JP2015073678A - Tracheal intubation tube - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a tracheal intubation tube capable of further reducing a burden on a patient than ever by suppressing displacement of the tracheal intubation tube within his/her body cavity to secure his/her airway.SOLUTION: A tracheal intubation tube comprises a tube body, and an annular extratracheal cuff through which the tube body is inserted and which can be expanded so that the extratracheal cuff can cover a patient's tracheal inlet region on the outside of his/her trachea in a state in which a tip of the tube body is inserted into his/her trachea.

Description

  The present invention relates to a tracheal intubation tube.

  A tracheal intubation tube used for tracheal intubation is a tube that is inserted orally or nasally for the purpose of securing the airway such as during upper airway obstruction or disturbance of consciousness. And in a tracheal intubation tube, the thing with a cuff and the thing without a cuff exist. The cuff is a balloon-like component provided on the tube body of the tracheal intubation tube. The cuff expands by injecting air or the like. The cuff is inflated after the trachea is inserted, so that the position of the tube is prevented from being displaced, and air leakage of exhaled breath can be prevented when the cuff is placed in the trachea. Cuff-free tracheal intubation tubes are mainly used for children with small trachea diameters.

  The cuffed tracheal intubation tube represented by Patent Document 1 has the above-mentioned advantages, but may cause a sore throat, airway mucosal blood flow disorder, subglottic edema, etc. in the patient after extubation. . The possibility of causing these complications is thought to increase as the cuff pressure applied to the cuff during surgery increases.

  On the other hand, a tracheal intubation tube without a cuff does not have the above-mentioned concerns associated with the use of a cuffed tracheal intubation tube, but it is necessary to minimize the leakage of exhalation that occurs because a cuff is not used. Therefore, when using a cuff-free tracheal intubation tube, a tube having a larger outer diameter is used compared to using a cuffed tracheal intubation tube. This is also for accurately monitoring carbon dioxide contained in exhaled breath at the time of treatment. There are also reports that patients complain of sore throat and sore throat as the outer diameter of the tube increases.

  Here, if the tracheal intubation tube having a large outer diameter is forcibly inserted into the trachea, there is a possibility that the patient's arytenoid subluxation may be caused. Also, especially in children, when using a cuffed tracheal intubation tube, if the operation time is prolonged, the cuff continues to contact the trachea with high cuff pressure, granulation occurs in the trachea, and granulation occurs. There is a possibility that it will not be possible to extubate.

Special table 2001-516252 gazette

  As mentioned above, when using a cuffed or non-cuffed tracheal intubation tube, intubate with the largest diameter tube possible, or increase the cuff pressure of the cuff for indwelling the trachea to the patient. May cause pain and tracheal mucosal damage.

  The technology of the present disclosure has been made in view of the above circumstances, and the purpose thereof is to secure a patient's airway by suppressing the displacement of the tracheal intubation tube in the body cavity of the patient, and to improve the patient's airway. An object of the present invention is to provide a tracheal intubation tube that can further reduce the burden on the patient.

The tracheal intubation tube of the present disclosure is an annular extratracheal cuff through which the tube main body and the tube main body are inserted, and the end of the tube main body is inserted into the patient's trachea, and the extratracheal cuff is outside the patient's trachea. And an extratracheal cuff that is inflatable to cover the patient's tracheal inlet.

  Furthermore, the tracheal intubation tube of the present disclosure is an endotracheal cuff through which the tube body is inserted, and the endotracheal cuff can be expanded in the patient's trachea with the tip of the tube body inserted into the patient's trachea. An endotracheal cuff is further provided.

  With the tracheal intubation tube having the above-described configuration, the tracheal intubation tube used for tracheal intubation with respect to the same patient can be reduced in diameter compared with the conventional one, and the patient's tracheal pain, airway mucosal blood flow disturbance, and the like can be reduced. In addition, positioning of the tracheal intubation tube using the extratracheal cuff can also prevent one-lung intubation and the like. In addition, since the distal end of the tracheal intubation tube is inserted into the trachea of the patient, it is also possible to prevent the positional displacement of the extratracheal cuff. In addition, by alternately expanding and contracting the cuff pressure of the endotracheal cuff and the extratracheal cuff, it is possible to suppress the occurrence of tracheal pain and airway mucosal blood flow problems that are a concern when using only the endotracheal cuff. It becomes.

  According to the technology of the present disclosure, a tracheal intubation tube that can prevent the patient from having a misalignment in the body cavity of the patient and secure the patient's airway and further reduce the burden on the patient than before is realized. be able to.

FIG. 1 is a side view showing a schematic configuration of a tracheal intubation tube according to Embodiment 1 of the present invention. FIG. 2 is a perspective view showing a schematic configuration of the tracheal intubation tube according to Embodiment 1 of the present invention. FIG. 3 is a schematic view when performing tracheal intubation using the tracheal intubation tube according to the first embodiment of the present invention. FIG. 4 is a side view showing a schematic configuration of a tracheal intubation tube according to Embodiment 2 of the present invention. FIG. 5 is a perspective view showing a schematic configuration of a tracheal intubation tube according to Embodiment 2 of the present invention. FIG. 6 is a schematic diagram when performing tracheal intubation using the tracheal intubation tube according to the second embodiment of the present invention.

  Hereinafter, a tracheal intubation tube according to an embodiment of the present invention will be described with reference to the drawings. However, the embodiment described below shows an example of a tracheal intubation tube, and is not limited to the configuration described below.

<Example 1>
As shown in the side view of FIG. 1, the tracheal intubation tube 1 according to the first embodiment of the present invention has a tube body 10. In the following description, the side of the tube body 10 where the extratracheal cuff 60 or the endotracheal cuff 80 is provided is the distal end side, and the side where the connector 100 is provided is the proximal end side. The tube body 10 is a long hollow cylindrical member. The entire tube body 10 is curved with a predetermined curvature. Since the tube body 10 is curved, the tracheal intubation tube 1 can be easily inserted into the airway and trachea through the patient's oral cavity during tracheal intubation. The tube body 10 is molded using a resin such as polyvinyl chloride (plasticizer: di-2-ethylhexyl phthalate) or silicone rubber. The tube body 10 has a flexibility that can be bent in accordance with the patient's body position and the like during tracheal intubation. As shown in FIG. 1, the distal end portion 10 a of the tube main body 10 is formed as an opening whose end surface has a predetermined inclination angle with respect to the central axis at the distal end of the tube main body 10.

  An endotracheal cuff 80 is provided on the distal end side of the tube body 10. The endotracheal cuff 80 is arranged so as to go around the outer peripheral surface of the tube body 10 in the vicinity of the distal end of the tube body 10. The endotracheal cuff 80 can inject air or the like therein. The endotracheal cuff 80 is expanded by injecting air into the interior. Further, the endotracheal cuff 80 contracts when the injected air is deaerated. As will be described later, the endotracheal cuff 80 is a cuff that is inflated in the trachea of a patient during tracheal intubation. The endotracheal cuff 80 is inflated when the distal end portion 10a of the tube body 10 is inserted into the trachea, so that the endotracheal cuff 80 is pressed against the inner wall of the trachea with a predetermined cuff pressure, and the tracheal intubation tube 1 is positioned in the body cavity of the patient. Can do. The endotracheal cuff 80 is molded using a resin such as polyvinyl chloride (plasticizer: di-2-ethylhexyl phthalate) or polyurethane.

  The endotracheal cuff 80 is connected to the inflation line 50. The inflation line 50 is a thin bendable tube, and one end is connected to the endotracheal cuff 80 and the other end is connected to the pilot balloon 30. The inflation line 50 extends to the vicinity of the proximal end of the tube body 10. The pilot balloon 30 is used when air is injected into the endotracheal cuff 80 or when the endotracheal cuff 80 is degassed. The practitioner inserts the distal end portion 10a of the tube body 10 into the trachea of the patient, then connects a syringe (not shown) to the pilot balloon 30, and uses the syringe to send air to the endotracheal cuff via the inflation line 50. Inject at 80.

  As shown in FIG. 1, an extratracheal cuff 60 is further provided on the distal end side of the tube body 10. The endotracheal cuff 60 is provided on the proximal end side of the tube body 10 with respect to the endotracheal cuff 80. As will be described later, the extratracheal cuff 60 is a cuff that is inflated at a predetermined position outside the trachea of the patient in tracheal intubation. Similar to the endotracheal cuff 80, the extratracheal cuff 60 is molded using a resin such as polyvinyl chloride (plasticizer: di-2-ethylhexyl phthalate) or polyurethane. The extratracheal cuff 60 is an annular member through which the tube body 10 is inserted. In the present embodiment, the extratracheal cuff 60 has a substantially elliptical outer peripheral shape as an example. The tube body 10 is inserted through the approximate center of the extratracheal cuff 60.

  The extratracheal cuff 60 expands when air is injected into the inside. Further, the extratracheal cuff 60 contracts when the injected air is deaerated. The extratracheal cuff 60, when degassed, has a smooth, flat wedge shape and is shaped like a dished dish. The extratracheal cuff 60 is inflated by injecting air when the tube body 10 is inserted into the airway. When air is injected into the extratracheal cuff 60 at a predetermined position in the airway, the extratracheal cuff 60 is grooved on the cuff upper portion 60a, that is, on the side close to the oral cavity, on the tongue base, and on both sides of the cuff 60b on both sides of the laryngeal mouth. In the piriform fossa located, the cuff lower part 60c comes into contact with the peripheral part of the laryngeal mouth located at the esophageal entrance. As a result, the extratracheal cuff 60 is in an expanded state so as to cover the patient's trachea inlet.

  The extratracheal cuff 60 is connected to the inflation line 40. The inflation line 40 is a thin bendable tube, and one end is connected to the extratracheal cuff 60 and the other end is connected to the pilot balloon 20. The inflation line 40 extends to the vicinity of the proximal end of the tube body 10. The pilot balloon 20 is used when air is injected into the extratracheal cuff 60 or when the extratracheal cuff 60 is degassed. After inserting the tube body 10 into the airway, the practitioner connects a syringe (not shown) to the pilot balloon 20 and injects air into the extratracheal cuff 60 via the inflation line 40 using the syringe.

In the tube body 10, a depth mark 70 is provided between the extratracheal cuff 60 and the endotracheal cuff 80. The depth mark 70 is used as an index for grasping the insertion depth of the tube body 10 when the tracheal intubation tube 1 is inserted into the airway. In the first embodiment, the depth mark 70 is an index indicating that the distal end of the tube body 10 comes near the center of the patient's trachea when the depth mark 70 overlaps the patient's glottis. The depth mark 70 is a standard indicating the position of the tube body 10 in the body cavity of the patient. Therefore, the practitioner performs tracheal intubation using the tracheal intubation tube 1 while making clinical judgments without depending on only the depth mark 70 in consideration of anatomical individual differences of patients.

  A connector 100 is connected to the proximal end of the tube body 10. The connector 100 is a hollow cylindrical member having a predetermined inner and outer diameter so as to be continuous with the inner wall of the tube body 10. The connector 100 is provided in the tube main body 10 so that attachment or detachment is possible. The connector 100 is positioned on the tube main body 10 by an annular flat plate-shaped flange 90 provided at the proximal end of the tube main body 10. The connector 100 is a member connected to a breathing circuit, an anesthetic circuit, etc. (not shown). After the tracheal intubation tube 1 is inserted into the patient's airway, air is injected into the extratracheal cuff 60 and the endotracheal cuff 80 and positioned, and then a breathing circuit, anesthesia circuit, and the like are connected to the connector 100.

  FIG. 2 is a perspective view of the tracheal intubation tube 1 shown in FIG. As shown in FIG. 2, the extratracheal cuff 60 is an inflatable cuff that swells in an annular shape so as to surround the tube body 10. The extratracheal cuff 60 has an annular bag portion and is attached to the outer peripheral surface of the tube body 10 by an adhesive or welding. Further, the endotracheal cuff 80 has a cylindrical bag portion that covers the outer periphery of the tube main body 10 and is attached to the outer peripheral surface of the tube main body 10 by an adhesive or welding.

  FIG. 3 shows the position of the tracheal intubation tube 1 according to Example 1 in the body cavity of the patient when tracheal intubation is performed using the tracheal intubation tube 1. The practitioner uses the tracheal intubation tube 1 when securing a patient's airway in a general anesthesia case or performing tracheal intubation in an emergency emergency situation. The tracheal intubation tube 1 is packaged in advance by sterilization packaging. First, the practitioner takes out the tracheal intubation tube 1 from the sterile packaging. Next, the practitioner confirms that the connector 100 is properly attached without looseness at the proximal end of the tracheal intubation tube 1. Next, the practitioner confirms the patency of the lumen of the tube body 10 of the tracheal intubation tube 1. The practitioner connects the syringe to the pilot balloons 20 and 30 and injects air into the extratracheal cuff 60 and the endotracheal cuff 80 before tracheal intubation. Then, the practitioner confirms that no air leakage has occurred in the extratracheal cuff 60, the endotracheal cuff 80, the pilot balloons 20, 30, and the inflation lines 40, 50.

  The practitioner inserts a laryngoscope (not shown) into the patient to deploy the patient's larynx and places the laryngoscope in an appropriate position where the patient's glottis can be seen. Next, the practitioner orally intubates the patient with the tracheal intubation tube 1 by an appropriate technique. As shown in FIG. 3, the tube body 10 is inserted into the pharyngeal cavity, and the tip of the tube body 10 moves into the airway. The practitioner aligns the depth mark 70 and the glottis with a laryngoscope. The practitioner connects a syringe to the pilot balloon 20 when the tip of the tube body 10 enters the trachea, and operates the syringe to inject air into the extratracheal cuff 60. In this embodiment, the practitioner advances the extratracheal cuff 60 to a predetermined insertion position in the manner of inserting a conventional Laringel mask (pharyngeal mask). And the extratracheal cuff 60 will be in the state which touches the peripheral site | part of the laryngeal mouth located in a patient's tongue base part, a piriform fossa, or an esophagus entrance part.

The practitioner connects the syringe to the pilot balloon 20 after the positioning of the extratracheal cuff 60 and the endotracheal cuff 80 within the body cavity of the patient is completed. Next, the practitioner operates the syringe to inject air into the endotracheal cuff 80 while confirming the cuff pressure of the endotracheal cuff 80 using a cuff pressure gauge or the like. The practitioner evaluates the cuff pressure of the endotracheal cuff 80 and adjusts it to an appropriate pressure by using the index indicated by the cuff pressure gauge and the minimum occlusion capacity or the minimum leak method in combination. Further, the practitioner similarly evaluates the cuff pressure of the extratracheal cuff 60 and adjusts it to an appropriate pressure. In addition, sizes, such as the outer diameter of the tracheal intubation tube 1, are suitably selected according to a patient's age, weight, etc. In addition, a reference amount of air to be injected into the extratracheal cuff 60 and the endotracheal cuff 80 is also defined according to the size of the tracheal intubation tube 1. The practitioner adjusts the cuff pressure in consideration of these elements of the tracheal intubation tube 1.

  As shown in FIG. 3, in this embodiment, when the intubation of the tracheal intubation tube 1 and the position fixation in the patient body cavity by injecting air into the endotracheal cuff 80 and the endotracheal cuff 80 are completed, the endotracheal cuff 60, Each intraluminal cuff 80 contacts the inner wall of the patient's trachea with a defined cuff pressure. As will be described later, the extratracheal cuff 60 supports the prevention of exhalation of breath and the maintenance of the airway without causing tracheal pain or blood flow mucosal disturbance in the patient. In addition, the endotracheal cuff 80 prevents the aspiration and allows the tracheal intubation tube 1 to be connected to the patient's body cavity even when the patient bends the neck or changes the patient's position when the treatment is performed for a long time. It is possible to prevent the position from being displaced.

  Here, the advantage in using the tracheal intubation tube 1 of a present Example is demonstrated. Traditionally, to minimize exhalation leaks, such as to increase exhaled carbon dioxide monitoring accuracy, the practitioner can intubate with the largest diameter tube possible or increase the cuff pressure in the endotracheal cuff excessively. I was doing. This may cause tracheal pain and tracheal mucosal damage to the patient after the procedure. However, as in this embodiment, the presence of the extratracheal cuff effectively suppresses the exhalation of the patient's exhalation. Thereby, tracheal intubation can be performed using the tracheal intubation tube 1 having a smaller diameter than the conventional one. As a result, by using the tracheal intubation tube 1 of the present embodiment, the patient's tracheal pain and airway mucosal blood flow disturbance can be reduced.

  Further, in the conventional tracheal intubation tube, it is necessary to continuously inflate the endotracheal cuff with a prescribed cuff pressure during the treatment in order to eliminate the leakage of exhalation and prevent aspiration. However, if the procedure is prolonged, the endotracheal cuff continues to compress the inner wall of the trachea, causing tracheal mucosal ischemia and subsequent ulcers, bleeding, granulation, tracheal stenosis after extubation, and tracheal softening there is a possibility. On the other hand, in the tracheal intubation tube 1 according to the present embodiment, even if the treatment time becomes long, the practitioner temporarily holds the endotracheal cuff 80 as long as the extratracheal cuff 60 is inflated with a specified cuff pressure. Can be degassed and contracted. Thereby, said obstacle etc. which are anxious about using the conventional tracheal intubation tube can be reduced. That is, by repeating air injection and deaeration alternately between the extratracheal cuff 60 and the endotracheal cuff 80, the burden on the patient can be reduced while maintaining the state where the tracheal intubation tube 1 is positioned in the body cavity of the patient. It becomes possible.

  In addition, when a patient's airway is secured using a conventional Laringel mask, if the patient's body position is changed, for example, if the patient's neck bend or lateral position is changed, the patient's body cavity The position of the Laringel mask in is shifted. In addition, if vomiting occurs during treatment, inflow into the airway cannot be prevented, and vomit may be guided into the airway. For this reason, when using the conventional Laringel mask, the airway management of the patient during the treatment may be difficult. On the other hand, in the tracheal intubation tube 1 in the present embodiment, positioning in the body cavity of the patient can be performed using the endotracheal cuff 80 in addition to the extratracheal cuff 60. Furthermore, unlike the conventional Laringel mask, the tube body 10 is inserted into the trachea. As described above, the practitioner can appropriately secure the patient's airway by using the tracheal intubation tube 1 even when the patient bends the neck or changes the posture of the patient.

Here, the position where the extratracheal cuff 60 in the tube body 10 is provided will be described. In general, the length of the human trachea is considered to be about 4.0 cm for newborns, 4.5-5.0 cm for infants and 10.0-12.0 cm for adults. And the proper position of the tracheal intubation tube in the body cavity is that the tip of the tracheal intubation tube by chest radiograph is positioned between 0.5cm head side from the tracheal bifurcation to the midline of both clavicles It is believed that. Therefore, in view of the length of the larynx, in the case of a tracheal intubation tube having an outer diameter (thickness) of 3.0 to 4.0 mm mainly used for newborns, 3.5 to 4. It is desirable to provide an extratracheal cuff at 0 cm. Further, in the case of a tracheal intubation tube having an outer diameter of 4.5 to 6.0 mm mainly used for infants, it is desirable to provide a position-tracheal cuff approximately 4.5 cm from the tip of the tube body. Furthermore, in the case of a tracheal intubation tube with an outer diameter of more than 6.0 mm, which is mainly used for infants and children and adults, an extratracheal cuff is provided at a position of 6.0 to 7.0 cm from the tip of the tube body. Is desirable. In each tracheal intubation tube, the depth mark is provided between the extratracheal cuff and the endotracheal cuff.

<Example 2>
Next, the tracheal intubation tube 2 according to Example 2 of the present invention will be described. In addition, about the tracheal intubation tube 2, the same code | symbol is attached | subjected about the component corresponding to the tracheal intubation tube 1 of Example 1, and detailed description is abbreviate | omitted. As shown in FIG. 4, the tracheal intubation tube 2 has a tube body 10, a pilot tube 20, an inflation line 40, an extratracheal cuff 60, a depth mark 70, a fringe 90, and a connector 100, similar to the tracheal intubation tube 1. Further, the distal end portion 10 a of the tube main body 10 also has an opening similar to the distal end portion 10 a of the tube main body 10 of the tracheal intubation tube 1. FIG. 5 shows a perspective view of the tracheal intubation tube 2 shown in FIG. The tracheal intubation tube 2 shown in FIG. 5 is the same as the tracheal intubation tube 1 shown in FIG.

  As in the first embodiment, when the tracheal intubation tube 2 is inserted into the body cavity of the patient, the practitioner keeps the patient in a predetermined position and opens the patient's larynx to the patient with a laryngoscope (not shown). And place the laryngoscope in an appropriate position to see the patient's glottis. Next, the practitioner orally intubates the tracheal intubation tube 2 from the distal end portion 10a of the tube body 10 by an appropriate technique. As shown in FIG. 6, the tube body 10 is inserted into the pharyngeal cavity, and the distal end of the tube body 10 moves into the airway. The practitioner aligns the depth mark 70 and the glottis with a laryngoscope.

  The practitioner connects a syringe to the pilot balloon 20 when the tip of the tube body 10 enters the trachea, and operates the syringe to inject air into the extratracheal cuff 60. Also in the present embodiment, the practitioner advances the extratracheal cuff 60 to the specified insertion position in the manner of inserting the conventional Laringer mask. That is, also in this embodiment, no special technique is required when positioning the extratracheal cuff 60. And the extratracheal cuff 60 will be in the state which touches the peripheral site | part of the laryngeal mouth located in a patient's tongue base part, a piriform fossa, or an esophagus entrance part.

  Here, the advantage in the case of using the tracheal intubation tube 2 of a present Example is demonstrated. Conventionally, a tracheal intubation tube having neither an endotracheal cuff nor an extratracheal cuff is generally used for tracheal intubation mainly for children. In addition, since the conventional tracheal intubation tube has no cuff, the tracheal intubation tube cannot be positioned with respect to the inner wall of the patient's body cavity, and the tracheal intubation tube can be inserted too far into the patient's trachea, resulting in a longer insertion length. There is sex. In addition, the insertion length may change depending on the change of body position and the degree of bending of the neck. However, by using the tracheal intubation tube 2 of the present embodiment, the tracheal intubation tube 2 can be fixed at an appropriate position in the body cavity of the patient by the extratracheal cuff, and single lung intubation can be prevented.

In addition, since positioning of the tracheal intubation tube 2 in the body cavity of the patient is performed using an extratracheal cuff, there is no need to worry about tracheal pain or airway mucosal blood flow disturbance for the patient when only the endotracheal cuff is used. . Further, in the present embodiment, there is no concern that granulation is formed in the trachea due to the pressure contact of the cuff and hinders extubation. And when securing a patient's airway with the conventional Laringel mask, there was a concern that the Laringel mask would be displaced in the body cavity of the patient. However, if the tracheal intubation tube 2 of the present embodiment is used, the above-described positional deviation can be prevented by inserting the tube main body into the patient's trachea.

  The above is the description related to the present embodiment, but the configuration and processing of the tracheal intubation tube and the like are not limited to the above-described embodiment, and are within the scope that does not lose the same technical idea as the present invention. Various changes are possible. For example, in the above description, oral intubation is assumed, but the configuration of a tracheal intubation tube similar to the above can also be adopted in the case of nasal intubation. In addition, the outer shape of each of the endotracheal cuff and the extratracheal cuff when contracted or expanded is not limited to the shape shown in the above description or each drawing.

1, 2, tracheal intubation tube 10 tube body 10a tube body tip 20, 30 pilot balloon 40, 50 inflation line 60 extratracheal cuff 70 depth marker 80 endotracheal cuff 90 fringe 100 connector

Claims (2)

A tube main body and an annular extratracheal cuff through which the tube main body is inserted, and with the distal end of the tube main body inserted into the patient's trachea, the extratracheal cuff is outside the patient's trachea and the patient's trachea An extratracheal cuff that is inflatable to cover the inlet,
Tracheal intubation tube comprising.   An endotracheal cuff through which the tube body is inserted, and further comprising an endotracheal cuff that can be expanded in the trachea of the patient with the distal end of the tube body inserted into the patient's trachea. The tracheal intubation tube according to claim 1.

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