JP5395537B2 - Separate lung ventilation system - Google Patents

Description

  The present invention relates to a separate lung ventilation device used for thoracic surgery and the like.

  In thoracic surgery, for example, as disclosed in Patent Document 1, a thin flexible tube is inserted from the patient's trachea to the bronchus to place the distal end in an appropriate position and isolate the damaged lung. There is a need to insert a flexible tube to occlude and supply air to the other lung.

  In such a separated lung ventilation device, even if the distal end of the flexible tube is surely inserted toward one desired lung, or even if the patient moves after insertion, the flexible tube for trachea There is a need to securely fix the cuff and bronchial cuff so that they do not come out of place or move.

  Also, in this type of separated lung ventilation device, it must be carefully avoided that the flexible tube collides with the inner wall of the trachea and bronchus during insertion and damages the trachea. Special care must be taken when passing through two bronchial bifurcations called carinas.

  Here, the bronchus that branches into two from Carina looks like a straight line when the right bronchus opposite the heart is seen from the oral cavity, while the left bronchus near the heart is slightly bent. It is common to see. However, there are individual differences in the direction and size of these two bronchi, depending on the patient's age and gender. Therefore, medical personnel need to correctly determine the bending state, insertion direction, and the like of the distal end portion of the flexible tube when handling the flexible tube of the separated lung ventilation device.

  If the distal end of the flexible tube is not correctly inserted into the patient's bronchus, the flexible tube must be pulled out and reinserted. However, such work increases the burden on the patient.

Special Table 2002-505925

  In view of such a conventional situation, the present invention prevents damage to the peripheral portion of a patient's carina, particularly when inserting a flexible tube, and can be easily obtained by anyone regardless of the skill of medical personnel. The distal end of the flexible tube is inserted into the bronchus, and the tracheal cuff and bronchial cuff can be securely fixed at a predetermined position. It is an object of the present invention to provide a separated lung ventilation device that can be positioned again in a predetermined position with a reduced number.

In order to achieve the above object, a separated lung ventilation device according to the present invention comprises:
The first inner hole 2 and the second inner hole 4 are separated from each other by a partition wall 6, and the first tube 8 constituting the first inner hole 2 constitutes the second inner hole 4. a flexible tube 12 which is formed a predetermined distance longer than the second tube 10,
And the first tube 8 and the second tube 10 Metropolitan tracheal cuff 14 attached to a tip end portion outer periphery of the formed flexible tube 12 from,
A bronchial cuff 18 installed on the outer periphery of the distal end portion of the extension portion 16 of the first tube 8 formed longer by a predetermined distance than the second tube 10;
It said removably inserted into the first inner hole 2, a first supply rod 22 vibration 20 is installed at the tip,
The second is inserted removably into the bore 4, a second introduction rod such that the bronchial cuff 18 can be arranged in a predetermined bronchial tip, the cuff 24 is set to an appropriate shape installed 26, and
At least the base end portion 28 of the extension portion 16 of the first tube 8 formed to be longer than the second tube 10 by a predetermined distance is bent so as to be deformed in advance in one direction by heat treatment. It is a feature.

  Further, in the present invention, the peripheral part of the tracheal cuff 14 and the bronchial cuff 18 includes an LED, an image sensor, etc. used for confirming the inside of the tube or the tube inner hole. The detector 46 is preferably embedded or attached.

  The separated lung ventilation device 40 having such a configuration is used as follows. That is, in the separation lung ventilation device 40, the first introduction rod 22 and the second introduction rod 26 are inserted in advance into the flexible tube 12, and the cuff 20 and the cuff 24 are expanded. Then, the flexible tube 12 is inserted into the oral cavity with the cuffs 20 and 24 inflated, and the flexible tube 12 is advanced by a predetermined distance. Here, when the flexible tube 12 is inserted inward of the trachea 32, the cuff 20 provided at the tip of the first introduction rod 22 first comes into contact with the carina as the bronchial branch point. Is so flexible that the carina will not be damaged. After the cuff 20 reaches the carina, the cuff 20 is degassed and the cuff 20 is deflated. Then, if the first introduction rod 22 is slightly lifted to the front side after the cuff 20 is deflated, the extended portion 16 of the first tube 8 returns to the bent state as in the manufacturing process. The extension portion 16 of the flexible tube 12 can be directed to the left bronchus 34 side. If the flexible tube 12 is further advanced, the bronchial cuff 18 can be advanced into the desired left bronchus 34.

  On the other hand, when the flexible tube 12 is advanced after the extension portion 16 of the first tube 8 is returned to the original bending posture, the cuff 24 at the tip of the second introduction rod 26 comes into contact with the carina. Further, the further advance of the flexible tube 12 is restricted by the contact of the cuff 24 with the carina. Even if the cuff 24 comes into contact with the carina, the cushioning action of the cuff 24 does not damage the peripheral portion of the carina.

  If air is introduced into the trachea cuff 14 and the bronchial cuff 18 from the state where the cuff 24 is in contact with the carina, the extended portion 16 of the first tube 8 is placed in the left bronchus 34. Can be fixed in the state. That is, the flexible tube 12 can be positioned and fixed at two locations by the bronchial cuff 18 and the tracheal cuff 14. Thereafter, if the cuff 24 is degassed, the second introduction rod 26 can be pulled out from the second tube 10.

  In addition, when the position shift has occurred, the second introduction rod 26 is inserted into the second inner hole, and the flexible tube 12 is advanced in a state where the cuff 24 at the distal end is inflated. Repositioning can be easily performed.

In addition, if an LED, an image sensor, etc. are installed in the peripheral part of the trachea cuff and the bronchial cuff, the internal state can be confirmed from the outside as required.

  According to the separated lung ventilation device of the present invention, regardless of the skill of medical personnel, anyone easily inserts a flexible tube into a desired bronchus, and puts the tracheal cuff and bronchial cuff into a predetermined position. It can be positioned and fixed securely. Thereby, air can be supplied to the desired bronchi.

  In addition, if the patient moves or the cuff is displaced after the trachea cuff and bronchial cuff are positioned, the second introduction rod is inserted again and the second introduction is performed. If the cuff at the tip of the rod is inflated and the flexible tube is slightly advanced after the cuff is inflated, it can be positioned again in the correct position. Thereby, it is possible to perform positioning again while minimizing the burden on the patient.

  In addition, by providing detectors such as LEDs and image sensors in the periphery of the tracheal cuff and bronchial cuff, the position of the bronchial cuff can be confirmed from the outside.

FIG. 1A is an exploded perspective view showing a separated lung ventilation apparatus according to one embodiment of the present invention, and FIG. 1B is a cross-sectional view taken along the line BB in FIG. FIG. 2 is a schematic view showing a state in which the cuff provided at the distal end portion of the first introduction rod has reached the carina after being inserted into the trachea with the separated lung ventilation device of FIG. 1 incorporated. FIG. 3 is a schematic view showing a state in which the cuff air at the tip is degassed from the state of FIG. 2 and the extended portion of the first tube returns to a bent posture as in the manufacturing process. FIG. 4 is a schematic diagram illustrating a state where the flexible tube is further advanced from the state of FIG. 3 and the cuff provided at the distal end portion of the second tube reaches the carina. 5, introducing air into the trachea cuff and bronchial cuff from the state of FIG. 4 is a schematic view when performing positioning.

  Hereinafter, an embodiment of a separated lung ventilation apparatus according to the present invention will be described with reference to the drawings.

  FIG. 1 shows a separated lung ventilation device 40 according to an embodiment of the present invention.

  The separation lung ventilation device 40 of this embodiment includes a flexible tube 12, a trachea cuff 14 installed on the outer periphery of the distal end portion of the flexible tube 12, and an outer periphery of the distal end portion of the extension portion 16 of the first tube 8. A bronchial cuff 18, a first introduction rod 22 detachably inserted into the first inner hole 2, and a second introduction detachably inserted into the second inner hole 4. And a rod 26.

  The flexible tube 12 of the separation lung ventilation device 40 is a translucent body, and the first tube 8 in which the first inner hole 2 is formed and the second tube in which the second inner hole 4 is formed. The first tube 8 and the second tube 10 are integrally formed, although the inner holes 2 and 4 are separated from each other by the partition wall 6. Further, the first tube 8 is formed such that the tip portion is longer than the second tube 10 by a predetermined distance.

In the present embodiment, the tip portion of the first tube 8 is formed as an inclined surface 30. As described above, if the tip of the first tube 8 is formed as the inclined surface 30, the cuff 20 of the first introduction rod 22 inserted into the first tube 8 is inflated as will be described later. Sometimes, the cuff 20 can be easily deformed. However, the tip of the first tube 8 may not be the inclined surface 30. The same function can be exhibited by devising the shape of the cuff 20.

  Further, the extended portion 16 of the first tube 8 provided on the distal end side of the first tube 8 may be formed of the same material as the flexible tube 12 or is formed of a different material. May be. When the material is different, it is preferable that the material is made of a material softer than the flexible tube 12.

  The flexible tube 12 and the extension portion 16 are made of, for example, silicone rubber, urethane, nylon 11, biphenyl chloride, or the like.

The length of the extension portion 16 in the first tube 8, as shown in FIG. 4, when the cuff 24 of the second introduction rod 26 is in contact with the Carina 36, the first tube 8 The opening of the inclined surface 30 is set in advance so as not to reach the upper left trunk 39. Therefore, in this embodiment, when the cuff 24 provided at the tip of the second introduction rod 26 contacts the carina 36, the opening of the extension portion 16 of the first tube 8 is stopped at a position before the left upper trunk 39. Can be made.

  As shown in FIG. 1, the extension portion 16 of the first tube 8 is formed by bending in advance in one direction with respect to an axis S extending in the natural direction of the flexible tube 12. The bending direction is a direction that branches from the trachea 32 to the left bronchus 34 as shown in FIG. Any method may be employed to bend the extension portion 16 of the first tube 8. For example, as shown in FIG. 1, the vicinity of the proximal end portion 28 of the extension portion 16 is heat-treated. Thus, the entire extension portion 16 can be bent from this portion. Thus, if the vicinity of the base end portion 28 is bent by heat treatment, the cost is low.

  Further, a tracheal cuff 14 is provided on the outer periphery of the distal end portion of the portion where the first tube 8 and the second tube 10 are integrated via the partition wall 6, and the outer periphery of the extended portion 16 of the first tube 8 is provided on the outer periphery. A bronchial cuff 18 is installed.

The trachea cuff 14 and the bronchial cuff 18 are connected to the flexible tube via the conduit 13 and the conduit 15 formed in the wall of the flexible tube 12, as shown in FIG. the first pilot balloon 31 respectively are attached to the outside of the 12 to be connected to the second pilot balloon 32 0. Incidentally, these first pilot balloon 31, the second pilot balloon 32 0, the valve mechanism is provided.

  Therefore, the tracheal cuff 14 can be inflated to a predetermined size by introducing air from the first pilot balloon 31 through the conduit 13. Moreover, it can return to the original deflated state by deaeration of air through the same pipe line 13.

On the other hand, bronchial cuff 18, the second pilot balloon 32 0, by introducing air through a conduit 15, may be inflated predetermined in size. In addition, when the air is deaerated through the same pipe line 15, the original deflated state can be restored.

  Hereinafter, the first introduction rod 22 and the second introduction rod 26 that are detachably inserted into the first inner hole 2 and the second inner hole 4 will be described.

The first introduction rod 22 and the second introduction rod 26 are made of a bendable resin or a soft metal, and are formed in a hollow shape. Thereby, an air passage is formed inside the first introduction rod 22 and the second introduction rod 26.

  On the other hand, pilot balloons 35 and 37 each having a valve mechanism are provided at proximal ends of the first introduction rod 22 and the second introduction rod 26 on the proximal side. Accordingly, if air is introduced from the pilot balloons 35 and 37, the cuffs 20 and 24 on the distal end side can be expanded. On the other hand, if the air is removed from the pilot balloons 35 and 37, the cuff 20 and the cuff 24 can be deflated.

  Thus, when the first introduction rod 22 provided with the cuff 20 and the second introduction rod 26 provided with the cuff 24 are mounted in the flexible tube 12, the air is deaerated beforehand. Mount after reducing the outer shape.

  When the first introduction rod 22 is mounted in the first inner hole 2, the extended portion 16 of the first tube 8 is bent in a substantially straight posture so that the first introduction rod 22 is The posture follows the shape.

  On the other hand, if the first introduction rod 22 is pulled out from the first inner hole 2, the extended portion 16 can be returned to the manufacturing posture in which it is bent again.

  A Y-shaped adapter 33 is installed on the head of the flexible tube 12, and gas is supplied to the first inner hole 2 and the second inner hole 4 through the Y-shaped adapter 33.

  The separated lung ventilation device 40 of this embodiment is used to fix the cuff 18 to the left bronchus 34. Therefore, the bendable first introduction rod 22 and the second introduction rod 26 may be bent at an appropriate angle for the left bronchus, or may be straight.

  For example, the first introduction rod 22 and the second introduction rod 26 are inserted from the Y-shaped adapter 33 toward the distal end side.

  The separated lung ventilation device 40 having such a configuration is used as follows.

  First, the first introduction rod 22 is inserted into the first inner hole 2 while being deaerated from the cuff 20. Similarly, the second introduction rod 26 is introduced into the second inner hole 4 while being deaerated from the cuff 24. By inserting the first introduction rod 22 into the first inner hole 2, in particular, the bent portion of the extension portion 16 of the first tube 8 is corrected, and the extension portion 16 becomes the first introduction portion. The posture follows the posture of the rod 22. Air is introduced into the cuff 20 and the cuff 24 from the state where the first introduction rod 22 is inserted into the first inner hole 2.

  Thus, the first introduction rod 22 and the second introduction rod 26 are inserted into the first inner hole 2 and the second inner hole 4 respectively, and air is further introduced into the cuff 20 and the cuff 24. From this initial state, the flexible tube 12 is inserted into the patient's pharynx.

  Since the distal end surface of the extended portion 16 of the first tube 8 is an inclined surface 30, when the cuff 20 is bulged with the first introduction rod 22 inserted, the cuff 20 is inclined. The posture is inclined along the surface 30. That is, as shown in FIG. 2, the cuff 20 is deformed. Even when the inclined surface 30 is not formed, the same function is exhibited by devising the shape of the cuff 20.

As shown in FIG. 2, when the flexible tube 12 is inserted into the trachea 32, first, the cuff 20 at the distal end portion of the first introduction rod 22 is near the carina 36 that is a bifurcation point of the left and right bronchi To reach.

  At this time, the cuff 20 formed at the tip of the first introduction rod 22 is in an inclined state as described above. From the state where the cuff 20 reaches the carina 36, the pilot balloon 35 attached to the first introduction rod 22 is operated to deaerate the air from the cuff 20. Then, after the cuff 20 is deflated, the first introduction rod 22 is pulled up as shown in FIG.

  Note that the cuff 20 can reach the carina 36 with a bronchoscope, an optical fiber cable, an image sensor, or the like. Moreover, in order to confirm the position of a flexible tube, you may attach | subject a radiopaque line etc. to the extension part 16 of the 1st tube 8. FIG.

  When the first introduction rod 22 is pulled up from the first tube 8 after the cuff 20 reaches the carina 36, the extended portion 16 of the first tube 8 returns to the bent state as in the manufacturing process. Thereby, as shown in FIG. 3, the extension part 16 of the flexible tube 12 can be turned to the left bronchus 34 side. If the flexible tube 12 is further advanced inward from this state, the bronchial cuff 18 can be advanced into the left bronchus 34.

  On the other hand, when the flexible tube 12 is advanced inward after the extended portion 16 of the first tube 8 returns to the original bending posture, this time, as shown in FIG. The cuff 24 contacts the carina 36. Thus, even if the cuff 24 contacts the carina 36, the impact force is absorbed by the cushioning action of the cuff 24, so that the carina 36 is not damaged.

  When the cuff 24 comes into contact with the carina 36, if the cuff 24 is designed in an appropriate shape in advance, the bronchial cuff 18 is disposed at a predetermined position in the bronchus 34. That is, the opening of the inclined surface 30 of the extended portion 16 stops before the upper left trunk 39.

  When the cuff 24 is inflated by introducing air into the tracheal cuff 14 and the bronchial cuff 18 from the state of FIG. The flexible tube 12 can be securely fixed. Therefore, it becomes possible to supply a predetermined gas into the bronchus 34 from the distal end opening of the extension portion 16 of the first tube 8.

  On the other hand, if air is introduced and fixed to the tracheal cuff 14 and the bronchial cuff 18 and then the cuff 24 is degassed and reduced in size, the second introduction rod 26 is moved to the second cuff 24 as shown in FIG. It can be pulled out of the tube 10.

  The state of whether or not the bronchial cuff 18 is disposed at a predetermined position can be confirmed with a bronchoscope, an optical fiber cable, an image sensor, or the like. In that case, it is preferable to carry out while irradiating the inside using a light emitting element such as an LED. As shown in FIG. 1, a detector 46 such as an LED or an image sensor used for confirming the internal state is preliminarily placed in the tube wall at the end of the tracheal cuff 14 or in the tube bore. It is desirable to attach it.

Even if the bronchial cuff 18 is placed at the correct position, the separated lung ventilation device 40 may be displaced from a predetermined position if the patient has moved. In such a case, in this embodiment, the second introduction rod 26 is again inserted into the second inner hole 4, and then the cuff 24 is bulged, and the flexible tube 12 is removed from this state. When advanced, the cuff 24 comes into contact with the carina 36, and the bronchial cuff 18 can be placed again at a predetermined position. That is, in the present invention, the position of the bronchial cuff 18 is uniquely determined by the cuff 24 coming into contact with the carina 36, so that repeated positioning can be easily performed.

  Therefore, even if the patient moves, performing the above procedure ensures that the flexible tube is positioned and fixed securely regardless of the skill of the person handling it and without placing a heavy burden on the patient. Can be done.

  As mentioned above, although one Example of this invention was described, this invention is not limited to the said Example at all.

  For example, in the above-described embodiment, the left bronchus is described. However, the present invention can also be applied to the right bronchus. In that case, it is necessary to deform the extension 16 of the first tube 8 for the right bronchus.

2 First inner hole 4 Second inner hole 6 Bulkhead 8 First tube 10 Second tube 12 Flexible tube 14 Tracheal cuff 16 First tube extension 18 Bronchial cuff 20 Cuff 22 First the introduction rod 24 cuff 26 second supply rod 28 proximal end 30 inclined surface 32 trachea <br/> 34 left bronchus 36 Carina 40 differential lung ventilator 46 detector

Claims (3)

The first inner hole (2) and the second inner hole (4) are separated from each other by the partition wall (6), and the first tube (8) constituting the first inner hole (2). a predetermined distance longer formed flexible tube (12) with respect to but a second tube constituting the second bore (4) (10),
And the installed tracheal cuff (14) to the distal end outer periphery of the first tube (8) and said second tube (10) from the configured flexible tube (12),
A bronchial cuff (18) installed on the outer periphery of the distal end portion of the extended portion (16) of the first tube (8) formed to be longer than the second tube (10) by a predetermined distance;
It said removably inserted into the first bore (2) in a first supply rod for vibrating (20) is installed at the tip (22),
Wherein is removably inserted into the second bore (4) in, such that bronchial cuff (18) can be arranged in a predetermined bronchial tip, cuff, which is set to an appropriate shape (24) is installed A second introduction rod (26),
At least the base end portion (28) of the extended portion (16) of the first tube (8) formed at a predetermined distance longer than the second tube (10) is deformed in advance in one direction by heat treatment. A separated lung ventilation device characterized in that the device is bent. The end surface of the tip of the first tube (8) formed longer than the second tube (10) by a predetermined distance is formed as an inclined surface (30), and the first introduction rod (22) is when in the inflated state is pre hear off (20) while being inserted into the first bore (2), the cuff (20 cuff (20) is in contact with the inclined surface (30) ) Is previously arranged in an inclined posture, and the separated lung ventilation device according to claim 1.   Detectors such as an LED and an image sensor used for checking the inside of the tube or the tube inner hole in the periphery of the tracheal cuff (14) and the bronchial cuff (18) 3. The separated lung ventilation device according to claim 2, wherein is embedded or attached.

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