JP6244603B2 - Intubation support device - Google Patents

Description

  The present invention relates to an intubation support device.

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

  Therefore, if the patient's airway is obstructed during tracheal intubation, the obstructed airway is opened using a metal device called a Macintosh laryngoscope, and then the tube is inserted into the trachea to secure the airway. There are many cases.

  However, tracheal intubation is a very difficult procedure in the emergency area. In particular, it is recommended in the Japanese version of the Emergency Resuscitation Guidelines that a tracheal intubation procedure using a Macintosh laryngoscope is performed by an expert. Since such a tracheal intubation procedure is a highly difficult procedure, when a person with relatively low skill level performs a tracheal intubation procedure, the tube is unintentionally inserted into an esophagus different from the trachea. There is a fear.

  Therefore, as a device for performing tracheal intubation, for example, a video laryngoscope having a camera for photographing the larynx and a monitor for displaying an image photographed by the camera has been proposed (for example, see Patent Document 1). . If this video laryngoscope is used, the tube can be advanced toward the trachea while viewing the glottis displayed on the monitor. For this reason, it becomes possible to perform the tracheal intubation safely even for a person with a relatively low level of skill as compared with the case of using a conventional Macintosh laryngoscope.

  However, in the video laryngoscope of Patent Document 1, for example, it is possible to discriminate between the entrance of the glottis and the entrance of the esophagus by visually recognizing the image, but the bronchial bifurcation located behind the glottis, It cannot be recognized by the image. For this reason, when the tube is inserted into the bronchus, it is difficult to reliably insert the tube into the target bronchus (left bronchus or right bronchus).

JP 2007-117116 A

  An object of the present invention is to provide an intubation support device that can reliably intubate a bronchi for an intubation tube.

Such an object is achieved by the present inventions (1) to (18) below.
(1) An intubation support device used when inserting a tube into a subject's trachea,
The main body,
A length that is detachably connected to the main body and inserted into the predetermined portion of the subject via the oral cavity of the subject in a state of being connected to the main body. An insertion part of the scale,
A first imaging unit fixedly provided with respect to the distal end of the insertion unit;
A second imaging unit movably provided along the longitudinal direction of the insertion unit;
An intubation support apparatus comprising: an image display unit that is provided in the main body unit and displays at least one of the images captured by the first imaging unit and the second imaging unit. .

  (2) The intubation assistance device according to (1), wherein the first imaging unit is arranged so that the position of the second imaging unit can be confirmed.

(3) In a state where the second imaging unit is aligned with the first imaging unit, or is positioned on the proximal end side with respect to the first imaging unit, the distal end portion of the insertion unit is placed on the covered portion. To reach a predetermined part of the examiner,
Thereafter, the intubation support device according to (1) or (2), wherein the second imaging unit is used so as to protrude from the distal end of the insertion unit.

(4) Furthermore, a long operation mechanism that is provided so as to be slidable along the longitudinal direction of the insertion unit and that moves the second imaging unit is provided.
The intubation assistance device according to any one of (1) to (3), wherein the second imaging unit is fixedly provided at a distal end portion of the operation mechanism.

  (5) The intubation support device according to (4), wherein the insertion unit includes a holding unit that holds the operation mechanism slidably along a longitudinal direction of the insertion unit.

  (6) Said (5) used so that the said front-end | tip part of the said insertion part may reach | attain the predetermined site | part of the said test subject in the state which inserted the said operation mechanism in the said tube hold | maintained at the said holding | maintenance part. The intubation support device according to 1.

(7) The intubation assistance device according to (5) or (6) , wherein the holding unit includes a groove formed along a longitudinal direction of the insertion unit.

(8) The above-mentioned (5) or (5) , wherein the insertion portion includes an insertion portion main body capable of detachably attaching the holding portion to a side surface, and an attachment mechanism for attaching the holding portion to the insertion portion main body. The intubation support device according to 6) .

  (9) The intubation support device according to (8), wherein the mounting mechanism is provided as a pair on both side surfaces of the insertion portion main body.

  (10) The mounting mechanism is configured to be capable of changing an angle formed by a central axis at a distal end portion of the holding portion and a central axis at a distal end portion of the insertion portion main body in a side view of the insertion portion. The intubation assistance apparatus according to (8) or (9) above.

  (11) The intubation assistance device according to any one of (4) to (10), wherein a change unit that changes a visual field direction of the second imaging unit is provided at a distal end portion of the operation mechanism.

  (12) The intubation assistance device according to any one of (4) to (11), further including a marker for grasping a rotation angle around the axis of the operation mechanism.

  (13) The operation mechanism includes, on a proximal end side thereof, a grip portion that is gripped when the second imaging unit is moved, and the marker is provided on the grip portion. Intubation support device.

(14) The image display unit is configured to display a first image captured by the first imaging unit and a second image captured by the second imaging unit,
  Further, a first display mode for displaying only the first image, a second display mode for displaying only the second image, and both the first image and the second image are displayed. The intubation assistance apparatus according to any one of (1) to (13), further including display switching means for switching between the third display mode.

  (15) When the tip of the operation mechanism is no longer confirmed on the first image in the first display mode, the operation mechanism is automatically switched to the second display mode or the third display mode. The intubation assistance apparatus according to (14), wherein any one of (4) to (13) is configured as described above.

  (16) The tube is provided with a first cuff capable of expanding and contracting provided in the middle of the longitudinal direction;
  A second cuff capable of being inflated and deflated provided closer to the proximal end than the first cuff;
  The intubation assistance apparatus according to any one of (1) to (15), further including a mark provided between the first cuff and the second cuff.

  (17) The viewing angle of the first imaging unit is different from the viewing angle of the second imaging unit.
The intubation assistance device according to any one of (1) to (16) above.

  (18) The intubation assistance device according to any one of (1) to (17), wherein a viewing angle of the second imaging unit is larger than a viewing angle of the first imaging unit.

  ADVANTAGE OF THE INVENTION According to this invention, the intubation assistance apparatus which can be reliably intubated into the bronchi intended for the intubation tube can be provided.

It is the perspective view which looked at the intubation assistance apparatus of 1st Embodiment from the front side. It is the perspective view which looked at the intubation assistance apparatus shown in FIG. 1 from the back side. It is the perspective view which looked at the intubation system which combined the intubation assistance apparatus and intubation tube shown in FIG. 1 from the front side. It is a block diagram of the intubation assistance apparatus shown in FIG. It is the sectional view on the AA line in FIG. It is the figure (a part is notched and shown) which looked at the intubation assistance apparatus shown in FIG. 1 from the arrow B side ((a) is a top view, (b) is a front view). It is the figure which shows typically the state which inserted the intubation system shown in FIG. 1 in the larynx, and the figure of the display screen displayed on the image display part in that case. It is a figure which shows typically the state which advanced the scope shown in FIG. 1 to the glottic vicinity, and the figure of the display screen displayed on the image display part in that case. It is a figure which shows typically the state which advanced the scope shown in FIG. 1 from the glottis, and the figure of the display screen displayed on an image display part in that case. It is the figure which shows the state which advanced the scope shown in FIG. 1 to the bronchial bifurcation part, and the figure of the display screen displayed on the image display part in that case. It is a figure which shows typically the state which advanced the scope shown in FIG. 1 to the left bronchus, and the figure of the display screen displayed on the image display part in that case. It is a flowchart which shows the control action of the control part with which the intubation assistance apparatus of 2nd Embodiment is provided. It is a figure ((a) is a front view, (b) is a top view, (c) longitudinal cross-sectional view) which shows the front-end | tip part of the scope insertion part with which the intubation assistance apparatus of 3rd Embodiment is provided. It is a figure which shows the front-end | tip part of the image acquisition part with which the intubation assistance apparatus of 4th Embodiment is provided, and the front-end | tip part of a scope insertion part. It is a disassembled perspective view of the insertion part with which the intubation assistance apparatus of 5th Embodiment is provided. It is a figure which shows the front end side of the insertion part with which the intubation assistance apparatus of 6th Embodiment is provided. It is a figure which shows the front end side of the intubation tube with which the intubation system of 7th Embodiment is provided.

  Hereinafter, the intubation assistance apparatus of the present invention will be described in detail based on preferred embodiments shown in the accompanying drawings.

<First Embodiment>
FIG. 1 is a perspective view of the intubation support device according to the first embodiment viewed from the front side, FIG. 2 is a perspective view of the intubation support device shown in FIG. 1 viewed from the back side, and FIG. 3 is the intubation shown in FIG. The perspective view which looked at the intubation system which combined the support apparatus and the intubation tube from the front side, FIG. 4 is a block diagram of the intubation assistance apparatus shown in FIG. 1, FIG. 5 is the sectional view on the AA line in FIG. 6 is a view of the intubation support device shown in FIG. 1 as viewed from the arrow B side (partially cut away) ((a) is a top view, (b) is a front view), and FIG. 7 is shown in FIG. The figure which shows typically the state which inserted the intubation system shown in the larynx, and the figure of the display screen displayed on the image display part in that case, FIG. 8 is the state which advanced the scope shown in FIG. 1 to the glottis vicinity FIG. 9 is a diagram schematically showing a display screen displayed on the image display unit at that time, and FIG. 9 is a glottal view of the scope shown in FIG. FIG. 10 is a diagram schematically showing a state in which the scope is advanced to the back, and a diagram of a display screen displayed on the image display unit at that time. FIG. 10 schematically shows a state in which the scope shown in FIG. FIG. 11 is a diagram schematically showing a state in which the scope shown in FIG. 1 is advanced to the left bronchus, and FIG. 11 is a diagram showing a display screen displayed on the image display unit at that time. It is a figure of the display screen displayed on an image display part.

  In the following, for convenience of explanation, in principle, the lower side in FIGS. 1 to 3 and 5 to 11 is referred to as a “tip”, and the upper side is referred to as a “base end”. However, since the insertion part of the intubation assistance device is curved in the middle, the distal direction changes accordingly.

  The intubation support apparatus 100 shown in these drawings is used when, for example, the intubation tube 7 is inserted into the trachea of a subject such as a patient who exhibits consciousness disorder, and is connected to the apparatus main body 1 and the apparatus main body 1. And a scope 6 that is used in a state in which it is used.

  The apparatus main body 1 includes a gripping part (main body part) 2 that is gripped with one hand or both hands when using the intubation support apparatus 100, an insertion part 3 that is detachably connected to the gripping part 2, and an insertion part 3 The image acquisition unit 4 is provided, and the display 5 is provided on the opposite side of the insertion unit 3 of the grip unit 2.

  As shown in FIGS. 1 and 2, the gripping portion 2 has a columnar outer shape. As shown in FIG. 5, a cylindrical connector 222 and an annular connecting portion 22 are formed on the distal end side. It is provided concentrically. A female screw 221 is formed on the inner peripheral surface of the connecting portion 22, and the female screw 221 can be screwed into a male screw 312 formed on the outer peripheral surface of the insertion portion 3. Thereby, the insertion part 3 and the holding part 2 can be connected detachably. With such a configuration, for example, the used insertion portion 3 can be detached from the grip portion 2 and the unused insertion portion 3 can be attached to the grip portion 2.

  In addition, the connection method of the holding part 2 and the insertion part 3 is not limited to the method by screwing, For example, the method (method) by a ratchet mechanism, the bayonet mount method, the cam method, the method by a latching claw, magnetic force (magnetic) It is also possible to adopt various methods such as In addition, the connection part 22 may be formed integrally with the grip part 2 or may be formed as a separate body from the grip part 2.

  Moreover, the holding part 2 has a waterproof structure. In addition, about this waterproof structure, conventionally well-known various structures (structure) are employable, for example.

  As shown in FIGS. 1 and 2, the insertion portion 3 is connected to the distal end side of the grip portion 2. This insertion part 3 is comprised by a long (long shape) member, and the front-end | tip part is located in the epiglottis of a subject or its vicinity (predetermined site | part) from a test subject's mouth (oral cavity). Inserted.

  The insertion portion 3 includes a long insertion portion main body 31, a groove 321 formed so as to open (open) on the side surface thereof, and a tongue formed so as to protrude from the distal end of the insertion portion main body 31 toward the distal end. It has a piece (projecting part) 33. The insertion portion 3 is inserted from the mouth of a subject who has suffered consciousness disturbance or a subject who has undergone general anesthesia, for example, and the tongue piece 33 lifts the epiglottis of the subject while the insertion portion main body 31 The subject's airway is secured by bringing a predetermined portion into contact with the tongue base portion of the subject.

  The insertion portion main body 31 has a curved portion 311 that is curved in the middle of its longitudinal direction (axial direction), and the angle formed by the proximal end side and the distal end side is approximately 90 °. In addition, the insertion part main body 31 may have a light transmittance as a whole, or only a necessary part may have a light transmittance.

  The length (full length) L1 of the insertion portion main body 31 shown in FIG. 5 is preferably about 150 to 170 mm for adults, and 115 to 135 mm for children. In the case of a newborn baby, it is preferably about 110 to 130 mm.

  As shown in FIG. 1, a groove 321 is formed on the side surface of the insertion portion main body 31 from the vicinity of the center in the longitudinal direction to the tip. In this groove 321, a scope insertion portion 61 of the scope 6 described later can be slid along the longitudinal direction of the insertion portion main body 31 (insertion portion 3) alone or the intubation tube 7 into which the scope insertion portion 61 is inserted. Retained. That is, in the present embodiment, the portion (wall portion) of the insertion portion main body 31 that defines the groove 321 constitutes the holding portion 32 that holds the scope insertion portion 61 and the intubation tube 7. For example, the scope insertion part 61 and the intubation tube 7 held in the groove 321 can be slid along the groove 321 to guide the scope insertion part 61 and the intubation tube 7 toward the trachea of the subject. it can.

  Ribs (projections) may be provided over the entire length of the groove 321 at the edge of the side wall (wall portion) that defines (defines) the groove 321. Each rib functions as a stopper (drop-off prevention means) for the scope insertion portion 61 and the intubation tube 7, and the scope insertion portion 61 and the intubation tube 7 held in the groove 321 are prevented from dropping from the groove 321.

  In addition, although the cross-sectional shape of the groove | channel 321 has comprised substantially U shape, for example, a U shape, a semicircle shape, etc. may be sufficient. Moreover, although the holding | maintenance part 32 is a structure provided with the groove | channel 321, the structure provided with the through-hole etc. which penetrate the holding | maintenance part 32 to a longitudinal direction may be sufficient, for example.

  In addition, a pair of tube holders 34 a and 34 b are formed on the side surface of the insertion portion main body 31 so as to protrude from the side toward the base end side of the groove 321. By holding the scope 6 and the intubation tube 7 with the tube holders 34a and 34b, it is more reliable that the scope 6 and the intubation tube 7 fall out of the groove 321 when they are slid with respect to the insertion portion main body 31. Can be prevented.

  In addition, a light-transmitting tongue piece (protrusion) 33 is provided at the distal end of the insertion portion main body 31. The tongue 33 has a plate shape and is formed continuously with the right side wall of the groove 321 in FIG. The tongue piece 33 can lift the subject's epiglottis, thereby ensuring the subject's airway easily and reliably.

  The shape of the tongue 33 in plan view is almost a quadrangle. Moreover, each corner | angular part of the tongue piece 33 is rounded (R-attached), and can improve the safety | security at the time of inserting the insertion part 3 into a pharynx and a larynx from a test subject's oral cavity. The shape of the tongue piece 33 in plan view is not limited to a quadrangle, and may be, for example, a semi-elliptical shape, a semi-circular shape, or the like.

  As shown in FIG. 6, the insertion portion main body 31 is formed with a through-hole 35 over the entire length in the longitudinal direction. The distal end of the through hole 35 is open to the tongue piece 33 side at the center of the insertion portion main body 31 in the width direction, and the proximal end of the through hole 35 is open to a position on the groove 321 side. The through-hole 35 has a substantially circular cross-sectional shape.

  Inside the through-hole 35, for example, a suction tube or forceps (not shown) is provided. The suction tube or forceps may be detachable from the insertion portion main body 31 or may be fixed to the insertion portion main body 31. For example, a foreign substance having fluidity such as saliva and sputum can be sucked and removed by the suction tube. In addition, for example, solid (solid) foreign matter can be removed by the forceps. The number of through holes 35 is one in the illustrated example, but may be two or more.

  Further, as shown in FIGS. 5 and 6, the insertion portion main body 31 is formed with a guide hole (lumen) 36 over the entire length in the longitudinal direction. The guide hole 36 is unevenly distributed on the right side in FIG. 6 in the width direction (short direction) of the tongue piece 33. Further, the distal end side of the guide hole 36 is bent (curved) toward the groove 321 side.

  The guide hole 36 has a substantially circular cross-sectional shape and is open (opened) at the proximal end of the insertion portion main body 31. In addition, a blocking portion 37 having light transmittance is provided at the distal end portion of the guide hole 36 (the distal end portion of the insertion portion main body 31). By the closing portion 37, the tip end portion of the guide hole 36 is sealed in a liquid-tight (air-tight) manner. Note that the closing portion 37 may be formed integrally with the insertion portion main body 31.

  The image acquisition unit 4 is provided inside the guide hole 36 of the insertion unit 3. The image acquisition unit 4 is inserted in the guide hole 36, and the distal end thereof is located in the vicinity of the blocking unit 37. As described above, since the distal end portion of the guide hole 36 is sealed by the closing portion 37, the distal end portion of the image acquisition unit 4 is not exposed to the outside of the apparatus main body 1 (not exposed to outside air). Yes.

  As shown in FIGS. 5 and 6, the image acquisition unit 4 includes a long tube body 41 having flexibility, an imaging unit 42 and an illumination unit 43 provided in the tube body 41, and the tube body 41. And a connector 44 that electrically connects the image acquisition unit 4 to a connector 222 provided at the distal end of the grasping unit 2. As described above, the distal end side of the guide hole 36 is bent (curved) toward the groove 321 side. Accordingly, the image acquisition unit 4 inserted into the guide hole 36 has a groove 321 at the distal end side. It is bent (curved) toward the side. Thereby, the image acquisition part 4 can image the scope insertion part 61 and the intubation tube 7 hold | maintained at the groove | channel 321 while imaging a predetermined part of a subject.

  The tube body 41 is made of, for example, a material such as resin, elastomer, or rubber. An imaging unit 42 and an illumination unit 43 are provided inside the tube body 41.

  The imaging unit 42 includes a first imaging unit 45 including a CCD (fixed camera) 421, an objective lens 422, and a light-transmitting window 423 arranged in order from the proximal end side of the tube body 41, a CCD 421, and a connector. 44, and an image signal cable 424 for connecting to the H.44. Specifically, a hole (not shown) is provided at the tip of the tube body 41, and a CCD 421 and an objective lens 422 to which an image signal cable 424 is connected are installed inside the hole. The window 423 is liquid-tightly sealed. In this imaging means 42, the reflected light (image light) from a predetermined part of the subject where the distal end portion of the insertion portion 3 is located forms an image on the light receiving surface (imaging surface) of the CCD 421 by the objective lens 422. A subject image (image light) is picked up by the CCD 421. That is, a predetermined part of the subject is imaged by the CCD 421.

  The illumination unit 43 provided in parallel with the imaging unit 42 includes a white LED (light emitting diode) 431, an illumination lens 432, and a light-transmitting window 433, which are sequentially arranged from the proximal end side of the tube body 41. And a lighting signal cable 434 that connects the white LED 431 and the connector 44 to each other. Specifically, a hole (not shown) different from the hole where the CCD 421 and the objective lens 422 are installed is provided at the distal end portion of the tube body 41, and the illumination signal cable 434 is connected to the inside of the hole. The white LED 431 and the illumination lens 432 are installed, and the tip of the hole is sealed in a liquid-tight manner by the window 433. Thus, by installing the CCD 421 and the white LED 431 in separate holes, it is possible to prevent the occurrence of halation due to the light emitted from the white LED 431.

  A connector 44 to which an illumination signal cable 434 and an image signal cable 424 are connected is provided on the proximal end side of the tube body 41. By connecting the connector 44 to the connector 222 provided in the grip portion 2, the CCD 421 and the white LED 431 are connected to a control portion 511 described later provided in the grip portion 2.

  As shown in FIGS. 1 and 2, a display (image display unit) 5 is provided on the side opposite to the insertion portion 3 of the grip portion 2, that is, on the base end side of the grip portion 2.

  The display 5 is provided so as to be rotatable (displaceable) with respect to the grip portion 2 around the rotation mechanism 52. The display 5 has a rectangular plate shape, and includes, for example, a liquid crystal display element, an organic EL display element, and the like. In the present embodiment, the display 5 has a vertically long shape, but may have a horizontally long shape, for example.

  The display 5 displays a first image captured by the image acquisition unit 4 and a second image captured by the scope 6. In this case, the display 5 may be configured to simultaneously display the first image and the second image, or may be configured to display alternately. Further, when displaying the first image and the second image at the same time, a method in which the other image is displayed so as to be superimposed on either one of the first image and the second image, so-called a so-called method. A picture-in-picture method may be adopted.

  Further, an operation button (display switching means) 53 for switching the image display mode as described above is provided at the lower right corner of the display 5 in FIG. When the operator presses the operation button 53, the display mode of the screen displayed on the display 5 can be changed. When the display 5 is a touch panel system, the operation button 53 can be configured to be displayed as an image on the display 5.

  In addition to the operation button 53, the display 5 includes, for example, a target mark for specifying the position of the glottal fissure, an indicator display indicating the remaining battery level of the power supply unit 512, and a warning for battery replacement when the battery is exhausted. A battery warning mark, an elapsed time from the start of intubation work (intubation time), and the like may be displayed.

  As described above, the display 5 can be rotated with respect to the grip portion 2 by the rotation mechanism 52. For this reason, the display 5 can be directed in a desired direction regardless of the direction in which the insertion portion 3 faces. Therefore, the image displayed on the display 5 can be easily seen regardless of the posture of the subject and the standing position of the operator, and the intubation work can be easily and reliably performed.

  The display 5 may be configured to be detachably attached to the grip portion 2. Further, the display 5 is not limited to the uniaxial direction, and may be rotatable in, for example, the biaxial direction and the triaxial direction.

  A connection terminal 54 for electrically connecting a scope 6 to be described later is provided on the rotation center axis of the rotation mechanism 52.

  Such an apparatus main body 1 is used in a state in which the image acquisition unit 4 is inserted into the guide hole 36 of the insertion unit 3 and the proximal end of the insertion unit 3 is connected to the connection unit 22 of the grip unit 2 (see FIG. 5). At this time, the CCD 421 is fixed to the distal end portion of the insertion portion 3.

  As shown in FIGS. 1 and 2, the scope 6 is electrically connected to the apparatus body 1 and a long scope insertion portion 61, a scope gripping portion 62 provided on the proximal end side of the scope insertion portion 61. A scope connection unit 65.

  As described above, the scope 6 is slidably held in the groove 321 of the insertion portion 3 alone or in a state of being inserted into the intubation tube 7. When the operator performs an operation of sliding (moving) the scope 6, it is possible to image a predetermined portion of the subject and the distal end portion of the intubation tube 7.

  As shown in FIGS. 1 and 6, the scope insertion portion 61 includes a long tube body 611 having flexibility, a scope imaging unit 63 and a scope illumination unit 64 provided in the tube body 611. ing. The tube body 611 is made of, for example, a material such as resin, elastomer, or rubber. For this reason, the scope insertion portion 61 can be flexibly deformed along the shape of the curved portion of the groove 321 and the shape of the intubation tube 7.

  Further, the cross-sectional shape of the tube body 611 (scope insertion portion 61) is substantially circular. There may be.

  The outer diameter of the tube body 611 is not particularly limited, but is preferably 4 mm or less, and more preferably about 1.0 to 3.5 mm.

  The length of the tube body 611 is not particularly limited, but is preferably about 300 to 500 mm.

  As shown in FIG. 6, a scope imaging unit 63 and a scope illumination unit 64 are provided inside the tube body 611.

  The scope imaging means 63 includes a CCD (moving camera) 631 arranged in order from the base end side of the tube body 611, a second imaging unit 67 including an objective lens 632 and a light-transmissive window 633, and a CCD 631. And an image signal cable 634 connected to each other. Specifically, a hole (not shown) is provided at the distal end portion of the tube body 611, and a CCD 631 and an objective lens 632, to which an image signal cable 634 is connected, are installed inside the hole, and the distal end portion of the hole is formed. The window 633 is liquid-tightly sealed. In this scope imaging means 63, reflected light (image light) from a predetermined part of the subject where the distal end portion of the scope insertion portion 61 is located forms an image on the light receiving surface (imaging surface) of the CCD 631 by the objective lens 632. The subject image (image light) is picked up by the CCD 631. That is, the CCD 631 images a predetermined part of the subject and the tip of the intubation tube 7. Further, the viewing angle (total field angle) θ2 of the scope 6 (CCD 631) having such a configuration is substantially equal to the total field angle (viewing angle) θ1 of the image acquisition unit 4 (CCD 421). The viewing angles θ1 and θ2 can be appropriately set according to the purpose of use, and are not particularly limited, but are preferably about 80 to 110 °.

  The scope illumination unit 64 provided in parallel with the scope imaging unit 63 includes a white LED (light emitting diode) 641, an illumination lens 642, and a light transmissive window arranged in order from the proximal end side of the tube body 611. The second illumination unit 68 including the unit 643 and the illumination signal cable 644 are included. Specifically, a hole (not shown), which is different from the hole in which the CCD 631 and the objective lens 632 are installed, is provided at the distal end portion of the tube body 611, and the white LED 641 and the illumination lens 642 are provided in the hole. And the tip of the hole is liquid-tightly sealed with a window 643. Thus, by installing the CCD 631 and the white LED 641 in different holes, it is possible to prevent the occurrence of halation due to the light emitted from the white LED 641.

  As shown in FIG. 1 and FIG. 2, a scope gripping portion 62 that can be gripped by an operator with fingers is provided on the proximal end side of the scope insertion portion 61. By operating the scope 6 with the operator holding the scope gripping part 62 with fingers, the scope insertion part 61 (CCD 631) is moved along the longitudinal direction of the insertion part 3 or rotated around its axis. Can be made. That is, in the present embodiment, a long operation mechanism for moving the CCD 631 (second imaging unit 67) is configured by the tube body 611 of the scope insertion unit 61.

  The cross-sectional shape of the scope holding part 62 is substantially circular, and a convex part 621 protrudes from the base end part in the lateral direction. The convex part 621 has a function as a marker for grasping the rotation amount (rotation angle) around the axis of the scope 6 (scope insertion part 61). The operator can grasp the rotation direction and the rotation amount of the scope insertion portion 61 by confirming the position of the convex portion 621 when the scope gripping portion 62 is rotated around the axis. In addition, the shape of the convex part 621 may be any shape. Further, a concave portion formed in the outer surface of the scope holding portion 62 may be used as a marker.

  Further, the outer surface of the scope gripping part 62 may be subjected to anti-slip processing for preventing the scope gripping part 62 from slipping down when the scope gripping part 62 is gripped. Examples of the anti-slip process include a process of forming a resin layer on the surface of the scope holding part 62, and a rough surface process.

  In addition, the scope holding unit 62 is provided with a scope connection unit 65 that connects the scope 6 to the apparatus main body 1. The scope connection portion 65 is provided on the tube body 650 in which the image signal cable 634 and the illumination signal cable 644 are disposed, and on the opposite side of the tube body 650 from the scope gripping portion 62. The image signal cable 634, the illumination signal And a connection terminal 651 to which a cable 644 is connected. By connecting the connection terminal 651 to the connection terminal 54 of the apparatus main body 1, the scope 6 and the apparatus main body 1 can be electrically connected.

  The length of the tube body 650 is preferably set longer than the length of the tube body 611 of the scope 6. Specifically, the length of the tube body 650 is set to about 350 to 650 mm. Thereby, operation which inserts the scope 6 in the intubation tube 7 or removes from the intubation tube 7 can be performed easily. For this reason, workability | operativity (easiness of intubation work) in intubation operation can be improved.

  Such a scope 6 has a waterproof structure. About this waterproof structure, conventionally well-known various structures (structure) are employable, for example.

  In the intubation support apparatus 100 as described above, as shown in FIG. 4, a control unit (circuit unit) that controls the operation of the image acquisition unit 4, the display 5, and the scope 6 inside the grip unit 2 of the apparatus body 1. 511, a power supply unit 512 that is connected to the control unit 511 and supplies power to each unit, and an input / output unit (not shown) are provided.

  The control unit 511 outputs an LED drive circuit (illumination drive circuit) that drives the white LEDs 431 and 641, a CCD drive circuit (image pickup device drive circuit) that drives the CCDs 421 and 631, and image data output from the CCDs 421 and 631. An image processing circuit for performing image processing, an image display circuit for converting image data output from the image processing circuit and displaying the image data on the display 5, a storage unit (storage means) for storing the image data, and a central processing circuit Etc.

  A battery is detachably installed in the power supply unit 512, and power is supplied from the power supply unit 512 to each unit such as the control unit 511. Note that a lid (not shown) is installed in the grip portion 2, and the battery can be attached and detached by opening the lid.

  In addition to the connection terminal 54, the input / output unit includes an external power input terminal for inputting (supplying) power (power) from the outside, an external monitor output terminal for outputting image data to an external monitor, And a memory terminal for image storage connected to a memory card (detachable memory device) such as an SD card or a CF card.

  As shown in FIG. 1, a switch 56 for switching the main power supply is installed on the right side surface of the grip portion 2 in FIG. By repeating this pressing operation of the switch 56, it is possible to repeat driving and stopping of each part (white LEDs 431 and 641, CCDs 421 and 631, display 5 and the like) of the intubation support device 100.

  As shown in FIG. 2, a lid 55 is installed on the right side of the grip 2 in FIG. 2, and the connection to the external power input terminal, the external monitor output terminal and the memory terminal for image storage is performed. Each is performed with the lid 55 opened. Further, the lid 55 can be opened and closed only with a dedicated instrument so that the lid 55 cannot be opened and closed carelessly.

  The intubation support apparatus 100 having such a configuration is used as an intubation system 200 as shown in FIG. 3 in combination with an intubation tube 7 inserted into the subject's trachea via the subject's mouth (oral cavity). Is possible.

  The intubation tube 7 includes a tube main body 71, a bronchial seal cuff 73 provided on the distal end side of the tube main body 71, and a tracheal seal cuff 72 provided on the proximal end side from the bronchial seal cuff 73.

  The tube main body 71 is a double lumen tube generally used for bronchial ventilation, and has a first lumen 711 and a second lumen 712. Further, the first lumen 711 and the second lumen 712 have a substantially circular cross-sectional shape. Moreover, the tube main body 71 is comprised with flexible materials, such as an elastomer and rubber | gum.

  The inner diameter of the first lumen 711 is set slightly larger than the outer diameter of the scope insertion portion 61 (tube body 611) of the scope 6. Therefore, when the intubation support device 100 is used in combination with the intubation tube 7, the scope insertion portion 61 of the scope 6 is inserted into the first lumen 711 as shown in FIG. It can be used by sliding along the longitudinal direction of 3).

  Further, on the proximal end side of the tube main body 71, a bronchial seal pilot balloon 731 connected to the bronchial seal cuff (first cuff) 73 and a tracheal seal pilot connected to the tracheal seal cuff (second cuff) 72 are provided. A balloon 721 is provided.

  A ventilator is connected to the proximal end opening 713 of the first lumen 711 and the proximal end opening 714 of the second lumen 712 of the tube body 71 after the scope 6 is removed (not shown).

  In the present embodiment, the intubation tube 7 is a double lumen tube, but may be a single lumen tube, for example.

Next, an example of a usage method (action) of the intubation support device 100 will be described.
The intubation support device 100 is used, for example, when the subject loses consciousness and it becomes necessary to insert the intubation tube 7 into the trachea. Below, the case where the intubation system 200 which combined the intubation tube 7 with the intubation assistance apparatus 100 is used is demonstrated.

  [1] First, when inserting the intubation tube 7, the intubation system 200 is assembled.

  In this case, first, the connector 44 of the image acquisition unit 4 is connected to the connector 222 of the grip unit 2 of the apparatus main body 1.

  Next, the image acquisition unit 4 is inserted into the guide hole 36 of the insertion unit 3, and the male screw 312 of the insertion unit 3 is screwed into the female screw 221 provided in the connection unit 22 of the gripping unit 2. The part 3 is attached to the grip part 2. If necessary, for example, a suction tube or the like may be inserted into the through hole 35 of the insertion portion 3 and installed.

  Next, the connection terminal 651 of the scope 6 is inserted into the connection terminal 54 of the grip portion 2, and the scope 6 and the apparatus main body 1 are connected. Further, the scope insertion portion 61 of the scope 6 is inserted into the first lumen 711 of the intubation tube 7, and in this state, the intubation tube 7 is inserted into the groove 321 of the insertion portion 3 and held. At this time, the distal end of the intubation tube 7 is positioned near the distal end of the groove 321, and the distal end of the scope 6 is projected from the distal end of the intubation tube 7. However, it is preferable that the second imaging unit 67 is arranged side by side with the first imaging unit 45 or in a state where the second imaging unit 67 is positioned closer to the proximal end side than the first imaging unit 45. As a result, the distal end of the scope insertion portion 61 does not protrude from the distal end of the insertion portion 3, so that the scope insertion portion 61 may become an obstacle during the operation of securing the airway by the apparatus body 1 in the next step [2]. Absent.

  [2] Next, the operator operates the switch 56 shown in FIG. 1 to drive each part (white LEDs 431 and 641, CCDs 421 and 631, display 5 and the like) of the intubation support device 100. The target mark M is displayed on the display 5 by driving the intubation support device 100.

Next, the insertion unit 3 is inserted from the subject's mouth toward the subject's trachea.
Specifically, the insertion portion 3 is inserted into the mouth of the subject while the right side in FIG. 1 of the bending portion 311 of the insertion portion 3 is along the tongue base (see FIG. 7A). In this case, the display 5 is in a first mode in which only the first image is displayed by the image acquisition unit 4 (CCD 421) (see FIG. 7B). Then, while confirming the first image displayed on the display 5, the epiglottis (predetermined part) of the subject is lifted to the tongue base side by the tongue piece (tip part) 33 of the insertion part 3, and the tip of the insertion part 3 is lifted. The predetermined portion on the side is brought into contact with the tongue base portion of the subject. This releases the airway obstruction. In addition, the operator operates the apparatus main body 1 so that the glottis of the subject displayed on the display 5 and the target mark M overlap. If the target mark M overlaps with the glottis of the subject, the extension lines of the scope insertion portion 61 and the distal end portion of the intubation tube 7 coincide with the glottis.

  At this time, since the tongue piece 33 (insertion portion 3) is light-transmitting, when the subject's epiglottis is lifted to the base of the tongue by the tongue piece 33, the epiglottis is moved by the CCD 421 via the tongue piece 33. An image can be taken and the image can be displayed on the display 5. Furthermore, since the tongue piece 33 has a plate shape, the epiglottis can be lifted up easily, quickly and reliably by the tongue piece 33, and thus the airway obstruction can be more reliably released.

  [3] Next, when the distal end of the insertion portion 3 releases the airway obstruction, the scope insertion portion 61 is moved along the intubation tube 7 (groove 321) while confirming the first image displayed on the display 5. Push forward (see FIG. 8A).

  As a result, the scope insertion portion 61 is guided by the intubation tube 7 (groove 321) and advances along the intubation tube 7. At this time, it is confirmed in the first image displayed on the display 5 that the tip of the scope insertion portion 61 protruding from the groove 321 is located at the center of the target mark M (FIG. 8B )reference). As described above, it is possible to reliably guide the distal end portion of the scope insertion portion 61 to the glottic fissure while confirming the position of the distal end portion of the scope insertion portion 61 in the first image by the image acquisition unit 4.

  The groove 321 is formed such that the scope insertion portion 61 and the distal end portion of the intubation tube 7 naturally advance toward the glottic fissure. Thereby, the scope insertion part 61 can be advanced so as to be naturally guided to the glottic cleft, and the distal end of the scope insertion part 61 can be more reliably and easily guided to the glottic cleft.

  [4] Next, when the distal end portion of the scope insertion portion 61 reaches the glottic fissure, the distal end portion of the scope insertion portion 61 is inserted into the glottic fissure while confirming the first image (FIG. 8A). reference).

  When the distal end portion of the scope insertion unit 61 is inserted into the glottis, the operation button 53 is pressed, and the display mode of the display 5 is changed from the first display mode for displaying only the first image to the image acquisition unit 4 (CCD 421). ) And the third display mode for simultaneously displaying both the first image by the scope 6 (CCD 631) (see FIG. 9B). At this time, in the second image, it is confirmed that the distal end portion of the scope insertion portion 61 is located in the trachea, and in the first image, the distal end portion of the scope insertion portion 61 is in the back of the glottic fissure. Confirm that it is inserted.

  When the distal end portion of the scope insertion portion 61 is inserted into the trachea, the intubation tube 7 is moved along the scope insertion portion 61 along the scope insertion portion 61 while confirming the first image and the second image displayed on the display 5. Project from the tip, insert into the glottic fissure and reach the trachea. At this time, in the second image, it is confirmed that the distal end portion of the scope insertion portion 61 is located in the trachea, and in the first image, the intubation tube 7 is inserted into the glottic fissure. Check. Thereby, the intubation tube 7 can be inserted into the trachea easily, quickly and reliably.

  [5] Next, when the distal end of the intubation tube 7 is inserted into the trachea, the operation button 53 is pressed to switch the display mode of the display 5 to the second mode in which only the second image is displayed (FIG. 10 ( B)).

  While confirming the second image, the distal end portion of the scope insertion portion 61 is further advanced to the back of the trachea to reach the bifurcation portion of the left bronchus and the right bronchus (see FIG. 10A).

  [6] Next, while confirming the second image, the distal end portion of the scope insertion portion 61 is inserted into the target bronchus (for example, the left bronchus) (see FIGS. 11A and 11B). As described above, since the branching portion is displayed on the display 5, it is possible to surely advance toward the bronchi aiming at the distal end portion of the scope insertion portion 61.

  Thereafter, the intubation tube 7 is moved forward along the scope insertion portion 61. At this time, the operator confirms the distal end portion of the intubation tube 7 protruding beyond the distal end portion of the scope insertion portion 61 in the second image, so that the distal end portion of the intubation tube 7 is inserted into the left bronchus. You can grasp what has been done.

  As described above, the scope insertion portion 61 functions as a stylet (guide) of the intubation tube 7 so that the intubation tube 7 can be easily and reliably inserted toward the target bronchus (left bronchus or right bronchus). Can do. Further, since the scope gripping portion 62 of the scope 6 is provided with the convex portion 621, the operator can grasp the rotation angle of the scope insertion portion 61 during the intubation operation. For this reason, the relationship between the direction of the second image displayed on the display 5 (vertical direction or horizontal direction) and the front-rear direction of the subject can be easily grasped, and the scope 6 can be reliably attached to the target bronchus. Can be inserted into.

  By the way, normally, in the case of a subject such as a child whose distance from the glottis to the bronchial bifurcation is relatively short, after the intubation tube 7 (especially a single lumen tube in the case of a child) is intubated, the intubation tube 7 (particularly, It may be confirmed by chest X-ray photography or the like that the distal end portion) is inserted (arranged) at an appropriate position in the trachea. This is because it is difficult to grasp whether the intubation tube 7 is reliably located in the target trachea, bronchus or the like because there are individual differences in the growth of children and the like. On the other hand, if the intubation system 200 provided with the scope 6 as described above is used, the insertion depth of the intubation tube 7 into the trachea (bronchi) can be easily grasped without using chest X-ray photography or the like. Can contribute to the improvement of safety.

  [7] Next, the bronchial seal pilot balloon 731 and the tracheal seal pilot balloon 721 shown in FIG. 3 are operated to inflate the bronchial seal cuff 73 and the tracheal seal cuff 72 to fix the intubation tube 7 to the trachea and bronchus. To do. Thereafter, the scope insertion portion 61 is removed from the intubation tube 7 and the intubation tube 7 is detached from the groove 321 of the insertion portion 3.

[8] Next, with the intubation tube 7 fixed to the trachea and bronchi, the insertion portion 3 is removed from the mouth of the subject.
As described above, the intubation tube 7 can be intubated into the target bronchus of the subject.

  As described above, according to the intubation support device 100, since the image acquisition unit 4 and the scope 6 are included, the operator can, for example, near the distal end of the insertion unit 3, the pharynx of the subject, The larynx and the like can be observed, and the positional relationship between the glottic cleft that is the entrance of the trachea and the distal end portion of the scope insertion portion 61 can be grasped. Thereby, the scope insertion part 61 can be easily and reliably inserted into the trachea and further to the target bronchus, and as a result, the intubation work of the intubation tube 7 can be performed easily and reliably.

  In particular, when the scope insertion unit 61 is inserted into the glottis, the position of the distal end portion of the scope insertion unit 61 can be grasped by the first image by the image acquisition unit 4, so that the operator can select the position shown in FIG. As shown in B), the scope 6 can be surely advanced to the glottis while looking inside the larynx, for example, the glottis.

  Further, when the scope insertion unit 61 is inserted into the trachea through the glottis, as shown in FIG. 10B or FIG. In the inner trachea, the bifurcation between the left bronchus and the right bronchus can be confirmed. Therefore, when the scope insertion part 61 must be inserted into, for example, the left bronchus, it is possible to avoid erroneous insertion into the right bronchus.

  Here, the insertion portion main body 31 may be made of a flexible material, and the entire length thereof may be set so as to reach the glottis. In this case, if the tongue piece 33 is brought into contact with the glottis and pushed out, not only the CCD (moving camera) 631 of the scope 6 but also the CCD (fixed camera) 421 of the insertion section 3 can be used for the left bronchus and the right. It becomes possible to image the bifurcation with the bronchus. For this reason, the front-end | tip part of the scope insertion part 61 can be more reliably inserted in the target bronchus.

  Then, by pushing the intubation tube 7 along the scope insertion portion 61, the intubation tube 7 can be reliably intubated into the target bronchus via the glottis and trachea.

  As described above, by using the intubation support device 100, even if the skill level of the practitioner is low, the tube can be reliably and safely intubated at a position where the intubation tube 7 is aimed.

  Moreover, according to the intubation support apparatus 100, since the insertion part 3 is detachable with respect to the holding | gripping part 2, it can be replaced | exchanged for every use, and the infection by a test subject's bacteria etc. (secondary infection) ) Can be prevented, and safety is high. In particular, since the guide hole 36 in which the image acquisition unit 4 is accommodated is hermetically sealed in a state where the insertion unit 3 is attached to the grip unit 2, the insertion unit 3 is replaced every time it is used. By doing so, it is not necessary to perform cleaning, disinfection, sterilization, etc., and labor can be reduced. Moreover, since the intubation tube 7 can be made disposable, it is possible to prevent infection (secondary infection) due to bacteria or the like of the subject from this point of view, and the safety is high.

  Moreover, since the insertion part 3 has the groove | channel 321 where the insertion part 3 hold | maintains and guides the scope insertion part 61 and the intubation tube 7, the insertion operation to the bronchus of the scope insertion part 61, ie, the intubation operation of the intubation tube 7, is carried out. It can be done easily and reliably. In particular, since the scope insertion portion 61 and the intubation tube 7 can be guided by the groove 321, it is not necessary to bend the cervical vertebra of the subject and project the jaw during the intubation operation. The intubation operation can be easily and reliably performed on a subject who has contusioned the cervical spine (a subject in a difficult intubation case).

  In addition, the groove 321 holds the intubation tube 7 in a state in which the insertion portion 3 is inserted from the subject's mouth so that the intubation tube 7 can be detached (separated). The insertion portion 3 can be removed from the subject's mouth while being inserted into the mouth.

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

  In this embodiment, the scope insertion portion 61 is inserted into the intubation tube 7 and the intubation tube 7 is held in the groove 321 of the insertion portion 3, that is, the scope insertion portion 61 and the intubation tube 7 are combined in advance. An example in which the intubation support device 100 is used in a state in which it has been described. However, this is only an example, and the intubation support device 100 first sets the scope insertion portion 61 alone in the groove 321 and slides it in the distal direction along the groove 321 to move the scope insertion portion 61 to the target bronchus. After being inserted into the tube, the intubation tube 7 is held in the groove 321 and pushed along the scope insertion portion 61 held in the groove 321, so that the tube can be reliably inserted into the target bronchus.

  Further, the intubation support device 100 does not have to be used in combination with the intubation tube 7, but is simply used to insert the scope insertion portion 61 into a predetermined part of the subject (eg, trachea, bronchi, nasal cavity, esophagus, etc.). Also good.

Second Embodiment
FIG. 12 is a flowchart illustrating the control operation of the control unit provided in the intubation assistance device of the second embodiment.

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

  The second embodiment is the same as the first embodiment except that the control unit 511 of the apparatus main body 1 is configured so that the screen display mode can be automatically switched.

  In the second embodiment, the control unit 511 is configured to automatically switch the display mode of the display 5 by the operator in steps [2] to [4] of the first embodiment.

  Hereinafter, a switching operation for switching the display mode of the display 5 by the control unit 511 will be described with reference to FIG.

  [2 '] The operator turns on the power supply of the intubation support device 100 in the same manner as in the step [2]. At this time, the control unit 511 starts driving each unit of the intubation assistance device 100 and displays the first image (see FIG. 12A) on the display 5 (step S1).

  Thereafter, as shown in FIG. 12B, the control unit 511 displays the target mark M on the first image of the display 5 (step S2).

  [3 '] In the same manner as in the step [3], the operator pushes the scope insertion portion 61 along the intubation tube 7 (groove 321), and causes the distal end portion of the scope insertion portion 61 to reach the glottic fissure.

  [4 '] In the same manner as in the step [4], the operator pushes the distal end portion of the scope insertion portion 61 so as to be inserted into the glottis fissure. At this time, the control unit 511 determines whether or not the distal end portion (edge portion) of the scope insertion portion 61 can be confirmed with the first image (step S3).

  If the distal end portion of the scope insertion unit 61 is confirmed on the first image, the control unit 511 causes the display 5 to continuously display only the first image (see FIG. 12C). On the other hand, when the distal end portion of the scope insertion unit 61 cannot be confirmed on the first image, the control unit 511 changes the display mode of the display 5 from the first display mode to the first image and the second image. Are switched to the third display mode (see FIG. 12D) for displaying both of them simultaneously (step S4). At the same time, as shown in FIG. 12E, the control unit 511 hides the target mark M displayed on the first image (step S5).

  As described above, when the distal end portion of the scope insertion portion 61 cannot be recognized on the first image, that is, when the distal end portion of the scope insertion portion 61 is inserted into the glottic fissure, the control unit 511 displays the display 5. The display mode is automatically switched from the first display mode to the third display mode.

  Thus, the operator presses the operation button 53 until the scope insertion portion 61 is inserted into the bronchi after the insertion portion 3 is inserted from the subject's mouth toward the subject's trachea. The work of switching the display mode of the display 5 can be omitted. For this reason, the operator can perform a series of intubation operations more smoothly without interrupting the intubation operation of inserting the intubation tube 7 into the target bronchus.

  In this embodiment, the control unit 511 switches the display mode of the display 5 from the first display mode to the third display mode after confirming that the distal end of the scope insertion unit 61 has been inserted into the glottis fissure. Although such a configuration is shown, a configuration in which the first display mode is switched to the second display mode may be used.

<Third Embodiment>
FIG. 13 is a view (a) is a front view, (b) is a top view, and (c) a longitudinal sectional view) of a distal end portion of a scope insertion portion of an intubation assistance device according to a third embodiment.

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

  The third embodiment is the same as the first embodiment except that the configuration of the distal end portion of the scope insertion portion 61 is different.

  The scope insertion portion 61 shown in FIG. 13 has a changing portion 66 at the tip. The changing portion 66 is a cylindrical portion formed integrally with the tube body 611 of the scope insertion portion 61, and a notch portion 661 that opens to the side is formed. In the longitudinal section, the notch 661 has a wedge shape that has a maximum depth in the vicinity of the objective lens 632 and the illumination lens 642 and gradually decreases toward the tip. Thus, the changing unit 66 has an inclined surface 662 that faces the objective lens 632 and the illumination lens 642.

  A metal film 663 is formed on the inclined surface 662 by, for example, vapor deposition. The metal film 663 reflects light that enters the objective lens 632 (CCD 631) (reflected light from a predetermined portion of the subject) and light (illumination light) emitted from the illumination lens 642 (white LED 641). Make up surface.

  By having the change part 66 of such a structure, the scope 6 can observe the side. That is, the changing unit 66 functions to change the viewing direction of the CCD 631 (second imaging unit 67).

  In the present embodiment, the angle θ formed by the metal film 663 and the central axis of the scope insertion portion 61 is less than 45 °, and it is possible to image (view) an oblique front in the traveling direction of the scope 6. Yes. Such a scope 6 can image the entire circumferential direction by rotating the scope insertion portion 61 about its central axis.

  The angle θ formed by the metal film 663 and the central axis of the scope insertion portion 61 can be appropriately set according to the purpose of use of the scope 6 and is not particularly limited, but is preferably about 5 to 60 °. More preferably, it is about 15 to 45 °.

  Further, since the changing portion 66 has the notch portion 661, the rigidity (flexibility) of the distal end portion of the scope insertion portion 61 can be made anisotropic. Specifically, the rigidity on the side where the notch 661 opens is lower than the rigidity on the opposite side. For this reason, it is easy to bend or curve the changing portion 66 toward the side where the notch 661 opens with respect to the central axis of the scope insertion portion 61.

  Therefore, for example, when the scope insertion unit 61 is inserted into the left bronchus, the left bronchus can be visually recognized after the distal end (change unit 66) of the scope insertion unit 61 reaches the vicinity of the bifurcation between the left bronchus and the right bronchus. That is, the side where the notch 661 is opened is directed to the left bronchus. In this state, if the scope insertion portion 61 is advanced forward and its distal end is brought into contact with the branch portion, it can be naturally bent or curved toward the left bronchus. Thereby, in this way, the distal end portion of the scope insertion portion 61 can be easily inserted into the left bronchus.

  The notch 661 may be filled with, for example, a resin material having optical transparency.

<Fourth embodiment>
FIG. 14 is a diagram illustrating a distal end portion of an image acquisition unit and a distal end portion of a scope insertion unit included in the intubation assistance device of the fourth embodiment. 14 is a view (partially cut away) seen from the arrow B side in FIG. 1, and corresponds to FIG.

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

  The fourth embodiment is the same as the first embodiment except that the installation position of the CCD 631 of the scope insertion unit 61 is different.

  Specifically, in the scope insertion unit 61 shown in FIG. 14, the CCD 631 is provided at a position closer to the distal end side of the insertion unit 3 than the position of the CCD 421 of the image acquisition unit 4. That is, the separation distance between the CCD 631 and the objective lens 632 is smaller than the separation distance between the CCD 421 and the objective lens 422 of the image acquisition unit 4. Thereby, the viewing angle (total viewing angle) θ2 ′ of the scope 6 (CCD 631) is larger than the total viewing angle (viewing angle) θ1 ′ of the image acquisition unit 4 (CCD 421).

  Thus, by enlarging the viewing angle θ2 'of the scope 6, it is possible to capture (view) a wider area in front of the scope insertion portion 61 in the traveling direction. Since the scope insertion part 61 moves toward the target site of the subject while moving in the groove 321 provided in the insertion part 3 of the apparatus main body 1 or the intubation tube 7, the scope insertion part 61 is visually recognized in a wider range. It is preferable.

  The viewing angle θ2 ′ can be appropriately set according to the purpose of use, and is not particularly limited, but is preferably about 90 to 120 °.

  According to such a configuration, the operator can confirm the front of the distal end portion of the scope 6 in a wider range when the distal end portion of the scope insertion portion 61 is inserted into the glottis, trachea, and bronchus. For this reason, the site | part (glottis, trachea, and bronchus) which should insert the front-end | tip part of the scope insertion part 61 can be confirmed more smoothly.

  In the present embodiment, the configuration in which the viewing angle θ2 ′ is adjusted by changing the position of the CCD 631 is shown. However, the viewing angle θ2 ′ is adjusted by changing the size of the objective lens 632 of the scope insertion unit 61. You can also.

  Further, not only the viewing angle θ2 ′ of the scope 6 (CCD 631) but also the viewing angle θ1 ′ of the image acquisition unit 4 (CCD 421) may be configured to capture a wider range.

<Fifth Embodiment>
FIG. 15 is an exploded perspective view of an insertion portion provided in the intubation assistance device of the fifth embodiment.

  Hereinafter, the intubation support device of the fifth embodiment will be described focusing on the differences from the first embodiment, and the description of the same matters will be omitted.

  In 5th Embodiment, it is the same as that of the said 1st Embodiment except the structures of the insertion part 3 which the apparatus main body 1 has differing.

  Specifically, the insertion portion 3 includes a long insertion portion main body 31 and a holding portion 32 including a groove 321 that opens (opens) on a side surface.

  A pair of grooves 38 are formed on both side surfaces of the insertion portion main body 31 from the proximal end to the distal end in the longitudinal direction. The groove 38 is provided near the center in the thickness direction on the side surface of the insertion portion main body 31. The groove 38 has a substantially T-shaped cross section. The cross-sectional shape of the groove 38 is not limited to the T shape, and may be a cross shape, a triangular shape having one apex on the side surface side of the insertion portion main body 31, or the like.

  The holding | maintenance part 32 comprises long shape, for example, is flexible by being comprised with materials, such as soft resin, an elastomer, and rubber | gum.

  On the side surface of the holding portion 32, a ridge 39 having a cross-sectional shape (T-shape) corresponding to the groove 38 is formed over the entire length. By inserting the ridge 39 into one of the pair of grooves 38, the holding portion 32 can be selectively mounted on both side surfaces of the insertion portion main body 31. In the present embodiment, the mounting mechanism 11 that mounts the holding portion 32 to the insertion portion main body 31 is configured by the groove 38 and the ridge 39. As described above, since the holding portion 32 has flexibility, it can be easily attached to the insertion portion main body 31 having a shape curved in the longitudinal direction.

  Further, it is possible to remove the holding portion 32 attached to one side surface of the insertion portion main body 31 and turn it upside down and attach it to the other side surface of the insertion portion main body 31. Thereby, the operator changes the position (right and left positions) of the holding portion 32 with respect to the insertion portion main body 31 according to the posture of the subject, the standing position of the operator, and the dominant hand (right-handed, left-handed) of the operator. can do. For this reason, intubation work can be performed more easily and reliably. Here, the intubation support apparatus 100 rotates the insertion portion 3 around the rotation axis of the grip portion 2 according to the posture of the subject, and the like, so that the tongue piece 33 of the insertion portion 3 as shown in FIG. 1 is attached to the grip 2 so that it is located on the left side in FIG. 1, that is, in the same direction as the display 5 is located, opposite to the right side in FIG. It is also possible to use in the state. Thus, even when the direction of the insertion portion 3 (tongue piece 33) relative to the display 5 is changed, the operator changes the position (left and right positions) of the holding portion 32 with respect to the insertion portion main body 31 according to the dominant hand. Thus, the intubation work can be performed more easily and reliably.

  Moreover, since the holding | maintenance part 32 has flexibility as mentioned above, the curve direction can be changed easily. For this reason, even when the holding portion 32 is attached to any side surface of the insertion portion main body 31, it can be easily attached.

  In addition, the holding portion 32 is slidable with respect to the insertion portion main body 31 because it is mounted on the insertion portion main body 31 by inserting the ridges 39 into the grooves 38. For this reason, the holding part 32 can be slid with respect to the insertion part main body 31, and the front-end | tip part can be made to protrude ahead rather than the front-end | tip of the insertion part main body 31. FIG. By using the distal end portion of the holding portion 32 so as to protrude forward from the distal end of the insertion portion main body 31, the scope insertion portion 61 and the intubation tube 7 can be guided closer to the target portion of the subject. it can.

  Note that the mounting mechanism 11 of the present embodiment is configured by the groove 38 formed in the insertion portion main body 31 and the ridge 39 formed in the holding portion 32, but the groove formed in the holding portion 32 Further, it may be constituted by a ridge formed on the insertion portion main body 31 and engaged with the groove.

<Sixth Embodiment>
FIG. 16 is a diagram illustrating a distal end side of an insertion portion included in the intubation assistance device of the sixth embodiment. FIG. 16A is a side view of the insertion portion main body, and FIGS. 16B, 16C, and 16D are views showing a state in which the holding portion is mounted on the insertion portion main body.

  Hereinafter, the intubation support device of the sixth embodiment will be described focusing on the differences from the first and fifth embodiments, and description of similar matters will be omitted.

  The sixth embodiment is the same as the fifth embodiment except that the configuration of the groove 38 is different.

  Specifically, the groove 38 branches in three directions at the tip portion, and three branch grooves 381, 382, 383 are formed.

  The branch groove 381 is located near the center of the insertion portion main body 31 in the thickness direction. The branch groove 382 is curved (bent) toward the tongue piece 33, and the branch groove 383 is bent (bent) toward the opposite side of the tongue piece 33. The central axis of the branch grooves 382 and 383 and the central axis of the branch groove 381 are substantially the same.

  Any one of the branch grooves 381 to 382 can be used in a state in which the tip of the ridge 39 is inserted. For example, when the distal end portion of the ridge 39 is inserted into the branch groove 381, the distal end portion of the holding portion 32 is substantially parallel to the insertion portion main body 31, as shown in FIG. Further, when the tip of the ridge 39 is inserted into the branch groove 382, the tip of the holding portion 32 is bent (curved) toward the tongue piece 33 as shown in FIG. When the distal end portion of the strip 39 is attached to the branch groove 383, the strip 39 is bent (curved) toward the opposite side of the tongue piece 33 as shown in FIG.

  In this way, by inserting the ridge 39 into one of the branch grooves 381 to 383, the central axis at the distal end portion of the holding portion 32 and the center at the distal end portion of the insertion portion main body 31 in a side view of the insertion portion 3. The angle formed with the axis can be changed. Thereby, after the operator starts the intubation work, for example, when it is difficult to insert the scope insertion unit 61 into the glottic fissure or the like due to the posture of the subject, the shape of the trachea, or the like, After the insertion portion 3 is removed from the subject and the direction in which the tip of the holding portion 32 faces is adjusted according to the situation, the intubation operation can be performed more reliably by restarting the intubation operation.

  For example, when the intubation tube 7 is relatively soft and easily deformed, the distal end portion of the intubation tube 7 can be obtained by setting the holding portion 32 to the insertion portion main body 31 as shown in FIG. When protruding from the tip of the groove 321, the tip of the intubation tube 7 is deformed downward in FIG. 16 due to its own weight, and is naturally positioned near the center of the insertion portion main body 31. Further, when the intubation tube 7 is relatively hard and curved in a natural state, the intubation tube 7 can be obtained by setting the holding portion 32 to the insertion portion main body 31 as shown in FIG. When the distal end portion of the tube is protruded from the distal end of the groove 321, the distal end portion of the intubation tube 7 comes to be naturally positioned near the center of the insertion portion main body 31 due to its curved shape. For this reason, in this embodiment, in any of the above cases, by changing the position of the distal end portion of the holding portion 32 according to the shape of the intubation tube 7 or the like, The tip can be easily pushed into the glottis.

<Seventh embodiment>
FIG. 17 is a diagram illustrating a distal end side of an intubation tube included in the intubation system of the seventh embodiment.

  Hereinafter, the intubation system according to the seventh embodiment will be described focusing on the differences from the first embodiment, and description of similar matters will be omitted.

  The seventh embodiment is the same as the first embodiment except that the configuration of the intubation tube 7 is different.

  As shown in FIG. 17, the tube main body 71 has a first lumen 711 and a second lumen 712. The distal end of the first lumen 711 opens to the distal end opening 74, and the distal end of the second lumen 712 opens to the distal end opening 75 on the proximal end side of the tube main body 71 relative to the distal end opening 74. .

  When such an intubation tube 7 is used as the intubation system 200 combined with the intubation support device 100, the scope insertion portion 61 of the scope 6 is inserted into the first lumen 711, as in the first embodiment. It can be used by sliding along the longitudinal direction of the intubation tube 7 (insertion portion 3). In addition, as shown in FIG. 17, the scope insertion portion 61 of the scope 6 is inserted into the second lumen 712 and is used by sliding along the longitudinal direction of the intubation tube 7 (insertion portion 3). Is also possible.

  A band-shaped mark 76 is formed along the outer periphery of the tube main body 71 between the tip opening 74 and the tip opening 75. The bronchial seal cuff 73 is located on the distal end side of the tube main body 71 with respect to the mark 76, and the tracheal seal cuff 72 is located on the proximal end side of the tube main body 71 with respect to the mark 76. In the intubation support operation, by confirming the positional relationship between the mark 76 and the bronchial bifurcation, whether or not the distal end portion (bronchial seal cuff 73) of the tube main body 71 is located in the bronchus, or The insertion depth into the bronchus can be confirmed.

  Next, the usage method (action | operation) of the intubation system 200 using the intubation tube 7 of such a structure is demonstrated centering on difference with 1st Embodiment.

  The usage method of the intubation system 200 in 7th Embodiment is the same as that of 1st Embodiment except process [6] differing.

  [6 ′] In the same manner as in the above [6], the operator inserts the distal end portion of the intubation tube 7 into the target bronchus (for example, the left bronchus) while confirming the second image (FIG. 6). 11 (A) and (B)).

  Next, when the distal end portion of the intubation tube 7 is inserted into the left bronchus, the scope 6 is removed from the tube body 71 of the intubation tube 7.

  Next, the scope insertion portion 61 of the removed scope 6 is inserted into the second lumen 712. At this time, as described above in the first embodiment, if the length of the tube body 650 is set longer than the length of the tube body 611 of the scope 6, the scope 6 connected to the grip portion 2 is The operation of inserting into or removing from the intubation tube 7 can be easily and reliably performed.

  Next, while confirming the second image by the scope 6, the scope insertion portion 61 is pushed forward, and the distal end of the scope insertion portion 61 is positioned near the distal end opening 75 as shown in FIG.

  Next, the insertion depth of the distal end portion of the tube main body 71 is adjusted while confirming the position of the mark 76 in the second image. As described above, the mark 76 is formed between the tip opening 74 and the tip opening 75. Therefore, if the mark 76 is positioned near the left bronchi entrance, the entire tracheal seal cuff 72 provided on the proximal side of the mark 76 is placed in the trachea, and the bronchial seal provided on the distal side of the mark 76. The entire cuff 73 can be surely inserted into the left bronchus.

  As described above, since the mark 76 is formed, the bronchial sealing cuff 73 and the tracheal sealing cuff 72 can be positioned more reliably in the trachea and bronchus. For this reason, even if a practitioner's skill level is low, it can insert reliably and more easily by the site | part which aims at the intubation tube 7. FIG.

  As described above, the intubation support device of the present invention has been described with respect to the illustrated embodiments. However, the present invention is not limited to these embodiments, and each part constituting the intubation support device can have any configuration that can exhibit the same function. Can be substituted. Moreover, arbitrary components may be added.

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

Further, the insertion portion of the apparatus main body may be fixed (adhered) to the gripping portion (main body portion).
Further, the apparatus main body and the scope may be connected not by wire but by radio.

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

  Further, a marker such as a symbol, a character, or a figure indicating a rotation angle around the scope axis may be formed as a part of the second image (electronic image) on the display (image display unit). A symbol or the like indicating the rotation angle around the scope axis may be formed on the base end surface of the window 633 of the imaging unit 67 by printing or the like, and this may be captured on the second screen.

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

  The use of the intubation support device is not limited to securing the airway (used when inserting the intubation tube into the subject's trachea). That is, the insertion portion of the apparatus body is inserted from the mouth of the subject into a predetermined part of the subject or in the vicinity thereof, but the part is not limited to the glottis, trachea, bronchus, for example, It may be a nasal cavity, esophagus or the like.

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

DESCRIPTION OF SYMBOLS 100: Intubation assistance apparatus 200: Intubation system 1: Apparatus main body 2: Gripping part 22: Connection part 221: Female screw 222: Connector 3: Insertion part 31: Insertion part main body 32: Holding part 33: Tongue pieces 34a, 34b: Tube Holder 35: Through-hole 36: Guide hole 37: Blocking portion 38: Groove 39: Projection 311: Curved portion 311: Male screw 321: Groove 381: Branching groove 382: Branching groove 383: Branching groove 4: Image acquisition unit 41: Tube 42: Imaging unit 43: Illumination unit 44: Connector 45: First imaging unit 46: First illumination unit 421: CCD
422: Objective lens 423: Window part 424: Image signal cable 431: White LED
432: Lens for illumination 433: Window part 434: Illumination signal cable 5: Display (image display part)
52: rotation mechanism 53: operation button 54: connection terminal 55: lid 56: switch 511: control unit 512: power supply unit 6: scope 61: scope insertion unit 62: scope gripping unit 63: scope imaging unit 64: scope illumination unit 65: scope connection unit 66: change unit 67: second imaging unit 68: second illumination unit 611: tube 621: convex portion 631: CCD
632: Objective lens 633: Window portion 634: Image signal cable 641: White LED
642: Illumination lens 643: Window 644: Illumination signal cable 650: Tube 651: Connection terminal 661: Notch 662: Inclined surface 663: Metal film 7: Intubation tube 71: Tube body 72: Tracheal seal cuff 73: Bronchial sealing cuff 711: first lumen 712: second lumen 713, 714: proximal opening 721: tracheal sealing pilot balloon 731: bronchial sealing pilot balloon 74, 75: distal opening 76: mark 11: mounting mechanism B: Arrow M: Target mark θ: Angles θ1, θ2, θ1 ′, θ2 ′: Viewing angle L1: Length

Claims (18)

An intubation support device used when inserting a tube into the trachea of a subject,
The main body,
A length that is detachably connected to the main body and inserted into the predetermined portion of the subject via the oral cavity of the subject in a state of being connected to the main body. An insertion part of the scale,
A first imaging unit fixedly provided with respect to the distal end of the insertion unit;
A second imaging unit movably provided along the longitudinal direction of the insertion unit;
An intubation support apparatus comprising: an image display unit that is provided in the main body unit and displays at least one of the images captured by the first imaging unit and the second imaging unit. .   The intubation assistance device according to claim 1, wherein the first imaging unit is arranged so that the position of the second imaging unit can be confirmed. In a state where the second imaging unit is aligned with the first imaging unit, or is located on the proximal end side with respect to the first imaging unit, the distal end portion of the insertion unit is placed on the subject. To reach a predetermined site,
Thereafter, the intubation support device according to claim 1 or 2, wherein the second imaging unit is used so as to protrude from the distal end portion of the insertion unit. Furthermore, it is provided so as to be slidable along the longitudinal direction of the insertion part, and includes a long operation mechanism for moving the second imaging part.
The intubation assistance apparatus according to any one of claims 1 to 3, wherein the second imaging unit is fixedly provided at a distal end portion of the operation mechanism.   The intubation support device according to claim 4, wherein the insertion unit includes a holding unit that holds the operation mechanism slidably along a longitudinal direction of the insertion unit.   The intubation according to claim 5, wherein the distal end portion of the insertion portion is used to reach a predetermined part of the subject in a state where the operation mechanism is inserted into the tube held by the holding portion. Support device.   The intubation support device according to claim 5 or 6, wherein the holding portion includes a groove formed along a longitudinal direction of the insertion portion.   The intubation of Claim 5 or 6 with which the said insertion part has the insertion part main body which can mount | wear the said holding | maintenance part detachably, and the mounting mechanism which mounts | wears with the said holding | maintenance part with respect to the said insertion part main body. Support device.   The intubation support device according to claim 8, wherein the mounting mechanism is provided as a pair on both side surfaces of the insertion portion main body.   The mounting mechanism is configured so that an angle formed by a central axis at a distal end portion of the holding portion and a central axis at a distal end portion of the insertion portion main body can be changed in a side view of the insertion portion. The intubation assistance apparatus according to 8 or 9.   The intubation assistance apparatus according to any one of claims 4 to 10, wherein a change unit that changes a visual field direction of the second imaging unit is provided at a distal end portion of the operation mechanism.   Furthermore, the intubation assistance apparatus of any one of Claim 4 thru | or 11 provided with the marker which grasps | ascertains the rotation angle around the axis | shaft of the said operation mechanism.   The intubation assistance device according to claim 12, wherein the operation mechanism includes a grip portion that grips the second imaging unit on a proximal end side when the operation mechanism is moved, and the marker is provided on the grip unit. The image display unit is configured to display a first image captured by the first imaging unit and a second image captured by the second imaging unit,
Further, a first display mode for displaying only the first image, a second display mode for displaying only the second image, and both the first image and the second image are displayed. The intubation assistance apparatus of any one of Claim 1 thru | or 13 provided with the display switching means which switches a 3rd display mode. Configuration tip before Symbol operation mechanism, when it is no longer seen on the first image in the first display mode, automatically switches as in the second display mode or the third display mode The intubation assistance apparatus according to claim 14 , wherein any one of claims 4 to 13 is cited . The tube has a first cuff capable of expanding and contracting provided in the middle of the longitudinal direction;
A second cuff capable of being inflated and deflated provided closer to the proximal end than the first cuff;
The intubation assistance apparatus of any one of Claim 1 thru | or 15 which has the mark provided between the said 1st cuff and the said 2nd cuff. The intubation assistance apparatus according to any one of claims 1 to 16 , wherein a viewing angle of the first imaging unit is different from a viewing angle of the second imaging unit. The intubation assistance apparatus according to any one of claims 1 to 17 , wherein a viewing angle of the second imaging unit is larger than a viewing angle of the first imaging unit.

Images