JP2701135B2 - Drainage drain with temporary pacing mechanism - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

The present invention is used primarily for temporary drainage of bleeding blood and exudate in the pericardium, which is essential for postoperative management after cardiac surgery (open heart surgery), and for temporary pacing of arrhythmias. The present invention relates to a drainage drain with a temporary pacing mechanism.

[0002]

2. Description of the Related Art In postoperative management after cardiac surgery (open heart surgery), an extracorporeal cardiac pacemaker which is disposed outside the body as a measure to discharge bleeding blood and exudate in the pericardium to the outside of the body and as a measure against cardiac arrhythmias. Pacing is performed using Therefore, when draining the bleeding blood and exudate in the pericardium to the outside and performing ventricular pacing and atrial pacing, the incision (1) in the body as shown in FIGS.
(2) is provided to insert the intra-pericardial drain (3) and the posterior sternum drain (4), and separate holes (5) and (6) in the body.
Pacing wire (7A) for cathode (seki electrode)
And a pacing wire (7B) integrated with an anode (indifferent electrode) pacing wire (7B) are inserted, and the tip of the pacing wire (7) is fixed to the ventricle (A) and the atrium (B). doing. However, in order to insert the pacing wire (7) into the body, the incisions (1) and (2) for inserting the intra-pericardial drain (3) and the posterior sternal drain (4) are different from those described above. Hole (5),
There is a problem that (6) must be newly provided. When the pacing wire (7) is fixed to the ventricle (A) or the atrium (B), a needle is attached to the tip of the pacing wire (7), and the needle penetrates the muscular layer and the skin from the mediastinum side. Then, the patient is guided outside the body, one needle is inserted into the myocardium, and fixed to the epicardium with another thread needle. In this case, if the pacing wire (7) is loosely fixed, the pacing wire (7) is easily detached from the myocardium. On the other hand, if the pacing wire (7) is too strong, it is difficult to remove the pacing wire (7).

[0003]

SUMMARY OF THE INVENTION The present invention has been devised in order to solve the above-mentioned problems, and is disclosed in the case where pacing is performed by integrating a pacing wire with a drain into which one end is inserted into a body. Provides a drainage drain with a temporary pacing mechanism that eliminates the need for a pacing wire insertion hole and ensures that the pacing wire is in close contact with the ventricle so that there is no risk of bleeding from the myocardium when the pacing wire is removed. Is what you do.

[0004]

According to the first aspect of the present invention,
A drain formed in a flat cross-sectional shape having a flat front surface and a rear surface abutting the diaphragm, one end of which is inserted between the heart and the diaphragm to discharge blood and exudate out of the body and abut the heart, A first electrode and a second electrode provided on the front surface of one end of the drain and in contact with the ventricle of the heart;
A first pacing wire integrated with the drain and having one end connected to the first electrode; a second pacing wire integrated with the drain and having one end connected to the second electrode; It is characterized by having. The invention according to claim 2 has a flat tubular cross section having one end inserted between the heart and the diaphragm to discharge blood and exudate to the outside of the body and to have a flat front surface in contact with the heart and a rear surface in contact with the diaphragm. A first electrode and a second electrode provided on the front surface of one end of the drain and in contact with the ventricle of the heart, and provided on the front surface of an intermediate portion of the drain to contact subcutaneous tissue. A third electrode to be contacted, a first pacing wire integrated with the drain and one end connected to the first electrode, and a first pacing wire integrated with the drain and one end connected to the second electrode A second pacing wire integrated with the drain and a third pacing wire contacting the subcutaneous tissue, and a fourth pacing integrated with the drain and having one end connected into the atrium. It is characterized by having a Guwaiya, the. The invention according to claim 3 is characterized in that a side hole is formed in a side surface of one end of the drain.

[0005]

When the present invention is used, a drain is inserted through an incision provided in the body, and one end of the drain is disposed between the diaphragm and the posterior inferior surface of the heart. Moreover, since the drain is formed in a flat tubular cross section by the flat front and rear surfaces, the front surface is in close contact with the posterior and lower surfaces of the heart, and the rear surface is in close contact with the diaphragm, so that the drain is stable without rotating. Arranged in state. Further, since a tip hole is formed at one end of the drain and side holes are formed at both sides of one end of the drain, the stored blood and discharged liquid pass through the drain from the tip hole and the side hole to the outside of the body. Is derived. In addition, an electrode is fixed to the drain and a pacing wire is integrated, so that when the drain is inserted into the body, the electrode can be brought into direct contact with the ventricle, so that the pacing wire is inserted into the ventricle with a needle or the like and fixed. No need. Therefore, according to the present invention, the pacing wire can be brought into close contact with the ventricle without newly providing a hole for inserting the pacing wire into the body, and when the pacing wire is removed, there is no risk of bleeding or the like due to myocardial injury.

[0006]

First Embodiment FIGS. 1 to 5 show a first embodiment of a drainage drain with a temporary pacing mechanism according to the present invention. As shown in FIGS. 1 and 2, the drain (12) of the drainage drain (10) with a temporary pacing mechanism of the present invention is formed of silicone rubber in a flat tubular shape. This allows
The drain (12) has a flat front surface (12A) and a flat rear surface (12B) opposite to the front surface (12A). In this embodiment, the length of the drain (12) is 50 cm and the thickness is 1.5 mm. The drain (12) is provided inside the drain (12).
A cavity (13) is formed to penetrate along the longitudinal direction of (2). The lateral dimension (L) of the hollow portion (13) is 12 m.
m and the height (H) are 8 mm (see FIG. 2). Therefore, one end (14) of the drain (12)
A tip hole (16) is formed at the tip of. Also, side holes (1) are provided on both sides of one end (14) of the drain (12).
8) are drilled three by three. The drain (12)
A first electrode rivet (20) made of stainless steel is provided on the front surface (12A) of the drain (12) at a position 1 cm from the end surface of the one end (14), and 3 cm from the end surface of the one end (14).
A second electrode rivet (22) made of stainless steel is fixed to the front surface (12A) of the drain (12) at the location (2). In this embodiment, the first electrode rivet (20) is set as a ventricular cathode and the second electrode rivet (22) is set as a ventricle anode. As shown in FIG. 2, the large-diameter portion (20A) of the first electrode rivet (20) and the large-diameter portion (22A) of the second electrode rivet (22) protrude from the drain (12), and the first electrode rivet ( The tip (20B) of the second electrode rivet (22) and the tip (22B) of the second electrode rivet (22) are fitted into the drain (12). Also, the tip (20B) of the first electrode rivet (20) and the second electrode rivet (2)
The tip (22B) of 2) is covered by a cover (24) formed continuously with the drain (12) (FIG. 2 shows only the second electrode rivet (22)). In addition,
In this embodiment, the large diameter portions (20A) and (22A) are set to 4 mm in diameter. As shown in FIG. 1, a first electric wire (26) and a second electric wire (28) are arranged in the drain (12) along the longitudinal direction of the drain (12). The first electric wire (26) and the second electric wire (28) are bundled by an appropriate member, and an intermediate portion is bonded to the drain (12) in a state of being integrated. As shown in FIGS. 3 and 4, the first electric wire (26) and the second electric wire (28) cover the middle part of the first pacing wire (30) and the second pacing wire (32) with Teflon. It is constituted by being covered with a body (34). As shown in FIG. 3, one end (30A) of the first pacing wire (30) of the first electric wire (26) is in an uncovered state and is wound around the tip (20B) of the first electrode rivet (20). Connected. In addition, one end (32A) of the second pacing wire (32) of the second electric wire (28) is also uncovered, and the tip (2) of the second electrode rivet (22) is uncovered.
2B). As shown in FIGS. 1 and 4, the other end (30B) of the first pacing wire (30) of the first electric wire (26) and the second electric wire (28).
Other end (32B) of the second pacing wire (32)
Is uncoated and is connected to an extracorporeal pacemaker (not shown).

Next, the operation of the first embodiment will be described.
When the drainage drain with a temporary pacing mechanism (10) is used as an intrapericardial drain, the drain (12) is sandwiched between the posterior and inferior surfaces of the heart (X) and the diaphragm (Y) as shown in FIG. Arrange in state. In this case, the drain (1
2) is a flat front surface (12A) because it has a flat cross section
Abuts on the posterior lower surface of the heart (X), and the planar posterior surface (12B) comes into close contact with the diaphragm (Y). Therefore,
The drain (12) is disposed between the heart (X) and the diaphragm (Y) in a stable state without accidentally turning. Further, since a tip hole (16) and a side hole (18) are formed at one end (14) of the drain (12), the stored blood and discharged liquid can be stored in the tip hole (16) and the side hole. From (18), it is efficiently and smoothly discharged out of the body through the cavity (13) of the drain (12). This allows
The drain (12) will serve as a drain. In addition, a first electrode rivet (20) and a second electrode rivet (22) are fixed to the drain (12), and a first electric wire (26) and a second electric wire (28) are bonded and integrated. If the incision (1) for inserting the drain (12) is provided,
The first electrode rivet (20) and the second electrode rivet (2) can be provided without providing holes for the electric wire (26) and the second electric wire (28).
2) The first electric wire (26) and the second electric wire (28) can be inserted into the body. Among the pacing mechanisms, the ventricular pacing is a first electrode rivet (20) and a second electrode rivet (2) fixed to one end (14) of the drain (12).
Since 2) directly contacts the ventricle (A), the first electrode rivet (20) of the cathode and the second electrode rivet (22) of the anode come into contact with the ventricle (A). Moreover, since the gap between the posterior and lower surfaces of the heart (X) and the diaphragm (Y) is small,
The first electrode rivet (20) and the second electrode rivet (22) are reliably brought into contact with the gravity of the heart (X). For this reason, the drainage drain with temporary pacing mechanism (10) only requires the first electrode rivet (20) and the second electrode rivet (22) to directly contact the ventricle (A). Therefore, in the drainage drain with a temporary pacing mechanism (10) of the present invention, the first pacing wire (30) and the second pacing wire (32) are inserted into the epicardium and the myocardium through the needle as in the conventional case. Since there is no need, there is no risk of bleeding due to myocardial damage. Further, the drainage drain (10) with a temporary pacing mechanism according to the present invention comprises a first electrode rivet (20) of a cathode for stimulating the heart (X) and a second electrode rivet (22) of an anode for drainage (12). Front (1
2A) is fixed to the ventricle (A) of the heart (X), so that the rear surface (12B) of the drain (12) made of silicon rubber, which is an insulator, contacts the diaphragm (Y). Therefore, the current does not leak to the diaphragm (Y) to cause diaphragm spasm.

[0008]

Second Embodiment FIGS. 6 to 8 show a second embodiment of a drainage drain with a temporary pacing mechanism according to the present invention. The drainage drain with a temporary pacing mechanism of the second embodiment can perform both ventricular pacing and atrial pacing at the same time. The same components as those in the first embodiment are denoted by the same reference numerals, and description thereof will be omitted. As shown in FIG. 6, the front surface (12A) of the drain (12) at a position 12 cm from the end surface of one end (14) of the drain (12) of the drainage drain (40) with a temporary pacing mechanism.
, A third electrode rivet (42) made of stainless steel is fixed. The third electrode rivet (42) has the same configuration as the first electrode rivet (20) and the second electrode rivet (22). In this embodiment, the third electrode rivet (42) is set as an atrial anode. FIG.
As shown in the figure, the front surface (12) of the drain (12)
In A), in addition to the first electric wire (26) and the second electric wire (28), a third electric wire (44) and a fourth electric wire (46) are arranged along the longitudinal direction of the drain (12). These third electric wire (44) and fourth electric wire (46) also have a drain (1
It is bonded to 2). As shown in FIG. 7, the third electric wire (44) is configured by covering an intermediate portion of a third pacing wire (48) with a covering (34) made of Teflon, and the fourth electric wire (46) is made of a fourth electric wire (46). 4 pacing wires (5
0) is covered with a cover (34) made of Teflon. Third of the third electric wire (44)
One end (48A) of the pacing wire (48) is uncoated, and the third electrode rivet (4
2) is connected. In this embodiment, one end (48A) of the third pacing wire (48) is an anode. The fourth electric wire (46) is free from the drain (12) after bypassing the third electrode rivet (42). One end (50A) of the fourth pacing wire (50) is in an uncovered state. As shown in FIG. 8, one end (50A) of the fourth pacing wire (50) is directly connected to the atrium (B) through the hole (60) from which the blood removal cannula was removed at the end of the cardiopulmonary bypass.
It is inserted inside and becomes a cathode. As shown in FIG.
The other end (48B) of the pacing wire (48) and the other end (50B) of the fourth pacing wire (50) are uncovered and are connected to an extracorporeal cardiac pacemaker (not shown). The other configuration is the same as that of the first embodiment, and the description is omitted.

Next, the operation of the second embodiment will be described.
Ventricular pacing when the drainage drain with temporary pacing mechanism (40) is used as an intrapericardial drain is the same as in the first embodiment, and a description thereof will be omitted. As shown in FIG. 8, the drainage drain 40 with the temporary pacing mechanism of the second embodiment can perform atrial pacing simultaneously with ventricular pacing. If atrial pacing is to be performed using the drainage drain with temporary pacing mechanism (40), a fourth wire (44) is used as the cathode for atrial pacing. First, the third electrode rivet (42) is brought into close contact with the subcutaneous tissue. This is the atrial anode. In addition, the fourth pacing wire (5
0) at the end of open heart surgery (50A), atrial (B)
The blood removal cannula inserted into the (right atrium) is inserted into the atrium (B) from the hole (60) formed when the blood removal cannula is removed. Then, one end (50A) of the fourth pacing wire (50) is fixed to the entire atria (B) from outside with a ligature. The other operation is the same as that of the first embodiment, and the description is omitted.

Although the drain (12) is formed of silicon rubber in the embodiment, it is a matter of course that the drain (12) is not limited to silicon rubber as long as it is an insulator. Further, in the second embodiment, an example is shown in which the drainage drain with a temporary pacing mechanism (40) is used for both ventricular pacing and atrial pacing, but may be used for only one of ventricular pacing and atrial pacing. Of course.

[0011]

As described above, according to the first aspect of the present invention, when performing pacing, it is not necessary to provide a hole for a pacing wire, so that it is possible to minimize damage to the body and to perform pacing. Since there is no need to insert the wire into the myocardium or the like, there is an excellent effect that bleeding due to myocardial damage can be prevented before removing the pacing wire. In addition, since the drain has a flat cross section and a flat front and rear surface, when the drain is inserted between the heart and the diaphragm, the front surface is in close contact with the heart and the rear surface is in close contact with the diaphragm, so the drain is stable. The pacing can be performed more reliably. Further, the present invention of claim 2 has an excellent effect that, in addition to the above effects, atrial pacing can be performed simultaneously with ventricular pacing by inserting the fourth pacing wire into the atrium. Further, the present invention of claim 3 has an excellent effect that blood and exudate can be efficiently and smoothly discharged outside the body by the tip hole and the side hole since the side hole is formed on the side surface of one end of the drain. Have.

[Brief description of the drawings]

FIG. 1 is a perspective view of a drainage drain with a temporary pacing mechanism according to a first embodiment of the present invention.

FIG. 2 is a sectional view of a drainage drain with a temporary pacing mechanism according to the first embodiment of the present invention.

FIG. 3 is an enlarged view of one end of a drainage drain with a temporary pacing mechanism according to the first embodiment of the present invention.

FIG. 4 is an enlarged view of the other end of the drainage drain with a temporary pacing mechanism according to the first embodiment of the present invention.

FIG. 5 is an operation explanatory view of the drainage drain with a temporary pacing mechanism of the first embodiment according to the present invention.

FIG. 6 is a perspective view of a drainage drain with a temporary pacing mechanism according to a second embodiment of the present invention.

FIG. 7 is a partially enlarged view of a drainage drain with a temporary pacing mechanism according to a second embodiment of the present invention.

FIG. 8 is an operation explanatory view of a drainage drain with a temporary pacing mechanism according to a second embodiment of the present invention.

FIG. 9 is a front view of a closed chest portion when performing conventional temporary pacing.

FIG. 10 is an enlarged front view of a heart portion when performing conventional temporary pacing.

[Explanation of symbols]

 (10) Drainage drain with temporary pacing mechanism (12) Drain (12A) Front (12B) Rear (18) Side hole (20) First electrode Rivets (22) ··· Second electrode rivets (26) ··· First wire (28) ··· Second wire (30) ··· First pacing wire (32) ··· Second pacing wire ( 40) Drainage drain with temporary pacing mechanism (42) Third electrode rivet (44) Third wire (46) Fourth wire (48) Third pacing Wire (50) ・ ・ ・ 4th pacing wire

Claims (3)

(57) [Claims] 1. One end is inserted between a heart and a diaphragm to discharge blood and exudate out of the body and abut the heart.
Flat cross section with a flat front surface and a rear surface that contacts the diaphragm
A drain formed in a tubular shape and one end of the drain
A first electrode provided on the front surface and in contact with a ventricle of a heart;
A first pacing wire integrated with the drain and having one end connected to the first electrode;
And one end is integrated with the drain and
A second pacing wire connected to the two electrodes, the drainage drain having a temporary pacing mechanism. 2. One end is inserted between the heart and the diaphragm to discharge blood and exudate out of the body and abut the heart.
Flat cross section with a flat front surface and a rear surface that contacts the diaphragm
A drain formed in a tubular shape and one end of the drain
A first electrode provided on the front surface and in contact with a ventricle of a heart;
A second electrode and a second electrode , provided on the front surface at an intermediate portion of the drain.
A third electrode that is connected to the subcutaneous tissue, a first pacing wire that is integrated with the drain and has one end connected to the first electrode, and a third pacing wire that is integrated with the drain and has one end. A second pacing wire connected to the second electrode, a third pacing wire integrated with the drain and in contact with subcutaneous tissue, and integrated with the drain and having one end connected into the atrium; And a fourth pacing wire, the drainage drain having a temporary pacing mechanism. 3. A side hole is formed in a side surface of one end of the drain.
3. The method according to claim 1 or 2, wherein:
Temporary pacing mechanism with drainage drain of.