RU2411918C1 - Device for stopping nasal bleeding - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: claimed invention relates to otolaryngology and can be used for stopping nasal bleedings, as an alternative to standard nasal tamponade. Device consists of tampon in form of elastic chamber, whose shape corresponds to sagittal section of nasal cavity. Chamber has stiffening ribs on edges and is provided with respiratory tube with holes at the ends and tube for supplying chamber filler. The latter contains a valve, connected with source of chamber filler supply, as well as a pneumoballoon. Pneumoballoon ensures regulation of pressure in chamber. Respiratory tube passes through chamber along the edge intended for introduction along nasal cavity bottom and having the form of a 62-68 cm long straight line segment. Tube for chamber filler supply is located near the hole of respiratory tube in the region of the edge intended for introduction into upper parts of nasal cavity, and representing jogged line. Along first from the side of filler supply tube from 1/4 to 1/3 of the length, distance between chamber edges increases from 5 mm to 18 mm, along the following from 1/4 to 1/3 of length the distance increases from 18 mm to 26 mm. Along the following from 1/3 to 1/4 of length the distance between chamber edges decreases from 26 mm to 18 mm, and along the remaining part of length the distance decreases from 18 mm to 5 mm. As a result the invention ensures fast and reliable hemostasis in case of nasal bleeding of any localisation due to correspondence of tampon structure during its blowing to shape of nasal cavity, as well as possibility of nasal respiration during tamponade, reduction of complications risk.

EFFECT: optimisation of position of tube for chamber filler supply reduces discomfort for patient during introduction of the device into nasal cavity.

2 cl, 3 ex, 1 dwg

Description

The invention relates to medicine, namely to medical equipment, and can be used in otorhinolaryngology to stop nosebleeds, as an alternative to nasal tamponade.

Epistaxis is one of the most common problems causing patients to seek emergency medical care. According to various sources, up to 60% of the population have ever experienced a similar condition, most often these are people over 45 years old. In most cases, nosebleeds are a symptom of another common disease.

As a rule, a patient with nosebleeds needs immediate medical attention and stopping hemorrhage. From this point of view, the most popular is the classification depending on the source of bleeding, on the basis of which nosebleeds are divided into anterior and posterior.

Anterior bleeding most often comes from the Kisselbach-Little zone.

Posterior epistaxis is diagnosed if it is not possible to determine the source of bleeding during anterior rhinoscopy; if bleeding cannot be stopped with anterior tamponade; or the patient has pharyngoscopic swelling of blood along the posterior pharyngeal wall in the absence of detectable bleeding.

Determining the location of the bleeding source allows you to choose the most effective methods of stopping bleeding.

Arrangements for emergency stopping of nosebleeds begins with anterior gauze tamponade according to Mikulich, along with hemostatic therapy. If bleeding occurs only from the Kisselbach zone, the anterior part of the nasal cavity is plugged, but if from the depth, the nasal cavity, starting from the posterior sections, is filled in layers with a 1.0 cm wide gauze turunda soaked in an antibiotic solution or antibacterial ointment, 5% epsilon solution -aminocaproic acid.

In cases of mild bleeding from the anterior sections of the nose, a tamponade technique is proposed with foam rubber tampons in glove rubber, which are inserted along the bottom of the nasal cavity with bayonet forceps. If the front tamponade is ineffective, Bellock back tamponade is performed, which is always supplemented by a tight front tamponade. It is necessary to ensure that the installed back tampon is located behind the tongue of the soft palate, otherwise there is a risk of necrosis of the tongue of the soft palate from pressure on the tongue.

The optimal term for tamponade of the nasal cavity is considered to be from 4 to 6 days, exceeding these terms leads to the development of complications, for example, purulent sinusitis, otitis media. To reduce the risk of infection, the swabs in the nose should be periodically soaked with a solution of antibiotics. Be sure to carry out systemic antibiotic therapy with broad-spectrum drugs.

Patients endure tamponade of the nasal cavity, as it is accompanied by the impossibility of nasal breathing, a feeling of lack of air, severe headache and pain in the face.

It is known "Device for tamponade", which can be used to stop nosebleeds from the middle and posterior parts of the nasal cavity (RF patent ı2012367 C1, Scheglov V.A., Obrezchikov V.V., Staroverov G.A., 1991) .

This device contains an outer and inner tube, a tampon, an exhaust cord. Moreover, the swab is placed on the inner tube, and the inner tube is plugged at the ends of the bottoms. A catheter is inserted into the cavity of the inner tube. In this case, the exhaust cord is fastened to the bottom of the inner tube, and a piston is placed in the cavity of the inner tube with which the exhaust cord is connected. The device is inserted into the blocked cavity, pressure is applied to the catheter, due to which the swab is squeezed into the blocked cavity and fills it, thus stopping the bleeding. At the same time, the external tube and catheter are removed. Subsequently, the spent swab is removed by the exhaust cord.

The disadvantage of this device is that when using such a device to stop nosebleeds, nasal breathing is completely blocked. In addition, the shape of the tampon cannot ensure the filling of the entire nasal cavity, the relief of which is formed by the surface of the nasal concha and nasal passages, and, therefore, cannot provide a complete stop of bleeding, especially from the posterior and upper parts of the nasal cavity. The absorbent material of the tampon can become a favorable environment for the development of microorganisms, as well as contribute to the maceration of the nasal mucosa.

In addition, the mismatch of the shape of the tampon with the anatomical shape of the nasal cavity complicates its introduction into the nasal cavity, its use may be accompanied by severe pain.

It is also known "Device for tamponade", which can be used to stop bleeding from the middle and posterior parts of the nasal cavity (RU 2012368 C1, Scheglov V.A., Obrezchikov V.V., Staroverov G.A., 1994). This device contains an outer and inner tube, a tampon, an exhaust cord. New in the device is that the outer tube is made of an elastic material, for example, medical rubber. The cavity of the inner tube and the volume bounded by the outer tube and the outer contour of the inner tube are communicated by a line provided with a shut-off device, and the shut-off device is placed in the inner tube.

The device is inserted into the blocked cavity, pressure is applied to the piston, while the plugging material is squeezed into the outer tube and fills it, the latter is straightened, thus stopping the bleeding.

The disadvantage of this device is that when it is used to stop nosebleeds, nasal breathing is completely blocked, and the shape of the tampon cannot fill the entire nasal cavity, the relief of which is formed by the surface of the nasal concha, nasal passages, and therefore cannot completely stop the bleeding , especially from the back and upper sections.

For this reason, tampons of this design have not been widely used to stop nosebleeds.

As a prototype, a device was chosen to stop bleeding in the nasal cavity (RF, utility model certificate No. 2331, M. Sulamanidze, July 16, 1996).

This device contains an elastic streamlined chamber with a tube for feeding the filler and a breathing tube passed through the chamber. When introduced into the nasal cavity, the chamber is filled with filler introduced through the tube to fill the nasal cavity. This device provides the ability to breathe when the bleeding stops, for which purpose a breathing tube is provided in its design.

The disadvantage of this device is that it has not been developed the optimal form for the plugging chamber, providing compression of the mucosa of all parts of the nasal cavity, which has a complex relief due to the presence of nasal concha and elements of the ostiomeatal complex. When such a swab is inflated, the upper parts of the nasal cavity, supplied by the ethmoid arteries, remain free. In addition, due to the streamlined shape, when the tampon is inflated, it is pushed into the front sections, which have a larger volume, and this does not provide compression of the vessels of the mucous membrane of the posterior sections of the nasal cavity. Thus, this swab is not effective in stopping posterior nosebleeds from the wedge-palatine artery, as well as bleeding from the ethmoid arteries, which are usually the most severe in clinical practice.

In addition, the design of the known prototype device does not provide a mechanism for regulating the pressure in the filled chamber. With excessive swelling of the swab, maceration of the mucosa develops, leading to recurrent bleeding after the swab is removed, and the risk of developing inflammatory diseases of the paranasal sinuses due to impaired drainage through natural anastomoses with the nasal cavity is also increased.

Another disadvantage of the tampon is that its design does not provide for the optimal location of the tubes relative to each other, which facilitates the introduction of the tampon into the nasal cavity, which is traditionally a painful manipulation for the patient.

We set the task: to develop a simple, effectively plugging nasal cavity device for stopping nosebleeds.

The technical result achieved by the implementation of the invention is to ensure fast and reliable hemostasis in nosebleeds of any localization by ensuring that the design of the tampon when it is inflated forms the nasal cavity while reducing the risk of complications caused by maceration of the nasal mucosa and impaired natural drainage of the nasal cavity through natural anastomoses and manifested in the form of relapses of bleeding and inflammatory diseases of the paranasal sinuses, respectively While maintaining the nasal breathing, reduce the discomfort to the patient when administered to the nasal cavity of the device by optimizing the arrangement of the tube for supplying the chamber filler.

The invention consists in the following.

We proposed a device for stopping nosebleeds, containing a tampon made in the form of an elastic chamber, and a tube for supplying a filler chamber. The camera is equipped with a breathing tube with holes at the ends. Moreover, the breathing tube is passed through the chamber. The tube for supplying the filler chamber contains a valve connected to a source of supply of filler chamber. At the same time, the tube for supplying the filler of the chamber further comprises a pneumatic balloon, which provides pressure control in the chamber. The camera has a shape corresponding to the sagittal section of the nasal cavity, with stiffeners along the edges. The breathing tube is located along the edge of the chamber, intended for insertion along the bottom of the nasal cavity and having the form of a straight line segment. The tube for supplying the filler chamber is located at the opening of the breathing tube in the region of the edge, intended for insertion into the upper sections of the nasal cavity. The edge intended for introduction into the upper parts of the nasal cavity is a broken line. The length of the edge of the chamber, intended for insertion along the bottom of the nasal cavity, is 62-68 mm.

In the particular case, in order to give the camera a shape corresponding to the sagittal section of the nasal cavity, for the first from the side of the tube for feeding the filler from 1/4 to 1/3 of the length of the edge of the chamber intended for insertion along the bottom of the nasal cavity, the distance between the edges of the chamber increases from 5 mm to 18 mm. Over the next 1/4 to 1/3 of the length of the edge of the chamber, intended for insertion along the bottom of the nasal cavity, the distance between the edges of the chamber increases from 18 mm to 26 mm. Over the next 1/3 to 1/4 of the length of the edge of the chamber intended for insertion along the bottom of the nasal cavity, the distance between the edges of the chamber decreases from 26 mm to 18 mm, and over the remaining length of the length of the edge of the chamber intended for insertion along the bottom of the cavity nose, the distance between the edges of the camera decreases from 18 mm to 5 mm.

A device for stopping nosebleeds is illustrated by the following drawing.

The drawing shows a diagram of a device for stopping nosebleeds in a swollen state (sagittal section),

where 1 is an elastic chamber,

2 - breathing tube,

3 - tube for supplying filler,

4 - alarm pneumocylinder, providing pressure control in the chamber;

5 - valve connected to a source of supply of filler chamber.

A device for stopping nosebleeds includes an elastic chamber (1), which contains a breathing tube (2) with holes at the ends, passed through the chamber. Additionally, the device for stopping nosebleeds contains a tube for supplying the filler (3) of the chamber. The tube for supplying the filler (3) of the chamber contains a signal pneumocylinder (4), which provides pressure control in the chamber, and a valve (5) connected to the supply source of the filler of the chamber. The shape of the elastic chamber (1) corresponds to the anatomy of the nasal cavity due to the fact that the camera has a shape corresponding to the sagittal section of the nasal cavity, with stiffeners along the edges. In this case, the breathing tube (2) is located along the edge of the chamber, intended for insertion along the bottom of the nasal cavity, which has the form of a straight line segment. The tube for feeding the filler (3) of the chamber opens into the cavity of the chamber and is located at the opening of the breathing tube (2) in the region of the edge of the chamber (1), intended for insertion into the upper sections of the nasal cavity and having the appearance of a broken curve. The length of the edge of the chamber intended for insertion along the bottom of the nasal cavity is from 62 to 68 mm. In the particular case, for the first from the side of the filler tube (3) from 1/4 to 1/3 of the length, the distance between the edges of the chamber increases from 5 mm to 18 mm, for the next from 1/4 to 1/3 of the length between the edges of the camera increases from 18 mm to 26 mm, over the next 1/3 to 1/4 of the length, the distance between the edges of the camera decreases from 26 mm to 18 mm, and throughout the remaining length of the length, the distance between the edges of the camera decreases from 18 mm to 5 mm.

The width of the tampon (chamber) in the idle position is 5-6 mm. When bringing the device into working position by inflating, the width of the tampon section located along the straight edge of the chamber reaches 15 mm, and the width of the upper section of the tampon located along the edge of the chamber, which has a broken curve, up to 5 mm.

The device operates as follows.

Preliminary anemization and application anesthesia of the nasal cavity are performed, for example, with a solution of 10% lidocaine. Using a nose dilator and cranked tweezers for the entire length of the nasal cavity parallel to the bottom of the nasal cavity, an elastic chamber (1) of the device is introduced to stop nosebleeds in the patient's sitting or lying position. At the same time, the edge of the chamber through which the breathing tube (2) is passed is positioned along the bottom of the nasal cavity. Through the tube for supplying the filler (3), for example air, inflate the chamber, obturating the nasal cavity and squeezing the bleeding areas of the nasal mucosa. In this case, the camera acts as a tampon. The degree of inflation of the chamber is controlled using a pneumatic balloon (4), which provides pressure control in the chamber. The chamber is sealed with a valve (5). The patient breathes freely through the breathing tube (2), one end of which opens into the nasopharynx, and the other end out in the area of the vestibule of the nose. The filler tube (3) is located above the breathing tube (2), which ensures the absence of pain when the device is inserted into the nasal cavity.

The duration of the tamponade is 3-4 days, after which air is blown off with a disposable syringe attached to the valve device. After that, the device is removed with cranked forceps from the nasal cavity.

In the particular case, the following form of the elastic chamber can be provided to make it conform to the sagittal section of the nasal cavity. Over the first, from the side of the tube for supplying filler from 1/4 to 1/3 of the length, the distance between the edges of the chamber increases from 5 mm to 18 mm, over the next from 1/4 to 1/3 of the length, the distance between the edges of the chamber increases from 18 mm up to 26 mm, over the next 1/3 to 1/4 lengths, the distance between the edges of the chamber decreases from 26 mm to 18 mm, and over the remaining length of the length, the distance between the edges of the chamber decreases from 18 mm to 5 mm.

Thus, the tampon is brought into working position when inflating the elastic chamber, such as air. In the working position, the structural elements of the device installed for the purpose of tamponade fulfill the following functions.

The breathing tube (2) provides free breathing during tamponade due to the presence of 2 holes, one of which opens into the nasopharynx, and the other outward - in the vestibule of the nasal cavity.

The tube for feeding the filler (3) of the chamber (1), the diameter of which may be, for example, 3 mm, opens at one end into a hermetically sealed elastic chamber and provides air for inflating and compresses the bleeding portions of the nasal mucosa. At the same time, during the tamponade, the filler tube (3) is located above the breathing tube (2). Such a mutual arrangement of the tubes provides the convenience and ease of installation of the tampon in the nasal cavity, and also eliminates the discomfort and pain from the pressure of the tube (3) on the mucous membrane of the bottom of the nasal cavity in working condition.

The signal pneumatic balloon (4), made, for example, of silicone, allows you to control the amount of incoming air into the endonasally located chamber and adjust the pressure in it during inflation.

The valve device (5) ensures the tightness of the endonasal pneumotampon when inflating and the air leaves it when deflating and removing the tampon.

The possibility of using the inventive device to achieve the specified purpose and technical result for stopping nosebleeds is also confirmed by the following examples.

Clinical example 1. Patient Grachev SN, 47 years old, was admitted to the clinic 03/22/2009 with nosebleeds from the right half of the nose. According to the patient, the bleeding began on the morning of March 22, 2009, did not stop on its own. The patient was taken by an ambulance to the hospital. With rhinoscopy: the mucosa of both halves of the nose is swollen, hyperemic, there is hemorrhagic discharge from the right half of the nose. In order to stop bleeding in an otorhinolaryngological hospital, an elastic chamber of the proposed device was introduced into the right half of the nose and tamponade was performed using this device by inflating a chamber introduced into the nasal cavity, the length of the edge of which is intended to be inserted along the bottom into the nasal cavity is 62 mm . Epistaxis has stopped.

Complications caused by meceration of the nasal mucosa and impaired natural drainage of the nasal cavity were not noted. 03/25/2009 the swab was removed.

Example 2. A patient Grishin A.V., 24 years old, was admitted to the clinic on 10.01.2009 with post-traumatic nosebleeds. From the anamnesis, it is known that on January 2, 2009 he was injured (a broken nasal bone from January 2, 2009), on January 9, 2009, profuse epistaxis of the rear localization appeared, which did not stop on its own. In the ENT hospital with the help of the proposed device was performed back tamponade. The length of the edge of the chamber of the device intended for insertion along the bottom of the nasal cavity is 68 mm. Epistaxis stopped. Complications caused by meceration of the nasal mucosa and impaired natural drainage of the nasal cavity were not noted. The tamponade is wealthy, removed on the 3rd day. No recurrence of bleeding was noted.

Example 3. Patient Nikitina RP, 52 years old, was admitted to the clinic 03/26/2009 with nosebleeds from the left half of the nose against a background of increased blood pressure to 150/90 mm Hg The patient received tamponade with an inflatable pneumotampon, antihypertensive therapy was performed. No relapses in nosebleeds. The tamponade was removed on March 30, 2009. 04/02/2009 the patient was discharged from the hospital in satisfactory condition.

Thus, the claimed invention has several advantages over the presented analogues:

1. The shape corresponding to the anatomy of the nose allows the tampon of the device to provide compression of the bleeding vessels of the mucous membrane of all sections of the nasal cavity, both front and rear, and thereby ensure the stopping of bleeding.

2. The shape of the swab in a deflated state facilitates the installation of the swab along the bottom of the nasal cavity.

3. The device has two handsets. The breathing tube passes in the lower part of the pneumotampon parallel to the bottom of the nasal cavity, opening with two holes, one in the nasopharynx and the other outward - in the vestibule of the nasal cavity, which ensures free breathing of the patient for the period of tamponade. The tube for supplying the filler chamber provides air and inflating the chamber, which brings it into position and provides compression of the bleeding sections of the nasal mucosa. In this case, the tube for supplying the filler chamber is located above the breathing tube. Such a mutual arrangement of the tubes provides the convenience and ease of installation of the tampon in the nasal cavity, eliminates the discomfort and pain from the pressure of the tubes on the mucous membrane of the bottom of the nasal cavity in working condition.

4. The advantage of this tampon is the presence in the tube for supplying the filler of the chamber signal pneumatic balloon, which allows you to control the amount of incoming air into the chamber when inflating. The ability to regulate the pressure in the pneumotampon avoids the development of bleeding with insufficient swelling of the tampon, as well as the development of maceration of the mucosa with excessive swelling, and thus prevent the recurrence of bleeding after removal of the tamponade.

Claims (2)

1. Device for stopping nosebleeds, containing a tampon made in the form of an elastic chamber, equipped with a breathing tube with holes at the ends, passed through the chamber, and a tube for supplying a filler chamber, and the tube for supplying a filler chamber contains a valve connected to a filler supply source chamber, characterized in that the tube for supplying the filler of the chamber further comprises a pneumatic cylinder, providing pressure control in the chamber, which has a shape corresponding to the sagittal nasal cavity, with stiffening ribs along the edges, while the breathing tube is located along the edge of the chamber, designed to be inserted along the bottom of the nasal cavity and having the form of a straight line segment, and the tube for supplying the filler of the camera is located at the opening of the breathing tube in the region of the edge intended for insertion in the upper sections of the nasal cavity and representing a broken line, and the length of the edge of the chamber, intended for insertion along the bottom of the nasal cavity, is 62-68 mm. 2. The device according to claim 1, characterized in that during the first from the side of the tube for supplying filler from 1/4 to 1/3 of the length, the distance between the edges of the chamber increases from 5 to 18 mm, over the next from 1/4 to 1 / 3 of the length, the distance between the edges of the chamber increases from 18 to 26 mm, over the next 1/3 to 1/4 of the length, the distance between the edges of the chamber decreases from 26 to 18 mm, and throughout the remaining length of the length, the distance between the edges of the chamber decreases from 18 up to 5 mm.

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