WO2022007184A1 - 气道操作喉罩 - Google Patents

气道操作喉罩 Download PDF

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Publication number
WO2022007184A1
WO2022007184A1 PCT/CN2020/114696 CN2020114696W WO2022007184A1 WO 2022007184 A1 WO2022007184 A1 WO 2022007184A1 CN 2020114696 W CN2020114696 W CN 2020114696W WO 2022007184 A1 WO2022007184 A1 WO 2022007184A1
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WIPO (PCT)
Prior art keywords
cavity
laryngeal mask
ventilation
airway
throat
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PCT/CN2020/114696
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English (en)
French (fr)
Inventor
高宏
俞卫锋
田鸣
高巨
朱江
周俊
王志萍
沈宁
Original Assignee
高宏
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Publication of WO2022007184A1 publication Critical patent/WO2022007184A1/zh

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/10—Preparation of respiratory gases or vapours
    • A61M16/105—Filters

Definitions

  • the invention relates to a laryngeal mask, belonging to the technical field of laryngeal masks.
  • Laryngeal mask is one of the important airway management tools in general anesthesia with little airway stimulation, easy to tolerate, less airway damage, and reliable ventilation effect.
  • the laryngeal mask cannot meet the surgical needs in many situations, such as:
  • the clinical anesthesia work is extremely busy, and the expensive medical instruments of the anesthesia machine are basically impossible to sterilize after a single operation, resulting in a great increase in the risk of cross-infection.
  • the clinical use of the breathing filter is connected to the mouth of the threaded tube, and the relatively bulky threaded tube brings a large pulling force to the tracheal tube, which increases the risk of the tracheal tube coming out.
  • the busy clinical work makes the breathing filter forget to use. If it occurs, it greatly increases the risk of respiratory cross-infection.
  • the purpose of the present invention is to overcome the deficiencies in the prior art, and to provide an airway operation laryngeal mask, which can synchronize ventilation during airway surgery, avoid hypoxia, ensure the use of breathing gas filtration, and reduce repetition during airway surgery. Inserting and removing operating tools greatly improves the efficiency of airway surgery and shortens the operation time.
  • the utility model has the advantages of compact structure, convenient use and greatly improved safety.
  • the airway-operated laryngeal mask includes a laryngeal mask body that surrounds the throat wall outside the glottis during ventilation, a laryngeal mask catheter arranged at the rear end of the laryngeal mask body and in sealing communication with the cavity of the mask body, and a laryngeal mask catheter arranged at the tail of the laryngeal mask catheter and the larynx.
  • the tube ventilation cavity is in sealing communication with the ventilation interface for connecting the breathing tube and the operation check valve for inserting the airway operating tool into the laryngeal ventilation cavity.
  • the gas in the throat ventilation cavity cannot escape through the operating one-way valve; operating tools can be inserted into the airway through the throat ventilation cavity and the mask cavity by operating the one-way valve; at the same time, the gas in the laryngeal ventilation cavity cannot pass through. Operate the one-way valve to escape.
  • the end of the throat ventilation cavity is sealed with a socket tube, the front end side of the socket tube can be matched and sleeved in the throat ventilation cavity, and the socket tube is provided with a ventilation interface and an operating one-way valve.
  • the ventilating interface is provided with a filter mesh membrane sleeve in the extending section in the ventilation cavity of the throat, and the mouth of the filter mesh membrane sleeve is sealed and connected with the opening of the ventilating interface extending section.
  • the ventilation interface extends in the ventilation cavity of the throat and is connected with a mesh support sleeve, and the filter mesh membrane sleeve is sleeved outside the mesh support sleeve.
  • the extension shaft in the laryngeal mask catheter is provided with a separation diaphragm to separate the ventilation cavity of the throat into the ventilation filter cavity and the airway operation cavity which are communicated with each other, and the filter mesh membrane sleeve is arranged in the ventilation filter cavity.
  • the ventilation filter cavity is located on the side adjacent to the ventilation interface, and the airway operating cavity is located on the side adjacent to the operating one-way valve.
  • a storage cavity is arranged in the mask body cavity, the front end of the throat ventilation cavity or the front section of the ventilation filter cavity adjacent to the laryngeal mask body; greater than 1 cubic centimeter.
  • a plurality of flaps are arranged at the opening of the storage cavity, one edge of the flaps is connected with the edge of the opening of the storage cavity, and the other side forms a small crack with the edge of the opening of the storage cavity.
  • An articulation fixing structure is arranged outside the laryngeal mask catheter.
  • the upper front part of the articulation fixing structure is provided with an articulation clamping block, a temporary locking block at the upper and rear part, and a sliding block at the lower part; the sliding block can slide along the long axis of the laryngeal mask catheter.
  • the laryngeal mask conduit is set as a rigid conduit, the tail of the laryngeal mask body is flexibly connected to the laryngeal mask conduit, and the rigid linear tool can enter the glottis through the operation one-way valve, the laryngeal ventilation cavity and the mask body cavity during ventilation.
  • the rigid conduit is a straight conduit, and a support spring is embedded in the cavity of the flexible connection part between the tail of the laryngeal mask body and the laryngeal mask conduit.
  • the advantages of the invention are as follows: through the setting of the filter ophthalmic membrane sleeve, the gas entering and leaving the patient's lungs can obtain a reliable filtering effect, avoiding the occurrence of cross-infection of the respiratory tract caused by the ventilator or the patient; the ophthalmic membrane sleeve is integrated with the ventilation catheter.
  • the setting can prevent the anesthesiologist from forgetting the application of the breathing filter due to the busy clinical work; an operating one-way valve is set at the end of the ventilation catheter, and the sealing effect will not be affected during normal ventilation.
  • the operation When the operation is performed in the airway, it can avoid breathing interruption during the airway operation, and can simultaneously implement reliable ventilation support to ensure the safety of the operation in the airway; the setting of the storage cavity can improve the efficiency of airway operation and reduce the operation of the airway injury. It reduces the bleeding time, reduces airway damage, shortens the operation time, and greatly improves the safety of endotracheal surgery; simplifies the structure and weight of the breathing filter, reduces the pulling force of the breathing filter on the laryngeal mask, and reduces access to the oropharynx. Risk of accidental prolapse of the cavity during surgery.
  • FIG. 1 is a schematic structural diagram of a first embodiment of the present invention.
  • FIG. 2 is a schematic structural diagram of the first operating one-way valve of the present invention.
  • FIG. 3 is a schematic structural diagram of the second operating one-way valve of the present invention.
  • FIG. 4 is a schematic structural diagram of the one-way valve of the present invention provided with a rigid guide tube.
  • FIG. 5 is a schematic structural diagram of the socket tube of the present invention. .
  • FIG. 6 is a schematic structural diagram of a filter mesh membrane sleeve provided in the present invention.
  • FIG. 7 is a schematic view of the structure of the present invention with a mesh support sleeve.
  • FIG. 8 is a schematic structural diagram of a second embodiment of the present invention.
  • FIG. 9 is a schematic diagram of a storage cavity provided in the laryngeal mask body of FIG. 8 according to the present invention.
  • FIG. 10 is a schematic diagram of the valve plate provided at the mouth of the storage cavity in FIG. 9 of the present invention.
  • FIG. 11 is a schematic diagram of a storage cavity provided in the ventilation cavity of the throat in FIG. 8 of the present invention.
  • Fig. 12 is a schematic diagram of the patient's position during the operation of the rigid bronchoscope of the present invention.
  • FIG. 13 is a schematic structural diagram of a third embodiment of the present invention.
  • FIG. 14 is a schematic longitudinal cross-sectional view of the articulation fixing structure of the present invention.
  • FIG. 15 is a schematic structural diagram of another embodiment of the socket tube of the present invention.
  • an airway-operated laryngeal mask includes a laryngeal mask body 1 surrounding the throat wall outside the glottis during ventilation, a laryngeal mask body 1 disposed at the rear end of the laryngeal mask body 1 in sealing communication with the mask body cavity 10
  • the laryngeal mask catheter 2 is arranged at the tail of the laryngeal mask catheter 2 and is in sealing communication with the laryngeal ventilation cavity 21 for connecting the ventilation interface 3 of the breathing circuit and the one-way operation for inserting the airway operation tool into the laryngeal ventilation cavity 21.
  • valve 4 is arranged at the tail of the laryngeal mask catheter 2 and is in sealing communication with the laryngeal ventilation cavity 21 for connecting the ventilation interface 3 of the breathing circuit and the one-way operation for inserting the airway operation tool into the laryngeal ventilation cavity 21.
  • the laryngeal mask body 1 When in use, the laryngeal mask body 1 is located at the bottom of the throat cavity, and the mouth of the mask body cavity 10 surrounds the mucous membrane of the throat cavity that is covered on the periphery of the glottis. ventilation.
  • the rear end of the laryngeal mask body 1 is in sealing communication with the cavity 10 of the laryngeal mask body, and a laryngeal mask catheter 2 is arranged in sealing communication.
  • the tail of the laryngeal mask catheter 2 is also provided with an operating one-way valve 4 for inserting an airway operating tool into the laryngeal ventilation cavity 21 .
  • operating the one-way valve 4 can make the gas in the throat ventilation cavity 21 not escape through the operating one-way valve 4; And the mask body cavity 10 inserts the operating tool into the airway; at the same time, the gas in the throat ventilation cavity 21 cannot escape through the operating one-way valve 4 .
  • operating the one-way valve 4 can provide an operating tool insertion channel for airway operation, and at the same time, can provide sealing for mechanical ventilation, so as to ensure the safety of airway operation.
  • an operating tool can be inserted into the airway through the throat ventilation cavity 21, the mask body cavity 10 and the glottis; at the same time, the gas in the throat ventilation cavity 21, the mask body cavity 10 and the airway cavity It cannot escape by operating the one-way valve 4 .
  • the operating tools such as: fiberoptic bronchoscope, electrocoagulation/electric cutting tools, sputum suction tube, tracheal support net, etc.
  • the operating tools By operating the one-way valve 4, the throat ventilation cavity 21, the mask body cavity 10 and the glottis, the trachea can be reached, thereby completing the operation in the airway.
  • the ventilation interface 3 is connected to a ventilator or anesthesia machine, and the sealing cavity formed by the laryngeal mask body 1 around the glottis and the airway can support the patient's breathing.
  • the technical solutions adopted by the operating one-way valve 4 include but are not limited to the following two solutions:
  • the annular hole soft membrane 41 is made of soft silicone, rubber, latex or other medical materials, and the diameter of the annular hole 40 matches with the commonly used cavity operation tools (the cross-sections are all circular), or is slightly smaller than the outer diameter of the commonly used cavity operation tools.
  • the diameter of the operating tool can be easily inserted, and the resistance cannot be too large.
  • the flexible material film on the edge of the annular hole 40 can fully contact the outer wall of the operating tool, which has a strong sealing effect.
  • the inner diameter of the annular hole 40 is optimally set to 2 mm.
  • the annular hole soft membrane 41 is set to have a tapered structure in which the tapered opening is far away from the opening of the operating check valve 4 .
  • a matching sealing cover 42 is provided to seal the opening cover where the operation check valve 4 is provided.
  • the annular hole soft film 41 is used to cooperate with the duckbill soft film 43 .
  • the function of the soft membrane 41 of the annular hole is the same as that of the first solution, and it can play a sealing role when the tool is placed in the throat cavity.
  • the duckbill soft membrane 43 is a sleeve membrane 431 on the outer side adjacent to the operation one-way valve 4, which matches the outer sleeve of the operation one-way valve 4.
  • the side adjacent to the throat ventilation cavity 21 is a linear opening 432, and the opening on both sides of the opening is a linear opening 432.
  • Diaphragm 433 is connected to sleeve membrane 431 .
  • the pressure in the larynx ventilation cavity 21 is relatively high, and the diaphragms 433 on both sides of the linear opening 432 fit each other under the action of positive ventilation pressure (anesthesia mechanical ventilation), so that the linear The opening 432 is closed, and the cavity of the throat ventilation cavity 21 cannot escape through the linear opening 432; when the airway operation tool is placed, the linear opening 432 of the duckbill pia 43 is opened, and the gas will escape, but at this time, the annular hole is soft.
  • the membrane 41 can play the role of sealing the outer gap of the airway operating tool, and the principle is the same as that of the first solution.
  • the soft film 41 of the annular hole or/and the soft film 43 of the duckbill in the operation one-way valve 4 may be reversely curled.
  • a hard tapered guide port 44 is arranged behind the soft film 41 to support the annular hole soft film 41 .
  • the shape of the hard tapered guide opening 44 is similar to that of the annular hole soft film 41 , and the diameter in the middle is larger than that of the annular hole 40 , and the optimal diameter is set to 4mm-5mm.
  • a hard duckbill valve support port 45 can be provided behind the duckbill soft membrane 43, the rear part of the hard duckbill valve support port 45 is cylindrical, and the front part is a wedge-shaped incision, and the cut surface of the wedge-shaped incision can meet the linear opening 432.
  • the diaphragms 433 on both sides provide support.
  • fitting holes 46 can be provided at the fitting positions of the annular hole soft membrane 41, the hard duckbill valve support port 45 and the rear end annular edge of the duckbill soft membrane 43, and the rear end annular edge of the corresponding hard tapered guide port 44 can be adapted.
  • a fixed post 47 is arranged at the matching position, and the ring hole soft membrane 41, the rigid duckbill valve support port 45 and the assembly hole 46 of the annular edge of the duckbill soft membrane 43 are aligned on the fixed post 47 during assembly.
  • a higher firmness can be achieved, and the annular hole soft membrane 41 and the duckbill soft membrane 43 can be prevented from accidentally protruding into the airway during use.
  • the rear end of the throat ventilation cavity 21 is sealed with a socket tube 5 , and the front end of the socket tube 5 is The side can be matched and sleeved in the throat ventilation cavity 21 , and the socket tube 5 is provided with a ventilation interface 3 and an operating one-way valve 4 .
  • the long axis of the operating one-way valve 4 and the ventilation interface 3 can be in the same direction as the long axis of the inner cavity of the throat ventilation cavity 21 , and the airway operating tool can be inserted more smoothly and conveniently.
  • the ventilation interface 3 When the ventilation interface 3 is connected to the breathing equipment, it is also more in line with the usage habits of clinicians. At the same time, operating the one-way valve 4 and the ventilation interface 3 in the same direction makes the structure of the socket pipe 5 more concise, reduces the cost of mold and assembly, and is beneficial to mass production.
  • the inner cavity of the throat ventilation cavity 21 is relatively thick, which provides sufficient implementation space for the insertion and application of the socket tube 5 .
  • the operation check valve 4 can also be arranged on the axis of the socket tube 5, The front end of the socket tube 5 is placed in the throat ventilation cavity 21 and fixed, and the operation one-way valve 4 is located at the rear end of the socket tube 5 .
  • the ventilation port 3 is connected and arranged on the side of the socket tube 5 for connecting to the breathing circuit.
  • the operating one-way valve 4 is provided with two annular aperture films 41 with different sizes and calibers, so as to adapt to operating tools with different outer diameters and thicknesses.
  • the diameter of the operating one-way valve 4 sleeve is preferably set at 7mm-10mm, and an airway tool with a diameter of 6-8mm can be placed;
  • the diameter of the annular hole 40 of the large annular hole membrane 41 is preferably set at 5mm, and it can be set to a diameter of 5mm.
  • the airway tool of 5.5-8mm can provide sealing;
  • the diameter of the annular hole 40 of the small annular hole membrane 41 is preferably set at 2.5mm, which can provide airway tools with a diameter of 3mm-6mm.
  • a filter mesh membrane sleeve 6 is provided in the extending section 31 of the throat ventilation cavity 21 of the ventilation interface 3 ;
  • One end of the mouth of the filter mesh membrane sleeve 6 is sealedly connected to the extension 31 of the ventilation interface 3 .
  • the other end of the filter mesh membrane sleeve 6 is a blind end, and forms a bag-like structure with the ventilation port 3 as an opening with the ventilation port 3 .
  • the gas first passes through the ventilation interface 3, then enters the filter mesh sleeve 6 for filtering, and then enters the patient's airway and lungs.
  • the exhaled air from the patient's lungs is first filtered through the filter mesh sleeve 6 , and then enters the breathing circuit through the ventilation interface 3 .
  • the gas entering and leaving the patient's lungs is filtered, which can not only prevent the exhaled gas of the patient from contaminating the breathing circuit of the ventilator or anesthesia machine, but also prevent the gas supplied by the ventilator or the anesthesia machine from contaminating the patient's airway, which can effectively avoid mechanical ventilation. cross infection.
  • anesthesia machines and ventilators should be disinfected one by one before use.
  • ICU respiratory department, cardiology department and other departments
  • each patient has a long breathing support time and a low frequency of ventilator use. Disinfect one by one.
  • the clinical anesthesia work is extremely busy, and the anesthesia machines are used very frequently. They cannot be disinfected one person at a time, nor can they be disinfected every day (the sales volume of anesthesia machines and the sales volume of anesthesia disinfection machines are seriously mismatched) . Even if a disinfection machine is used to sterilize the anesthesia machine, it takes at least 1 hour for each effective disinfection.
  • the current method is to use artificial nose in the breathing circuit, and filter paper is installed in the artificial nose.
  • the filtering area of the artificial nose is small.
  • the pore size of the filter membrane used is 5nm, and the filtering effect is slightly insufficient. .
  • the use of artificial nose forgetting often occurs. In some areas (such as Guangzhou, Fujian, Zhejiang, etc.) the artificial nose cannot be charged, and it is a rigid expenditure for the hospital.
  • some hospitals use inferior artificial noses, or deliberately repeatedly use artificial noses, or even do not use artificial noses, which brings the risk of cross-infection to patients.
  • the filter mesh membrane sleeve 6 As shown in Figure 6, its length is increased, the filter membrane can be folded back and forth, and the effective filtering area is greatly increased. Under the condition of maintaining the respiratory resistance comparable to that of the existing artificial nose, a filter membrane with a finer pore size can be used, thereby providing a more reliable filtering effect. Specifically, N95 material or higher quality N99 material can be used to provide better filtering effect and avoid respiratory cross infection.
  • the filter mesh sleeve 6 is set in the throat ventilation cavity 21, which is integrated with the product, which can completely avoid the forgetting use of the artificial nose, and also reduce the clinical workload of taking the artificial nose, unpacking, and connecting the artificial nose. .
  • the artificial nose used clinically is large in size and weight, which forms a large pulling force on the laryngeal mask, which sometimes causes the laryngeal mask to be displaced, prolapsed or the connection port of the breathing circuit is disengaged.
  • the design of the filter mesh sleeve 6 placed in the throat ventilation cavity 21 reduces the artificial nose shell, reduces the weight, and greatly reduces the occurrence of such events.
  • the filter mesh sleeve 6 itself is a flexible material.
  • the inhalation phase when the positive pressure gas enters the ventilation interface 3, the gas is filtered through the filter mesh sleeve 6 and enters In the throat ventilation cavity 21, under the action of the positive pressure inside the sleeve cavity of the filter membrane sleeve 6, the filter mesh membrane sleeve 6 shows a tendency to open, and the ventilation resistance can be maintained at a normal level.
  • the exhalation phase when the gas enters the filter mesh sleeve 6 through the throat ventilation cavity 21, under the action of the positive pressure outside the filter mesh sleeve 6 sleeve cavity, the filter mesh sleeve 6 presents a closing trend.
  • the ventilation cavity in the filter sleeve 6 is reduced, possibly resulting in an increase in breathing resistance. It is more severe in older patients with greater airway resistance, especially those with asthma.
  • a mesh support sleeve 60 is extended and connected to the ventilation interface 3 in the throat ventilation cavity 21 , and the filter mesh sleeve 6 is sleeved on the mesh support sleeve. Outside of the barrel 60 .
  • a mesh support sleeve 60 is sleeved in the inner cavity of the filter mesh sleeve 6, and the mesh support sleeve 60 can support the filter mesh sleeve 6 to prevent the filter mesh sleeve 6 from being over-closed during exhalation. , to avoid the resulting increase in respiratory resistance and ensure that the airway is unobstructed when the air in the lungs is exhaled.
  • the mesh support sleeve 60 is made of an elastic material with a higher hardness than the filter mesh sleeve 6, and has a mesh sleeve structure, which can ensure the effective area and ventilation area of the filter mesh sleeve 6 for gas filtration.
  • FIG. 8 it is a schematic diagram of another more optimized embodiment of the present invention.
  • the extension shaft of the laryngeal mask catheter 3 is provided with a separation diaphragm 22 to separate the ventilation cavity of the throat ventilation cavity 21 into a ventilation filter cavity 211 and an airway operation cavity 212 that communicate with each other, and the filter mesh membrane sleeve 6 is arranged in the ventilation filter cavity 211;
  • the ventilation filter cavity 211 is located on the side adjacent to the ventilation interface 3
  • the airway operation cavity 212 is located on the side adjacent to the operating one-way valve 4 .
  • the filter mesh membrane sleeve 6 is a flocculent structure with rough surface and many burrs under the microcosm. Some operating tools are sharp at the top, such as cable-handled scissors, cable-handled pliers, etc., which are more likely to cause damage to the filter mesh sleeve 6 .
  • the setting of the separation membrane 22 provides a special channel airway operation cavity 212 for the insertion and withdrawal of the operating tool, which can avoid damage to the filter mesh sleeve 6 when the operating tool is inserted, and ensure the filtering effect during ventilation.
  • the central axis of the operating one-way valve 4 is close to or coincident with the central axis of the airway operating cavity 212 .
  • the curvature of the airway tool during insertion can be minimized, the contact area of the airway tool with the laryngeal mask catheter 2 can be minimized, and the airway can be reduced to a minimum.
  • the resistance during tool placement is minimized.
  • the inner wall of the laryngeal mask catheter 2 can be super-slipped, or the outer wall of the airway tool can be coated with lubricant before placement.
  • the ventilation interface 3 is arranged on the lateral side of the central axis of the laryngeal mask catheter 2, which can avoid the path when the airway tool is placed, and provide the best channel for the placement of the airway tool.
  • the gas passing through the side wall of the filter mesh sleeve 6 is not affected, and the ventilation resistance is basically the same.
  • the incision is bleeding during the time interval between the extraction of the operating tool (removal of part of the tumor) and the insertion of the operating tool (partial hemostasis of the incision).
  • the amount of bleeding is not large, intra-airway bleeding poses a great risk to the patient.
  • the resection of tumors in the oropharyngeal cavity requires repeated operations, especially for tumors with rich blood supply, especially the vascular site, and the risk of removing and inserting operating tools is greatly increased.
  • a storage cavity 7 is provided in the front section of the laryngeal mask body 1, and the storage cavity 7 is a bag with an open end on one side and a blind end on the other side.
  • the open side is adjacent to the filter mesh sleeve 6, and the storage cavity 7 has a volume greater than 1 cubic centimeter.
  • the mask body cavity 10 formed by the laryngeal mask body 1 is large enough to set the storage cavity 7 .
  • the storage cavity 7 disposed adjacent to the front section of the laryngeal mask body 1 does not affect the ventilation effect, but provides a storage space for surgically removed tissue.
  • This structure is not only highly practical in the resection of tumors in the airway, but also extremely valuable in the removal of foreign bodies in the airway. Because when the foreign body is removed, the foreign body is mostly easily broken food such as peanuts, melon seeds, jelly, etc., and repeated operations are required during the operation to remove the entire foreign body.
  • FIG. 10 it is a schematic structural diagram of a plurality of valve sheets 71 arranged in the opening of the storage chamber 7 in FIG. 9 .
  • the valve sheets 71 are arranged to prevent accidental prolapse of the extracted tissue.
  • the valve sheet 71 is a soft medical material.
  • One side edge of the valve sheet 71 is connected to the inner or outer side edge of the annular opening, and the other side edge is separated from the annular opening edge and only remains in contact or forms a small crack.
  • FIG. 11 it is another embodiment of the storage cavity 7 .
  • a storage cavity 7 is provided at the front end of the throat ventilation cavity 21 . Its structure and function are similar to those in FIG. 8 , and it is preferable to set several valve flaps 71 in the mouth, which will not be repeated here. And the space of the throat ventilation cavity 21 is also sufficient to set the storage cavity 7, which does not affect the ventilation effect.
  • Rigid bronchoscopes are straight metal lumen with built-in light source and video capture and display device. They are clinically popular because they are less difficult to operate than flexible fiberoptic bronchoscopes. However, when the rigid bronchoscope is placed, the patient's head and neck should be tilted back to the limit, so that the oropharyngeal glottis are on the same straight line, as shown in Figure 12.
  • the laryngeal mask catheter 2 is set as a rigid catheter 02, and the tail of the laryngeal mask body 1 is connected to the laryngeal mask catheter 2 with a flexible A support spring 11 is embedded in the interface cavity.
  • a hard linear tool can enter the glottis through the operation of the one-way valve 4, the throat ventilation cavity 21 and the mask cavity 10.
  • the tail of the laryngeal mask body 1 and the laryngeal mask catheter can be changed at will. 2 Connection angle. After the laryngeal mask body 1 is placed at the bottom of the throat cavity and correctly aligned, move and extremely tilt the patient's head and neck back so that the patient's oropharynx is in a straight line.
  • the laryngeal mask catheter 2 located inside and outside the patient's mouth and The laryngeal mask body 1 at the bottom of the throat cavity adaptively adjusts the angle automatically through the flexible interface, so that the laryngeal mask catheter 2 and the oropharyngeal linear axis are close to or overlapped, so that the laryngeal mask catheter 2 and the patient's glottis are located on the same straight line.
  • the head and neck position of the patient and the laryngeal mask catheter 2 are fixed, and the airway operation can be started.
  • the rigid conduit 02 is preferably a straight conduit, and a curved conduit with a smaller arc can also be used. If a curved catheter is selected, the extension line of the central axis of the operation check valve 4 at the rear end of the rigid catheter 02 should fall in the outlet cavity of the front end of the rigid catheter 02 . That is to say, when a rigid bronchoscope is used, after the rigid bronchoscope is inserted into the rigid catheter 02 by operating the one-way valve 4, it can enter the cavity 10 of the cover through the front end outlet of the rigid catheter 02, and then enter the patient through the patient's glottis. within the airway.
  • Using a straight catheter or a rigid catheter with a smaller curvature can reduce or avoid the friction between the rigid bronchoscope and the rigid catheter 02 when the rigid bronchoscope is placed, so that the rigid bronchoscope can be smoothly inserted into the glottis and into the trachea for subsequent operations.
  • a support spring is embedded in the flexible interface discount. Under the action of the support spring, the bending flexibility of the flexible interface is basically unchanged, but it can ensure the cross section of the inner cavity of the flexible interface and ensure the ventilation effect.
  • the fixation of the laryngeal mask for airway manipulation according to the present invention is particularly important.
  • the good fixation effect between the laryngeal mask and the patient's articulation during airway operation is an important guarantee to ensure that the patient's oropharyngeal glottis are in the same straight line during airway operation.
  • an articulation fixing structure 8 is provided outside the laryngeal mask catheter 2.
  • the articulation fixing structure 8 is provided with an articulation fixing block 81 in the front part, a temporary locking block 82 in the upper rear part, and a lower part.
  • the sliding block 83 is an annular structure, and is wrapped around the outside of the laryngeal mask catheter 2 .
  • the inner cavity of the sliding block 83 is adapted to the outer shape of the laryngeal mask catheter 2, and is slightly larger than the outer shape of the laryngeal mask catheter 2, and can be sleeved on the outside of the laryngeal mask catheter 2 and slide along the long axis of the laryngeal mask catheter 2.
  • the articulation clamping block 81 is an arc-shaped groove, and the arc-shaped curvature is adapted to the dentition.
  • the temporary locking block 82 is in the shape of the screw 84 , the screw surface is provided with threads, and the top of the screw is provided with an adjusting cap, and the screw 84 can be rotated by rotating the adjusting cap.
  • the annular side wall of the sliding block 83 is provided with a matching screw hole 85 , and the inner surface of the screw hole 85 is provided with a thread matching the screw rod 84 .
  • the sliding block 83 is slid along the laryngeal mask catheter 2 so that the articulating block 81 can be correctly aligned with the patient's articulation.
  • the grooves of the articulator securing block 81 are correctly aligned with the patient's dentition or gums, adjust and tighten the temporary locking block 82 to lock the adjusting sliding block 83 and the laryngeal mask catheter 2 .
  • the airway-operated laryngeal mask of the present invention is set through the filter mesh sleeve 6 to minimize the cross-infection of the respiratory tract; through the setting of the operation one-way valve 4, the airway can be operated at the same time as breathing support; through the storage cavity 7
  • the setting can improve the efficiency of airway operation and operation, and improve the safety of intra-airway surgery; through the setting of the articulation fixing structure 8, it is convenient to fix the airway to operate the laryngeal mask. Safe, reliable, easy to use, and worthy of promotion.

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  • Health & Medical Sciences (AREA)
  • Pulmonology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Anesthesiology (AREA)
  • Biomedical Technology (AREA)
  • Emergency Medicine (AREA)
  • Hematology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
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  • Veterinary Medicine (AREA)
  • Respiratory Apparatuses And Protective Means (AREA)
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Abstract

一种气道操作喉罩，其包括用于通过口齿部置入患者口咽腔的较细的喉罩导管(2)和使用时环绕在患者声门外的喉罩罩体(1)，喉罩导管(2)尾端设置通气接口(3)及操作单向阀(4)。通过通气接口(3)能与呼吸管路匹配连接，通过操作单向阀(4)能置入操作工具，能保证密封性，对气道实施各种操作，同时，实施机械通气。通气接口(3)在喉管通气腔(21)内设置过滤网膜套筒(6)，能对呼吸气体实施过滤。该气道操作喉罩结构简单，成本低廉，通气时能过滤呼吸气体，能实施气道内手术，安全可靠。

Description

气道操作喉罩 技术领域
本发明涉及一种喉罩，属于喉罩的技术领域。
背景技术
喉罩对气道刺激小，容易耐受，不易发生气道损伤，通气效果可靠，是全身麻醉中重要的气道管理工具之一。
但喉罩在许多场合下不能满足手术需求，如：
1、气管异物取出术时，手术操作时需要中断通气，常导致手术时患者氧分压下降，甚至导致严重的低氧血症，增加患者手术风险。异物取出时常发生破碎，此时，需要将取物钳多次置入气道，夹取异物碎块后再退出气管导管，反复中断呼吸，使患者缺氧风险大大增加。取物钳多次，多次置入并退出气道，给手术者带来极大不便，使手术时间大大延长，气道损伤增加。
2、气管内肿瘤介入手术时，需要将电刀电凝等手术工具经喉罩口置入，此时，通气中断，使患者缺氧风险大大增加。气管内肿瘤较大，需要多次碎切肿块，多次凝血止血，多次取出肿瘤碎块。除例1风险外，手术工具反复进入并退出气道，大大延长了凝血等待时间，使气道内出血增加。气道内出血增加风险极大，极易在小气道内形成血栓，导致肺泡闭合，甚至导致部分肺不张发生，使患者肺功能严重下降。
3、临床麻醉工作极为繁忙，麻醉机昂贵的医疗仪器，单次手术使用后消毒基本不可能实现，导致交叉感染风险大大增加。目前临床使用呼吸过滤器接在螺纹管口部，较为笨重的螺纹管给气管导管带来较大牵扯力，增加了气管导管脱出的风险；同时，繁忙的临床工作，使呼吸过滤器遗忘使用时有发生，更是大大增加了呼吸道交叉感染的风险。
临床需要一种改进型喉罩，解决以上问题，使手术通气时能经喉罩口置入手术工具，实施气道内操作，避免操作工具多次进入并退出喉罩，减少手术时间，提高手术效率，提高手术安全性。使喉罩使用时，能确保过滤效果，避免呼吸过滤器遗忘使用。
发明内容
本发明的目的是克服现有技术中存在的不足，提供一种气道操作喉罩，实施气道手术时可以同步通气，避免缺氧、能确保呼吸气体过滤使用、能减少气道手术时反复插拔操作工具，大大提供气道手术效率，缩短手术时间。其结构紧凑，使用方便，安全性大大提高。
所述气道操作喉罩，包括通气时环绕在声门外咽喉壁的喉罩罩体、设置在喉罩罩体后 端与罩体腔密封连通的喉罩导管、设置在喉罩导管尾部与喉管通气腔密封连通用于连接呼吸管路的通气接口和用于向喉管通气腔内置入气道操作工具的操作单向阀。
通气时，喉管通气腔内气体不能经操作单向阀逸出；通过操作单向阀能经喉管通气腔和罩体腔向气道内置入操作工具；同时，喉管通气腔内气体不能经操作单向阀逸出。
所述喉管通气腔尾部密封设置插口管，所述插口管前端一侧能匹配套置在喉管通气腔内，插口管设置通气接口和操作单向阀。
所述通气接口在喉管通气腔内延伸段设置过滤网膜套筒，所述过滤网膜套筒筒口部与通气接口延伸段开口密封连接。
所述通气接口在喉管通气腔内延伸并连接设置网状支撑套筒，所述过滤网膜套筒套置在网状支撑套筒外部。
所述喉罩导管内延长轴设置分离隔膜将喉管通气腔分隔成互相连通的通气过滤腔和气道操作腔，过滤网膜套筒设置在通气过滤腔内。通气过滤腔位于邻近通气接口一侧，气道操作腔位于邻近操作单向阀一侧。
在所述罩体腔、喉管通气腔前端或通气过滤腔邻近喉罩罩体的前段内设置储物腔；储物腔设置为后侧开口，前侧为盲端的袋状腔，储物腔容积大于1立方厘米。
在储物腔开口部设置若干瓣膜片，瓣膜片一侧边缘和储物腔开口部边缘相连，另外一侧与储物腔开口部边缘形成较小裂隙。
在喉罩导管外部设置口齿固定结构，口齿固定结构上方前部设有口齿卡固块、上方后部设有临时锁定块、下部设有滑动块；滑动块能延喉罩导管长轴滑移，使口齿卡固块卡固在牙齿或牙龈部，并使用临时锁定块将口齿固定结构和喉罩导管临时锁定。
所述喉罩导管设置为硬质导管，喉罩罩体尾部与喉罩导管柔性连接，通气时硬质线型工具能经操作单向阀、喉管通气腔和罩体腔进入声门。
所述硬质导管为直线型导管，在喉罩罩体尾部与喉罩导管柔性连接部腔内埋设支撑弹簧。
本发明的优点：通过过滤网膜套筒设置，使进出患者肺内的气体均得到可靠的过滤效果，避免因呼吸机或患者引起的呼吸道交叉感染的发生；过滤网膜套筒与通气导管一体设置，能避免麻醉医生因临床工作过于繁忙，遗忘呼吸过滤器的应用；在通气导管尾端设置操作单向阀，正常通气时不影响密封效果，经操作单向阀置入相应工具，对气道内实施操作时，能在气道操作同时避免呼吸中断，能同步实施可靠的通气支持，确保气道内操作的安全性；储物腔的设置，能提高气道操作的效率，减少气道内损伤操作时的出血时间，减少气道损伤， 缩短手术时间，大大提高气道内手术的安全性；简化了呼吸过滤器的结构和重量，减少了呼吸过滤器对喉罩的牵扯力，减少了通口咽腔在手术中意外脱出风险。
附图说明
图1为本发明第一种实施例的结构示意图。
图2为本发明第一种操作单向阀结构示意图。
图3为本发明第二种操作单向阀结构示意图。
图4为本发明单向阀设置硬质引导管的结构示意图。
图5为本发明插口管的结构示意图。。
图6为本发明设置过滤网膜套筒的结构示意图。
图7为本发明设置网状支撑套筒的结构示意图。
图8为本发明第二种实施例的结构示意图。
图9为本发明图8中喉罩罩体设置储物腔的示意图。
图10为本发明图9中储物腔口部设置瓣膜片的示意图。
图11为本发明图8中喉管通气腔内设置储物腔的示意图。
图12为本发明硬质支气管镜操作的患者体位示意图。
图13为本发明第三种实施例的结构示意图。
图14为本发明口齿固定结构的纵剖面示意图。
图15为本发明插口管的另一种实施例结构示意图。
附图标记说明：1-喉罩罩体、10-罩体腔、11-支撑弹簧、02-硬质导管、2-喉罩导管、21-喉管通气腔、211-通气过滤腔、212-气道操作腔、22-分离隔膜、3-通气接口、31-延伸段、4-操作单向阀、40-环形孔、41-环形孔软膜、42-密封盖、43-鸭嘴软膜、431-套筒膜、432-线性开口、433-膜片、44-硬质锥形引导口、45-硬质鸭嘴阀支撑口、46-装配孔、47-固定柱、5-插口管、6-过滤网膜套筒、60-网状支撑套筒、7-储物腔、71-瓣膜片、8-口齿固定结构、81-口齿卡固块、82-临时锁定块、83-滑动块。
具体实施方式
下面结合具体附图和实施例对本发明作进一步说明。
如图1所示，本发明所述一种气道操作喉罩，包括通气时环绕在声门外咽喉壁的喉罩罩体1、设置在喉罩罩体1后端与罩体腔10密封连通的喉罩导管2、设置在喉罩导管2尾部与喉管通气腔21密封连通用于连接呼吸管路的通气接口3和用于向喉管通气腔21内置入气道操作工具的操作单向阀4。
使用时，所述喉罩罩体1位于咽喉腔底部，所述罩体腔10口部环绕罩盖在声门外围的咽喉腔粘膜，位置合适时能对声门形成较好的密封效果，实现机械通气。喉罩罩体1后端与罩体腔10密封连通设置喉罩导管2，在喉罩导管2尾部密封连通设置通气接口3和呼吸管路连通用于呼吸支持，其工作原理此处不再赘述。喉罩导管2尾部还设置了用于向喉管通气腔21内置入气道操作工具的操作单向阀4。
正常通气时，操作单向阀4的作用能使喉管通气腔21内气体不能经操作单向阀4逸出；需要进行气道操作时，通过操作单向阀4能经喉管通气腔21和罩体腔10向气道内置入操作工具；同时，喉管通气腔21内气体不能经操作单向阀4逸出。这样，操作单向阀4能为气道操作提供操作工具置入通路，同时能为机械通气提供密封性，确保气道操作安全性。
具体的，能通过操作单向阀4，经喉管通气腔21、罩体腔10和声门，能向气道内置入操作工具；同时，喉管通气腔21、罩体腔10和气道内腔的气体不能经操作单向阀4逸出。这样，需要在气道内行手术操作时，仅需将操作工具，如：纤支镜、电凝/电切工具、吸痰管、气管支撑网等，经操作单向阀4置入，操作工具经操作单向阀4、喉管通气腔21、罩体腔10和声门能到达到气管内，从而完成气道内手术操作。气道内手术操作同时，将通气接口3连接呼吸机或麻醉机，能经喉罩罩体1环罩声门，与气道形成的密封腔道，能对患者行呼吸支持。
为了达到操作单向阀4在通气时，无论置入或不置入操作工具，均不漏气的效果，所述操作单向阀4采用的技术方案包括但不限于以下两种方案：
方案一：如图2所示，使用环形孔软膜41和密封盖42配合。环形孔软膜41采用柔软的硅胶、橡胶、乳胶或其他医用材料制作，其环形孔40孔径与常用的腔道操作工具(截面均为圆形)匹配，或稍小于常用的腔道操作工具外径，达到操作工具能轻松置入，阻力不能过大，同时环形孔40边缘的柔性材料膜能与操作工具外壁充分接触，起到较强的密封效果。环形孔40的内径设置为2mm最佳。为了加强置入操作工具时的通气密封性，环形孔软膜41设置为锥形口远离操作单向阀4开口部的锥形结构最佳。在没有进行气道操作时，为了避免通气时经环形孔40漏气，设置匹配的密封盖42，将设置操作单向阀4的开口封盖密封即可。
方案二：如图3所示，使用环形孔软膜41和鸭嘴软膜43配合。环形孔软膜41的作用是与方案一相同，在置入咽喉腔工具时能起到密封作用。而鸭嘴软膜43在邻近操作单向阀4外部一侧为套筒膜431，与操作单向阀4外部套筒匹配，其邻近喉管通气腔21一侧为线性开口432，开口两侧的膜片433与套筒膜431连接。机械通气时，当没有置入操作工具时，喉管通气腔21腔内压力较高，线性开口432两侧的膜片433在通气正压压力(麻醉机械通气) 作用下互相贴合，使线性开口432闭合，喉管通气腔21腔内不能经线性开口432逸出；当置入气道操作工具时，鸭嘴软膜43线性开口432张开，气体会逸出，但此时，环形孔软膜41能起到密封气道操作工具外侧间隙的作用，原理与方案一相同。
如图4所示，为了避免气道操作中，将气道操作工具拔出时，造成操作单向阀4内的环形孔软膜41或/和鸭嘴软膜43反向卷曲，可以在环形孔软膜41后设置硬质锥形引导口44，对环形孔软膜41行支撑作用。硬质锥形引导口44外形与环形孔软膜41相似，中间的孔径较环形孔40更大，最佳直径设置为4mm-5mm。同理，可以在鸭嘴软膜43后设置硬质鸭嘴阀支撑口45，硬质鸭嘴阀支撑口45后部为圆筒状，前部为楔形切口，楔形切口切断面能对线性开口432两侧的膜片433行支撑作用。
为了确保环形孔软膜41和鸭嘴软膜43装配后的牢固度，避免环形孔软膜41和鸭嘴软膜43松动脱出，造成气道内异物，导致手术意外。可以在环形孔软膜41、硬质鸭嘴阀支撑口45和鸭嘴软膜43后端环形边缘适配位置设置若干装配孔46，并在对应的硬质锥形引导口44后端环形边缘适配位置设置固定柱47，装配时将环形孔软膜41、硬质鸭嘴阀支撑口45和鸭嘴软膜43环形边缘的装配孔46对位环套在固定柱47上。就能达到较高的牢固度，避免使用时环形孔软膜41和鸭嘴软膜43意外脱出到气道内。
如图5所示，为了便于上述方案的实施，为了进一步提高气道操作工具置入和操作时的便捷性，所述喉管通气腔21尾部密封设置插口管5，所述插口管5前端一侧能匹配套置在喉管通气腔21内，插口管5设置通气接口3和操作单向阀4。如此，操作单向阀4和通气接口3长轴可以与喉管通气腔21内腔长轴方向一致，置入气道操作工具时，更为顺畅，操作更加便捷。而通气接口3与呼吸装备连接时，也更符合临床医生的使用习惯。同时，方向一致的操作单向阀4和通气接口3使插口管5结构更加简洁，减少模具成本及装配成本，有利于大批量生产。喉管通气腔21内腔较粗，为插口管5的置入和应用提供了充足的实施空间。
如图15所示，为了减少或避免通气接口3连接呼吸管路时对气道操作工具置入操作单向阀4的干扰，也可以将操作单向阀4设置在插口管5的轴线上，插口管5前端置入喉管通气腔21并固定，操作单向阀4位于插口管5后端。通气接口3连接设置在插口管5的侧方，用于连接呼吸管路。本实施例中，操作单向阀4设置了二个大小口径不同的环形孔膜41，以便适应外径粗细不同的操作工具。操作单向阀4套筒口径设置在7mm-10mm最佳，可以置入直径在6-8mm的气道工具；大的环形孔膜41的环形孔40直径设置在5mm为佳，可以为直径在5.5-8mm的气道工具提供密封；小的环形孔膜41的环形孔40直径设置在2.5mm为佳，可以为直径在3mm-6mm的气道工具提供密封的气道工具
如图6所示，所述通气接口3在喉管通气腔21内延伸段31设置过滤网膜套筒6；所述过滤网膜套筒6筒口部与通气接口3延伸段31开口密封连接。
所述过滤网膜套筒6筒口部一端与通气接口3延伸段31密封连接。过滤网膜套筒6另外一端为盲端，与通气接口3形成一个以通气接口3为开口的袋状结构。机械通气时，吸气相时，气体首先经过通气接口3，再进入过滤网膜套筒6过滤，然后，进入患者气道及肺部。呼气相时，患者肺部呼出气体先经过滤网膜套筒6过滤，再经通气接口3进入呼吸管路。这样，进出患者肺内气体均经过过滤处理，既能避免患者呼出气体污染呼吸机或麻醉机呼吸管路，也能避免呼吸机或麻醉机供应气体污染患者气道，能有效避免机械通气引起的交叉感染。
在目前临床工作中，麻醉机和呼吸机使用前原则上应一人一消毒，在ICU、呼吸科、心内科等科室，每个患者呼吸支持时间较长，呼吸机使用频率较低，可以做到一人一消毒。但在全国所有麻醉科，临床麻醉工作极为繁忙，麻醉机使用频率极高，均做不到一人一消毒，也做不到一天一消毒(麻醉机销售量和麻醉消毒机销售量严重不匹配)。即使使用消毒机对麻醉机消毒，每次有效消毒需要至少1小时以上，在目前工作条件下，根本不能满足麻醉机和呼吸机繁忙的临床使用需求；同时，消毒时需取下二氧化碳吸收剂罐体，倒出二氧化碳吸收剂，造成浪费。没有执行严格的消毒措施，极易造成麻醉机源性经呼吸道交叉感染，但缺乏相应的研究和证明。
为了减少交叉感染，目前方法是在呼吸管路中使用人工鼻，人工鼻内装置过滤纸，人工鼻的过滤面积较小，为了减少呼吸阻力，使用的过滤膜孔径为5nm，过滤效果稍有不足。在临床工作时，还常发生人工鼻遗忘使用的情况。在某些地区(如广州，福建，浙江等)人工鼻不能收费，为医院硬性支出。有医院为了降低成本，使用劣质人工鼻，或故意反复使用人工鼻，甚至不使用人工鼻，给患者带来交叉感染风险。
利用如图6所示的过滤网膜套筒6，其长度增加，过滤膜可往返折叠，有效过滤面积大大增加。在保持与现有人工鼻相当的呼吸阻力情况下，可以使用过滤孔径更细微的过滤膜，从而提供更为可靠的过滤效果。具体的，可选用N95材料，或更优质的N99材料，提供更好的过滤效果，避免呼吸道交叉感染。过滤网膜套筒6设置在喉管通气腔21腔内，与本产品一体设置，能完全避免人工鼻的遗忘使用，也减少了另外拿取人工鼻，拆包装，连接人工鼻的临床工作量。同时，临床使用的人工鼻体积大，重量大，对喉罩形成较大的牵扯力，有时会导致喉罩移位、脱出或呼吸管路连接口脱开。而置入喉管通气腔21腔内的过滤网膜套筒6设计，减少了人工鼻外壳，减少了重量，极大程度减少了此类事件的发生。
但随之而来，可能的问题是：所述过滤网膜套筒6本身为柔性材料，吸气相时，在正压气体进入通气接口3内时，气体经过滤网膜套筒6过滤进入喉管通气腔21腔内，在滤网膜套筒6套筒腔内侧正压作用下，过滤网膜套筒6呈张开趋势，通气阻力能保持在正常水平。呼气相时，气体经喉管通气腔21腔内进入过滤网膜套筒6内时，在滤网膜套筒6套筒腔外侧正压作用下，过滤网膜套筒6呈闭合趋势，过滤网膜套筒6内通气腔减少，可能由此导致呼吸阻力增加。在气道阻力较大的老年患者，尤其是哮喘患者，更为严重。
为了解决上述问题，如图7所示，在所述通气接口3在喉管通气腔21内延伸并连接设置网状支撑套筒60，所述过滤网膜套筒6套置在网状支撑套筒60外部。
在过滤网膜套筒6内腔套置网状支撑套筒60，网状支撑套筒60能对过滤网膜套筒6起到支撑作用，避免呼气相时过滤网膜套筒6过度闭合，避免因此导致的呼吸阻力增加，确保肺内气体呼出时的气道通畅。所述网状支撑套筒60选用硬度比过滤网膜套筒6更高的弹性材料制成，呈网状套筒结构，能确保过滤网膜套筒6对气体过滤的有效面积及通气面积。
如图8所示，是该发明另一种更优化的实施例示意图。所述喉罩导管3内延长轴设置分离隔膜22将喉管通气腔21通气腔分隔成互相连通的通气过滤腔211和气道操作腔212，过滤网膜套筒6设置在通气过滤腔211内；通气过滤腔211位于邻近通气接口3一侧，气道操作腔212位于邻近操作单向阀4一侧。
通过分离隔膜22的设置，将过滤网膜套筒6和置入的气道工具分隔开，各有各的腔道。过滤网膜套筒6为表面粗糙，微观下有许多毛刺的絮状结构，很容易和置入的操作工具发生碰触，进而被损害，导致破口，使过滤效果下降。有些操作工具顶端较为尖锐，如索柄剪刀，索柄钳子等，更容易引起过滤网膜套筒6破坏。分离隔膜22的设置，为操作工具置入和退出提供了专用通道气道操作腔212，能避免操作工具置入时对过滤网膜套筒6的破坏，确保通气时的过滤效果。
优选设置为：喉罩导管2拉伸成直线后，所述操作单向阀4中轴线与气道操作腔212中轴线贴近或重合。这样，经操作单向阀4置入咽喉腔工具时，将气道工具置入时的弯曲度降到最低，能将气道工具对喉罩导管2的接触面积降到最低，从而将气道工具置入时的阻力降到最低。为了进一步减少气道工具置入时的阻力，所述喉罩导管2内壁可做超滑处理，或置入前给气道工具外壁涂设润滑剂。
通气接口3设置在喉罩导管2中轴线侧方，能避开气道工具置入时的路径，为气道工具置入提供最佳通道。通气时，气体经过滤网膜套筒6侧壁通过不受影响，通气阻力基本一致。
目前临床气道手术操作时，若使用喉罩作为呼吸管理工具，操作时较为繁琐。每次将操作工具置入咽喉腔后，钳夹异物或其他组织后，均需将整个操作工具退出气道，将取出物保存后，再置操作工具入进行下次操作。反复拔出或置入咽喉腔操作工具，耗费了大量无效操作时间。还增加了操作工具进出喉罩的次数，多次操作的连续性中断，造成手术效果下降。更为严重的是，若进行的是口咽腔内肿瘤切除术，在拔出操作工具(切除部分肿瘤)到置入操作工具(对切口部分止血)，这段操作时间间隔中，切口处于出血期，出血量虽然不多，但气道内出血带给患者的风险极大。而口咽腔内肿瘤切除需要多次反复操作，特别是血供丰富的肿瘤，尤其是血管部位，拔插操作工具的风险大大增加。
进一步的，为了提高气道操作手术效率和安全性，如图9所示，在所述喉罩罩体1前段设置储物腔7，储物腔7为一侧开口另一侧为盲端的袋状腔，开口侧邻近过滤网膜套筒6，储物腔7容积大于1立方厘米。
喉罩罩体1形成的10罩体腔空间较大，足以设置储物腔7。这样，邻近喉罩罩体1前段设置的储物腔7并不影响通气效果，但却提供了一个手术取出组织的存放空间。实施气道手术操作时，无需每次都要将全部操作工具拔出本发明所述气道操作喉罩内腔。仅需拔出少许，退到喉罩罩体1后部，将操作工具头端进入储物腔7，即可将松开取物钳，将取出的组织存放在储物腔7内，然后将操作工具头端退出储物腔7，再次将气道操作工具置入气道内继续手术操作。等手术结束患者清醒拔管后，破坏本发明所述气道操作喉罩，将多次操作存放在储物腔7内的标本组织一起取出。
这种结构不仅在气道内肿瘤切除有较高的实用，在气道内异物取出时也有极高价值。因为在异物取出时，异物多为花生，瓜子，果冻等容易破碎的食物，手术时需多次反复操作，才能将整个异物取出。
如图10所示，为图9中储物腔7开口部设置若干瓣膜片71的结构示意图，瓣膜片71的设置是为了防止取出组织的意外脱出。瓣膜片71为柔软的医用材料，瓣膜片71一侧边缘和环形开口内侧或外侧边缘相连，另外一侧边缘与环形开口边缘相分离，仅保持为接触状态，或形成较小裂隙。放置取出组织时，仅需将取物钳伸进该空腔内，松开钳口，后退钳口，在瓣膜片71阻挡作用下，取出组织脱落在储物腔7内。在瓣膜片71阻挡作用下，保存在储物腔7内的取出组织很难脱出。
如图11所示，为储物腔7的另外一种实施例。在喉管通气腔21前端设置储物腔7。其结构和功能和图8类似，优选在口部设置若干瓣膜片71，此处不再赘述。而喉管通气腔21空间也足够设置储物腔7，并不影响通气效果。
硬质支气管镜为直线型金属腔道，内设光源和视频采集显示装置，在临床上因为操作难度较软质纤维支气管镜更低，受临床欢迎。但硬质支气管镜置入时，需患者头颈部近乎极限后仰，使口咽喉声门处在同一条直线上，如图12所示。
进一步的，为了使本发明所述产品便于硬质支气管镜使用，如图13所示，所述喉罩导管2设置为硬质导管02，喉罩罩体1尾部与喉罩导管2连接的柔性接口腔内埋设支撑弹簧11，通气时硬质线型工具能经操作单向阀4、喉管通气腔21和罩体腔10进入声门。
使用时，仅需将喉罩罩体1置入咽喉腔并正确对位，利用喉罩罩体1尾部与喉罩导管2连接的柔性接口，可以随意改变喉罩罩体1尾部与喉罩导管2连接角度。喉罩罩体1置入咽喉腔底部并正确对位后，移动并极度后仰患者头颈部，使患者口咽喉位于一条直线上，此时，位于患者口腔内外的喉罩导管2和位于患者咽喉腔底部的喉罩罩体1通过柔性接口适应性自动调节角度，使喉罩导管2和口咽喉直线轴贴近或重合，使喉罩导管2和患者声门位于同一条直线上。此时，固定患者头颈体位和喉罩导管2，即可开始气道操作手术。
所述硬质导管02优选直线导管，也可使用弧度较小的弯曲导管。若选用弯曲导管，硬质导管02尾端的操作单向阀4的中轴线延长线应落在硬质导管02前端出口腔内。也就是说，使用硬质支气管镜时，硬质支气管镜经操作单向阀4置入硬质导管02后，能经硬质导管02前端出口进入罩体腔10内，然后通过患者声门进入患者气道内。使用直线导管或弧度较小的硬质导管，能减少或避免硬质支气管镜置入时和硬质导管02的摩擦，便于将硬质支气管镜顺利的置入声门，进入气管进行后续操作。
所述喉罩罩体1尾部与喉罩导管2连接的柔性接口在弯曲角度较大时，容易造成柔性接口打折，甚至瘪陷，给后续操作带来不利因素，为了避免柔性接口打折，可以在柔性接口打折内埋设支撑弹簧。在支撑弹簧作用下，柔性接口弯曲灵活性基本不变，却能确保柔性接口内腔横截面，保证通气效果。
在气道操作时，尤其是使用硬质支气管镜进行气道操作时，本发明所述气道操作喉罩的固定显得尤其重要。气道操作喉罩与患者口齿良好的固定效果，是确保气道操作中患者口咽喉声门处在同一条直线上的重要保障。
为了提高固定效果，如图14所示，在喉罩导管2外部设置口齿固定结构8，口齿固定结构8上方前部设有口齿卡固块81、上方后部设有临时锁定块82、下部设有滑动块83；滑动块83能延喉罩导管2长轴滑移，使口齿卡固块81卡固在牙齿或牙龈部，并使用临时锁定块82将口齿固定结构8和喉罩导管2临时锁定。
所述滑动块83为环形结构，包绕套置在喉罩导管2外部。滑动块83内腔与喉罩导管 2外形适配，较喉罩导管2外形稍大，能套置在喉罩导管2外部沿喉罩导管2长轴滑移。所述口齿卡固块81为一弧形凹槽，弧形曲度与牙列适配。所述临时锁定块82为螺杆84外形，螺杆表面设有螺纹，螺杆顶部设有调节帽，转动调节帽能旋转螺杆84。贯穿滑动块83环形侧壁设有适配的螺孔85，螺孔85内表面设有和螺杆84适配的螺纹。持续正方向旋转螺帽，能使螺杆84在螺孔85转动前进，使螺杆84顶部靠近并顶持在喉罩导管2外表面，直至螺帽不能转动为止。需要松开口齿固定结构8时，反方向转动螺帽，使螺孔85转动后退，直至螺杆顶部离开喉罩导管2外表面即可。
当喉罩罩体1与声门正确对位、喉罩导管2位置正确后，沿喉罩导管2滑移调节滑动块83，使口齿卡固块81能正确对位患者口齿部位。当口齿卡固块81凹槽和患者牙列或牙龈正确对位后，调节旋紧临时锁定块82，使调节滑动块83和喉罩导管2锁定即可。
口齿固定结构8具体实施方案有多种，此处不再一一赘述。
总之，本发明所述气道操作喉罩，通过过滤网膜套筒6设置，最大限度减少呼吸道交叉感染；通过操作单向阀4设置，能在气道操作同时呼吸支持；通过储物腔7设置，提高气道操作手术效率，提高气道内手术安全性；通过口齿固定结构8的设置，能方便固定气道操作喉罩。安全可靠，使用方便，值得推广。

Claims (10)

  1. 一种气道操作喉罩，其特征是：包括通气时环绕在声门外咽喉壁的喉罩罩体(1)、设置在喉罩罩体(1)后端与罩体腔(10)密封连通的喉罩导管(2)、设置在喉罩导管(2)尾部与喉管通气腔(21)密封连通用于连接呼吸管路的通气接口(3)和用于向喉管通气腔(21)内置入气道操作工具的操作单向阀(4)；
    通气时，喉管通气腔(21)内气体不能经操作单向阀(4)逸出；通过操作单向阀(4)能经喉管通气腔(21)和罩体腔(10)向气道内置入操作工具；同时，喉管通气腔(21)内气体不能经操作单向阀(4)逸出。
  2. 根据权利要求1所述的气道操作喉罩，其特征是：所述喉管通气腔(21)尾部密封设置插口管(5)，所述插口管(5)前端一侧能匹配套置在喉管通气腔(21)内，插口管(5)设置通气接口(3)和操作单向阀(4)。
  3. 根据权利要求2所述的气道操作喉罩，其特征是：所述通气接口(3)在喉管通气腔(21)内延伸段(31)设置过滤网膜套筒(6)；所述过滤网膜套筒(6)筒口部与通气接口(3)延伸段(31)开口密封连接。
  4. 根据权利要求3所述的气道操作喉罩，其特征是：所述通气接口(3)在喉管通气腔(21)内延伸并连接设置网状支撑套筒(60)，所述过滤网膜套筒(6)套置在网状支撑套筒(60)外部。
  5. 根据权利要求4所述的气道操作喉罩，其特征是：所述喉罩导管(2)内延长轴设置分离隔膜(22)将喉管通气腔(21)通气腔分隔成互相连通的通气过滤腔(211)和气道操作腔(212)，过滤网膜套筒(6)设置在通气过滤腔(211)内；通气过滤腔(211)位于邻近通气接口(3)一侧，气道操作腔(212)位于邻近操作单向阀(4)一侧。
  6. 根据权利要求1或5所述的气道操作喉罩，其特征是：在所述罩体腔(10)、喉管通气腔(21)前端或通气过滤腔(211)邻近喉罩罩体(1)的前段内设置储物腔(7)；储物腔(7)设置为后侧开口，前侧为盲端的袋状腔，储物腔(7)容积大于1立方厘米。
  7. 根据权利要求6所述的气道操作喉罩，其特征是：在储物腔(7)开口部设置若干瓣膜片(71)；瓣膜片(71)一侧边缘和储物腔(7)开口部边缘相连，另外一侧与储物腔(7)开口部边缘形成较小裂隙。
  8. 根据权利要求1所述的气道操作喉罩，其特征是：在喉罩导管(2)外部设置口齿固定结构(8)，口齿固定结构(8)上方前部设有口齿卡固块(81)、上方后部设有临时锁定块(82)、下部设有滑动块(83)；滑动块(83)能延喉罩导管(2)长轴滑移，使口齿 卡固块(81)卡固在牙齿或牙龈部，并使用临时锁定块(82)将口齿固定结构(8)和喉罩导管(2)临时锁定。
  9. 根据权利要求1所述的气道操作喉罩，其特征是：所述喉罩导管(2)设置为硬质导管(02)，喉罩罩体(1)尾部与喉罩导管(2)柔性连接，通气时硬质线型工具能经操作单向阀(4)、喉管通气腔(21)和罩体腔(10)进入声门。
  10. 根据权利要求9所述的气道操作喉罩，其特征是：所述硬质导管(02)为直线型导管，在喉罩罩体(1)尾部与喉罩导管(2)柔性连接部腔内埋设支撑弹簧(11)。
PCT/CN2020/114696 2020-07-06 2020-09-11 气道操作喉罩 WO2022007184A1 (zh)

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