JPH02286170A - Exocirculating device - Google Patents

Abstract

PURPOSE:To prevent the congestion in the lung by providing a blood transfer tube, the front end aperture of which is to be detained in the pulmonary trunk, the left ventricle or the left atrium and the base end is connected to an upstream side of the pump of a blood removing line. CONSTITUTION:The blood is removed from the front end of a catheter 21 for blood removal detained in the vein of a patient 7 when the pump 3 is operated. This blood is introduced through a catheter 51 for blood sending into the artificial lung 4 and is sent through a catheter 52 for blood sending into the artery of the patient 7, in which artery the front end of the above-mentioned catheter is held detained. On the other hand, the blood is also removed by the suction force of the pump 3 from the section (plumonary trunk, the left ventricle or the left atrium) where the front end of a vent tube 6 is held detained. This blood joins with the blood flowing in the catheter 21 for blood removal at the root end thereof. The blood is removed from the plumonary trunk, the left ventricle or the left atrium by the vent tube 6 in such a manner and, therefore, the congestion in the lung is prevented even when the living heart weakens.

Description

DETAILED DESCRIPTION OF THE INVENTION <Industrial Application Field> The present invention relates to an extracorporeal circulation device used for VA bypass in an artificial lung system.

<Prior Art> In recent years, an artificial lung extracorporeal circulation circuit using a VA (venous-arterial) bypass using an artificial lung has been used as an aid in cardiac surgery, cardiac insufficiency, and respiratory failure. This circuit includes a devascularization, a pump, an oxygenator, and a blood vessel,
Blood is removed from the patient's veins or surgical tubes, and is then oxygenated and decarbonized using an oxygenator before being sent to the patient's arteries.

However, such conventional oxygenator extracorporeal circulation circuits (devices) have the following drawbacks.

%W In an emergency VA bypass, if the living heart is weakened, the left ventricle will be unable to pump blood due to the aortic pressure. As a result, blood congestion occurs in the lungs, the amount of extracorporeally circulating blood decreases, and insufficient blood removal occurs, making it impossible to obtain sufficient support from the oxygenator extracorporeal circulation circuit.

In particular, when a constant flow pump such as a centrifugal pump is used as the pump installed in one circuit, the diastolic blood pressure increases, making it difficult to extract the living heart, and the above-mentioned drawbacks become conspicuous.

Furthermore, in conventional extracorporeal circulation devices, veins and arteries are secured through a thoracotomy, which places a heavy physiological burden on the patient and tends to cause accumulation due to bleeding in the surgical instrument.

<Problems to be Solved by the Invention> The present invention has been made in view of the above-mentioned drawbacks of the prior art, and its purpose is to 'ensure sufficient extracorporeal blood circulation by preventing blood congestion in the lungs. Another object of the present invention is to provide an extracorporeal circulation device that places less physiological burden on a patient.

〈Means for solving problems〉 Such objects are achieved by the present invention as described below.

That is, the present invention provides: a blood removal line that percutaneously removes blood from a vein; a pump attached to the blood removal line that pumps blood; and an oxygenator that exchanges gas with the blood pumped from the pump. , a blood supply line that percutaneously sends gas-exchanged blood to the artery.

Extracorporeal circulation characterized by comprising a blood transfer tube whose distal opening is for placement in the pulmonary artery, left ventricle or left atrium, and whose proximal end is connected to the upstream side of the pump in the blood removal line. It is a device.

Preferably, the pump is an extracorporeal circulation device that is a constant flow pump.

Further, it is preferable that the extracorporeal circulation device includes a balloon that can be expanded and contracted at the tip of the blood transfer tube.

"Percutaneously" means to do it through the skin without making an incision, and "percutaneously insert and place" means inserting a catheter or tube into the target site, such as a blood vessel, heart, or liver. For placement, a vein or artery is secured through the skin using the Seldinger technique, and a guide wire is inserted into the guide and placed.

Hereinafter, the extracorporeal circulation apparatus of the present invention will be explained based on the accompanying drawings.

FIG. 1 is a schematic diagram showing a configuration example of an extracorporeal circulation apparatus of the present invention. As shown in the figure, the extracorporeal circulation apparatus 1 includes a blood removal line 2, a pump 3, and so on.

The circuit includes an artificial lung 4, a blood supply line 5, and a blood transfer tube (vent tube) 6.

The blood removal line 2 is provided with a blood removal catheter 21 .

The tip of the blood removal catheter 21 (hereinafter, the upstream side in the blood flow direction is referred to as the tip and the downstream side is referred to as the proximal end) is percutaneously placed in the vein of the patient 7, and the proximal end of the blood removal catheter 21 is connected to a pump. It is connected to the inlet of 3.

The blood feeding line 5 is provided with blood feeding catheters 51 and 52.

The distal end of the blood feeding catheter 51 is connected to the discharge port of the pump 3, and the proximal end of the blood feeding catheter 51 is connected to the blood inlet of the artificial lung 4.

Further, the distal end of the blood feeding catheter 52 is connected to the blood flow outlet of the oxygenator 4, and the proximal end of the blood feeding catheter 52 is percutaneously placed in the artery of the patient 7.

Bent Chee-Pro is inserted percutaneously, and its tip is
It is placed in either the pulmonary artery, left ventricle, or left atrium of patient 7. Further, the proximal end of the vent tube is connected to the upstream side of the pump 3, that is, to an arbitrary position in the middle of the blood removal catheter 21.

Examples of the configuration of this vent tube 6 include the following.

(2) A vent tube constituting a separate line from the blood removal catheter 21 is provided, and its proximal end is connected directly to the suction port of the pump 3, or connected to the relatively proximal side of the blood removal catheter 21.

This configuration has the advantage that blood can be reliably removed from the tip of the vent tube.

■ As shown in Fig. 2, a relatively small diameter vent tube 6a is provided that branches from near the tip of the blood removal catheter 21, and the tip of this vent tube 6a passes through the right atrium, right ventricle, and pulmonary valve in sequence. and is placed in the pulmonary artery.

This configuration has the advantage that the extracorporeal circulation circuit can be simplified.

In this case, the outer diameter of the blood removal catheter 21 is 6 to 10 mm.
It is preferable that the inner diameter is about 4~9!1ffl, and the outer diameter of the vent tube 6a is about 2~5+nm, and the inner diameter is about 1ffl.
~4 mm is preferable.

(2) As shown in FIG. 3, it has a double-tube structure in which a vent tube 9 is housed within a blood removal catheter 8.

That is, the tip of the blood removal catheter 8 is closed, and a blood removal lumen 81 is formed inside. In addition, a blood removal lumen 81 is provided on the outer periphery of the distal end of the blood removal catheter 8.
A plurality of side holes 82 are formed that communicate with the.

On the other hand, the vent tube 9 is housed in the blood removal lumen 81 and the distal end blockage 8 of the blood removal catheter 8.
A balloon 95 that protrudes through the tube 3 and can be expanded and deflated is attached to the distal end of the balloon 95.

This balloon 95 is constructed by inserting a thin film cylindrical body made of an elastic material such as silicone rubber or latex rubber so as to cover the tip of the vent tube, and attaching both ends of the cylindrical body to the outer periphery of the vent tube 9. It is fixed by gluing it or tying it with thread.

This balloon 95, when placing the vent tube 9,
It is intended to be expanded and fixed to the left ventricle, left atrium, etc.

Inside the vent tube 9, a vent lumen 91 for sucking blood and a balloon expansion lumen 92 are formed.

The tip of the vent lumen 91 is open. Note that a vent tube 9 is provided in this vent lumen 91.
A guide wire (not shown) is inserted during the tip guidance.

In addition, the tip of the balloon expansion lumen 92 is filled with a filling material 93.
The outer periphery of the tip of the vent tube 9 is
A side hole 94 is formed that communicates the inside of the balloon 95 and the inside of the expansion lumen 92.

As a result, when a working fluid (physiological saline, contrast agent, CO, gas, etc.) is injected from the proximal side of the balloon expansion lumen 92, this working fluid passes through the expansion lumen 92, through the side hole 94, and into the balloon 95. The balloon 95 expands. Also, if the working fluid is removed, the balloon 9
5 is contracted.

In this case, the outer diameter of the blood removal catheter 8 is preferably about 6 to 12 mm, and the inner diameter of the blood removal lumen 81 is preferably about 6 to 10 mm. Also, the outer diameter of the vent tube 9 is 2
~5mm, the inner diameter of the vent lumen 91 is 1~4m
m, and the inner diameter of the balloon expansion lumen 92 is 0.5~
It is preferable to set it to about 2 mm.

Note that, unlike the configuration shown in FIG. 3, the blood removal catheter 8
The blood removal lumen 81 may be opened to the distal end without providing the closing part 83 at the distal end, and the side hole 82 may not be provided.

In such a configuration example, the tip of the vent tube 9 can be placed in the pulmonary artery after passing through the right atrium, right ventricle, and pulmonary valve sequentially. It can also be passed through the septum to reach the left atrium and placed there.

Pump 3 may be of either a steady flow or unsteady flow type, but especially when a steady flow pump is used, the lowest blood pressure tends to increase and it is difficult to obtain the ejection of the living heart. The provision of the vent tube, which is a feature of the invention, has great significance and is therefore preferable.

Examples of such steady flow pumps include centrifugal pumps, roller pumps, and the like.

Further, the discharge rate of the pump is preferably about 2 to 101/min.

The artificial lung 4 performs gas exchange, that is, adds oxygen to blood and removes carbon dioxide gas, and its type, model, etc. are not particularly limited.

As the oxygenator 4, for example, a hollow fiber oxygenator,
Examples include membrane type oxygenators.

Furthermore, the gas exchange performance of the artificial lung 4 is such that, for example, hemoglobin concentration Hb = 12 g/dj, blood flow Q b = 41
/m1n, oxygen transfer amount 200mj/ff1in
The above are preferred.

Blood removal catheter 21, 8, blood feeding catheter 51.5
2 and vent tube 6.6a.

Each of the tubes 9 may be a single tube or a plurality of tubes having the same diameter or different diameters connected to each other. Also,
These tubes are preferably constructed of flexible materials such as polyvinyl chloride, polyurethane, polyethylene, polypropylene, nylon, silicone, EVA, etc. In particular, the tip of the bent tube has a high plasticizer content. (For example, plasticizer DO for 100 parts by weight of PVC
It is preferable to impart appropriate flexibility by preparing P (containing about 10 to 60 parts by weight).

In addition, the tube may be impregnated with a plasticizer at a predetermined temperature for a predetermined time (for example, if the tube material is nylon, POBO
It is also possible to impart flexibility by impregnating the material in an ethanol solution of (roseoxybenzoic ethylhexyl) at 60"C for 30 minutes).

The inner and/or outer surfaces of these tubes are also preferably coated with an antithrombotic agent, such as heparin or segmented polyurethane.

In such an extracorporeal circulation apparatus 1, when the pump 3 is activated, the blood removal catheter 21 placed in the vein of the patient 7 is activated.
(or 8, hereinafter represented by 21), blood is removed from the tip (side hole 82 at the tip), and the blood is transferred to the blood removal catheter 2.
The blood discharged from the pump 3 is further introduced into the oxygenator 4 through the blood feeding catheter 51.

The blood introduced into the oxygenator 4 is oxygenated and carbon dioxide is removed from it, and the blood passes through the blood supply catheter 52 from the blood outlet of the oxygenator 4, and its tip is delivered to the patient 7 indwelling. blood is sent to the arteries of

On the other hand, due to the suction force of the pump 3, blood is also removed from the site where the tip of the vent tube 6 (or 6a59, hereinafter referred to as 6) is indwelled (pulmonary artery, left ventricle, or left atrium), and this blood is removed from the vent tube. It passes through the tube 6 and merges with the blood flowing through the blood removal catheter 21 at its proximal end,
Pump 3 as above. The blood is returned to the patient's 7 artery via the blood feeding catheter 51, the artificial lung 4, and the blood feeding catheter 52.

Since blood is removed from the pulmonary artery, left ventricle, or left atrium using the vent tube 6, congestion in the lungs is prevented even when the living heart is weakened, thereby ensuring a sufficient amount of extracorporeal circulating blood. be able to.

In the extracorporeal circulation apparatus having such a configuration, blood is removed from both the blood removal catheter 21 and the vent tube 6 by suction from the pump 3. In this case, the ratio of the amount of blood removed in the vent tube 6 to the amount of blood removed in the blood removal catheter 21 is preferably about 1750 to 1/4.
This ratio of blood removal amount mainly depends on the blood removal catheter 21.
And what is necessary is just to adjust by the inner diameter of the vent tube 6.

Note that the extracorporeal circulation apparatus of the present invention is not limited to the circuit configuration described above.

For example, a recirculation line, a cardiomy reservoir, a venous reservoir, a bubble trap, a sampling manifold, an air bleed line, a pump tube, a thermometer, various connectors, etc. may be appropriately arranged in the circuit.

<Example> (Example 1) An adult (2
An experiment of extracorporeal blood circulation by VA bypass was conducted on a female (0 kg, female) using the following procedure.

Note that the vent tube in this extracorporeal circulation apparatus had the configuration shown in FIG. 2.

A centrifugal pump is used for the pump, and its average discharge volume is '
;l j/sin.

Capiox II-33 (manufactured by Terumo Corporation; effective membrane area = approximately 3.3) was used as an oxygenator.

First, after anesthetizing an adult with Ketaral, a blood supply catheter and a blood removal catheter (outside diameter 8
mm, inner diameter 611! +) was inserted by the Seldinger method, and V-A bypass was started. The blood flow rate at this time was lj/win.

Next, a vent tube (outer diameter 3 I, inner diameter 2 au*) was inserted from the femoral vein using the Seldinger method.
The tip of the vent tube was placed in the pulmonary artery via the right atrium, right ventricle, and pulmonary valve, and the proximal end of the vent tube was connected to the middle of the blood removal catheter using a branch connector.

First, with the vent tube clamped (occluded), the heart was temporarily stopped using potassium chloride, and VA bypass was performed.

Immediately after cardiac arrest, a blood loss amount of 2 j/win was obtained, but thereafter the blood loss amount gradually decreased, and 15 minutes later, the blood loss amount was 500 mj/ff1in.

So, when I opened the vent tube clamp,
The amount of blood removed increased and recovered to 1.5j/min 5 minutes after opening.

Thus, with the help of vent tube blood removal,
It was confirmed that sufficient extracorporeally circulating blood volume could be secured.

(Example 2) An experiment on extracorporeal blood circulation was conducted under the same conditions as in Example 1 except that the vent tube was configured as shown in FIG. In this experiment, almost the same results as in Example 1 were obtained.

<Effects of the Invention> By using the extracorporeal circulation device of the present invention, blood can be removed from the pulmonary artery, left ventricle, or left atrium using the vent tube, thereby preventing congestion in the lungs and ensuring sufficient extracorporeally circulating blood volume. can be ensured.

In particular, when a steady-flow pump is used for blood pumping, it is highly effective because an increase in diastolic blood pressure makes it difficult to extract the living heart.

Furthermore, since a thoracotomy is not required, there is less physiological burden on the patient, and the device can be easily set up.

[Brief explanation of the drawing]

FIG. 1 is a circuit configuration diagram schematically showing a configuration example of an extracorporeal circulation apparatus of the present invention. FIG. 2 is a perspective view showing an example of the configuration of a vent tube in the extracorporeal circulation apparatus of the present invention. FIG. 3 is a longitudinal sectional view showing another example of the configuration of the vent tube in the extracorporeal circulation apparatus of the present invention. Explanation of symbols 1... Extracorporeal circulation device 2... Blood removal line 21... Blood removal catheter 3... Pump 4... Artificial lung 5... Blood supply line 51, 52... Blood supply Blood catheter 6.6a...Vent tube 7...Patient 8...Blood removal catheter 81...Blood removal lumen 82...Side hole 83...Occluded part 9...Vent tube 91... Vent lumen 92... Balloon expansion lumen 93... Filler 94... Side hole 95... Balloon FIG, 1

Claims (3)

[Claims] (1) A blood removal line that percutaneously removes blood from a vein, a pump attached to the blood removal line that pumps blood, an oxygenator that exchanges gas with the blood pumped from the pump, and gas exchange. a blood supply line for percutaneously transmitting blood to an artery; 1. An extracorporeal circulation device comprising a blood transfer tube. (2) The extracorporeal circulation apparatus according to claim 1, wherein the pump is a constant flow pump. (3) The extracorporeal circulation apparatus according to claim 1 or 2, wherein the blood transfer tube includes a balloon that can be expanded and contracted at the distal end thereof.