ( (See FIG. 9A). At this time, in the first image, the intubation tube 2 is advanced forward along the scope insertion portion 31 while confirming that the distal end portion of the scope insertion portion 31 is located in the trachea (FIG. 9B). )reference). Thereby, the front-end | tip part of the intubation tube 2 can be easily, rapidly and reliably inserted in a trachea through a glottic fissure.

  At this time, the operator confirms the distal end portion of the intubation tube 2 protruding beyond the distal end portion of the scope insertion portion 31 in the first image, so that the distal end portion of the intubation tube 2 is inserted into the trachea. Can be understood.

  [6A] Next, while confirming the first image, the distal end portion of the scope insertion portion 31 is further advanced to the back of the trachea to reach the bifurcation portion of the left bronchus and the right bronchus (FIG. 10 ( (See A) and (B)). In this way, since the branching portion is displayed on the display 42, it is possible to reliably advance toward the bronchi aiming at the distal end portion of the scope insertion portion 31.

  [7A] Next, while confirming the first image, the distal end portion of the scope insertion portion 31 is inserted into the target bronchus (for example, the left bronchus) (see FIG. 11A).

  Thereafter, the intubation tube 2 is moved forward along the scope insertion portion 31. At this time, in the first image, the intubation tube 2 is advanced forward along the scope insertion portion 31 while confirming that the distal end portion of the scope insertion portion 31 is located in the target bronchus (see FIG. 11 (B)). Thereby, the intubation tube 2 can be easily, quickly and reliably inserted into the target bronchus.

In addition, the operator confirms the distal end portion of the intubation tube 2 protruding beyond the distal end portion of the scope insertion portion 31 in the first image, so that the distal end portion of the intubation tube 2 is inserted into the left bronchus. Can be understood. Thereby, the intubation tube 2 can be easily, quickly and reliably inserted into the target bronchus.
Note that the step [7A] may be omitted as necessary.

  By the way, normally, when a child or the like having a relatively short distance from the glottis to the bronchial bifurcation is a subject, the intubation tube 2 (especially its distal end) is positioned at an appropriate position in the trachea after the intubation tube 2 is intubated. It may be confirmed by chest X-ray imaging or the like that it is inserted (arranged) in the chest. This is because it is difficult to grasp whether the intubation tube 2 is reliably located in the target trachea, bronchus or the like because there are individual differences in the growth of children and the like. On the other hand, if the medical instrument 100 including the scope 3 as described above is used, the insertion depth of the intubation tube 2 into the trachea (bronchi) can be easily grasped without using chest X-ray photography or the like. Can contribute to the improvement of safety.

  As described above, the scope insertion portion 31 functions as a stylet (guide) for the intubation tube 2 so that the intubation tube 2 can be easily and reliably inserted toward the target trachea or bronchus (left bronchus or right bronchus). can do. Further, since the scope gripping portion 32 of the scope 3 is provided with the convex portion 321, the operator can grasp the rotation angle of the scope insertion portion 31 during the intubation work. Therefore, the relationship between the direction of the first image displayed on the display 42 (vertical direction or horizontal direction) and the longitudinal direction of the subject can be easily grasped, and the scope 3 can be used for the target trachea or bronchus. Can be securely inserted.

  [8A] Next, the trachea seal pilot balloon 231 shown in FIG. 4 is operated to inflate the trachea seal cuff 23 to fix the intubation tube 2 to the trachea. Thereafter, the scope insertion portion 31 is removed from the intubation tube 2.

  [9A] Next, with the intubation tube 2 fixed to the trachea, the supraglottic device 1 is removed from the mouth of the subject.

  As described above, the airway of the subject can be secured and the intubation tube 2 can be intubated into the target trachea or bronchus of the subject.

  As described above, according to the medical instrument 100, since the scope 3 is provided, the operator can, for example, view the distal end portion of the supraglottic device 1 or the pharynx of the subject in the image by the scope 3. Can observe the larynx, trachea, bronchi, etc. By performing the operation while confirming this image, the mask portion 12 of the supraglottic device 1 can be reliably brought into close contact with the surrounding tissue of the subject's larynx, and the scope insertion portion 31 is further connected to the trachea and further to the target. It can be easily and reliably inserted into the bronchi. As a result, the intubation work of the intubation tube 2 can be performed easily and reliably.

  Further, when the scope insertion unit 31 is inserted into the trachea through the glottis, as shown in FIG. 10B and FIG. In the inner trachea, the bifurcation between the left bronchus and the right bronchus can be confirmed. Therefore, it is possible to avoid accidentally inserting the scope insertion unit 31 into the right bronchus when the scope insertion unit 31 has to be inserted into the left bronchus, for example. Then, by pushing the intubation tube 2 along the scope insertion portion 31, the intubation tube 2 can be reliably intubated into the target bronchus via the glottis and trachea.

  As described above, by using the medical instrument 100, it is possible to reliably and safely intubate at a position where the intubation tube 2 is aimed even if the practitioner is less skilled.

  In addition, according to the medical instrument 100, the supraglottic device 1, the scope 3, and the image display device 4 can be assembled and disassembled, so that the supraglottic device 1, the intubation tube 2, and the scope 3 are attached each time it is used. Can be exchanged. For this reason, the infection (secondary infection) by the test subject's bacteria etc. can be prevented, and safety is high. Furthermore, by making these disposable, there is no need to perform cleaning, disinfection, sterilization, etc., and labor can be reduced. Also from this viewpoint, infection (secondary infection) due to bacteria of the subject can be prevented, and safety is high.

  Moreover, since the main gland part 11 has the guide hole 13 which guides the scope insertion part 31 and the intubation tube 2, the supraglottic device 1 inserts the scope insertion part 31 into the trachea and bronchus, that is, intubation of the intubation tube 2. Work can be performed easily and reliably. In particular, since the scope insertion portion 31 and the intubation tube 2 can be guided by the guide hole 13, it is not necessary to bend the subject's cervical vertebra to project the jaw during the intubation operation. The intubation operation can be easily and reliably performed on a subject who has contusioned the cervical spine (a subject having a difficult intubation case).

  Moreover, according to the medical instrument 100, the time required for intubation work can be shortened, and the burden on the subject can be reduced.

  In the present embodiment, the scope insertion portion 31 of the scope 3 is inserted into the intubation tube 2 and the intubation tube 2 is inserted into the guide hole 13 of the supraglottic device 1, that is, the scope 3 and the intubation tube 2 An example in which the medical instrument 100 is used in a state in which these are combined in advance has been described. However, this is only an example, and the medical instrument 100 first sets the scope insertion portion 31 alone into the guide hole 13 and slides it in the distal direction along the guide hole 13 to move the scope insertion portion 31 to the target. After insertion into the trachea or bronchus, the intubation tube 2 can be inserted into the guide hole 13 and can be used by sliding in the distal direction along the scope insertion portion 31 in the state of being inserted into the guide hole 13. . Even in this way, the intubation tube 2 can be reliably inserted into the target trachea or bronchus.

  In addition, the medical device 100 may not be used in combination with the intubation tube 2, but may be used simply to insert the scope insertion portion 31 into a predetermined part (eg, trachea, bronchus, nasal cavity, esophagus) of the subject. Good.

Second Embodiment
FIG. 12 is a diagram schematically showing a state where the distal end portion of the supraglottic device is inserted into the entrance portion of the esophagus.

  Hereinafter, the medical device 100 of the second embodiment will be described focusing on the differences from the first embodiment, and the description of the same matters will be omitted.

  The second embodiment is the same as the first embodiment except that the configuration of the medical device 100 is different.

  A medical instrument 100 shown in FIG. 12 includes an intubation tube 2 and a scope 3. In FIG. 12, the image display device 4 connected to the scope 3 is omitted.

  Moreover, the medical device 100 can be used in combination with the separately prepared glottic device 1.

  Below, an example of the usage method (action | operation) of the medical instrument 100 combined with the supraglottic device 1 is demonstrated.

  The second embodiment is the same as the first embodiment except that the operations in the steps [1A] and [2A] of the first embodiment are different.

  [1B] Prior to starting the intubation operation of the intubation tube 2, the medical instrument 100 is assembled.

  First, the connection terminal 351 of the scope 3 is inserted into the connection terminal 422 of the image display apparatus 4 to connect the scope 3 and the image display apparatus 4.

  Next, the scope insertion portion 31 of the scope 3 is inserted into the tube body 21 of the intubation tube 2. At this time, the distal end of the scope insertion portion 31 is positioned near the distal end portion of the tube main body 21.

  [2B] Next, as shown in FIG. 12, the supraglottic device 1 is grasped, and the supraglottic device 1 is inserted from its tip toward the larynx through the mouth of the subject.

  Next, the operator operates the switch 44 to drive each part of the medical instrument 100 (white LED 341, CCD 331, display 42, etc.). Accordingly, the first image by the scope 3 (CCD 331) is displayed on the display 42.

  Next, the tube body 21 in which the scope insertion portion 31 is inserted is inserted into the guide hole 13 of the supraglottic device 1. At this time, while confirming the first image, the tube body 21 is pushed along the guide hole 13, and the distal end portion of the scope insertion portion 31 (scope 3) is aligned with the distal end portion of the body portion 11 (supraglottic device 1). Or it is set as the state located in the base end side rather than the front-end | tip part of the main-body part 11. FIG.

  Thereafter, in the same manner as in the step [3A], the operator pushes the supraglottic device 1, the intubation tube 2, and the scope insertion portion 31 while confirming the first image, and releases the airway obstruction.

  As described above, by using the medical instrument 100, in the present embodiment as well, as in the first embodiment, even if the skill level of the practitioner is low, the distal end portion (mask portion 12) of the supraglottic device 1 can be used. It can be easily and surely inserted into the location targeted by the subject.

<Third Embodiment>
FIG. 13 is a perspective view of the medical device 100 according to the third embodiment viewed from the front side, and FIG. 14 displays an image when the distal end portion of the supraglottic device 1 shown in FIG. 13 is inserted into the entrance portion of the esophagus. FIG. 15 is a diagram of a display screen displayed on the image display unit when the distal end of the scope insertion unit shown in FIG. 13 is advanced to the vicinity of the glottis. These are figures of the display screen displayed on an image display part, when the front-end | tip part of the scope insertion part shown in FIG. 13 is advanced behind a glottis.

  Hereinafter, the medical device 100 according to the third embodiment will be described with a focus on differences from the first embodiment, and description of similar matters will be omitted.

  The third embodiment is the same as the first embodiment except that the device device 51 and the device illumination unit 52 are provided in the glottic device 1 and that the configuration of the image display device 4 is different.

  The glottic device 1 shown in FIG. 13 is provided with device imaging means 51 and device illumination means 52 and a connecting pipe 53 that connects them to the image display device 4.

  The device imaging means 51 and the device illumination means 52 are fixed to the inner wall on the proximal end side of the mask portion 12 and arranged so as to image and illuminate the distal end portion of the mask portion 12.

  The device imaging unit 51 has the same configuration as the scope imaging unit 33 included in the scope 3. That is, the device imaging unit 51 includes an imaging unit (second imaging unit 511) including a CCD, an objective lens, and a window unit, and an image signal cable connected to the CCD.

  The device illumination unit 52 has the same configuration as the scope illumination unit 34 included in the scope 3. That is, the device illumination means 52 has an illumination part (second illumination part 521) including a white LED, an illumination lens, and a window part, and an illumination signal cable connected to the white LED.

  An image signal cable of the device imaging means 51 and an illumination signal cable of the device illumination means 52 are disposed inside the base end side of the main body 11, and a connection pipe having a connection terminal 531 for connecting them to the image display device 4. 53 is provided.

  By connecting the connection terminal 531 to the connection terminal 414 exposed by removing the lid 413 of the image display device 4, the device imaging unit 51, the device illumination unit 52, and the image display device 4 are electrically connected. be able to. The installation positions of the connection terminal 414 and the switch 44 are not limited to the illustrated positions, and may be provided at any place. For example, in FIG. 13, the connection terminal 414 is provided on the surface (right side surface) where the switch 44 of the main body 41 is located, but the surface opposite to the surface where the switch 44 of the main body portion 41 is located (left side surface). ) May be provided.

  An image (second image) captured by such a device imaging means 51 (CCD) is displayed on the display 42 provided in the image display device 4. For this reason, the second image captured by the device imaging unit 51 and the first image captured by the scope 3 are displayed on the display 42. The display 42 may be configured to display the first image and the second image simultaneously, or may be configured to display alternately. Further, when displaying the first image and the second image at the same time, a method in which the other image is displayed so as to be superimposed on either one of the first image and the second image, so-called a so-called method. A picture-in-picture method may be adopted.

  Further, an operation button (display switching means) 43 for switching the image display mode as described above is provided at the lower right corner of the display 42 in FIG. When the operator presses the operation button 43, the display mode of the screen displayed on the display 42 can be changed. When the display 42 is a touch panel system, the operation button 43 can be configured to be displayed as an image on the display 42.

  Next, the usage method (action) of the medical instrument 100 of the third embodiment having such a configuration will be described focusing on differences from the first embodiment.

  In the third embodiment, in steps [2A] to [5A] of the first embodiment, the operator presses the operation button 43 to perform the intubation work while switching the screen displayed on the display 42.

  [2C] The operator turns on the power of the medical instrument 100. Thereby, the second image captured by the device imaging unit 51 (CCD) is displayed on the display 42.

  Next, the operator inserts the supraglottic device 1 from the subject's mouth toward the larynx in the same manner as in the step [2A].

  [3C] In the same manner as in the above [3A], the operator pushes the supraglottic device 1 and causes the mask portion 12 to reach the entrance portion of the subject's esophagus (see FIG. 7A). This releases the subject's airway obstruction. In this case, the display 42 is in the second mode in which only the second image by the device imaging means 51 (CCD) is displayed (see FIG. 14). The operator can confirm that the distal end portion of the mask portion 12 is inserted into the entrance portion of the esophagus by confirming the second image.

  Next, the operator finely adjusts the position and orientation of the mask portion 12 in the same manner as in the step [3A]. At this time, the degree of close contact between the peripheral portion 121 of the mask portion 12 and the surrounding tissue of the larynx is confirmed by the second image by the device imaging means 51.

  [4C] In the same manner as in the above [4A], the operator pushes the distal end portion of the scope insertion portion 31 along the intubation tube 2 of the guide hole 13 (see FIG. 8A) and inserts it into the glottic fissure. To do. At this time, the position of the glottic fissure and the position of the distal end portion of the scope insertion portion 31 can be confirmed on the second image by the device imaging means 51 (see FIG. 15). Can be guided more securely into the glottis and inserted further.

  Next, when the distal end portion of the scope insertion portion 31 is inserted into the glottis, the operator presses the operation button 43 to change the display mode of the display 42 from the second display mode that displays only the second image. Switch to the third display mode in which both the second image and the first image by the scope 3 are displayed simultaneously (see FIG. 16). Thereby, the operator confirms that the distal end portion of the scope insertion portion 31 is inserted into the glottic fissure in the second image. In the first image, it can be confirmed that the distal end portion of the scope insertion portion 31 is located in the trachea.

  [5C] In the same manner as in the above [5A], the operator pushes the intubation tube 2 forward along the scope insertion portion 31 (see FIG. 9A). At this time, the distal end portion of the intubation tube 2 is inserted into the glottic fissure in the first image while confirming that the distal end portion of the scope insertion portion 31 is located in the trachea in the second image. Make sure to go. Thereby, the intubation tube 2 can be easily, quickly and reliably inserted into the trachea.

  [6C] Next, when the distal end portion of the intubation tube 2 is inserted into the trachea, the operator presses the operation button 43 to display the display mode of the display 42 from the third display mode and display only the first image. Switch to the first mode (see FIG. 10B).

  Thereafter, while confirming the first image in the same manner as in the step [6A], the distal end portion of the scope insertion portion 31 is made to reach the branch portion between the left bronchus and the right bronchus (see FIG. 10A). .

  As described above, since the device imaging unit 51 is provided, the operator observes the scope insertion unit 31 in the second image together with the vicinity of the subject's larynx and the tip of the supraglottic device 1. can do. Therefore, the operator can grasp the positional relationship between the glottis and the distal end portion of the scope insertion portion 31 as shown in FIG. Thereby, the scope insertion part 31 can be easily and reliably inserted into the glottis, for example.

  Further, since both the second image by the device imaging means 51 and the first image by the scope 3 can be displayed on the display 42 at the same time, as shown in FIG. While confirming that the distal end portion is inserted into the glottic fissure, it is possible to confirm from the first image that the distal end portion of the scope insertion portion 31 is located in the trachea. For this reason, as a result, the intubation work of the intubation tube 2 can be performed easily and reliably.

  In the present embodiment, the device imaging unit 51 and the device illumination unit 52 are configured to be disposed on the inner surface on the proximal end side of the mask unit 12 so as to face the distal end side. However, for example, at the distal end of the mask unit 12 It may be configured to face the front end side, or may be configured to face the opening 122 on the inner surface of the bottom of the mask portion 12.

<Fourth embodiment>
FIG. 17 is a view (a) is a front view, (b) is a top view, and (c) is a longitudinal sectional view) showing a distal end portion of a scope insertion portion provided in the medical instrument of the fourth embodiment.

  Hereinafter, the medical instrument of the fourth embodiment will be described focusing on the differences from the first embodiment, and the description of the same matters will be omitted.

  The fourth embodiment is the same as the first embodiment except that the configuration of the distal end portion of the scope insertion portion 31 is different.

  A scope insertion portion 31 shown in FIG. 17 has a changing portion 36 at the tip thereof. This change part 36 is a cylindrical part integrally formed with the tube body 311 of the scope insertion part 31, and a notch part 361 that opens to the side is formed. In the longitudinal section, the notch 361 has a wedge shape that has a maximum depth in the vicinity of the objective lens 332 and the illumination lens 342 and gradually decreases toward the tip. Thereby, the changing unit 36 has an inclined surface 362 that faces the objective lens 332 and the illumination lens 342.

  A metal film 363 is formed on the inclined surface 362 by, for example, vapor deposition. The metal film 363 reflects light that enters the objective lens 332 (CCD 331) (reflected light from a predetermined portion of the subject) and light (illumination light) emitted from the illumination lens 342 (white LED 341). Make up surface.

  By having the change part 36 of such a structure, the scope 3 can observe the side. That is, the changing unit 36 functions to change the viewing direction of the CCD 331 (imaging unit 37).

  In the present embodiment, the angle θ formed by the metal film 363 and the central axis of the scope insertion portion 31 is less than 45 °, so that an oblique front in the traveling direction of the scope 3 can be imaged (viewed). Yes. Such a scope 3 can image the entire circumferential direction by rotating the scope insertion portion 31 around its central axis.

  The angle θ1 formed between the metal film 363 and the central axis of the scope insertion portion 31 can be appropriately set according to the purpose of use of the scope 3 and is not particularly limited, but is preferably about 5 to 60 °. More preferably, it is about 15 to 45 °.

  Further, since the changing portion 36 has the notch portion 361, the rigidity (flexibility) of the distal end portion of the scope insertion portion 31 can be made anisotropic. Specifically, the rigidity on the side where the notch 361 is opened is lower than the rigidity on the opposite side. For this reason, it is easy to bend or curve the changing portion 36 toward the side where the notch 361 opens with respect to the central axis of the scope insertion portion 31.

  Therefore, for example, when the scope insertion unit 31 is inserted into the left bronchus, the left bronchus can be visually recognized after the distal end portion (change unit 36) of the scope insertion unit 31 reaches the vicinity of the bifurcation between the left bronchus and the right bronchus. That is, the side where the notch 361 is opened is directed to the left bronchus. In this state, if the scope insertion part 31 is advanced forward and its tip part is brought into contact with the branch part, it can be bent or curved naturally to the left bronchus side. In this way, the distal end portion of the scope insertion portion 31 can be easily inserted into the left bronchus.

  Note that the notch 361 may be filled with, for example, a resin material having optical transparency.

<Fifth Embodiment>
FIG. 18 is a perspective view of the supraglottic device provided in the medical instrument of the fifth embodiment as seen from the front side.

  Hereinafter, the medical device 100 according to the fifth embodiment will be described with a focus on differences from the first embodiment, and description of similar matters will be omitted.

  The fifth embodiment is the same as the first embodiment except that the configuration of the tip portion of the supraglottic device 1 is different.

  The supraglottic device 1 shown in FIG. 18 has a cuff 15 provided on the mask portion 12 along the peripheral portion 121, and a pilot balloon 16 connected to the cuff 15.

  For example, the cuff 15 has an inner peripheral portion of an annular (ring-shaped) elastic film fixed to the inner surface of the peripheral portion 121 of the mask portion 12, covers the peripheral portion 121, and the outer peripheral portion is fixed to the outer surface of the peripheral portion 121. It is formed by doing. As a result, an annular space is defined in the cuff 15 and its volume is variable. Examples of the method for fixing the elastic film to the mask portion 12 include adhesion with an adhesive or the like, fusion with heat, and the like. The elastic film is made of a material such as a thermoplastic elastomer or rubber.

  Such a cuff 15 expands when a working fluid (for example, medical oxygen) is supplied to the inside by a pilot balloon 16 described below, and contracts when the working fluid is discharged from the inside. To do.

  The pilot balloon 16 is connected to the proximal end side of the cuff 15 via a tubular connection portion 161. The pilot balloon 16 is a hollow body having a substantially cylindrical shape, and is made of, for example, a material such as a thermoplastic elastomer or rubber. A one-way valve (not shown) is provided inside the pilot balloon 16. This one-way valve has a function of allowing the working fluid to flow into the cuff 15 but preventing the working fluid from flowing out of the expanded cuff 15. Therefore, by connecting a syringe or the like to the pilot balloon 16 and press-fitting the working fluid, the working fluid is supplied into the cuff 15 via the connecting portion 161, and the cuff 15 is inflated and maintains its state.

  In the step [1A], the working fluid in the cuff 15 is discharged by the pilot balloon 16, and the cuff 15 is contracted. In step [3A], when it is confirmed that the tip of the mask 12 has reached the entrance of the esophagus, the working fluid is supplied into the cuff 15 by the pilot balloon 16. At this time, the state where the working fluid is supplied into the cuff 15, that is, the state where the cuff 15 swells can be confirmed on the screen displayed on the display 42. In this manner, the working fluid is supplied, the cuff 15 is expanded, and the outer peripheral portion 151 is brought into close contact with the surrounding tissue of the larynx.

At this time, the degree of close contact between the outer peripheral portion 151 of the cuff 15 and the surrounding tissue of the larynx may be confirmed on the screen displayed on the display 42.
In the present embodiment, the cuff 15 is provided on the entire circumference of the peripheral edge 121, but may be provided only on a part of the peripheral edge 121, for example. The cuff 15 may be formed by fixing an annular (ring-shaped) tube to the peripheral portion 121.

<Sixth Embodiment>
FIG. 19 is a perspective view of the medical device of the sixth embodiment viewed from the front side, and FIG. 20 is a view of the laryngoscope blade shown in FIG. 19 viewed from the arrow B side (partially cut away). ((A) is a front view, (b) is a top view), FIG. 21 is a diagram schematically showing a state in which the laryngoscope blade shown in FIG. 19 is inserted into the larynx, and an image at that time FIG. 22 is a diagram of a display screen displayed on the display unit, and FIG. 22 is a diagram schematically showing a state in which the nasal intubation tube shown in FIG. 19 is advanced to the vicinity of the epiglottis, and is displayed on the image display unit at that time. FIG. 23 is a diagram schematically showing a state in which the nasal intubation tube shown in FIG. 19 is advanced from the vicinity of the glottis, and a display displayed on the image display unit at that time It is a figure of a screen.

  Hereinafter, the medical device 100 of the sixth embodiment will be described focusing on differences from the first embodiment and the third embodiment, and the description of the same matters will be omitted.

  The sixth embodiment is the same as the first embodiment and the third embodiment except that the nasal intubation tube 7 is provided instead of the supraglottic device 1 and the configuration of the image display device 4 is different. .

  As shown in FIG. 19, the nasal intubation tube 7 includes a main body 71 and a tracheal sealing cuff 73 provided on the distal end side of the main body 71. This nasal intubation tube 7 is inserted, for example, from the nose of a subject who has impaired consciousness or a subject who has undergone general anesthesia, and is inserted into the trachea or bronchi of the subject. Thereby, the state which ensured the airway of the subject is maintained.

  The main body 71 is composed of a long tubular member, and its cross-sectional shape is substantially circular. The main body 71 has flexibility by being made of a material such as soft resin, elastomer, or rubber. Thereby, when inserting the nasal intubation tube 7 from a subject's nostril (nasal cavity), the main-body part 71 can deform | transform according to the shape etc. of the organ which prescribes | regulates a subject's airway. Therefore, the nasal intubation tube 7 (main body portion 71) can be easily and safely inserted up to the intended location (part) of the subject.

  The nasal intubation tube 7 is used in a state where the scope insertion portion 31 is inserted into the main body 71 having such a configuration. Here, when the inner diameter of the main body 71 is X [mm] and the outer diameter of the scope insertion portion 31 is Y [mm], it is preferable that the relationship 1.2 ≦ X / Y ≦ 10.0 is satisfied. More preferably, the relationship of 1.5 ≦ X / Y ≦ 8.0 is satisfied. Thereby, the scope insertion part 31 can be smoothly slid and rotated with respect to the main body part 71.

  Moreover, it is preferable that the main-body part 71 is about 300-360 mm in length (full length), and the largest internal diameter (the outer diameter of the part in which the cuff 73 for tracheal sealing at the time of shrinkage | contraction was provided) is 6-8 mm. It is preferable that it is 6-7 mm.

  As shown in FIG. 19, a tracheal seal pilot balloon 731 connected to the tracheal seal cuff 73 is provided on the proximal end side of the main body 71.

  A ventilator is connected to the proximal end opening 713 of the main body 71 after the scope 3 is removed (not shown).

  In the image display device 4 shown in FIG. 19, a laryngoscope blade (insertion unit) 8 and an image acquisition unit 9 are detachably connected to the distal end side of the main body 41 instead of a support member.

  A laryngoscope blade (hereinafter also simply referred to as “blade”) 8 includes a long blade body 81, a groove 82 formed to open (open) on the side surface thereof, And a tongue piece (protruding portion) 83 that protrudes from the tip toward the tip. The blade 8 is inserted from the subject's mouth and lifts the epiglottis of the subject with the tongue piece 83 while bringing a predetermined portion of the blade body 81 into contact with the tongue base portion of the subject. Secure the examiner's airway.

  The blade body 81 has a curved portion 813 that is curved in the middle of its longitudinal direction (axial direction), and the angle formed by the proximal end side and the distal end side is approximately 90 °. The blade body 81 as a whole may have light transmission properties, or only necessary portions may have light transmission properties.

  In addition, the length (full length) of the central axis of the blade body 81 is preferably about 150 to 170 mm for adults, and preferably about 115 to 135 mm for children. In the case of a newborn, it is preferably about 110 to 130 mm.

  As shown in FIG. 19, a groove 82 is formed on the side surface of the blade body 81 from the center in the longitudinal direction to the tip. In the groove 82, for example, a suction tube or the like can be slidably held along the longitudinal direction of the blade body 81 (blade 8). The cross-sectional shape of the groove 82 is substantially U-shaped, but may be, for example, U-shaped or semicircular.

  In addition, a pair of tube holders 84 a and 84 b are formed on the side surface of the blade body 81 so as to protrude from the groove 82 toward the base end side.

  A tongue piece (protrusion) 83 provided at the tip of the blade body 81 has a plate shape and is light transmissive. Each corner of the tongue piece 83 is rounded (R-attached). The tongue piece 83 has a substantially quadrangular shape in plan view, but may be, for example, semi-elliptical or semi-circular.

  As shown in FIG. 20, a guide hole 86 and a through hole 85 are formed in the blade body 81 along the longitudinal direction thereof.

  The distal end of the through hole 85 is open to the tongue piece 83 side at the center of the blade body 81 in the width direction, and the proximal end of the through hole 85 is open to a position on the groove 82 side. The through hole 85 has a substantially circular cross-sectional shape.

  Further, the guide hole 86 is unevenly distributed on the right side in FIG. 20 in the width direction (short direction) of the tongue piece 83, and the distal end side thereof is bent (curved) toward the groove 82 side. The guide hole 86 has a substantially circular cross-sectional shape and is open (opened) at the base end of the blade body 81. In addition, a blocking portion 87 having a light transmitting property is provided at the distal end portion of the guide hole 86 (the distal end portion of the blade body 81).

  The image acquisition unit 9 is inserted into the guide hole 86 of the blade 8. The image acquisition unit 9 is inserted into the guide hole 86, and the distal end portion thereof is positioned in the vicinity of the closing portion 87, and the proximal end portion thereof is electrically connected to the image display device 4.

  The image acquisition unit 9 is made of, for example, a material such as resin, elastomer, rubber, and has a long tube body 91 having flexibility, and an imaging unit 92 and an illumination unit 93 provided in the tube body 91. Have.

  The imaging unit 92 has the same configuration as the scope imaging unit 33 included in the scope 3 described above. That is, as shown in FIG. 20, the imaging means 92 includes an imaging unit (second imaging unit 95) including a CCD 921, an objective lens 922, and a window 923, and an image signal cable 924 connected to the CCD 921. doing.

  The illumination means 93 has the same configuration as the scope illumination means 34 included in the scope 3 described above. That is, an illumination unit (second illumination unit 96) including a white LED 931, an illumination lens 932, and a window portion 933, and an illumination signal cable 934 are provided.

  The image (second image) captured by the image acquisition unit 9 (CCD) is displayed on the display 42 provided in the image display device 4.

  Next, the usage method (action) of the medical device 100 of the sixth embodiment having such a configuration will be described focusing on differences from the first embodiment and the third embodiment.

  [1D] When the nasal intubation tube 7 is inserted, the medical instrument 100 is assembled.

  First, the connector of the image acquisition unit 9 is connected to the connector of the image display device 4. As a result, the image acquisition unit 9 is connected to the image display device 4.

  Next, the image acquisition unit 9 is inserted into the guide hole 86 of the blade 8 and the blade 8 is attached to the image display device 4.

  Next, the connection terminal 351 of the scope 3 is inserted into the connection terminal 422 of the image display apparatus 4 to connect the scope 3 and the image display apparatus 4. Further, the scope insertion portion 31 of the scope 3 is inserted into the main body portion 71 of the nasal intubation tube 7. At this time, the distal end of the scope insertion portion 31 is further slightly protruded from the distal end of the nasal intubation tube 7.

  [2D] Next, the operator presses the switch 44 of the medical instrument 100 to turn on the power. Thereby, the second image captured by the image acquisition unit 9 (CCD 921) is displayed on the display 42.

  Next, the operator inserts the blade 8 from the tip through the subject's mouth toward the larynx (see FIG. 21A). Specifically, the blade 8 is inserted from the mouth of the subject toward the larynx while keeping the right side of the blade body 81 in FIG. 19 along the tongue.

  Then, while confirming the second image displayed on the display 42, the epiglottis (predetermined part) of the subject is lifted by the tongue piece (tip part) 83 of the blade 8, and the tip part of the blade body 81 is Lift the tongue base of the subject. This releases the airway obstruction. At this time, the display 42 is in the second display mode in which only the second image is displayed by the image acquisition unit 9 (CCD 921) (see FIG. 21B).

  [3D] Next, when the distal end portion of the blade 8 releases the airway obstruction, the body portion 71 and the scope insertion portion 31 of the nasal intubation tube 7 are grasped in a lump, and these are attached to the subject's nose. The tip is inserted from the hole, and the tip of the tip reaches the pharynx (near the glottis) (see FIG. 22A). At this time, the position of the distal end portion of the main body 71 and the distal end portion of the scope insertion portion 31 is confirmed while confirming the position of the glottic fissure in the second image by the image acquisition unit 9 (see FIG. 22B). ). Thereby, the operator can confirm that the front-end | tip part of the main-body part 71 and the front-end | tip part of the scope insertion part 31 are located in the vicinity of the glottis fissure.

  Thus, in the second image, since the positional relationship between the glottal crevice and the distal end portion of the main body 71 and the distal end portion of the scope insertion portion 31 can be confirmed, the operator erroneously performs these. , Can be prevented from being inserted into the entrance portion of the esophagus. For this reason, regardless of the skill level of the operator, the distal end portion of the scope insertion portion 31 can be easily and reliably inserted into the trachea of the subject.

  In the above-described operation of causing the distal end portion of the nasal intubation tube 7 to reach the vicinity of the glottic fissure, the nasal intubation tube 7 is made while the distal end portion of the nasal intubation tube 7 is along the groove 82 of the blade body 81. 7 may reach the glottis. By pushing the nasal intubation tube 7 along the groove 82 in this way, the distal end portion of the nasal intubation tube 7 can be more reliably and more easily reached near the glottis fissure.

  [4D] Next, when the distal end portion of the scope insertion portion 31 reaches the glottis fissure, the distal end portion of the scope insertion portion 31 is inserted into the glottis fissure while confirming the second image (FIG. 23A). reference).

  When the distal end portion of the scope insertion portion 31 is inserted into the glottis, the operation button 43 is pressed, and the display mode of the display 42 is changed from the second display mode in which only the second image is displayed to the second image and the second image. The display mode is switched to the third display mode for displaying both of the first image (see FIG. 23B). Thereby, the operator confirms that the distal end portion of the scope insertion portion 31 is inserted in the back of the glottic fissure in the second image, and the scope insertion portion 31 in the trachea in the first image. It can be confirmed that the tip of the is located.

  [5D] Next, when the distal end portion of the scope insertion portion 31 is inserted into the trachea, the operator moves the main body portion 71 of the nasal intubation tube 7 along the scope insertion portion 31 while confirming the second image. And push forward. At this time, the distal end portion of the scope insertion portion 31 is inserted into the glottic fissure in the first image while confirming that the distal end portion of the scope insertion portion 31 is located in the trachea in the second image. Make sure to go. Thereby, the nasal intubation tube 7 can be easily and quickly and reliably inserted into the trachea.

  [6D] Next, when the distal end portion of the nasal intubation tube 7 is inserted into the trachea, the operator presses the operation button 43 to change the display mode of the display 42 from the third display mode to the first image only. Is switched to the first display mode.

  Next, the operator pushes the distal end portion of the scope insertion part 31 further forward while confirming the first image in the same manner as in the step [6A], and reaches the branching portion between the left bronchus and the right bronchus. (See FIGS. 10A and 10B).

[7D] Next, in the same manner as in the above [7A], while confirming the first image, the distal end portion of the scope insertion portion 31 is inserted into the target bronchus (for example, the left bronchus), and then The nasal intubation tube 7 is moved forward along the scope insertion portion 31 (see FIGS. 11A and 11B).
Note that the step [7D] can be omitted if necessary.

  [8D] Next, in the same manner as in the above [8A], the tracheal seal pilot balloon 231 shown in FIG. 19 is operated to inflate the trachea seal cuff 23. Thereby, the intubation tube 2 is fixed to the trachea.

  Thereafter, the scope insertion portion 31 is removed from the nasal intubation tube 7 and the insertion portion 8 is removed from the subject's mouth.

  As described above, the airway of the subject can be secured, and the nasal intubation tube 7 can be intubated into the target trachea or bronchus of the subject.

  As described above, according to the medical instrument 100, since the image acquisition unit 9 is provided, the operator can, for example, perform the glottal cleft that is the entrance of the trachea and the main body 71 of the nasal intubation tube 7. The positional relationship between the distal end portion and the distal end portion of the scope insertion portion 31 can be grasped. Thereby, for example, as shown in FIG. 22 (B), the operator reliably advances the nasal intubation tube 7 and the scope 3 to the glottic fissure while confirming the position of the glottic fissure which is the entrance portion of the trachea. I can go.

  As mentioned above, although the medical instrument of this invention was demonstrated about embodiment of illustration, this invention is not limited to these, Each part which comprises a medical instrument is a thing of arbitrary structures which can exhibit the same function. Can be substituted. Moreover, arbitrary components may be added.

  For example, in the present invention, any configurations of the first to sixth embodiments may be combined.

  Further, the image display device and the scope may be connected not by wire but by radio.

  Furthermore, the image display device may include an electronic data transmission device that transmits the image data to a hospital that is a transport destination of the subject via a wireless communication network. Accordingly, preparation for treatment of the subject can be performed in the hospital while the subject is being transported by an ambulance or the like.

  Further, a marker such as a symbol, a character, or a figure indicating a rotation angle around the scope axis may be formed on the display (image display unit) as a part of the first image (electronic image), or the imaging unit 37. A symbol or the like indicating a rotation angle around the scope axis may be formed on the base end surface of the window portion 333 by printing or the like, and this may be captured on the first screen.

  Further, the scope may be provided with an operation mechanism for rotating the distal end portion of the scope insertion portion at 360 °. As such an operation mechanism, a mechanism generally used in an endoscope can be employed. In this case, the scope holding unit is provided with an operation unit (operation knob, operation lever). Therefore, this operation unit may be used as a marker for grasping the rotation angle around the axis of the scope insertion unit.

  The use of the medical instrument is not limited to securing the airway (used when inserting an intubation tube into the subject's trachea). That is, the blade of the apparatus body is inserted from the mouth or nose of the subject into a predetermined part of the subject or in the vicinity thereof, but the part is not limited to the glottis, trachea, bronchi, It may be an esophagus.

  In the above-described embodiment, the CCD is used as the moving camera and the second imaging unit included in the scope imaging unit, but a CMOS or the like may be used.

DESCRIPTION OF SYMBOLS 100: Medical instrument 1: Glottic device 11: Main-body part 12: Mask part 13: Guide hole 14: Through-hole 15: Cuff 16: Pilot balloon 121: Peripheral part 122: Opening 131: Proximal opening part 132: Tip opening part 141: proximal end opening 142: distal end opening 151: outer periphery 161: connection portion 2: intubation tube 21: tube main body 23: tracheal sealing cuff 24: proximal end opening 231: tracheal sealing pilot balloon 3: scope 31 : Scope insertion part 32: Scope gripping part 33: Scope imaging means 34: Scope illumination means 35: Scope connection part 36: Change part 37: Imaging part 38: Illumination part 311: Tube 321: Convex part 331: CCD
332: objective lens 333: window 334: image signal cable 341: white LED
342: Illumination lens 343: Window portion 344: Illumination signal cable 350: Tube 351: Connection terminal 361: Notch 362: Inclined surface 363: Metal film 4: Image display device 41: Main body portion 42: Display 43: Operation button 44: Switch 411: Control unit 412: Power supply unit 413: Cover 414: Connection terminal 421: Rotating mechanism 422: Connection terminal 51: Device imaging unit 52: Device illumination unit 53: Connection pipe 511: Second imaging unit 521: 2nd illumination part 531: Connection terminal 7: Nasal intubation tube 71: Main body part 73: Tracheal sealing cuff 713: Proximal opening part 731: Pilot balloon for tracheal sealing 8: Blade 81: Blade main body 82: Groove 83: Tongue pieces 84a, 84b: Tube holder 85: Through hole 86: Guide hole 87: Blocking portion 813: Curved portion : Image acquisition unit 91: pipe 92: imaging means 93: Lighting device 95: the second imaging unit 96: second illumination section 921: CCD
922: objective lens 923: window 924: image signal cable 931: white LED
932: Illumination lens 933: Window portion 934: Illumination signal cable B: Arrow θ: Angle θ1: Angle

Claims (14)

A medical instrument used to secure the subject's airway,
A tubular member that is inserted so that a distal end portion is located at a predetermined site of the subject via the oral cavity or nasal cavity of the subject;
In the tubular member, it is slidably inserted relative to the tubular member, and has a long insertion part having an imaging part at the tip part,
The medical instrument is used so that the distal end portion of the tubular member reaches a predetermined part of the subject in a state where the insertion portion is inserted into the tubular member and assembled. Medical equipment to do.   The medical instrument according to claim 1, wherein a change unit that changes a visual field direction of the imaging unit is provided at a distal end of the insertion unit.   The medical instrument according to claim 1, further comprising a marker for grasping a rotation angle around the axis of the insertion portion. On the proximal end side of the insertion part, provided with a gripping part to grip when operating the insertion part,
The medical instrument according to claim 3, wherein the marker is provided on the grip portion.   The medical instrument of any one of Claim 1 thru | or 4 provided with the image display part which displays the image image | photographed by the said imaging part.   The medical instrument according to any one of claims 1 to 5, further comprising a second imaging unit different from the imaging unit.   The medical instrument according to claim 6, wherein the second imaging unit is arranged so that at least a position of the imaging unit can be confirmed. The image display unit is configured to display a first image captured by the imaging unit and a second image captured by the second imaging unit,
Further, a first display mode for displaying only the first image, a second display mode for displaying only the second image, and both the first image and the second image are displayed. The medical instrument according to claim 6 or 7, further comprising display switching means for switching between the third display mode. In the medical instrument, the distal end portion of the tubular member is placed in a state where the imaging portion is aligned with the distal end portion of the tubular member or is located closer to the proximal end side than the distal end portion of the tubular member. To reach a predetermined site of the subject,
The medical instrument according to any one of claims 1 to 8, wherein the imaging unit is used so as to protrude from a distal end of the tubular member.   The medical device according to any one of claims 1 to 9, further comprising a diameter-expanding portion that is provided on a distal end side of the tubular member and increases at least in an inner diameter as the distance from the tubular member increases.   The medical device according to claim 10, wherein a central axis of the enlarged diameter portion is inclined with respect to a central axis of the tubular member.   The medical device according to claim 11, wherein the enlarged-diameter portion includes a cuff portion that can expand and contract at a peripheral portion thereof. The insertion part has a substantially circular cross-sectional shape,
13. The relationship according to any one of claims 1 to 12, wherein a relation of 1.2 ≦ X / Y ≦ 10.0 is satisfied, where an inner diameter of the tubular member is X [mm] and an outer diameter of the insertion portion is Y [mm]. The medical device according to Item 1. The insertion part has a substantially circular cross-sectional shape,
The medical instrument according to any one of claims 1 to 13, wherein an outer diameter of the insertion portion is 1.0 to 4.0 mm.

Images