JPS61179160A - Tracheal tube assembly and its production - Google Patents

Abstract

(57) [Summary] This bulletin contains application data before electronic filing, so abstract data is not recorded.

Description

DETAILED DESCRIPTION OF THE INVENTION [Industrial Application Field] The present invention comprises a device-side end portion that can be connected to a gas supply device, a patient-side end portion that opens into the trachea, and an inflatable gas supply device. The present invention relates to a bronchial tube assembly of the type comprising a bronchial tube with a removable cuff and a method for manufacturing the same.

In particular, the present invention relates to an endobronchial tube for use in pulmonary anesthesia of a patient and a method for making the same.

[Conventional technology]

Various tube assemblies have been proposed for pulmonary anesthesia procedures. In one device proposed by Gale and Waters in 1931, a tube with a single cuff was inserted into the right bronchus, and the cuff was inflated just above the keel. , causing the right bronchus to close.

However, this cuff has the problem that it also closes the left trachea and prevents the left lung from collapsing.

If the tube is inserted further into the trachea, there is a risk that the cuff will block the upper lobe of the right trachea.

In 1936, Magill proposed a tube assembly with a one-separation blocker.

The tube is positioned so that it passes over the keel and is sealed to the trachea by a cuff.

The blocker is in the form of a thin tube with an inflatable cuff that is inserted into the left trachea through the main tube. A cuff closes off the left trachea from the right trachea, while allowing the lumen to separately insufflate the left lung via a thin tube.

This device has the problem that the blocker cannot be used if the left trachea is obstructed.

Another endobronchial tube assembly is
(Green) and Gordon (
It was proposed in January 1957 by Anesthesia Law, Vol. 12 (NLI).

The assembly consists of a tube with two cuffs, with the patient end of the tube positioned just below the upper lobe of the right trachea. One standard cuff seals the trachea above the keel, while the other cuff soles the right trachea near the upper lobe to seal the left and right trachea. . The device-side end of the latter cuff has a circular cross section, and the remainder of its length has a semicircular cross section. A circular section is placed over the upper lobe to seal the right trachea, while the semicircular part of the cuff contacts only the semicircular part of the bronchial wall opposite the upper lobe.

According to this device, a semicircular portion at the patient end of the cuff moves the tip of the tube to the side of the trachea opposite the cuff. Therefore, the tip of the tube comes into contact with the trachea,
The gases that cause abrasion and are generated cause local drying of the bronchial walls. As the tip of the tube is forced into one side of the bronchus, a small gas passage is created between the end of the tube and the upper lobe. If ventilation of the upper leaflet is to be ensured, it is necessary to provide a separate transverse hole in the tube wall near the upper leaflet.

[Object of the present invention]

SUMMARY OF THE INVENTION It is an object of the present invention to provide an improved bronchial tube assembly and a method for manufacturing this assembly to solve the above-mentioned problems.

[Means for solving problems]

According to the invention, the patient end of the tube opens into the bronchus below the upper lobe, and the inflatable cuff has a generally circular cross-section and, when inflated, opens into the bronchus above the upper lobe. The cuff also surrounds the tube near the upper lobe so as to occlude the bronchus.

The patient end of the cuff has a channel-shaped recess extending along the length of the cuff such that the recess forms a gas path between the patient end of the tube and the upper lobe. An endobronchial tube assembly is provided.

The shape of the cuff and the recess is such that the cuff is held in the center of the bronchus and on the wall of the gas supply tube to the upper lobe.
Eliminates the need for horizontal holes.

The cuff is preferably tapered toward the patient end so that it is generally pear-shaped.

The recess has a generally rectangular cross section.

and extends along approximately two-thirds of the length of the cuff. The width of the recess is less than the diameter of the tube or about half the diameter of the tube.

The bronchial assembly includes an inflation lumen extending along the tube through the wall and opening into the interior of the cuff.

The only gas supply path to the upper lobe may consist of an opening and a recess in the patient end. That recess is.

A longitudinal strip may be formed by gluing along the cuff of the tube.

The assembly includes a tracheal tube extending along the bronchial tube, the tracheal tube communicating with the patient end above the cuff of the bronchial tube, and having a second inflatable cuff.

In order to seal the trachea when inflated and to allow the gas supplied to the tracheal tube to flow to another trachea,
Surrounds the bronchial and tracheal side tubes.

Furthermore, according to the invention, a bronchial tube having a device end suitable for connection of a gas supply, a patient end leading to the bronchus, an inflatable cuff, and an inflation lumen leading to the cuff on the outer surface of the tube. A method of manufacturing a bronchial tube assembly comprising a tube above an opening of an inflation lumen.

placing a flexible sleeve of generally circular cross section over the tube and forming an inflatable cuff over the tube;
The step of applying the sleeve to the outer periphery of the tube at both ends, and applying the sleeve to the wall of the tube to form a groove-shaped recess between the patient-side end of the tube and the upper leaflet to allow gas to flow. gluing a longitudinal strip of the sleeve extending from the patient end along its length.

〔Example〕

DESCRIPTION OF THE PREFERRED EMBODIMENTS Preferred embodiments of a two-tube endobronchial tube assembly and a method for manufacturing the same according to the present invention will be described below with reference to the accompanying drawings.

As shown in FIGS. 1 to 4, this two-piece endobronchial tube assembly includes a bronchial tube (1) and a tracheal tube (10) joined in parallel to each other.

Both tubes +1) and α[ are made of flexible plastic material such as PVC, and have an inner diameter of 7 mm and an outer diameter of 85 mm.
It's a struggle. The length of the bronchial tube (1) is 430fi
It is. The length of the tracheal tube 0ω is rather short,
3701+Im and bronchial tube (1)
It opens above 608 from the patient side end 02 of. These dimensions vary depending on the size of the patient and for children.

Under normal conditions, the bronchial tube (1).

Patient side end (approximately 70 mm from I■ to device side end αD)
It extends straight from the tracheal tube 01, then bends at an angle of about 20 degrees and leaves the tracheal tube 01. The patient-side end 0'2 of the bronchial tube (1) is inclined and smoothly rounded to prevent damage. On the other hand, a coupling (4) for connecting to an anesthetic gas source or a ventilator is provided at the device side end αD in the usual manner.
It is widely available.

There is a small diameter lumen C inside the bronchial tube (1).
υ are provided in the longitudinal direction. This lumen is
The bronchial tube (1) is closed at the patient side end (1) 1 and the device side end az, but opens to the inside of the bronchial cuff (2) through a hole Qυ cut in the tube.

One end of the expansion tube (3) is connected to the lumen ■ near the device side end of the tube, and the other end of the expansion tube is
It is equipped with a conventional coupling wire and an expansion indicator port.

A bronchial cuff (2) is provided near the patient end 021 of the bronchial tube (1). It tapers toward the patient end 0''2 so that it assumes a generally pear shape when inflated at low pressure.

The length of the cuff (2) is about 30 m, and the device side end having a maximum diameter of about 25 mm has a circular cross section as shown in FIG.

In particular, as shown in FIG. 4, the cuff (2) is provided with a groove-shaped recess Q4 having a rectangular cross section and extending longitudinally from the patient-side end over about 8 lengths of the cuff (2).

The recess I241 is defined by a generally flat or convexly curved bottom wall (c) consisting of a longitudinal strip partially glued to the tube (1), and by an inclined side wall (a) and an end wall (c). It's being carried away. The width of the recess C4 is the same as that of the tube (1
), preferably about half of that diameter.

The groove-shaped recess may have any shape as long as it has a side wall that slopes in the flow direction.

The patient end of the cuff serves to space the tube (1) away from the bronchial wall.

The tracheal tube αQ extends straight under normal conditions, and its patient-side end αJ is cut at a certain angle so that it separates from the bronchial tube. , smoothly rounded.

A tracheal cuff (41) surrounds both tubes (1) (10) immediately after the patient-side end (32) of the tracheal tube αα.

A small diameter lumen 0υ extends longitudinally along the inner surface of the tracheal tube θ. The lumen (4υ) is closed at the patient and device ends of the tracheal tube, but opens to the inside of the tracheal cuff (4) through a hole +43 cut in the tube.

One end of the expansion tube (43) is connected to the lumen 0υ near the device side end of the tube, and the other end is provided with a conventional coupling 441 and an expansion indicator (c).

Tracheal Cuff 3Q is a normal low pressure cuff that when inflated,
The dimensions are such that it can seal against the surface of the patient's trachea. Near both ends of this cuff (connected to the 4G assembly), fill the gap between the tracheal tube α [and the bronchial tube (1)] with plastic cement.
It is formed into a smooth convex surface.

A method of using the endobronchial tube assembly will now be described with reference to FIG.

Deflate both cuffs (21 (41 m) and insert the bronchial tube (
Insert the assembly through the patient's mouth (not shown) and trachea (7) until the patient end az of 1) enters the right bronchus OD and extend it just below the upper lobe (32). ,
The patient side end OJ of the tracheal tube α is positioned in the trachea (7) directly above the carina. A stylet may be used to straighten the tracheal tube during insertion.

When inserted correctly, the bronchial cuff (2)
2 and extends vertically along the trachea θl). Radiopaque markers are applied to the assembly for precise positioning.

When a predetermined amount of gas is pumped through the expansion tubes (3) and (43) and lumens (2) and (00).

Cuffs (2) and (41) are inflated. In this way,
The device-side end of the bronchial cuff (2) seals the right tracheal orifice η in a region directly above the upper lobe portion c32, and
2) Extends downward.

A recess 04) is located inside the curved part of the tube (1),
In addition, since the recessed portion (24) is adjacent to the upper lobe portion G2, the bronchial cuff (2) is stretched. The trachea cuff (41) seals the trachea ω at the upper part of the keel □□□.

Ventilation is performed by directing gas to the device end of the tubes (1+ and OQ) in the usual manner.

The gas f' is supplied to the tracheal tube a.

It exits into the trachea from the patient end Q31.

The gas passage from the tracheal tube to the right bronchus C31 is closed by the bronchial cuff (2), so all the gas supplied to the tracheal tube (lG) flows to the left bronchus. The gas supplied to (1) is

flowing from its patient end (12) into the right bronchus +31);
It flows freely into the upper lobe via the recess (24).

Therefore, the shape of the bronchial cuff (2) is effective for sealing the right bronchus Cl1) without the risk of sealing the right bronchus. Furthermore, the recess c24 ventilates the upper leaflet G3 without making additional holes in the tube wall. Due to the shape of the cuff (2), the patient end O3 of the tube (1) is held in the center of the bronchus C31), so that the risk of damage to the bronchus is small.

In Figure 6, the cuff (2) on the bronchial tube (1) is shown.
), place a pear-shaped flexible plastic sleeve mark on the tube (1) so that it overlaps with the lumen expansion hole Qυ, and glue both ends to the sleeve by solvent or heat welding. made by doing.

The groove-shaped recess Q4 has a sleeve 6C on the outside of the tube (1).
The strip is formed by gluing longitudinal strips 50 of the strip. By this means, the bottom wall G of the recess is formed, and the adjacent parts of the sleeve form the side walls (A) and the bottom wall of the recess. Strip 6υ is applied with solvent or adhesive to the outside of the tube or the inside of the sleeve.

Or it can be glued to the tube by heat welding.

The recess (2 sides) can be formed by a pre-shaped sleeve, but according to the method described above, a conventionally shaped sleeve can be used.

Moreover, there is no need to make a specially shaped cuff by molding it.

Bronchial cuffs do not necessarily have to be pear-shaped.
For example, it may be cylindrical or spherical. Bronchial cuffs can also be used with other bronchial tubes that have only one lumen.

[Brief explanation of the drawing]

FIG. 1 is a perspective view of the tube assembly of the present invention. FIG. 2 is a side view of the patient end of the tube assembly. 3 and 4 are cross-sectional views taken along lines 1 and 2 in FIG. 2, respectively. FIG. 5 shows the assembly in use. FIG. 6 shows the patient end at a preliminary stage during manufacturing. (1) Bronchial tube (2) Cuff (31 (43) inflation tube (4) Coupling αυ
Tracheal tube αυ Device side end αN31 Patient side end ■Lumen (21) hole Inflation indicator of normal coupling C! (a) Groove-shaped recess ■ Convex bottom wall
(B) Slanted side wall (3) End wall (To) Trachea 01) Right bronchus Upper lobe (To) Keel (B) Left bronchus (4Q tracheal cuff (4D lumen (4Z hole)
Gloss sleeve 60 longitudinal strips

Claims (1)

[Scope of Claims] (1) A bronchial tube assembly having a bronchial tube having a device end adapted for connection to a gas supply device, a patient end leading to a bronchus, and an inflatable cuff. The patient-side end of the tube (1) communicates with the bronchus (31) below the upper lobe (32), and the inflatable cuff (2) has a generally circular cross section and when inflated. , upper lobe (32)
A cuff (2) surrounds the tube (1) in the region of the upper lobe (32) in order to seal the bronchus (31) above, and a cuff (2) is attached to the patient end (12) of the tube.
and an upper lobe (32), the bronchial tube assembly having a channel-shaped recess (24) extending from the patient end of the cuff in the longitudinal direction of the cuff to allow gas flow. . (2) The bronchial tube assembly according to claim (1), wherein the patient side end of the cuff (2) is tapered so as to have a generally pear shape. . (3) A bronchial tube assembly according to claim 1 or 2, wherein the recess (24) has a generally rectangular cross section. (4) The bronchus according to any one of claims (1) to (3), wherein the recess (24) extends approximately two-thirds of the length of the cuff. tube assembly. (5) The bronchial tube assembly according to any one of claims (1) to (4), wherein the width of the recess (24) is smaller than the diameter of the tube (1). (6) Bronchial tube assembly according to claim (5), characterized in that the width of the recess (24) is approximately half the diameter of the tube (1). (7) It has an inflation lumen (20) oriented in the longitudinal direction of the tube (1) and communicating through the wall of the tube (1) to the inside of the cuff (2). The bronchial tube assembly according to any one of items ) to (6). (8) The only gas supply path to the upper lobe (32) is at the open patient-side end of the tube (1) and the recess (24)
Claim No. (1) characterized in that it leads to
The bronchial tube assembly according to any one of paragraphs to (7). (9) The recess (24) is formed by gluing a longitudinal strip (51) in the tube (1) along the cuff (2). The bronchial tube assembly according to any one of items (1) to (8). (10) The tracheal tube (10) extending along the bronchial tube (1) and the cuff (
2) When the tracheal tube (20) opening at the upper end on the patient side (13) and the second cuff (40) are inflated, the trachea is sealed and the tracheal tube is supplied to the tracheal tube. Claims characterized in that it comprises a second inflatable cuff (40) for the bronchus and surrounding the tracheal tube in the region of the trachea (30) for the flow of gas to the other trachea (34). The bronchial tube assembly according to any one of items (1) to (9). (31) a device end adapted for connection of a gas supply;
A method of manufacturing a bronchial tube assembly comprising a bronchial tube having a patient end communicating with a bronchus and an inflatable cuff and an inflation lumen on an outer surface of the tube communicating with the cuff, the method comprising: placing a flexible sleeve (50) of generally circular cross section over the tube (1) above the opening (21) of the lumen (20); and placing an inflatable cuff (2) over the tube (1). ), the sleeve (50) is brought into close contact with the outer periphery of the tube (1) at both ends thereof, and the gas is allowed to flow between the patient-side end (12) and the upper leaflet (32) of the tube. A sleeve (50) extending from the patient end (12) along the length of the sleeve in the wall of the tube (1) to form a groove-shaped recess (24) in the cuff (2) that allows
) gluing a longitudinal strip (51) of a bronchial tube assembly.