JPH06197991A - Pacemaker device, catheter used for it, pacemaking method, and electrode used therefor - Google Patents

Abstract

PURPOSE: To conduct a pacemaking action of the heart by providing a pair of electric conductors made of a first electric conductor transmitting an electrical signal to a first electrode connecting between the first electrode and a pacemaking electric generator, and a second electric conductor transmitting an electric energy onto between them by connecting the second electrode to the pacemaking electric generator. CONSTITUTION: A pacemaking signal from a pacemaking electrode 14 transmits to the right ventricle 68 and right atrium 64 of a patient by passing through the internal wall of the esophagus of the patient where the heart 62 of the patient is made to pulsate in response to these pacemaking signals. A responding portion or ground working portion of the pacemaking signal returns to the pacemaking electric generator 10 through the pacemaking electrode 20 of the base end. Such a stimulation or pacemaking current is regulated through an electric generator of signal. The electric generator of signal has a variable voltage, and a constant current supplies power. And a current value supplied to the heart 62 through the pacemaking electrodes 14, 20 inserted into the esophagus 60 is displayed by a digital display under milliampere unit.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a pacing device suitably used for pacing in an emergency such as surgery, and particularly for pacing in an emergency such as surgery in which a catheter is inserted into the esophagus, and a catheter used therefor. And a method for adjusting and an electrode used for the method.

[0002]

2. Description of the Related Art Generally, during surgery, a patient is anesthetized and a flexible catheter is inserted from the nose of the patient into the esophagus to monitor the functions of various parts of the body. For example, US Pat. No. 4,476,87
2, 4,439,031, 4,176,660, and 3,951,136, an esophageal catheter may be used to monitor a patient's electrocardiogram, heart rate and temperature. it is obvious. Similarly, US Pat.
According to 763,663 and 4,619,268, it is clear that an esophageal catheter is also used to monitor heart sounds and body temperature. In addition, US Patent 4,4
No. 75,555 states that an esophageal probe with a general attachment is compatible with a stethoscope that listens to body sounds, a temperature sensor that measures body temperature, a pressure transducer, or a light source. .

The above-mentioned two esophageal catheters have electrodes for diagnostic pacing. One of these devices is the Asbacher Pill Electrode, which is used as a diagnostic pacifier, and the other is the Sieko Model Stat Pace II, which is used as a light vein wire to feed the esophagus. With these devices, the patient's heart typically has a high velocity, for example 120
Stride at a speed of about struck / minute. Then, after the signal from the pacing device is removed, the patient's heart is monitored by the EGC sensor, and the speed and function after the removal of the pacing pulse are clearly indicated. However, the pacing electrodes of these catheters have a relatively small surface area, which results in high current densities. If the pacing operation continues for a long time, the patient's esophagus may be burned.

[0004]

One problem that can occur during surgery when the patient is undergoing general anesthesia is
The point is that the patient's heart strikes irregularly or too slowly, or is unable to function fully under stress during anesthesia or surgery.
In such cases, anesthesiologists and other surgical team physicians must immediately restore the patient's heart to normal rhythm. This is usually done by externally applying some pacing action to the patient. However, to do so, at least one external electrode must be introduced into the patient's chest. Performing such emergency operations during the course of surgery is extremely difficult, if not impossible. For example, if the patient is undergoing surgery from the back side, the patient is placed face down on the operating table and cannot be moved without major injury. . for that reason,
The introduction of pacing electrodes poses a tremendous risk to the patient.

Therefore, it is an object of the present invention to provide an emergency pacing device that can be used quickly and easily during the course of surgery performed under general anesthesia.

Another object of the present invention is to provide an emergency pacing device which can be connected to an esophageal catheter used during the course of surgery performed under general anesthesia.

Another object of the present invention is to provide an esophageal catheter which can be used as a pacing device for emergency of the heart of a patient during surgery.

[0008] Still another object is to provide a pacing method capable of immediately pacing a patient's heart during a surgery performed under general anesthesia.

Yet another object is to provide a pacing electrode for use with an esophageal catheter for pacing the patient's heart and which does not damage the patient's esophagus during pacing.

Still another object is to use this in an intensive care unit of a hospital, a cardiac treatment unit, or another treatment unit in a hospital in an emergency such as when the patient has an arrhythmia or is in a cardiac arrest state. It is an object of the present invention to provide a pacing method capable of quickly pacing a patient's heart.

[0011]

SUMMARY OF THE INVENTION Some of the above-mentioned objects include a flexible catheter to be inserted into a patient's esophagus, a pair of pacing electrodes arranged along an outer wall of the flexible catheter, and a patient's heart. A pacing electromotive device that generates an electric signal for pacing and an electric conductor that is provided inside the flexible catheter and that connects the pacing electrode to the pacing electromotive device, continuously pacing the movement of the patient's heart. Achieved by an emergency pacing device.

From another point of view of the present invention, some of the above-mentioned objects are used during surgery and connected to the outer wall of the esophageal catheter so that the patient's heart can be paced directly through the esophagus. This is accomplished by providing an esophageal catheter having a pacing electrode that operates.

From another viewpoint of the present invention, some of the above-mentioned objects are achieved by a pair of electrically pacing electromotive force during a surgery performed while a patient receives general anesthesia. This is accomplished by providing a pacing method for continuously pacing the patient's heart by inserting a flexible catheter with pacing electrodes into the patient's esophagus.

Yet another object and advantage of the present invention is familiar with the technique from what is described in detail below, namely from the illustrated embodiment which simplifies the best possible method for carrying out the invention. It will be immediately apparent. The present invention can be implemented by other different specific examples as long as they do not depart from the scope of the invention, and many specific structural requirements can be improved in various points. . Therefore, the drawings and the description here are considered as one practical example, and are not limited to these.

[0015]

According to the present invention, the pacing signal generated by the pacing electromotive device is transmitted from the esophagus of the patient to the heart through the pacing electrode provided on the catheter inserted into the esophagus of the patient. In response to the pacing signal, contraction of the heart is caused, which causes pacing of the heart.

[0016]

EXAMPLE An esophageal catheter is one that is usually used during surgery performed while the patient is under general anesthesia. When anesthetized, the patient becomes unconscious, and in this state a flexible plastic catheter is inserted from the patient's nose into the esophagus until its distal end abuts the bottom of the esophagus.

As shown in FIG. 1, the esophageal catheter 30 of the present invention is made of a flexible plastic tube such as monotherm, which is usually about 35 cm in length. The inside of the tube is in a flexible hollow state, and is allowed to be used as various medical instruments as described below. Both the pacing electrode 14 on the distal side and the pacing electrode 20 on the proximal side are arranged along the catheter 30, and more specifically, the pacing electrode 14 on the distal side is located near the distal end of the catheter 30. In addition, the pacing electrode 20 on the proximal end side is separated from the catheter 30 by a predetermined distance.
It is located near the base end of the.

The two pacing electrodes 14 of the catheter 30
The portion located between and 20 and the portion connected to the distal side where the pacing electrode 14 is provided together form a stethoscope that monitors the sound of the patient's body, as described in detail below. There is. At the base end portion of the catheter 30, there is provided a mounting portion 42 which is connected to a well-known and commonly used earpiece (not shown) for listening to these sounds. A well known conventional thermistor 50, such as a monotherm, is located between the pacing electrodes 14 and 20. The thermistor 50 is a catheter 30
Through to the wire 52 which is connected at its proximal end to a well-known and conventional connector 54. The connector 54 is inserted into a well-known and conventional temperature monitor (not shown) that monitors the temperature of the patient during surgery.

Next, FIG. 2 showing an exploded view of the device for the pacing electrode
Will be described. A flexible tube 32 having an outer diameter slightly smaller than the inner diameter of the pacing electrode 20 on the proximal end side is inserted into the hollow portion of the pacing electrode 20. Pacing electrode 20
Is secured to flexible tube 32 by any suitable means such as medical grade adhesive or clips. Similarly, the flexible tube 34 having an outer diameter slightly smaller than the inner diameter of the pacing electrode 14 on the terminal side is inserted into the hollow portion of the pacing electrode 14 and fixed to the pacing electrode 14 in the same manner as described above.

The flexible tube 32 is inserted into the tube 36 at the end portion on the side forming the proximal end of the pacing catheter 30. The outer diameter of the flexible tube 32 is slightly smaller than the inner diameter of the tube 36, and both are fixed with an adhesive. Further, the end of the flexible tube 32 is inserted into a middle tube 38 having an outer diameter substantially the same as that of the tube 36. Specifically, tube 3
8 is provided with a series of holes 40 on the outer peripheral surface, forming the stethoscope as described above. A thin and flexible membrane (not shown) is attached to the tube 38 to prevent liquid such as water from entering the inside of the catheter 30. The proximal end of the tube 34 is inserted into the distal end of the tube 38 and fixed there by the same method as described above.

The distal end of the catheter 30 is composed of a flexible tube 44 having the same outer diameter as the tube 36 and an inner diameter slightly larger than the outer diameter of the tube 34. The distal end of the flexible tube 44 is sealed, and the proximal end is joined and adhered to the distal end of the tube 34 as described above. Like the tube 38, the tubular portion 44 of the flexible tube is provided with a hole 46 along its outer peripheral surface for forming a stethoscope that informs the auditory earpiece 42 of body sound. ing. Further, the tubular portion 44 of the flexible tube has a thin flexible film (not shown) on the outer surface thereof to prevent liquid from entering the inside of the catheter 30.

More specifically, the outer diameters of the pacing electrodes 14 and 20 are formed to be equal to the outer diameters of the tubes 36, 38, 44, so that they are substantially discontinuous when assembled. It is designed to provide a smooth, seamless surface that can be easily inserted into and removed from the patient's esophagus.

It will be readily appreciated that the use of a stethoscope is optional, as the operation of the stethoscope is completely separate from the operation of the pacing device. Specifically, for example, the tubes 38 and 44 may not be provided with the holes 40 and 44 as described above and may have exactly the same shape as the tube 36. Similarly, the use of the thermistor 50 is optional.

The position where the esophageal catheter 30 is inserted into the esophagus and heart of the patient is as shown in FIG. Catheter 30 is placed into esophagus 60 through the patient's nose. The esophagus 60 is located behind the heart 62 and slightly to the left. The heart 62 is configured to have four chambers, namely a right atrium 64, a left atrium 66, a right ventricle 68 and a left ventricle 70. The right ventricle 68 has a venous nodule 72 for flowing or pumping blood to each chamber of the heart 60 in response to an electrical pacing signal. As is well known, the pacing action is the right ventricle 68 or the right atrium 64.
By applying a pacing signal to each of these chambers to contract them. First, when the first blood pumping operation is performed, the right ventricle 68 contracts. Since the pacing electrodes 14 and 20 as described above are provided at predetermined positions on the catheter 30, the pacing signal is transmitted to the right ventricle 6
It causes contraction of both 8 and the right atrium 64, which maximizes pacing efficiency.

Thus, the pacing electrodes 14 and 20 produce sufficient current to pacing the ventricles and atria,
It is also possible to prevent an excessive current density that would damage the esophagus. According to the inventors, the pacing electrodes 14 and 20 have a minimum of about 1.
It has been found that it is preferable to have a surface area of about 5 cm square. Since the standard size catheter 30 has a diameter of 2.5 mm, obtaining the above results means that the pacing electrodes 14 and 20 are set to a length of about 2.0 cm. Means Pacing electrode 14,20
However, after being inserted with the pacing catheter 30 into the esophagus, they are considered simply conductive metals that do not react with liquids in the body, such as platinum and stainless steel.

The operation of the emergency pacing device of the present invention will now be described with reference to FIG.

A well known conventional pacing electromotive device 10, such as the Sieko Stat Pace II or SynchroMeds EP 1000, produces a pacing signal which is output to a wire 12 connected to a pacing electrode 14 on the distal side of the esophageal catheter 30. The pacing signal travels from the pacing electrode 14 through the patient's esophageal lining 16 to the patient's right ventricle 68 and right atrium 64 where it causes the patient's heart 62 to pulsate in response to these pacing signals. Further, the response amount or the ground component of the pacing signal is returned to the pacing electromotive device 10 through the pacing electrode 20 on the proximal side.

Such stimulation or pacing current is regulated via a signal electromotive. Signal generators have a variable voltage and a constant current powers them. And the esophagus 60
The current value sent to the heart 62 via the pacing electrodes 14 and 20 inserted into the heart is shown on a digital display in units of milliamps. Further, a well-known conventional ammeter is used to increase or decrease the current to be passed through the body of the patient. Here, this signal electromotive force has a current range of 1.5 mA to 25 mA.

The example described and illustrated above is only one particular embodiment of the present invention and, in fact, does not depart from the true spirit and purpose of the invention as defined in the appended claims. It goes without saying that the specific constitutional requirements can be variously changed as long as they are inside.

[0030]

As described above, according to the present invention,
The pacing signal generated by the pacing electromotive force is transmitted from the esophagus to the heart through a pacing electrode provided on a catheter inserted into the patient's esophagus. Then, the contraction of the heart is caused in response to the pacing signal, and the pacing of the heart is thereby performed. Therefore, the pacing device and the pacing method of the present invention are effective in an emergency, for example, during an operation such as an operation performed under general anesthesia.

[Brief description of drawings]

FIG. 1 is a diagram showing a catheter of the present invention.

FIG. 2 is an exploded view showing the configuration of the pacing electrode and the distal end of the catheter of the present invention.

FIG. 3 is a perspective view showing a state in which the catheter of the present invention is inserted into the esophagus of a patient.

FIG. 4 is a block diagram of a pacing device of the present invention.

[Explanation of symbols]

 10 pacing electromotive device 14 terminal pacing electrode (first pacing electrode) 20 proximal side pacing electrode (second pacing electrode) 30 catheter 60 esophagus 62 heart

Claims (16)

[Claims] 1. An emergency pacing device for continuously pacing a patient's heart, comprising a flexible catheter to be inserted into a patient's esophagus and a flexible catheter connected to the flexible catheter and located near the distal end of the flexible catheter. A pair of pacing electrodes consisting of a first electrode and a second electrode located near the proximal end of the flexible catheter; a pacing electromotive device for generating an electrical signal for pacing the patient's heart; Between the second electrode and the rectifier, a first electric conductor provided inside the first electrode and connecting the first electrode and the rectifier to send an electric signal to the first electrode; A pacing device comprising: a pair of electric conductors that are connected to each other and transmit a electric energy between the second electric conductors. 2. The pacing device according to claim 1, wherein each of the pair of pacing electrodes is a hollow metal tubular body connected to the outer wall of the flexible catheter. 3. The pacing device according to claim 1, wherein each of the pair of pacing electrodes causes a current to flow at a current density of less than 1.5 mA per 1 cm square. 4. The pacing device according to claim 1, wherein each of the pair of pacing electrodes has a surface area of at least 1.5 cm square. 5. The pacing device according to claim 2, wherein each of the pair of pacing electrodes has a length longer than 2.0 cm along the longitudinal axis. 6. A catheter for use in a patient undergoing surgery, wherein a flexible tube is inserted into the esophagus of the patient and extended, and electric energy is sustained through the patient's esophagus to the heart. And a means for transmitting energy for pacing the heart to transmit the energy to the heart. 7. The catheter according to claim 6, wherein the energy transmission means transmits electric energy with a current density of less than 25 mA per 1 cm square. 8. The catheter according to claim 6, wherein the energy transmission means has a pair of electrodes connected to the catheter. 9. The catheter according to claim 6, further comprising means provided inside the flexible tube for monitoring the temperature inside the body of the patient. 10. The catheter according to claim 6, further comprising means for transmitting a sound emitted from the body of the patient from the distal end to the proximal end of the catheter. 11. The catheter according to claim 6, wherein each of the pair of electrodes has a surface area of at least 1.5 cm square. 12. The catheter according to claim 8, wherein the pair of electrodes are hollow cylindrical bodies each having a length of more than 2.0 cm along the longitudinal axis. 13. A pacing method for continuously pacing a patient's heart during surgery, comprising: inserting a flexible catheter having a pair of electrodes electrically connected to a pacing electromotive device into a patient's esophagus; A pacing signal is generated in the electromotive device, and the pacing signal is transmitted from the pacing electromotive device to one of the pair of electrodes, and the pacing signal is then transmitted from the electrode to the patient's heart through the wall of the esophagus. A pacing method characterized by transmitting. 14. The pacing method according to claim 13, wherein a current density of the pacing signal transmitted from the electrode is smaller than 25 mA per 1 cm square. 15. An electrode used for pacing a patient's heart during general anesthesia surgery, for transmitting a pacing signal through the patient's esophagus.
An electrode having a hollow cylindrical body shape having a surface area larger than 1.5 cm square. 16. The electrode according to claim 15, having a length of more than 2.0 cm along the longitudinal axis.