WO2018133175A1

WO2018133175A1 - Slidable multi-lumen drainage tube

Info

Publication number: WO2018133175A1
Application number: PCT/CN2017/075187
Authority: WO
Inventors: 林静; 李娅姣; 秦臻; 杜磊
Original assignee: 四川大学华西医院
Priority date: 2017-01-18
Filing date: 2017-02-28
Publication date: 2018-07-26
Also published as: CN107441614A

Abstract

A slidable multi-lumen drainage tube comprises an outer cannula (1) and an inner catheter (2) positioned inside the outer cannula (1). The inner catheter (2) is provided with a tubular guiding core (3) therein. An intravascular stent (4) is provided between the outer cannula (1) and the inner catheter (2). The intravascular stent (4) is fixed to an outer wall of the inner catheter (2). A user can implant the drainage tube in the left ventricle of a patient by means of a subclavian artery, an axillary artery or a femoral artery, such that a fluid can be removed from the left ventricle without having to perform a thoracic surgery, thereby easing the pain of a patient, reducing blood loss, shortening operation time, causing no damage to the aortic valve, and measuring a pressure variation in the left ventricle.

Description

Slidable multi-cavity drainage tube

Technical field

The present invention relates to medical surgical instruments, and more particularly to a slidable multi-cavity drainage tube.

Background technique

For patients with severe heart failure, in order to maintain the life of the patient after other means of treatment is ineffective, it is generally preferred to use a mechanical aid, that is, after the blood is taken out of the body, with or without artificial lung oxygenation, and then driven by a pump (artificial heart) Blood is injected into the body. This technique is called "buying life to God." It is the most common way to withdraw blood from the body through the femoral vein. However, this method can not effectively reduce the left ventricular preload and increase the left ventricular afterload, which will lead to increased left ventricular oxygen consumption and delayed recovery. Therefore, this model is not suitable for patients with left ventricular failure. Left atrial drainage can reduce left ventricular preload to a certain extent, thereby reducing cardiac work. However, for patients with severe left ventricular failure, its role is limited. In addition, the route of left atrial drainage requires thoracotomy, so it is not commonly used clinically. Left ventricular drainage can directly reduce the left ventricular preload and reduce the intracardiac pressure, which not only reduces myocardial oxygen consumption, but also increases coronary blood supply, thereby promoting left ventricular function recovery. Therefore, left ventricular drainage is extremely important for patients with severe left ventricular failure. At present, a kind of left ventricular drainage tube used in clinical practice needs to be placed in the thoracic cavity, and the left ventricle is directly incision. Such surgery has great trauma to the myocardium and more bleeding, so it is not commonly used in clinical practice. The other type uses a longer drainage tube that passes through other arterial vessels, such as the femoral artery, retrogradely through the aortic valve to the left ventricle. However, in heart failure, the left ventricular drainage tube will severely compress the aortic valve (especially without the coronary valve), causing severe aortic regurgitation, which not only reduces the effect of left ventricular drainage, but also is not conducive to The recovery of left ventricular function, and long-term compression of the aortic valve, may result in severe valvular dysfunction, and even adhesion and loss of valve function, resulting in permanent aortic regurgitation.

Summary of the invention

The invention aims to provide a slidable multi-cavity drainage tube, which can be inserted into the left ventricle of a patient through a subclavian artery or a radial artery or a femoral artery, and the target of left ventricular drainage can be achieved without opening the chest. Not only can the patient's pain be alleviated, but also reduce the amount of bleeding and shorten the operation time; it will not cause damage to the aortic valve, and measure the left ventricular pressure change.

In order to achieve the above object, the technical solution adopted by the present invention is as follows:

A slidable multi-lumen drainage tube includes an outer cannula and an inner catheter located in the inner cannula lumen, the inner catheter lumen is provided with a guiding die; and the outer cannula and the inner catheter are further provided with a blood vessel stent, the blood vessel stent Fixed on the outer wall of the inner catheter.

The inner catheter is implanted in the outer cannula, and the inner catheter can slide in the outer cannula as needed. After the outer cannula is retracted, the vascular stent fixed on the inner catheter can be released, thereby supporting the inner catheter in the middle of the blood vessel to prevent the inner catheter from compressing the aortic valve. This results in aortic regurgitation and destruction of the aortic valve (long-term compression). The guiding die guides the outer cannula and the inner catheter during the placement of the drainage tube, thereby retrograde into the ascending aorta via the peripheral artery.

The inner catheter rear opening is connected to the drive system (such as a centrifugal pump, a roller pump, etc.), and the left ventricular blood is drained to the outside through a drive system.

Preferably, the inner wall of the inner tube is provided with a pressure measuring channel, the front opening of the pressure measuring channel is located at the outer wall of the front end of the inner tube, and the rear opening of the pressure measuring channel is located at the outer wall of the rear end of the inner tube.

Preferably, the utility model further comprises a pressure measuring tube, and one end of the pressure measuring tube is connected to the rear opening of the pressure measuring channel. The piezometer can be directly inserted into the rear opening of the pressure measuring channel. Of course, the rear opening position of the pressure measuring passage can be provided with a connecting head, and the pressure measuring tube is connected to the pressure measuring passage through the joint; when the pressure measuring is not required, the connecting head There is also a closed head to prevent blood from flowing out of the pressure measuring channel.

The left end chamber pressure can be continuously measured after the other end of the piezometer is connected to the pressure sensor. The pressure measuring tube is also provided with a pipe clamp, which can block the passage of the pressure measuring tube and the pressure measuring channel.

Preferably, the inner tube front wall has a side hole formed therein, and the side hole communicates with the inner tube inner cavity and close to the inner tube front opening.

The front end of the inner catheter body is provided with a plurality of side holes to avoid being blocked during the drainage process.

Preferably, the pressure measuring tube is further provided with a pipe clamp for blocking the pressure measuring tube.

Preferably, the vascular stent is secured to the front of the inner catheter. The vascular stent at the front of the inner catheter allows the inner catheter to be located in the center of the three aortic valves, preventing the inner catheter from compressing the aortic valve and causing aortic regurgitation and destruction of the aortic valve.

The blood vessel support comprises a support rib and a connecting rib, the support rib is a cutting support, the support rib has a large cross section, the connecting rib part is a woven support, the woven support is woven by a thin metal wire, the wire cross section is small, and the support rib is between The braided stents are connected to form repeating units of different lengths to form a blood vessel stent.

The basic structure of the supporting rib is a ring structure surrounded by a sinusoidal curve. The supporting rib has a plurality of basic structural repeats. The valleys and troughs of the sinusoidal valleys of the two adjacent basic structures are opposite, and the peaks and peaks are opposite;

The basic structure of the support rib is divided into the straight line of the support rib and the corner of the support rib. The basic structure of the support rib and the basic structure of the support rib are alternately transformed into a ring structure. The cross section of the basic structure of the support rib is designed with variable cross section. The cross-sectional area of the basic structure of the support rib is small, and the cross-sectional area of the basic structure of the support rib is large. The cross-sectional area of the support rib from the straight line to the bend gradually becomes larger, and then gradually decreases from the bend to the straight line. And repeat the changes accordingly.

The top of the basic structure of the support rib has a protruding joint at the top, and the main function of the support rib joint is for the connection of the support rib and the connecting rib; the connecting rib adopts a woven bracket and a woven bracket The connection with the support ribs is through the connection between the braided support wire and the support rib joint, and the connection method is a fusion welding method.

The connecting rib adopts a woven bracket, and the wire is taken out from the joint of the basic structure of one supporting rib, and is connected by a connecting angle of a basic structure of another supporting rib by rotating a certain angle, and the rotation is divided into left-handed and right-handed, left-handed and The right-handed rotation is alternately distributed.

The connecting ribs are made of woven brackets and 6 wires are respectively taken out from 6 joints of the basic structure of one supporting rib. 3 are left-handed, 3 are right-handed, and left-handed and right-handed are alternately distributed, and the rotation angle is 240 degrees. It is in turn connected to the six connectors of the basic structure of the other support rib.

The wire of the braided bracket portion is made of a memory alloy material, and the support support portion is made of stainless steel or alloy.

Preferably, the guiding die comprises a guiding wire and a guiding tube fitted on the guiding wire, and the guiding wire is slidably connected with the guiding tube.

It is an object of the present invention to provide a catheter for left ventricular drainage that can be placed into the left ventricle by a user via a subclavian artery or a radial or femoral artery. The slidable multi-lumen drainage tube is placed into the left ventricle under the guidance of the guiding wick. When the longer inner catheter reaches the correct position of the left ventricle, the guiding wick is withdrawn, and the retracting outer cannula releases the vascular stent at the front of the inner catheter such that the inner catheter is centered in the three aortic valves. The inner conduit is connected to the drive system (such as a centrifugal pump, a roller pump, etc.), and the pressure tube on the inner catheter opens the tube clamp, connects the pressure sensor, and continuously measures the left ventricular pressure. The invention can achieve the goal of left ventricular drainage without opening the chest, so the use is convenient, not only can reduce the pain of the patient, but also can reduce the bleeding, shorten the operation time; does not cause damage to the aortic valve; and simultaneously measures the left ventricular pressure change, available The evaluation of the left ventricular function and feedback control the flow of the pump.

The invention is suitable for patients with severe left ventricular dysfunction, and these patients can only effectively reduce the left ventricular front by using the currently used venous-arterial heart assist or venous-venous lung assist. The load, which seriously affects the recovery of left ventricular function. By using the present invention, blood in the left ventricle can be discharged, and the left ventricular preload can be lowered. As the intracardiac pressure drops, the blood supply to the heart muscle improves, thereby promoting recovery of the heart.

DRAWINGS

Figure 1 is a schematic view of the structure of the present invention.

Figure 2 is a cross-sectional view of the inner catheter.

Figure 3 is a cross-sectional view of the inner conduit.

Figure 4 is a cross-sectional view of the present invention.

Figure 5 is a diagram of an embodiment.

Figure 6 is an ultrasound diagram A.

Figure 7 is an ultrasound diagram B.

Figure 8 is a Doppler A.

Figure 9 is an ultrasound image C.

Figure 10 is a Doppler plot B.

Figure 11 is a Doppler plot C.

Figure 12 is an ultrasound image D.

Figure 13 is a Doppler map D.

In the figure: 1-outer cannula, 2-inner catheter, 3-guided wick, 4-vascular stent, 5-pressure channel, 6-pressure channel front opening, 7-pressure channel rear opening, 8-pressure Tube, 9-side hole, 10-tube clamp, 11-guide wire, 12-guide tube, 13-inner catheter front opening, 14-inner catheter rear opening, 15-outer casing rear opening, 16-handle, 17- Non-crown valve, 18-aortic valve, 19-left heart drainage tube, 20-aortic short axis, 21-slidable multi-lumen drainage tube.

detailed description

In order to make the objects, technical solutions and advantages of the present invention more comprehensible, the present invention will be further described in detail with reference to the accompanying drawings.

As shown in Figure 1, a slidable multi-cavity drainage tube comprises an outer cannula 1 and an inner catheter 2 located in the inner lumen of the outer cannula 1. The inner catheter 2 is provided with a guiding die 3; the outer cannula 1 and the inner cannula A blood vessel support 4 is also disposed between the catheters 2, and the blood vessel support 4 is fixed to the outer wall of the inner catheter 2.

As shown in FIG. 2 and FIG. 3, the inner wall of the inner tube 2 is provided with a pressure measuring channel 5, the front opening 6 of the pressure measuring channel is located at the outer wall of the front end of the inner tube 2, and the rear opening 7 of the pressure measuring channel is located at the inner tube 2 The outer wall of the rear end. A pressure measuring tube 8 is also included, one end of which is connected to the pressure measuring channel rear opening 7. A side hole 9 is formed in the front end wall of the inner tube 2, and the side hole 9 communicates with the inner tube 2 inner cavity and is adjacent to the inner tube front opening 13. The pressure measuring tube 8 is further provided with a pipe clamp 10 for blocking the pressure measuring tube 8.

As shown in FIG. 4, the blood vessel stent 4 is fixed to the front of the inner catheter 2. The guiding die 3 comprises a guiding wire 11 and a guiding tube 12 fitted over the guiding wire 11, the guiding wire 11 being slidably connected to the guiding tube 12.

For ease of operation and fixation, the inner tube rear opening 14 and the outer wall of the outer sleeve rear opening 15 are fixed with a crown 16 which is made of a hard plastic. When the inner tube 2 and the outer sleeve 1 are slid in operation, The position of the handle 16 is applied with force to facilitate sliding; at the same time, when the inner tube 2 is connected with the driving system, the inner tube can be provided with a thread or a thread, and the plug connection is convenient for fixing.

As shown in FIG. 5, the slidable multi-lumen drainage tube of the present invention is used to successfully puncture the left iliac artery, or other suitable artery, such as the right subclavian artery and the femoral artery, first placing the guiding wire, and fitting the guiding tube The outer end of the wire is guided, the guide tube is slowly implanted, and the slidable multi-lumen drainage tube of the present invention is placed through the guide tube to reach above the aortic sinus. Then, the outer sleeve is kept stationary, and the inner cannula is pushed into the proper position of the left ventricle, then the outer cannula is retracted, the blood vessel stent is released, and the vascular sinus is fixed. The drainage tube is maintained to maintain its center position within the aorta. After the guide wick is removed, the inner catheter is connected to the ECMO into the blood end, and the ECMO is activated. Under the drive of the artificial pump, blood is passed from the left ventricle - through the inner catheter of the present invention. Under the action of blood flow, the ultrasound can be seen that the multi-lumen drainage tube is fixed in position, located in the middle of the three valve leaflets of the aortic valve. There is no obvious compression on the aortic valve, and the aortic valve regurgitation is reduced, and the blood can be drained from the left ventricle. The tube reaches the artificial pump and the left ventricular drainage is completed.

In an animal experiment using a conventional left ventricular drainage tube 19, the aortic condition was observed by echocardiography:

As shown in Figures 6 and 7, cardiac color Doppler ultrasound shows left ventricular failure using a left heart drainage tube for drainage, regardless of whether the aortic valve 18 is closed or open, the aortic valve without a coronary valve 17 on the long axis of the left ventricle is compressed. Another valve is open and free.

As shown in Figure 8, color Doppler suggests: aortic valve 18 moderate eccentric regurgitation.

As shown in Fig. 9, the aortic short axis 20 indicates that the position of the left cardiac drainage tube 19 is not in the middle of the three leaflets of the aortic valve 18, but rather that one side of the aortic valve is forced to be compressed.

As shown in Figure 10, color Doppler suggests: eccentric regurgitation of the aortic short axis 20.

The results of the experiment were: In the left ventricular failure, echocardiography showed that the left ventricular short axis and the long axis saw the unsupervised flap compressed by the left cardiac drainage tube respectively. Doppler color ultrasound showed that the left cardiac drainage tube compressed the aortic valve to cause the valve. (mainly without crown flap) moderate eccentric return.

In an animal experiment using a slidable multi-lumen drain tube of the present invention, aortic regurgitation was observed by echocardiography:

As shown in FIG. 11, using the slidable multi-lumen drainage tube of the present invention, the left iliac artery is successfully punctured, the guiding wick is placed, and the slidable multi-cavity drainage tube of the present invention is placed through the guiding wick to reach the aortic sinus Above. The color Doppler image suggests that when the present invention is located in the median position of the aortic valve, there is no compression of the coronary valve, and the aortic regurgitation is significantly reduced.

As shown in Fig. 12, the aortic valve short-axis color Doppler shows that the slidable multi-lumen drainage tube of the present invention is located in the median position of the three aortic valves.

As shown in Figure 13, the aortic valve short-axis image suggests a central regurgitation of the aortic valve.

The experimental results are as follows: after placing the vascular stent, the device of the present invention is lifted up, located in the middle of the aorta and the aortic valve, avoiding the drainage tube pressing the aortic valve, and then the heart color ultrasound prompts that the originally compressed valve is opened and closed. Freely, there are no signs of oppression, and the left ventricular long axis and short axis images respectively indicate that the aortic valve eccentric regurgitation is converted into a central regurgitation, and the return flow is reduced or even disappeared.

The invention may, of course, be embodied in a variety of other embodiments, and various changes and modifications can be made in accordance with the present invention without departing from the spirit and scope of the invention. And modifications are intended to fall within the scope of the appended claims.

Claims

A slidable multi-lumen drainage tube, comprising: an outer sleeve and an inner tube located in the inner sleeve inner cavity; the inner tube inner cavity is provided with a guiding die; and the outer sleeve and the inner tube are further provided with a blood vessel bracket, The blood vessel stent is fixed to the outer wall of the inner catheter.
The slidable multi-cavity drainage tube according to claim 1, wherein the inner wall of the inner tube has a pressure measuring channel, and the front opening of the pressure measuring channel is located at the outer wall of the front end of the inner tube, and the pressure measuring channel The rear opening is located at the outer wall of the rear end of the inner conduit.
The slidable multi-cavity drainage tube according to claim 2, further comprising a pressure measuring tube, wherein the pressure measuring tube has a pressure measuring channel at one end and is connected to the opening.
A slidable multi-cavity drainage tube according to claim 1, wherein a side hole is formed in the wall of the front end of the inner tube, and the side hole communicates with the inner tube inner cavity and close to the front opening of the inner tube.
A slidable multi-cavity drainage tube according to claim 3, wherein the pressure measuring tube is further provided with a tube clamp for blocking the pressure measuring tube.
A slidable multi-lumen drainage tube according to claim 1 wherein said vascular stent is secured to the front of the inner catheter.
A slidable multi-cavity draft tube according to any of claims 1-6, wherein the guiding die comprises a guiding wire and a guiding tube fitted over the guiding wire, the guiding wire being slidably connected to the guiding tube.