JPH08322937A - Air way for cavity of pharynx - Google Patents

Abstract

PURPOSE: To obtain an airway for the pharynx that can be easily inserted from the mouth into the lower pharynx without necessity to insert it into the trachea, can air-seal the connection part of the lower pharynx to the esophagus and surroundings of the pharynx, and through which a pressured artificial respiration can be conducted while making protection of an air passage. CONSTITUTION: The airway is composed of an airway tube 1 having an air pass opening 2 in a side surface in front part and its top end is closed as obtuse circular shaped, and a swelled balloon 3 that is jointed to the surrounding of the air pass opening 2 and jointed to the periphery of the front and rear surroundings and surrounds the outer periphery of the top part of the tube 1 for pharynx. And a thin hole 4, that works as the air passage, is arranged in the side wall of the tube 1, and its top end is open in the balloon 3, and a thin hole 5 equipped with a plug or a valve 6 and a connector 7 is jointed with the rear end of the thin hole 4.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an airway for a pharyngeal cavity used to secure an airway necessary for breathing by an unconscious patient. More specifically, without using an endotracheal tube, the airway of a patient who is under general anesthesia or in a coma is secured, and it is easy to inhale or exhale air or oxygen or anesthetic gas from the patient's larynx to the trachea and lungs. )
The present invention relates to an airway for a pharyngeal cavity, which is effective as a device for securing a medical airway for ensuring that the airway is maintained from the oral cavity to the pharyngeal cavity, and intermittent intermittent artificial respiration can be performed through it.

[0002]

2. Description of the Related Art Conventionally, as a medical device for anesthesia, emergency resuscitation, or management of an airway for severe patient management, a tracheal tube, oropharyngeal airway (oropharyngeal airway) has been used.
aryngeal airway), nasopharyngeal airway
airway), closed esophageal airway (EOA), laryngeal mask (LM), etc.

If an endotracheal tube is orally or nasally inserted into the trachea of a patient and is used by connecting it to an anesthesia machine, a respirator or a resuscitator, the airway is surely secured and intratracheal suction is also possible. It has been most widely used because it is easy to perform as needed, reflux products from the stomach and esophagus are also isolated from the respiratory tract, and pressurized artificial respiration can be performed without problems if necessary.

[0004] However, if an endotracheal tube is to be surely operated in an emergency for the purpose of emergency lifesaving, the operation of endotracheal intubation accompanied by direct larynx deployment causes serious arrhythmia and nerve reflex such as reflux of stomach contents. It is a medical procedure that is likely to cause various side effects, is highly dangerous, and has a high degree of invasiveness, and it is difficult for a doctor who is familiar with this operation to actually perform it.In addition, it has a strong reflex effect on the pharynx and delicate endotracheal villi. By stimulating the epithelium with an endotracheal tube and its cuff, side effects such as foreign body sensation, hoarseness, difficulty in sputum, etc. are caused later.
Furthermore, the high risk of causing serious complications such as glottic edema and tracheitis is a major problem, and it is better to avoid inserting foreign substances into the larynx and trachea to secure the airway. That is the medical trend in recent years.

On the other hand, the oropharyngeal airway and the nasal airway have been widely used for many years, but the tip of the relatively short airway that is simply inserted into the oropharynx mechanically supports the base of the tongue and prevents its airway obstruction by its subsidence. However, it often fails to support the mucous membrane structure that touches the peripheral edge of the distal end of the mucous membrane. In addition, it is a big problem that it is required to hold the face mask airtightly by hand when artificial respiration is not prevented because it cannot prevent backflow from the esophagus to the trachea. Generally limited. However, it is an important advantage that not only doctors who are familiar with handling endotracheal tubes but also nurses and paramedics can widely use them.

Further, it is not necessary to perform larynx deployment like in endotracheal intubation, and it is inserted blindly and quickly into the esophagus, and a balloon attached near the distal end of the tube is inflated in the esophagus to adhere to the esophageal wall. In addition, the lower end of the esophagus is occluded by the tip of the tube that is the blind end to prevent backflow of the stomach contents and ensure airtightness, and once gas is discharged from the side hole of the tube into the upper esophagus, the pharynx・ Esophageal closed airway (EOA) that pushes into the trachea for artificial respiration
However, it is imported from the United States and widely used for paramedics.

However, since the airtightness cannot be maintained unless the face mask is held in close contact with the patient's face by hand at the same time as artificial respiration, pressurized artificial respiration cannot be performed sufficiently in an ambulance running. However, since it uses a face mask, it is not suitable for surgery, anesthesia, intensive care, and is mainly limited to short-term use for emergency resuscitation by a paramedic for dying patients.

[0008] Furthermore, Archibald, a doctor in London, England
Invented by IJ Brain (UK Patent No. 2,111,39
No. 4), a laryngeal mask (LM), which is used by putting a rubber cushion (mask) on the tip of a large-diameter arcuate tube and covering it over the larynx mouth, has recently been introduced in Japan to provide anesthesia. It is used for emergency and resuscitation. in Japan,
1983 Laryngeal of the Brain in Br.J.Aneasth.
It has become popular clinically since it was made known by the paper titled mask and the introduction of Amaha et al. in the academic journal "Anesthesia" in 1989. However, the liquid accumulated in the mask area is sucked out of the body by a siphon method. The invention in which the invention is added is disclosed in JP-A-2-283378 (1990).
However, it has not been marketed in this form yet.

When a larynx mask (LM) is used, if a foreign object is not inserted into the trachea and it is inserted correctly,
It is convenient for general anesthesia under spontaneous breathing except when prone breathing management is particularly difficult, and it can be used safely without postoperative complications, and is attracting attention all over the world. However, it is not always easy to determine the correct use position and settle it there when inserted without spontaneous breathing. The pressure that presses the cushion (mask) toward the pharyngeal mouth in the pharyngeal cavity is not so easy. Since there is not enough gas, when performing artificial respiration, gas leaks around the cushion when the airway pressure exceeds a certain level (about 30 cmH ₂ O or more),
It is difficult to perform sufficient artificial ventilation and the degree of closure of the upper esophagus is inadequate, so that reflux of gastric contents and inflow into the trachea (accidental swallowing) are unavoidable.

In Japan, not only doctors but also nurses and paramedics can use the laryngeal mask (LM). However, for emergency resuscitation, there is a limit to the pressurization of positive pressure artificial respiration, and the correct insertion depth and Sometimes it is difficult to determine the position and hold it.

[0011]

As described above, there are various conventional airways for the pharyngeal cavity as medical instruments for securing the airway, but there are advantages and disadvantages, and improvements are desired. Is the current situation.

The present invention has been made in view of the above-mentioned conventional circumstances, and it is not necessary to insert it into the trachea, it can be easily inserted from the oral cavity to the lower pharynx, and at the same time, the site of transition from the lower pharynx to the esophagus is blocked, and at the same time. An object of the present invention is to provide an easy-to-use airway for the pharyngeal cavity capable of performing artificial respiration by firmly sealing the entrance of the laryngeal mouth and securing the upper airway (airway) and performing strong artificial respiration.

[0013]

An airway for a pharyngeal cavity according to the invention of claim 1 is an airway having an arcuate curve and a blunt end closed, and a vent opening on the front side surface near the end. Tube and the front and rear of the ventilation opening and the outer peripheral surface of the airway tube around the periphery of the ventilation opening, and bulges greatly to surround the front and rear of the ventilation opening, from the lower pharynx to the esophagus A balloon made of a flexible thin film formed so as to seal the transition site and the periphery of the laryngeal opening, and is provided along the long axis of the airway tube, and the tip is a gas delivery path opened in the balloon and this gas. It is provided with a stopcock or valve provided at the rear end of the feeding path for controlling the injection or discharge of gas and a thin tube provided with a connector.

In the airway for the pharyngeal cavity according to the second aspect of the present invention, the balloon is deflated by negative pressure until there is no residual cavity, and under normal pressure the balloon in front of the ventilation opening is naturally bulged. In addition, the balloon at the rear of the ventilation opening is formed so as to keep a naturally contracted state.

In the airway for the pharyngeal cavity according to the third aspect of the present invention, the balloon contracts under negative pressure until the residual cavity disappears, the balloon naturally maintains a slightly bulged state under normal pressure, and greatly expands under positive pressure. It is formed of a flexible film made of a flexible material so that it closely adheres to the irregularities formed by the mucous membrane in the pharyngeal cavity and maintains airtightness.

In the airway for the pharyngeal cavity according to the invention of claim 4, the ventilation opening does not reduce the bending resistance of the airway tube while ensuring a sufficient ventilation area as a whole. It is formed by arranging a plurality of vertically elongated hole groups.

In a pharyngeal cavity airway according to a fifth aspect of the present invention, a tube existing along the major axis of the airway tube is opened at the tip of the tube, and a suction connector is attached to the rear end. It has a suction tube.

According to the sixth aspect of the airway for the pharyngeal cavity of the present invention, the obtuse rounded tip of the airway tube has an oblique shape extending rearward or rearward, and the tip of the tube is substantially straight. It is formed in a shape that eliminates the arcuate curvature.

[0019]

In the airway for the pharyngeal cavity according to the first aspect of the invention, when the tube for the airway is inserted into the lower larynx from the oral cavity, the arcuately curved and obtuse rounded end of the airway holds the sphincter or stenosis of the upper part of the esophagus. It stops, and the ventilation opening provided on the side surface near the tip thereof matches the larynx. In this state, the balloons joined to the outer peripheral surface of the airway tube at the front and rear of the ventilation opening and at the periphery of the ventilation opening are greatly expanded through a gas feeding path provided along the tube of the airway tube. By inflating and sealing the part that moves from the lower pharynx to the esophagus and the periphery of the larynx, it is safe and reliable, easy to use, and effective as an artificial respiration device used in an emergency.

In the airway for the pharyngeal cavity according to the second aspect of the present invention, the balloon is deflated under negative pressure until there is no residual cavity, and under normal pressure, the balloon keeps a shape that naturally expands from the ventilation opening. The shape of the balloon behind the ventilation opening keeps it in a naturally contracted state, which makes it easy to insert the airway tube into the pharyngeal cavity and allows the tip of the balloon, which naturally inflates with flat pressure, to be inserted. Since it can be attached to the sphincter or stenosis of the upper part of the esophagus, it can be reliably positioned at a predetermined position.

In the airway for the pharyngeal cavity according to the third aspect of the invention, the balloon contracts under negative pressure until there is no residual cavity, the balloon naturally keeps a slightly bulged state under normal pressure, and the balloon bulges greatly under positive pressure and becomes pharyngeal. The airway tube is easy to insert into the pharyngeal cavity because it is formed of a flexible material so that it adheres closely to the irregularities formed by the mucous membrane in the cavity and maintains airtightness. Since the slightly inflated distal end of the balloon can be caught by the sphincter or stenosis of the upper part of the esophagus, it can be reliably positioned at a predetermined position.

In the pharyngeal cavity airway according to the invention of claim 4, the ventilation opening is formed by an array of a plurality of vertically elongated hole groups arranged so as not to reduce the bending resistance of the airway tube. By doing so, the airway tube can be smoothly inserted into the oropharyngeal cavity, and the bending resistance of the airway tube can be secured while ensuring a sufficient total area for ventilation.

In the airway for the pharyngeal cavity according to the fifth aspect of the invention, the suction tube provided along the major axis of the airway tube is opened at the tip of the airway tube, and the suction connector is provided at the rear end. By providing the suction tube to which is attached, it is possible to suck and remove secretions such as gas and gastric juice that have regurgitated in the esophagus, and it is possible to reliably prevent the regurgitation from entering the respiratory tract.

In the airway for the pharyngeal cavity according to the sixth aspect of the invention, when the tip of the airway is inserted to the lower pharynx, the entire airway tube is curved in an arcuate shape toward the front. The blunt round tip has an obliquely cut shape that extends along the back or back, and since the tip of the tube is formed in a substantially straight line, without entering the anterior larynx, or It can be reliably introduced into the esophagus without being caught by the irregularities around it.

[0025]

Embodiment 1 An embodiment of the present invention will be described in detail below with reference to the accompanying drawings. 1 is a partially cutaway side view showing the structure of a pharyngeal cavity airway that is Embodiment 1 of the present invention, FIG. 2 is a side view during balloon inflation at atmospheric pressure, and FIG. 3 is a side view after balloon inflation. FIG. 4 is a diagram showing the relationship between the applied pressure and the internal pressure of the balloon when performing artificial respiration.

1 to 3, reference numeral 1 denotes a large-diameter airway tube curved in an arc shape.
Has a blunt round shape with its tip extending rearward or rearward and has a ventilation opening 2 on the front side surface near the tip. This ventilation opening 2 has a plurality of side holes 2a (for example, 9) formed inside the airway tube 1 in an arcuate shape so as to prevent the bending resistance of the airway tube 1 from decreasing. It is opened vertically in the direction, and its arrangement is also devised so as to be even so that some tube walls do not become weak.

The numeral 3 is joined to the front and rear of the ventilation opening 2 of the airway tube 1 and to the periphery of the ventilation opening 2, and is greatly expanded so as to surround the distal end of the airway tube 1 and the ventilation opening 2. The balloon is capable of air-tightly sealing the part that transitions from the lower larynx to the esophagus and around the larynx.

Reference numeral 4 is a thin tube as a gas supply tube provided along the tube wall of the airway tube 1 in the lengthwise direction. The thin tube 4 has an opening 8 in the balloon 3 and a rear end thereof. A connector 7 for connecting a cylinder or the like for controlling the supply of gas for inflating and deflating the balloon 3, a cock 6 for opening and closing a thin tube, and a pilot balloon for externally sensing the inflation pressure of the balloon 3. The thin tube 5 attached with 9 is connected.

The material of the airway tube, balloon, etc. constituting the airway for the pharyngeal cavity is not particularly limited as long as it is a material that is generally used in the manufacture of medical devices and has excellent safety and flexibility. It is preferable to use soft vinyl chloride resin or silicone rubber. Further, as shown in FIG. 2, it is easy to keep a part of the balloon 3 in a state where it is naturally bulged by a flat pressure and to make other parts deflate by adjusting the thickness and hardness thereof. Can be realized. However, other parts may naturally bulge at atmospheric pressure as well.

Next, the operation of the first embodiment will be described.
As shown in FIG. 2, when the airway tube is inserted from the oral cavity O into the lower pharynx P, when the tip of the airway tube 1 passes through the oropharyngeal cavity OP, the oropharyngeal cavity OP bends. Since it is pushed and narrowed by the tongue base Z etc., the balloon 3 at the tip is sucked airtightly and kept under this condition by negative pressure as shown in FIG. Put on the lubricant and let it pass.

The obtuse rounded tip that passes along the back side of the lower pharynx P without being caught by the anterior laryngeal opening AL
When the cock 6 near the rear end of the thin tube 5 for inflating the balloon is opened, the inside of the balloon 3 returns to the normal pressure, and the balloon portion 3a located in the front portion of the ventilation opening 2 moves to the position shown in FIG. As shown in FIG. 4, the swelling state is naturally inflated, so that it is possible to easily and surely proceed from the lower pharynx P on the rear side of the larynx mouth AL to the sphincter M on the upper part of the esophagus E.

When the balloon 3 is held in the sphincter M and gas is injected into the balloon 3 through the thin tube 5 and the pores 4, the balloon 3 is flexible and extends in the longitudinal direction, the lateral direction, and the backward direction, except for the ventilation opening 2. As shown in FIG. 3, the front part 3a of the balloon 3 softly seals the entire surface of the upper esophagus from the lower pharynx P, and the rear part 3b of the balloon 3 softly seals the periphery of the larynx ostium AL as shown in FIG. In addition to sealing the inner surface of the lower pharynx, the ventilation opening 2
The airway to the larynx L (airway) can be secured by communicating the airway with the larynx mouth AL.

Therefore, when a resuscitator (not shown) is connected to the connector 10 conforming to the international standard for performing artificial ventilation, and air or oxygen is intermittently pushed in, the lumen of the airway tube 1 is opened. The gas that has passed through is the opening 2 for ventilation of the tube 1.
, And is sent to the trachea T via the larynx L, and then when the pressurization is stopped, exhaled air flows in the opposite direction and is discharged.

The balloon 3 is a thin film made of a flexible and stretchable material so as to keep airtightness by closely adhering to the irregularities formed by the mucous membrane on the inner surface of the pharynx at a low gas pressure of about 30 cmH ₂ 0 under atmospheric pressure. It can be completely sealed without damaging the intimate mucous membrane, but when intermittent positive positive pressure artificial respiration is performed through the airway tube 1 by intermittently applying a gas pressure higher than that. As shown in FIG. 4, the gas pressure (positive pressure applied to the respiratory tract) is
Until the inner pressure of the balloon becomes equal to the inner pressure of the airway by acting on the outer surface of the balloon 3 which seals the periphery from the ventilation opening 2 which is in contact with and compressing the flexible balloon while partially distorting the balloon. The airtightness can be naturally maintained by intermittently raising it.

[0035]

[Embodiment 2] FIG. 5 is a side view showing the structure of an airway for a pharyngeal cavity according to Embodiment 2 of the present invention, and FIG. 6 is an AA line in FIG.
It is an expanded sectional view which follows a line. The large-diameter airway tube 21 curved in an arc shape has a blunt round closed end and a vertically elongated hole group 22a on the front side surface in the vicinity of the distal end, as in the first embodiment shown in FIG.
Has an opening 22 for ventilation.

At the tip of the airway tube 21, there is provided a balloon 23 which can be inflated so as to surround the peripheral edge of the ventilation opening 22 and the outer peripheral surface near the front and rear thereof. 5 and 6 show a state in which the balloon 23 is inflated.

The airway tube 21 is provided in the lengthwise direction along the wall of the tube, has a tip opening into the balloon 23, and a gas supply for inflating and deflating the balloon 23 at its rear end. A connector 27 for connecting a controlled syringe or the like and a thin tube 25 provided with a cock 26 with a pilot balloon 29 are connected. In addition, from the suction opening 32 at the tip of the airway tube 21 to the vicinity of the insertion portion of the connector 30, along the tube wall, the secretions such as gas and gastric juice that have refluxed in the esophagus can be sucked and discharged. A suction passage 31 is provided. The suction passage 31 has an inner diameter of about 3 to 5 mm and is preferably a circular or elliptical passage.

In use, the airway for the pharyngeal cavity of FIG. 5 is first inserted into the balloon 23 in a reduced state by applying a negative pressure,
The balloon 23 with its tip reaching the lower pharynx P and inflated naturally is stopped when it is lightly caught by the sphincter M of the upper part of the esophagus E, and immediately after confirming that the air flow passes through the airway 23 When the patient is inflated and the artificial respiration is performed, the rear part of the balloon 23 is opened to the larynx ostium AL.
The front part of the balloon 23 is pressed against the inner wall surface of the esophagus E from the lower pharynx P, thereby increasing the airtightness between the larynx ostium AL and the balloon 23, and when performing pressurized breathing. It becomes possible to seal so as not to lose the maximum pressure of the intake air.

Further, secretions such as gas and gastric juice accumulated in the stomach which has regurgitated in the esophagus can be positively sucked and removed through the suction passage 31, so that the strays of such gas into the respiratory tract are surely ensured. Can be prevented.

[0040]

As described above, according to the invention described in claim 1, when the tube for the airway is inserted from the oral cavity into the lower pharynx,
A balloon that curves in an arcuate shape and naturally inflates near the obtuse rounded tip catches and stops at the sphincter of the upper esophagus, and the vent opening near the tip matches the entrance to the laryngeal mouth . In this state, a balloon joined to the outer peripheral surface of the airway tube at the front and rear of the ventilation opening and the peripheral edge of the ventilation opening is greatly inflated through a gas feeding path provided along the airway tube, The airway for the pharyngeal cavity is safe, reliable, easy to use, and effective as an artificial respiration device for emergencies because it is configured to hermetically seal the site of transition from the lower pharynx to the esophagus and the entrance to the larynx. You can

According to the second aspect of the invention, the balloon is deflated under negative pressure until there is no residual cavity, and under normal pressure, the balloon portion in front of the ventilation opening keeps a shape that naturally bulges out. Since the balloon portion located rearward of the opening portion is configured to be naturally deflated, the airway tube can be easily inserted into the oropharyngeal cavity and can be reliably positioned at a predetermined position.

According to the third aspect of the invention, the balloon is deflated by the negative pressure until there is no residual cavity, the balloon naturally keeps a slightly bulged state under the normal pressure, and the balloon is largely bulged by the positive pressure and the inside of the pharyngeal cavity is increased. Since it is made of a flexible material such as a membrane that adheres closely to the irregularities formed by the mucous membrane and maintains airtightness, it is easy to insert the airway tube into the pharyngeal cavity and securely position it in place. It can be used with good airtightness.

According to the fourth aspect of the invention, the ventilation opening is formed by an even array of a plurality of vertically elongated hole groups so as not to deteriorate the bending resistance of the airway tube.
The airway tube can be smoothly inserted into the pharyngeal cavity and the bending resistance of the airway tube can be secured.

According to the fifth aspect of the present invention, a suction tube is provided which is provided along the long axis of the airway tube, opens at the tip of the airway tube, and has a suction connector attached to the rear end. Therefore, it is possible to suck and remove secretions such as gas and gastric juice that have refluxed in the esophagus, and it is possible to reliably prevent the refluxed substances from entering the respiratory tract.

According to the sixth aspect of the present invention, the obtuse rounded tip of the airway tube has a slanted shape extending rearward or rearward, and the tip portion is formed in a substantially linear shape. , Can be reliably introduced into the esophagus without entering the anterior larynx or being caught in the surrounding irregularities.

[Brief description of drawings]

FIG. 1 is a partially cutaway side view showing a pharyngeal cavity airway according to a first embodiment of the present invention.

FIG. 2 is a side view showing the structure of the airway for a pharyngeal cavity of Example 1 during balloon inflation.

FIG. 3 is a side view showing the structure of the airway for a pharyngeal cavity of Example 1 after balloon inflation.

FIG. 4 is a diagram showing a relationship between a pressurizing force (airway pressure) and an internal pressure of a balloon when performing intermittent press-fit breathing using the airway for a pharyngeal cavity of the first embodiment.

FIG. 5 is a side view showing the structure of a pharyngeal cavity airway according to a second embodiment of the present invention.

6 is an enlarged sectional view taken along the line AA of FIG.

[Explanation of symbols]

1, 21 Airway tube 2 , 22 Airway opening 3, 23 Balloon 4, 24 Pore 5, 25 Fine tube 6, 26 Stopcock or valve 7, 27 Connector 8, 28 Opening 9, 29 Pilot balloon 31 Suction passage 32 Suction opening

Claims (6)

[Claims] 1. An airway tube having an arcuate shape, the tip of which is closed in a blunt round shape, and a ventilation opening on a side surface near the tip, and the front and rear of the ventilation opening and the peripheral edge of the ventilation opening. Of a flexible thin film that is joined to the outer peripheral surface of the airway tube and swells greatly so as to surround the front and rear of the ventilation opening, and seals around the site of transition from the lower pharynx to the esophagus and the laryngeal opening. And a gas supply path provided along the long axis of the airway tube, the tip of which is opened in the balloon, and a stopcock that is provided at the rear end of the gas supply path to control the injection or discharge of gas or An airway for a pharyngeal cavity, comprising a valve and a thin tube provided with a connector. 2. The balloon is deflated by negative pressure until there is no residual cavity, and under normal pressure, the balloon in the front part of the ventilation opening keeps a shape that is naturally bulged, and the balloon in the back part of the ventilation opening is The airway for a pharyngeal cavity according to claim 1, wherein the airway is formed so as to naturally contract. 3. The balloon is deflated by negative pressure until there is no residual cavity, the balloon naturally maintains a slightly bulged state under normal pressure, and greatly bulged by positive pressure along the irregularities formed by the mucous membrane in the pharyngeal cavity. The airway for the pharyngeal cavity according to claim 1, wherein the airway is formed of a thin film made of a flexible material so as to be in close contact and maintain airtightness. 4. The pharyngeal cavity according to claim 1, wherein the ventilation opening is formed by arranging a plurality of vertically elongated hole groups so as not to reduce the bending resistance of the airway tube. For airway. 5. A suction tube having a suction tube attached to the airway tube, the suction tube having a suction connector attached to the distal end of the airway tube. Item 1. An airway for a pharyngeal cavity according to item 1. 6. The blunt round tip of the airway tube has an oblique shape extending rearward or rearward, and the tip has a substantially linear shape. Airway for the pharyngeal cavity.