JP5916341B2 - Tracheal intubation device - Google Patents

Description

  The present invention relates to a tracheal intubation device used at the time of tracheal intubation for securing a patient's airway.

  At the time of tracheal intubation, a tube is often inserted and placed using a metal device called a Macintosh blade.

  Tracheal intubation is performed in the emergency area as well as during surgery for introducing anesthesia. Tracheal intubation in the emergency area is a very difficult procedure, and the Japanese version of the Emergency Resuscitation Guidelines recommends that skilled personnel perform procedures using Macintosh blades.

  Complications are assumed during the above tracheal intubation procedure. Among the possible complications, one that must be avoided is the so-called “unattended esophageal intubation” in which the practitioner inserts the tube into the esophagus without noticing it.

  Therefore, for example, it has been proposed to assist tracheal intubation using a video laryngoscope including a camera that captures the larynx and a monitor that displays images captured by the camera (see, for example, Patent Document 1). With this video laryngoscope, it is only necessary to advance the tube while looking at the glottis displayed on the monitor. Therefore, even if the level of proficiency is relatively low compared to the case of using a conventional Macintosh blade, the trachea It is thought that intubation can be performed safely.

JP 2007-117116 A

  By the way, it is desired to perform a reliable tracheal intubation procedure without complications quickly in a field where every moment is contested such as an emergency area.

  In the case of tracheal intubation, a double lumen tube may be used to intubate, for example, the left bronchus. In this case, the right bronchus should not be inadvertently intubated.

  In addition, a single lumen tube may be intubated into the trachea, especially in children, since the trachea is short, the appropriate range for indwelling the distal end of the tube is narrow, and the distal end of the tube is in the proper position within the bronchus. It is difficult to put in.

  Here, assuming the case where the intubation treatment is performed using the video laryngoscope of Patent Document 1, although the inside of the larynx can be photographed with a camera, it is only a laryngoscope, so that it is inserted behind the glottis. It is not possible to shoot up to the glottis, and it is not possible to shoot the trachea deeper than the glottis.

  For this reason, it is impossible to know where the tip of the tube is behind the glottis, and in both the above-mentioned double lumen tube and single lumen tube, the tracheal intubation treatment can be completed securely and safely as intended. Was insufficient.

  The present invention has been made in view of such a point, and the object of the present invention is to enable reliable and safe intubation at a position aimed at the tube even if the skill level of the practitioner is low. There is.

  In order to achieve the above object, in the present invention, an imaging unit is provided in both the intubation support apparatus and the tube, and an image photographed by these imaging units can be displayed on the monitor unit.

A first invention is a tracheal intubation device comprising a tube to be intubated into the trachea and an intubation support device for guiding the tube to the trachea, wherein the intubation support device is inserted into the larynx from the oral cavity and A guide unit serving as a guide; and a support device side imaging unit provided on a distal end side of the guide unit, and the tube includes a tube side imaging unit provided on a distal end side of the tube, and the support unit. A monitor unit that displays an image captured by the apparatus side imaging unit and the tube side imaging unit, and a control unit to which the support apparatus side imaging unit, the tube side imaging unit, and the monitor unit are connected, and the control unit Detects the intensity of light emitted from the light emitter provided on the distal end side of the tube on the oral cavity side than the glottis and determines whether or not the light intensity has decreased by a predetermined value or more. Before judging The support device side image captured by the support device side imaging unit is displayed on the monitor unit, and after determining that the image has decreased by a predetermined value or more, the tube side image captured by the tube side imaging unit is displayed on the monitor unit. Thus, it is configured to automatically select the support device side image and the tube side image without depending on the hand of the practitioner .

  According to this configuration, since the image of the support device side imaging unit provided on the distal end side of the guide unit of the intubation support device can be displayed on the monitor unit, the practitioner can remove the tube while watching the larynx, for example, the glottis. It becomes possible to proceed to the glottal surely.

  Then, when the tube passes through the glottis and is inserted into the trachea, an image of the tube side imaging unit provided on the distal end side of the tube can be displayed on the monitor unit. Thereby, the position of the front-end | tip part of a tube can be grasped | ascertained behind a glottis. Therefore, inadvertent intubation into the right bronchus, for example when the left bronchus must be intubated, is avoided, and even if the trachea is short, such as in children, the tip of the tube should be placed in the proper position. Is possible.

Further , since the support device side image and the tube side image are automatically selected and displayed on the monitor unit, the act of selecting one image by the practitioner becomes unnecessary.

In addition , when the light emitter on the distal end side of the tube passes through the glottis and is inserted into the trachea, the light of the light emitter is less likely to reach the oral cavity than the glottis due to the presence of the glottis. According to the present invention, before the light intensity of the light emitter on the tube tip side detected on the oral cavity side of the glottis is equal to or lower than a predetermined value, that is, when the tip portion of the tube does not pass through the glottis, By projecting the image on the monitor, it is possible to reliably advance the tip of the tube to the glottis. On the other hand, after the light intensity of the light emitter on the tube tip side detected on the oral cavity side from the glottis becomes below a predetermined value, that is, when the tube tip portion passes through the glottis, the tube side image is displayed on the monitor unit. In this way, the position of the tip of the tube can be grasped deeper than the glottis.

In a second aspect based on the first aspect , an illumination unit that illuminates the imaging range of the tube side imaging unit is provided on the distal end side of the tube, and the control unit emits light emitted from the illumination unit. It is characterized by determining whether the intensity | strength of this fell by more than predetermined value.

  According to this configuration, since the illumination unit for the tube side imaging unit is used as a light emitter, it is possible to detect whether or not the tube has passed through the glottis without providing a light emitter separately.

According to a third aspect of the present invention, there is provided a tracheal intubation device including a tube to be intubated into the trachea and an intubation assisting device for guiding the tube to the trachea. A guide unit serving as a guide; and a support device side imaging unit provided on a distal end side of the guide unit, and the tube includes a tube side imaging unit provided on a distal end side of the tube, and the support unit. A monitor unit that displays an image captured by the device-side imaging unit and the tube-side imaging unit; and a control unit to which the support-device-side imaging unit, the tube-side imaging unit, and the monitor unit are connected, and the tube Is provided with a portion to be detected closer to the base end than the distal end portion, and the guide portion of the intubation support device is provided with detection means for detecting the detected portion, and the detection means is provided on the tube. The tip is It is arranged to detect the detected part when the tube moves until it passes through the gate, and the control unit detects the detected part by the support device side imaging unit before the detecting unit detects the detected part. The captured support device side image is displayed on the monitor unit, and after the detection unit detects the detected portion, the tube side image captured by the tube side imaging unit is displayed on the monitor unit. The support device-side image and the tube-side image are configured to be automatically selected without depending on the hand of the practitioner .

  According to this configuration, since the detected portion is not detected by the detecting means until the distal end portion of the tube passes through the glottis, the support device side image is displayed on the monitor portion, and the distal end portion of the tube is surely connected to the glottis. It becomes possible to proceed. On the other hand, when the tip of the tube passes through the glottis, the detected part is detected by the detection means, so that the tube side image is displayed on the monitor unit, and the position of the tip of the tube is grasped deeper than the glottis Can do.

  According to the first aspect of the invention, since the images of the support device side imaging unit provided in the intubation support device and the tube side imaging unit provided in the tube are displayed on the monitor unit, the practitioner displays the tube in the glottis The position of the tube can be confirmed in the trachea and bronchi deeper than the glottis. Thereby, even if the skill level of the practitioner is low, the tube can be reliably and safely intubated at a position where the tube is aimed.

In addition , since the support device side image and the tube side image are automatically selected and displayed on the monitor unit, both images can be confirmed while reducing the burden on the operator.

Also , before the light intensity of the light emitter on the tube tip side detected on the oral cavity side from the glottis is less than or equal to a predetermined value, the support device side image is displayed on the monitor unit, and after the intensity is less than or equal to the predetermined value, the tube side Since the image can be displayed on the monitor unit, both the burden on the operator and a safe intubation treatment can be achieved.

According to the second invention, it is possible to detect whether or not the tube has passed through the glottis using the illumination unit that illuminates the imaging range of the tube side imaging unit. As a result, it is not necessary to provide a light emitter separately, so that the cost can be reduced.

According to the third invention, it is possible to reliably detect whether or not the tube has passed through the glottis using the detection means provided in the intubation support device and the detected portion of the tube, so that the burden on the practitioner Both mitigation and safe intubation can be achieved.

It is a perspective view of a tracheal intubation device according to Reference Example 1. FIG. 2 is a view corresponding to FIG. 1 in a state before the tube is held in the intubation support device. It is the perspective view which looked at the intubation assistance apparatus from the insertion side to a patient. It is the perspective view which looked at the tube from the insertion side to a patient. It is a fragmentary sectional view by the side of the tip of a tube. It is a block diagram of a tracheal intubation device. It is a figure which shows the monitor part which displayed the image of the assistance apparatus side camera. It is a figure which shows the monitor part which displayed the image of the 1st tube side camera. It is the monitor part which displayed the image of the assistance apparatus side camera and the 1st tube side camera. FIG. 9 is a view corresponding to FIG. 8 when the tube is advanced to the bronchial bifurcation. FIG. 9 is a view corresponding to FIG. 8 when the tube is advanced to the left bronchus. It is a figure which shows the monitor part which displayed the image of the 2nd tube side camera at the time of advancing a tube to the left bronchus. It is a figure which shows the monitor part which displayed the image of the 1st tube side camera and the 2nd tube side camera. It is a flowchart which shows the procedure of tracheal intubation. It is a figure explaining the state which inserted the guide part of the intubation assistance apparatus in the larynx. It is a figure explaining the state which advanced the tube to the glottic vicinity. It is a figure explaining the state which advanced the tube to the back rather than the glottis. It is a figure explaining the position of the tube advanced to the back rather than the glottis. It is a figure explaining the position of the tube advanced to the left bronchus. FIG. 6 is a view corresponding to FIG. 1 according to Reference Example 2. FIG. 5 is a diagram corresponding to FIG. 4 according to Reference Example 2. FIG. 4 is a diagram corresponding to FIG. 3 according to the first embodiment. FIG. 4 is a diagram corresponding to FIG. 3 according to the first embodiment. FIG. 4 is a diagram corresponding to FIG. 3 according to the second embodiment. It is an expansion perspective view of the tube concerning Embodiment 2. FIG.

  Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings. It should be noted that the following description of the preferred embodiment is merely illustrative in nature, and is not intended to limit the present invention, its application, or its use.

( Reference Example 1)
FIG. 1 shows a tracheal intubation device 1 according to Reference Example 1. The tracheal intubation device 1 is used, for example, when performing a tracheal intubation treatment for securing an airway of a patient who has lost consciousness in a lifesaving emergency area.

  As shown in FIGS. 2 and 3, the tracheal intubation device 1 includes a tube 10 that is intubated into the trachea, and an intubation support device 30 that guides the tube 10 to the trachea.

  As shown in FIG. 4, the tube 10 includes a tube main body 13 composed of a double lumen tube having first and second lumens 11 and 12 for bronchial ventilation, and a first tube side provided at the distal end of the tube main body 13. The camera 14 and the first illumination LED 15 (see FIG. 5), and the second tube side camera 16 and the second illumination LED 17 provided on the proximal end side of the tube body 13 with respect to the first tube side camera 14 are provided. Yes.

  A bronchial sealing cuff 18 is provided at the distal end of the tube body 13. A tracheal sealing cuff 19 is provided closer to the proximal end of the tube main body 13 than the bronchial sealing cuff 18 on the distal end side of the tube main body 13.

  On the proximal end side of the tube body 13, a bronchial seal pilot balloon 20 connected to the bronchial seal cuff 18 and a tracheal seal pilot balloon 21 connected to the tracheal seal cuff 19 are provided. A ventilator is connected to the proximal end portions of the first and second lumens 11 and 12 of the tube body 13.

  In addition, the tube body 13 supplies power to the first and second tube-side cameras 14 and 16 and the first and second illumination LEDs 15 and 17 and receives image signals output from the tube-side cameras 14 and 16. A flowing wiring 22 is provided. As will be described later, the wiring 22 is connected to a control device (control unit) 38 of the intubation support device 30.

  As shown in FIG. 5, the first tube-side camera (tube-side imaging unit) 14 and the first LED 15 for illumination are integrated, and are fixed to the inner surface of the distal end portion of the tube body 13 so that the tube body 13 It faces outward along the center line of the tip from the tip. Therefore, the imaging range of the first tube-side camera 14 is a range that faces the tip opening of the tube body 13 and is wider than the tip opening. The first LED 15 for illuminating is for irradiating light to the imaging range of the first tube side camera 14.

  The second tube side camera 16 and the second illumination LED 17 are also integrated. The second tube side camera 16 and the second illumination LED 17 are fixed to the outer surface between the bronchial seal cuff 18 and the tracheal seal cuff 19 in the tube main body 13. The orientation of the second tube side camera 16 and the second LED 17 for illumination is directed to the outside of the tube body 13 and is obliquely distal to the center line of the tube body 13. Therefore, the imaging range of the second tube side camera 16 is an oblique side of the tube body 13. The second illumination LED 17 is for irradiating light to the imaging range of the second tube side camera 16.

  As shown in FIG. 1, a carbon dioxide sensor A is attached to the proximal end portion of the first lumen 11 of the tube 10. The carbon dioxide sensor A is a well-known sensor capable of measuring the concentration of carbon dioxide in real time by transmitting a laser beam of a predetermined wavelength through the breath and inhalation flowing through the inside and detecting the degree of wavelength attenuation at the light receiving unit. It is. A connection line A1 extends from the carbon dioxide sensor A. As will be described later, the connection line A1 is connected to the control device 38 of the intubation support device 30. When the power supply of the intubation support device 30 is turned on, power is supplied from the intubation support device 30 to the carbon dioxide sensor A, the carbon dioxide sensor A is activated, and a signal related to the carbon dioxide concentration is transmitted to the control device 38.

  The intubation support device 30 includes a device main body 31, a guide unit 33 that is inserted into the larynx from the oral cavity and serves as a guide for the tube 10, a support device side camera (support device side imaging unit) 34 (shown in FIG. 3), And a support device side illumination LED 35.

  The apparatus main body 31 includes a monitor unit 37, a control device 38 (shown in FIG. 6), and a case 39 that houses the control device 38. The monitor unit 37 is attached to the outer surface of the case 39 via a rotating shaft (not shown), and the angle can be adjusted according to the request of the practitioner. The monitor unit 37 has a known color liquid crystal panel. The angle adjustment mechanism of the monitor unit 37 is not essential and may be omitted.

In this reference example , the monitor unit 37 has a vertically long shape, but is not limited thereto, and may be a horizontally long shape, for example.

  The monitor unit 37 may be detachable from the case 39. In this case, the monitor unit 37 can be placed in a place where the practitioner can easily see and does not interfere with the intubation treatment. In addition to the control device 38, a battery 41 as a power source is accommodated in the case 39.

  When the monitor unit 37 is detachably attached to the case 39, it is preferable that a power source is built in the monitor unit 37 so that the monitor unit 37 and the control device 38 perform wireless communication.

  A guide portion 33 is detachably attached to the case 39. The guide part 33 can be comprised similarly to the intubation assistance tool currently disclosed by the said patent document 1, for example. That is, the guide portion 33 extends in a curved manner from the case 39 side (base end side) toward the distal end side in a side view, and is formed in a thick plate shape as a whole. As shown in FIG. 2, a tube insertion groove 33 a for inserting the tube 10 is formed on the side portion in the width direction of the guide portion 33. The tube insertion groove 33 a is opened to one side surface of the guide portion 33 and is also opened to the distal end surface of the guide portion 33. The tube 10 inserted into the tube insertion groove 33a is relatively movable along the direction in which the guide portion 33 extends.

  The proximal end of the tube insertion groove 33 a is located in the vicinity of the central portion in the longitudinal direction of the guide portion 33. Furthermore, tube holders 33b and 33b are provided on one side surface of the guide portion 33 on the proximal end side with respect to the tube insertion groove 33a so as to protrude from the side surface. Therefore, as shown in FIG. 1, the tube 10 is inserted and held in the tube insertion groove 33 a from the distal end portion thereof to a portion where the bronchial sealing cuff 18 and the tracheal sealing cuff 19 are formed.

  As shown in FIG. 3, the support apparatus side camera 34 and the support apparatus side illumination LED 35 are integrated. The support device-side camera 34 and the support device-side illumination LED 35 are provided so as to be positioned on the side of the open portion of the tube insertion groove 33 a at the distal end portion of the guide portion 33. The directions of the support device side camera 34 and the support device side illumination LED 35 substantially coincide with the extending direction on the distal end side of the guide portion 33. Therefore, the shooting range of the support device side camera 34 is a range that faces the tip of the guide portion 33 and is wider than the projected area of the tip. The support device side illumination LED 35 is for irradiating light to the photographing range of the support device side camera 34.

  The control device 38 has a well-known central processing unit, a memory, and the like, and the tube side image captured by the first tube side camera 14 and the support device side image captured by the support device side camera 34, It is configured such that it can be automatically selected and displayed on the monitor unit 37 regardless of the practitioner's hand.

  As shown in FIG. 6, the control device 38 includes the monitor unit 37, the first tube side camera 14, and the support device side camera 34, the carbon dioxide sensor A, the second tube side camera 16, the first and second illuminations. LEDs 15 and 17, support device side illumination LED 35, ON / OFF switch 45 and camera changeover switch 46 are connected.

  When the control device 38 is turned on by the operation of the ON / OFF switch 45, the monitor unit 37, the first tube side camera 14, the support device side camera 34, the carbon dioxide sensor A, the second tube side camera 16, the first The second illumination LEDs 15 and 17, the support device side illumination LED 35, and the carbon dioxide sensor A are supplied with electric power.

  The control device 38 detects an output signal from the carbon dioxide sensor A, detects whether or not the carbon dioxide concentration has increased by a predetermined value or more compared to immediately after the power is turned on, and has increased by a predetermined value or more. Before the determination, the support apparatus side image is displayed on the full screen on the monitor unit 37 (FIG. 7), and after determining that the image has risen by a predetermined value or more, the tube side image is displayed on the monitor unit 37 on the full screen (FIG. ) Is configured as follows.

  That is, when the tube 10 passes through the glottis and is inserted into the trachea, air from the lungs flows into the tube 10, so the carbon dioxide concentration of the air in the tube 10 suddenly increases. . The increase degree of the carbon dioxide concentration at this time is stored in advance in the control device 38 as the predetermined value. This predetermined value may be set slightly lower than the actual value in order to provide a margin. Then, the stored value is compared with the output signal from the carbon dioxide sensor A to make the above determination.

  The support device side image and the tube side image may be displayed only on a part of the monitor unit 37 as shown in FIG.

  Further, as shown in FIG. 7 and the like, the control device 38 always displays the carbon dioxide concentration obtained from the output signal of the carbon dioxide sensor A on the monitor unit 37. A carbon dioxide concentration display region 37a is provided at the lower part of the monitor unit 37, and the carbon dioxide concentration is displayed in this region 37a by using two types of display forms of a specific numerical value and a bar graph format. . In the bar graph display format, the larger the number of bars, the higher the carbon dioxide concentration.

  As shown in FIG. 7, the display and non-display of the target mark M can be switched by the selection of the practitioner. The target mark M is for indicating that the extension line of the tip of the tube 10 matches the glottis when the mark M is aligned with the glottis.

  The control device 38 is configured to display on the monitor unit 37 which camera the image is captured. When an image captured by the first tube side camera 14 is displayed on the monitor unit 37, “first tube side camera” (see FIG. 8) is displayed on the upper part of the monitor unit 37, and the second tube When the image captured by the side camera 16 is displayed, “second tube side camera” (see FIG. 12) is displayed, and when the image captured by the support apparatus side camera 34 is displayed. Is displayed as “support device side camera” (see FIG. 7).

  A camera changeover switch 46 shown in FIG. 6 is a switch for switching between the automatic mode and the manual mode. In the automatic mode, the support device side image shown in FIG. 7 is displayed on the monitor unit 37 at the start of the procedure, and then the tube side image shown in FIG. 8 is automatically switched when the carbon dioxide concentration increases by a predetermined value or more. This is the display mode. Instead of switching the images, as shown in FIG. 9, both the support device side image and the tube side image may be displayed.

  On the other hand, the manual mode is selected by the practitioner or assistant by selecting any camera from the first and second tube side cameras 14 and 16 and the support device side camera 34 by the switch operation. In this mode, an image captured by the camera is displayed on the monitor unit 37.

  Next, the case where the tracheal intubation device 1 configured as described above is used will be described based on the flowchart shown in FIG.

  First, preparation is performed in step S1 after the start of the flowchart. That is, as shown in FIGS. 1 and 3, the tube 10 is inserted into the tube insertion groove 33 a of the intubation assistance device 30 and the tube holders 33 b and 33 b hold the tube 10. At this time, the distal end portion of the tube 10 is positioned slightly closer to the proximal end than the distal end portion of the guide portion 33 of the intubation assisting device 30, and the first tube side camera 14 and the assisting device side camera 34 face substantially the same direction. ing. When the ON / OFF switch is turned on, an image captured by the support apparatus side camera 34 is displayed on the monitor unit 37.

  When the preparation is completed, the process proceeds to step S2, and the distal end side of the guide portion 33 of the intubation support device 30 is inserted from the oral cavity into the larynx.

  Then, it progresses to step S3, moves to the laryngeal deployment technique, and inserts the guide part 33 deeply into the larynx (see FIG. 15).

  Then, since the support device side camera 34 is provided at the tip of the guide unit 33, the inside of the larynx is imaged and displayed on the monitor unit 37 (see FIG. 7).

  In step S4, it is determined whether or not the vicinity of the glottis is projected on the monitor unit 37 based on the image shown in FIG. 7, and if not projected, the process returns to step S3 to move the guide unit 33 and perform the laryngeal deployment technique. continue.

  If the vicinity of the glottis is projected, the practitioner moves the intubation support device 30 so that the glottal and the target mark M are aligned, and proceeds to step S5.

  When the target mark M matches the glottis, the process proceeds to step S5, and the tube 10 is moved in the insertion direction while looking at the monitor unit 37 (see FIG. 16). When the tube 10 is moved in the insertion direction, the distal end portion of the tube 10 enters the imaging range of the support apparatus side camera 34 and the distal end portion of the tube 10 is projected on the monitor unit 37 as shown in FIG. By advancing the tube 10 while looking at the monitor unit 37, the tip of the tube 10 can be reliably inserted into the glottis.

  In step S6 following step S5, it is determined based on the detection result of the carbon dioxide sensor A whether or not the distal end portion of the tube 10 has passed through the glottis. This is a step performed by the control device 38.

  That is, as shown in FIGS. 17 and 18, when the distal end of the tube 10 passes through the glottis, air from the lungs flows into the tube 10. Then, the carbon dioxide concentration of the air in the tube 10 is clearly increased as compared to before the tube 10 is inserted into the glottis. Since the carbon dioxide sensor A detects the carbon dioxide concentration of the air in the tube 10 in real time, the control device 38 determines the carbon dioxide concentration of the air in the tube 10 based on the detection result of the carbon dioxide sensor A. It determines with having raised more than a value, and it becomes YES in step S6.

  On the other hand, if the tip of the tube 10 does not pass through the glottis in step S5, the carbon dioxide concentration of the air in the tube 10 does not change significantly, so the carbon dioxide concentration of the air in the tube 10 has increased by a predetermined value or more. It is determined that there is no, NO in step S6, and the process returns to step S5.

  In step S7, which is determined as YES in step S6, the control device 38 performs a process of switching the image displayed on the monitor unit 37 from the support device side image to the tube side image. As a result, the image displayed on the monitor unit 37 is automatically switched regardless of the practitioner's hand.

  At this time, both the support apparatus side image and the tube side image may be displayed on the monitor unit 37 as shown in FIG. The image displayed on the monitor unit 37 may be switched by operating the camera switch 46 by the practitioner.

  As shown in FIG. 8, the tube side image is displayed on the monitor unit 37, so that the practitioner can see the inside of the trachea deeper than the glottis and the tip of the tube 10 is deeper than the glottis. The position can be grasped.

  In step S8, the practitioner advances the tube 10 to the left and right bronchial bifurcation while confirming the tube side image displayed on the monitor unit 37 shown in FIG. As shown in FIG. 10, since the branching portion is projected on the monitor unit 37, it can be reliably advanced toward the bronchus (left or right bronchus) targeting the tube 10.

  At this time, the practitioner operates the camera changeover switch 46 to display the image captured by the second tube side camera 16 on the monitor unit 37 (see FIG. 12), and determines whether or not the branch unit has been reached. Alternatively, step S9 may be used. Since the second tube-side camera 16 faces the outside of the tube 10 between the bronchial sealing cuff 18 and the tracheal sealing cuff 19, the inner wall of the trachea is imaged until reaching the bifurcation as shown in FIG. 18. become. Then, as shown in FIG. 19, when the distal end portion of the tube 10 is inserted into the left bronchus through the branching portion and the second tube side camera 16 reaches the branching portion, the inner wall of the trachea is not imaged and the inner wall of the right bronchus is imaged. (See FIG. 12). At this time, the image of the first tube-side camera 14 is an image of the inner wall of the left bronchus as shown in FIG. By confirming this, the practitioner knows that the distal end portion of the tube 10 has been reliably inserted into the left bronchus.

  As shown in FIG. 13, images of both the first tube side camera 14 and the second tube side camera 16 may be displayed on the monitor unit 37.

  Step S9 may be omitted.

  Thereafter, the process proceeds to step S10, the bronchial seal pilot balloon 20 and the tracheal seal pilot balloon 21 are operated to inflate the bronchial seal cuff 18 and the tracheal seal cuff 19, and the tube 10 is fixed to the trachea and bronchus in an intubated state. .

As described above, according to the tracheal intubation device 1 according to the reference example 1, the image of the support device side camera 34 provided in the intubation support device 30 is displayed on the monitor unit 37 until the tube 10 is inserted into the glottis. Therefore, the practitioner can reliably advance the tube 10 to the glottis while looking inside the larynx, for example, the glottis, as shown in FIG.

  When the tube 10 passes through the glottis and is inserted into the trachea, the image of the first tube side camera 14 provided at the distal end side of the tube 10 is displayed on the monitor unit 37 as shown in FIGS. It becomes possible. Thereby, the position of the front-end | tip part of the tube 10 can be grasped | ascertained behind a glottis. Thus, for example, if the left bronchus must be intubated, accidental intubation into the right bronchus is avoided.

Therefore, by using the tracheal intubation device 1 according to the reference example 1, even if the skill level of the practitioner is low, the tube 10 can be reliably and safely intubated at a position where the tube 10 is aimed.

  Further, since the carbon dioxide concentration is always displayed on the monitor unit 37, the practitioner can specifically grasp the change in the carbon dioxide concentration during the treatment. This also makes it possible to accurately determine whether or not the tube 10 has passed through the glottis. Moreover, since the change in the carbon dioxide concentration can be grasped even after intubation, it can be determined whether or not artificial respiration is properly performed.

  Further, whether or not the tube 10 has passed through the glottis can be determined by detecting the carbon dioxide concentration in the tube 10. Then, before determining that the carbon dioxide concentration in the tube 10 has increased by a predetermined value or more, that is, before the tube 10 passes through the glottis, the support device side image is projected on the monitor unit 37 and determined to have increased by a predetermined value or more. Later, that is, after the tube 10 passes through the glottis, the tube side image is projected on the monitor unit 37. Thereby, since an image necessary for the practitioner can be displayed on the monitor unit 37 in accordance with the position of the distal end portion of the tube 10, both the burden on the practitioner and a safe intubation treatment can be achieved.

  In addition, since the support device side image and the tube side image are automatically selected and displayed on the monitor unit 37, both images can be confirmed while reducing the burden on the operator.

In the above reference example , the image of the support device side camera 34 and the images of the first and second tube side cameras 14 and 16 are displayed on the monitor unit 37 on the full screen. The image of the support device side camera 34 and the image of the first tube side camera 14 may be displayed in two, or the image of the first tube side camera 14 and the image of the second tube side camera 16 may be displayed. You may make it display.

  The timing at which the image of the support device side camera 34 and the image of the first tube side camera 14 are simultaneously displayed is preferably the timing at which the distal end portion of the tube 10 passes the glottis. The practitioner may be able to select the two-screen display.

  The timing at which the image of the first tube side camera 14 and the image of the second tube side camera 16 are displayed simultaneously is preferably the timing at which the distal end portion of the tube 10 passes through the glottis. The practitioner may select a two-screen display by an operation.

( Reference Example 2)
FIG. 20 shows a tracheal intubation device 1 according to Reference Example 2. The tracheal intubation device 1 of the reference example 2 is the same as that of the reference example 1 except that the configuration of the tube 50 is different, and the configuration of the tube 50 will be described in detail below.

  As shown in FIGS. 21 and 22, the tube 50 includes a tube main body 51 made of a single lumen tube, a tube-side camera 52 and an illumination LED 53 provided at the distal end of the tube main body 51.

  The tube main body 51 is provided with a wiring 55 through which an image signal output from the tube side camera 52 flows while supplying electric power to the tube side camera 52 and the illumination LED 53. The wiring 55 is connected to the control device 38 of the intubation support device 30.

The tube-side camera (tube-side imaging unit) 52 and the illumination LED 53 are integrated, and the inner surface of the distal end portion of the tube body 51 is the same as the first tube-side camera 14 and the first illumination LED 15 of Reference Example 1. It is fixed to.

Although not shown, a carbon dioxide sensor is also attached to the tube 50 of Reference Example 2.

Next, the case where the tracheal intubation device 1 according to Reference Example 2 is used will be described.

In the flowchart shown in FIG. 14, steps S1 to S8 are performed in Reference Example 2. That is, the tube 50 of Reference Example 2 is not inserted into the left and right bronchi but is placed in the trachea.

Even in the case of the reference example 2, it is possible to display the image of the support device side camera 34 provided in the intubation support device 30 on the monitor unit 37 until the tube 50 is inserted into the glottis. The tube 50 can be reliably advanced to the glottis while looking inside the larynx, for example, the glottis.

  When the tube 50 passes through the glottis and is inserted into the trachea, an image of the tube-side camera 52 provided on the distal end side of the tube 50 can be displayed on the monitor unit 37. Thereby, the position of the front-end | tip part can be grasped | ascertained in the place deeper than a glottis. Therefore, even when the bronchus is short, such as a child, the tip of the tube 50 can be placed at an appropriate position.

Therefore, by using the tracheal intubation device 1 according to Reference Example 2, even if the practitioner's skill level is low, the tube 10 can be reliably and safely intubated at a position where the tube 10 is aimed.

(Embodiment 1 )
In the above Reference Examples 1 and 2, but so as to determine whether the tube 10, 50 has passed through the glottis by detecting the carbon dioxide concentration in the tube 10, 50, in the first embodiment, the tube 10, It is configured to determine whether or not the tubes 10 and 50 have passed through the glottis by detecting the intensity of light emitted from a light emitter provided at the tip of 50 on the oral cavity side of the glottis.

  As shown in FIG. 23, an optical sensor 56 that can detect the intensity of light is provided at the distal end portion of the guide portion 33 of the intubation assistance device 30. The optical sensor 56 is connected to the control device 38, and a signal related to the light intensity is input to the control device 38. Since the guide part 33 is not inserted deeper than the glottis, the optical sensor 56 can detect the intensity of light emitted from the illumination LEDs 15 and 53 as the light emitter on the oral cavity side from the glottis.

  And since the light is not blocked by the glottis before the lighting LEDs 15 and 53 at the distal ends of the tubes 10 and 50 pass through the glottis, the intensity of the light detected by the optical sensor 56 is strong. Light emitted from the LEDs 15 and 53 for illumination is blocked by the glottis and hardly reaches the oral cavity side, and the intensity of light detected by the optical sensor 56 is weakened.

  The control device 38 determines whether or not the light intensity has decreased by a predetermined value or more. Before determining that the light intensity has decreased by a predetermined value or more, the control device 38 projects the support device side image on the monitor unit 37 and determines that the light intensity has decreased by a predetermined value or more. After that, it is assumed that the tube side image is projected on the monitor unit 37. This predetermined value is a value corresponding to the change in intensity of light detected before and after the illumination LEDs 15 and 53 are inserted into the glottis.

  Thus, since the image of the support device side camera 34 can be displayed on the monitor unit 37 until the tubes 10 and 50 are inserted into the glottis, the practitioner moves the tube 10 while looking at the larynx, for example, the glottis. Then, when the tube 10 passes through the glottis and is inserted into the trachea, an image of the first tube side camera 14 provided on the distal end side of the tube 10 is displayed on the monitor unit 37. It becomes possible to project to. Thereby, the position of the front-end | tip part of the tube 10 can be grasped | ascertained deeply from the glottis.

Therefore, by using the tracheal intubation device 1 according to the first embodiment, the tube 10 can be reliably and safely intubated at a position where the tube 10 is aimed even if the skill level of the practitioner is low.

  In addition, since the lighting LEDs 15 and 53 are used as light emitters, the structure of the tube 10 can be simplified and costs can be reduced as compared with the case where a light emitter is separately provided.

  The light emitter may be composed of an LED other than the illumination LEDs 15 and 53, and the like.

In the first embodiment, the carbon dioxide sensor A may or may not be provided.

  Further, as a method of detecting the light intensity of the illumination LEDs 15 and 53, for example, the control device 38 may detect based on the brightness of the image of the support device side camera 34 displayed on the monitor unit 37. . In this case, when the image of the support apparatus side camera 34 becomes dark from a bright state, it is determined that the light intensity has decreased by a predetermined value or more.

(Embodiment 2 )
FIG. 24 shows the tracheal intubation device 1 according to the second embodiment. In the above Reference Examples 1 and 2, but so as to determine whether the tube 10, 50 has passed through the glottis by detecting the carbon dioxide concentration in the tube 10, 50, in the second embodiment, the tube 10, It is configured to determine whether or not the tubes 10 and 50 have passed through the glottis using the detected part provided in 50 and the detection means provided in the guide part 33 of the intubation assistance device 30.

  That is, as shown in FIG. 25, the tubes 10 and 50 are provided with an IC tag 60 as a detected portion at a portion closer to the base end than the tip end portion. As shown in FIG. 24, an IC tag reader 61 as a detecting means for detecting the IC tag 60 is provided at the distal end portion of the guide portion 33 of the intubation support device 30.

  The position of the IC tag 60 is at the proximal end side of the guide portion 33 with respect to the detection range of the IC tag reader 61 in a state where the tubes 10 and 50 are held by the intubation support device 30, and the tubes 10 and 50 are placed on the guide portion 33. When it is moved in the insertion direction until it protrudes beyond the tip, it enters the detection range of the IC tag reader 61. The amount of protrusion at this time is such that the tip of the tube 10 passes through the glottis.

  Before the IC tag reader 61 detects the IC tag 60, that is, before the tubes 10 and 50 held by the intubation support device 30 are moved in the insertion direction, the control device 38 projects the support device side image on the monitor unit 37. After the IC tag reader 61 detects the IC tag 60, that is, after the tube 10 is moved in the insertion direction and passed through the glottis, the tube side image is displayed on the monitor unit 37.

  Thus, since the image of the support device side camera 34 can be displayed on the monitor unit 37 until the tubes 10 and 50 are inserted into the glottis, the practitioner moves the tube 10 while looking at the larynx, for example, the glottis. After the tube 10 passes through the glottis and is inserted into the trachea, the images of the first tube side cameras 14 and 52 provided on the distal end side of the tube 10 are monitored. It is possible to project to the part 37. Thereby, the position of the front-end | tip part can grasp | ascertain the tube 10 in the back rather than a glottis.

Therefore, by using the tracheal intubation device 1 according to the second embodiment, the tube 10 can be reliably and safely intubated at a position where the tube 10 is aimed even if the skill level of the practitioner is low.

  In addition to the IC tag 60, the detected portion may be, for example, characters or symbols that can be photographed by a camera. In this case, the detection means may be a camera (for example, the support device side camera 34).

  In the above embodiment, the first and second tube side cameras 14 and 16 and the control device 38 are connected by wire, but may be connected wirelessly. Similarly, the support apparatus side camera 34 may be wirelessly connected.

  Moreover, you may make it transmit the image of the 1st, 2nd tube side cameras 14 and 16 and the assistance apparatus side camera 34 to the place away from the place which is performing intubation treatment. In this case, the image input to the control device 38 may be transmitted using a known wireless transmission device, for example, via a mobile phone communication network. As a method of using this system, for example, there is a method of transmitting the state to a medical institution such as a hospital while performing an intubation treatment in an ambulance or a doctor helicopter.

  Further, a storage medium may be provided inside the intubation support device 30 and the images of the first and second tube side cameras 14 and 16 and the support device side camera 34 may be stored in the storage medium. In addition, an external output terminal may be provided in the intubation support device 30, and the images of the first and second tube side cameras 14, 16 and the support device side camera 34 may be displayed on an external monitor.

  The output to the external monitor may be performed wirelessly.

  As described above, the tracheal intubation device according to the present invention is particularly useful when performing a tracheal intubation treatment in a lifesaving emergency area, for example.

1 Intubation support device 10 Tube (double lumen)
14 1st tube side camera (tube side imaging part)
15 LED for 1st illumination (illumination part, light-emitting body)
16 Second tube side camera 17 Second illumination LED
30 Intubation support device 33 Guide unit 34 Support device side camera (support device side imaging unit)
35 LED for support device side lighting
37 Monitor unit 38 Control device (control unit)
50 tubes (single lumen)
60 IC tag (detected part)
61 IC tag reader (detection means)
A carbon dioxide sensor

Claims (3)

A tube that is intubated into the trachea;
In the tracheal intubation device provided with an intubation support device for guiding the tube to the trachea,
The intubation support device has a guide unit that is inserted into the larynx from the oral cavity and serves as a guide for the tube, and a support device side imaging unit provided on the distal end side of the guide unit,
The tube has a tube-side imaging unit provided on the distal end side of the tube,
A monitor unit that displays images captured by the support device side imaging unit and the tube side imaging unit ;
A control unit to which the support device side imaging unit, the tube side imaging unit, and the monitor unit are connected ;
The control unit detects the intensity of light emitted from a light emitter provided on the distal end side of the tube on the oral cavity side from the glottis and determines whether or not the light intensity has decreased by a predetermined value or more. Before determining that the image has decreased, the support device side image captured by the support device side imaging unit is displayed on the monitor unit. After determining that the image has decreased by a predetermined value or more, the tube imaged by the tube side image capturing unit A tracheal intubation device configured to automatically select the support device side image and the tube side image without depending on a practitioner's hand so as to project a side image on the monitor unit . The tracheal intubation device according to claim 1,
An illumination unit that illuminates the imaging range of the tube side imaging unit is provided on the distal end side of the tube,
The tracheal intubation device , wherein the control unit is configured to determine whether the intensity of light emitted from the illumination unit has decreased by a predetermined value or more . A tube that is intubated into the trachea;
In the tracheal intubation device provided with an intubation support device for guiding the tube to the trachea,
The intubation support device has a guide unit that is inserted into the larynx from the oral cavity and serves as a guide for the tube, and a support device side imaging unit provided on the distal end side of the guide unit,
The tube has a tube-side imaging unit provided on the distal end side of the tube,
A monitor unit that displays images captured by the support device side imaging unit and the tube side imaging unit;
A control unit to which the support device side imaging unit, the tube side imaging unit, and the monitor unit are connected;
The tube is provided with a portion to be detected at a portion closer to the base end than the tip end,
The guide part of the intubation support device is provided with a detecting means for detecting the detected part,
The detection means is arranged to detect the detected portion when the tube moves until the distal end of the tube passes through the glottis,
Before the detection means detects the detected part, the control unit displays an image on the support device side photographed by the support device side imaging part on the monitor unit, and the detection means detects the detected part. After that, the support device side image and the tube side image are automatically selected without depending on the practitioner's hand so that the tube side image taken by the tube side imaging unit is reflected on the monitor unit. The tracheal intubation device is characterized by being configured as described above.

Images