JPS63229065A - Tracheal tube with cuff for applying internal pressure to trachea - 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 [Field of Industrial Application] The present invention relates to endotracheal tubes and tracheostomy tubes (hereinafter collectively referred to as tracheal tubes) for medical or veterinary use. More specifically, the present invention relates to a cuffed tracheal tube that is inserted into the trachea through the oral cavity, nasal cavity, or tracheostomy, and is used for artificial respiration by connecting an artificial respirator and the lungs.

[Prior Art] The cuff of a cuffed endotracheal tube inserted into a person's trachea and used for ventilation is used to prevent vomit from entering the trachea from the esophagus, etc., and to connect the tube. The space between the inner wall of the trachea and the endotracheal tube is kept airtight to ensure sufficient ventilation when performing intermittent positive pressure breathing, etc., while also preventing gas leakage from the gap with the tracheal wall. However, when a conventional cuffed endotracheal tube is connected to a ventilator and the patient's breathing is controlled, the ventilator will release the air when the patient's lung compliance decreases. Since it is necessary to increase the gas pressure for inhalation several times higher than the normal internal cuff pressure, the cuffed gas pressure must be lightly adhered to the inner wall of the trachea to maintain airtightness at the desired pressure. The cuff of the endotube becomes deformed due to the pressure difference between the lung side and the laryngopharyngeal side of the airway, and becomes displaced every time positive pressure ventilation is performed. Eventually, the airtightness between the cuff and the inner wall of the trachea is compromised, and air cannot be delivered. Gas leakage may result in insufficient ventilation or movement of the endotracheal tube, leading to serious consequences.

One way to prevent this is to raise the internal pressure of the cuff in advance to a level much higher than the required maximum airway pressure. This sometimes compresses the capillaries on the inner wall of the trachea, obstructing blood flow, leaving functional impairment in mucosal cells in contact with the cuff, and sometimes leading to necrosis.

In order to solve this problem, if it is possible to increase the cuff pressure when necessary, that is, when the intrapulmonary pressure increases, and reduce the cuff pressure to the necessary minimum when the intrapulmonary pressure decreases, it is possible to increase the cuff pressure. Even if the inner wall of the trachea is temporarily compressed and the blood flow in the capillaries is obstructed, the cuff pressure decreases due to the pattern of decrease in intrapulmonary pressure during the expiratory phase, and the blood flow in the capillaries on the inner wall of the trachea also decreases. After thinking that this could be improved and prevent damage to the inner wall of the trachea, we developed the cuff roller (trade name, manufactured by Respironics, USA), which is used by connecting to a cuffed endotracheal tube, and the breathing pressure superimposition type. Inventions such as a cuff pressure adjustment device (Japanese Patent Application No. 81-029098) have been made.

Here, the cuff roller is a small case (2'D) having a connection port (toward) as shown in Fig. 2.
The air sac pressed by a spring is airtightly placed inside the sac, and the air sac has a gas inlet Q4 equipped with a check valve.
A connecting port is formed to connect with the cuff (C) of the endotracheal tube (T). This connection port and cuff (C)
When gas is injected from the gas inlet Q4 during use, the air sac communicating with the cuff (C) also expands, pushing the spring (5), but the pushing force of this spring is made to have a force corresponding to the desired pressure of the cuff (C), so the pushing force of the spring n at the desired cuff pressure is within the operating stroke of the spring n. On the other hand, by communicating the connection port of the small case (2°C) with the airway of the endotracheal tube (T), pressure changes in the airway are transmitted to the air sac, so the desired airway pressure is added to the cuff pressure.However, this method
The problem is that the price increases due to the installation of expensive devices that are disposable.

In addition, the respiratory pressure superimposition type cuff pressure adjustment device is a method that uses oxygen gas or compressed air from medical gas piping as a power source to add airway internal pressure to the cuff pressure. Since it uses , it could not be used in places where there is no pressure gas.

[Problems to be Solved by the Invention] The present invention has been made in view of the above-mentioned problems, and has a simple mechanism, excellent safety, and a reliable method for synchronizing the cuff of a cuffed tracheal tube with intrapulmonary pressure. The purpose of the present invention is to provide an economical cuffed tracheal tube that constantly maintains the cuff pressure level at or above the minimum level of cuff adjustment while ascending and descending, and that causes less deformation and displacement of the cuff. do.

[Means for Solving the Problems] In order to solve the above-mentioned problems, the present invention provides a cuffed endotracheal tube or a tracheostomy tube in which the inside and outside walls of the tracheal insertion tube are connected near the distal end of the tube. A plurality of communicating vent holes are provided, and approximately cylindrical or pear-shaped thin membranes are arranged in double layers, inside and outside separately, so as to surround the outer circumferential portion of the tube including the ventilation holes, and the double Both ends of each membrane are airtightly attached to the outer periphery of the tube to form an inner and outer double cuff, and the air chamber formed between the membranes of the double cuff is filled with gas. A cuff inflation tube is provided to freely inflate and deflate the outer cuff by injecting and discharging the cuff.

[Operation of the Invention] Since the cuffed tracheal tube of the present invention is constructed as described above, to explain using FIG. The located outer cuff (hereinafter referred to as the tracheal sealing cuff) (5) inflates when gas is injected from the cuff inflation tube (6) and tightly adheres to the inner wall of the trachea ('7), sealing the trachea and trachea. It has the function of sealing between it and the tube (1). The cuff on one side (hereinafter referred to as the cuff for adding intratracheal pressure) (4) causes the gas pressure in the airway gas passage (2) to rise, causing the air chamber (9) to
When the pressure in the airway exceeds the airway pressure, the gas in the airway gas passage (2) flows in through the airway pressure inlet (3), and the airway pressure that separates this airway gas from the gas in the air chamber (9) increases. Push the additional cuffs (4) until their respective pressures are balanced. Therefore, the tracheal sealing cuff (5) presses the inner wall of the trachea of the patient, etc., at a pressure corresponding to the airway pressure at that time, through the gas in the cuff, so the cuff succumbs to the increased intratracheal pressure. It is unlikely that the position will shift.In this case, the airway pressure is transmitted through the gas, so the tracheal sealing cuff (5) is pushed evenly from the inside, so there is almost no distortion, and the cuff The position of (5) is less likely to shift.

[Example] Next, an example of the present invention will be described based on the drawings.

FIG. 1 is a diagram showing a tracheal tube according to a preferred embodiment of the present invention.

The tracheal tube of the present invention is a cuffed tracheal tube that is inserted into the trachea of a patient etc. for the purpose of respiratory management, and a preferred example thereof is an endotracheal tube (1) as shown in FIG. There is a gas passage in the airway (
An airway pressure introduction port (3) that opens to the outside from the airway pressure introduction port (3) is provided, and a cuff (4) for adding airway pressure is attached to the outer periphery of the endotracheal tube (1) in which the airway pressure introduction port (3) is provided. The cuff (4) for applying pressure within the airway is further airtightly wrapped from the outside by a cuff (5) for sealing the trachea. Then, gas is injected into and discharged from the cuff (5) for tracheal sealing through a cuff inflation tube connection passage (8) formed on the wall of the endotracheal tube (1). A cuff inflation tube (6) that inflates and deflates the cuff (5) is connected and communicates with the air chamber (9) formed between the two cuffs (4) and (5). There is.

The endotracheal tube (1) is made of a flexible resin such as soft vinyl chloride resin, silicone rubber, polyurethane, etc., and has appropriate flexibility and elasticity. The endotracheal tube (1) has an airway gas passageway (2) with a large inner diameter that is open at both ends, and a gas passageway (2) that is closed at the distal end (patient side) and opened at an appropriate part on the proximal end (operator side). A cuff inflation tube connection passage (8) with a small inner diameter is formed, and the tip of the endotracheal tube (1) is beveled to facilitate insertion into the trachea. In the vicinity of the cuff (4) for adding airway pressure, there is one or more small airway pressure introduction ports (
3) is drilled.

Cuff for adding airway pressure (4) and cuff for tracheal sealing (5)
The endotracheal tube (
1) is arranged and formed on the outer periphery of. The inner airway pressure adding cuff (4) communicates with the airway gas passage (2) via the airway pressure introduction port (3), and inflates when the airway pressure becomes greater than the pressure in the air chamber (9). - The tracheal sealing cuff (5) is inflated by injecting gas from the cuff inflation tube (6) in advance. It has the function of lightly compressing the inner wall of the trachea (7) to seal between the trachea and the endotracheal tube (1).

The cuff inflation tube (6) is made of a small diameter flexible resin such as soft vinyl chloride resin, silicone rubber, polyurethane, polyethylene, etc., and one end thereof is inserted through the opening of the cuff inflation tube connection passage (8). It is airtightly adhesively fixed to this cuff inflation tube connection passage (8). The other end of the cuff inflation tube (6) is connected to the gas supply means (
(not shown), and is formed in a shape that can be connected to the tip of a syringe, but is usually placed midway through the tube (6) to check the inflation state of the tracheal sealing cuff (5) from the outside. A pilot balloon OO is provided.

Next, an example of the use of the cuffed tracheal tube for applying airway pressure according to the present invention will be described.

After testing the airtightness of the tracheal sealing cuff (5) by injecting and discharging gas through the cuff inflation tube (6) as necessary, the airway internal pressure is An additional cuffed tracheal tube is inserted and placed at a desired position within the patient's trachea. Then, gas is injected using the cuff inflation tube (6) until the compression pressure of the tracheal sealing cuff (5) against the tracheal inner wall (7) reaches the desired pressure, and then the cuff inflation tube (6) is closed. and place the endotracheal tube (
Connect the proximal end of 1) and manage the patient's breathing with intermittent positive pressure ventilation. In this case, the breathing pattern that corresponds to the inspiratory phase in natural breathing corresponds to the action of mechanically pressurizing breathing gas and pushing it into the lungs in pressurized breathing. Therefore, at this time, as a matter of course, the intrapulmonary pressure and the gas pressure within the airway gas passage (2) of the endotracheal tube (1) that communicates with the intratracheal tube (1) increase.

The gas pressure in the airway gas passage (2) increases and the air chamber (9
), gas in the airway flows in from the airway pressure introduction port (3), and this airway gas and air chamber (9)
), push out the airway pressure adding cuff (4) that separates the gas in the airway until the pressures are balanced. In other words, the tracheal sealing cuff (5), through the gas inside the cuff,
The inner wall of the trachea (7) of the patient, etc. is compressed with a pressure corresponding to the airway pressure at that time. Moreover, since the tracheal sealing cuff (5) is concentrically configured to be pushed evenly from the inside in a symmetrical manner, the pressure difference between the lung side and the laryngopharyngeal side of the airway becomes large. The tracheal sealing cuff (5) is hardly distorted, and the position of the cuff (5) is less likely to shift.

In addition, when the gas pressure in the airway gas passage (2) becomes lower than the set pressure in the air chamber (9), the airway pressure addition cuff (4) is activated by the pressure in the air chamber (9). tube(
Although it is pressed against the outer periphery of airway pressure inlet (3)
Since the pore diameter of the cuff (4) is sufficiently small and there are multiple holes if necessary, the thin film of the cuff (4) for applying airway pressure does not penetrate into the intratracheal gas passage (2). Therefore, the movement of the airway pressure adding cuff (4) stops at this position, so the air chamber (9)
The pressure inside settles down to the desired pressure set initially. That is, even if the pressure in the airway gas passage (2) drops below the pressure in the air chamber (9), the compressive force of the trachea sealing cuff (5) against the trachea inner wall (7) maintains the desired set pressure. Therefore, sufficient airtightness can be maintained.

Therefore, the compressive pressure on the tracheal wall orifice of the patient, etc.
When the pressure in the airway gas passage (2) is low, the pressure becomes the initial setting pressure of the tracheal sealing cuff (5), and the pressure in the airway gas passage (2) becomes lower than the initial setting pressure of the trachea sealing cuff (5). When the airway pressure increases, the airway pressure at that point becomes the same, so in synchronization with positive pressure breathing, the range from the initial set pressure of the tracheal sealing cuff (5) to the pressure corresponding to the airway pressure at that point. The compression action will be repeated variably.

However, it is desirable to create the cuffs (4) and (5) in a suitable shape so that the cuffs (4) and (5) are evenly inflated and require as little elasticity as possible to appropriately inflate the cuffs.

[Effects of the Invention] As is clear from the above explanation, the cuffed tracheal tube for applying airway pressure according to the present invention has the following advantages.

(1) Since the mechanism is simple, there are few constituent members, and it is economical because it does not require a special power source.

(2) In conventional cuffs, low-pressure, large-capacity cuffs are preferred because they apply soft pressure to the inner wall of the trachea, but the measured airway pressure pushes the cuff membrane away from the measurement within the trachea, deforming the cuff and increasing the cuff inner pressure. Because the cuff is distorted and pushed out of place each time you perform pressurized breathing, the cuff easily damages the ciliated mucosa on the inner wall of the trachea, and the endotracheal tube also moves easily, and the breathing circuit is connected to the endotracheal tube. However, by using the endotracheal tube of the present invention, such accidents can be largely prevented. .

[Brief explanation of drawings]

FIG. 1 is an explanatory diagram showing an embodiment of the present invention, and FIG. 2 is an explanatory diagram of a conventional example. (Main symbols in the drawing) (1): Endotracheal tube (2): Airway gas passage (3): Airway pressure introduction port (4): Airway pressure addition cuff (5): Tracheal sealing cuff (6): Cuff inflation tube (8) Two cuff inflation tube connection passage (9): Air chamber Patent applicant Ni-Sosho Co., Ltd. A77 Figure n Figure 22

Claims (1)

[Claims] 1. A tracheal insertion tube is provided with one or more ventilation ports communicating between the inside and outside of the wall of the tube near the distal end thereof, and has a substantially cylindrical or pear-shaped shape surrounding the outer periphery of the tube including the ventilation port. A flexible thin membrane is arranged in double layers with the inner and outer parts separated, and both ends of each of the double membranes are airtightly attached to the outer periphery of the tube to form a dual inner and outer cuff. An airway characterized by being connected to a cuff inflation tube that inflates and deflates the outer cuff as desired by injecting and discharging gas into the air chamber formed between the membranes of the heavy cuff. Tracheal tube with cuff for applying internal pressure.