WO2022037595A1 - 可视喉镜和可视导芯组合的双可视双定位气管插管套装 - Google Patents

可视喉镜和可视导芯组合的双可视双定位气管插管套装 Download PDF

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Publication number
WO2022037595A1
WO2022037595A1 PCT/CN2021/113131 CN2021113131W WO2022037595A1 WO 2022037595 A1 WO2022037595 A1 WO 2022037595A1 CN 2021113131 W CN2021113131 W CN 2021113131W WO 2022037595 A1 WO2022037595 A1 WO 2022037595A1
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Prior art keywords
guide core
intubation
visual
laryngoscope
tracheal
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PCT/CN2021/113131
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English (en)
French (fr)
Inventor
黄加庆
王金领
王莹
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黄加庆
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Priority claimed from CN202010840687.5A external-priority patent/CN111803773A/zh
Priority claimed from CN202021744864.1U external-priority patent/CN212651201U/zh
Application filed by 黄加庆 filed Critical 黄加庆
Priority to JP2023512401A priority Critical patent/JP2023538122A/ja
Priority to US18/022,139 priority patent/US20240008732A1/en
Priority to EP21857687.4A priority patent/EP4183437A1/en
Publication of WO2022037595A1 publication Critical patent/WO2022037595A1/zh

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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/04—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00002—Operational features of endoscopes
    • A61B1/00011—Operational features of endoscopes characterised by signal transmission
    • A61B1/00016—Operational features of endoscopes characterised by signal transmission using wireless means
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00002—Operational features of endoscopes
    • A61B1/00043—Operational features of endoscopes provided with output arrangements
    • A61B1/00045—Display arrangement
    • A61B1/00052—Display arrangement positioned at proximal end of the endoscope body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00064—Constructional details of the endoscope body
    • A61B1/00066—Proximal part of endoscope body, e.g. handles
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/04—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances
    • A61B1/05—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor combined with photographic or television appliances characterised by the image sensor, e.g. camera, being in the distal end portion
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/267—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for the respiratory tract, e.g. laryngoscopes, bronchoscopes
    • 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
    • A61M16/0488—Mouthpieces; Means for guiding, securing or introducing the 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
    • A61M2205/00—General characteristics of the apparatus
    • A61M2205/35—Communication
    • A61M2205/3546—Range
    • A61M2205/3569—Range sublocal, e.g. between console and disposable
    • 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
    • A61M2205/00—General characteristics of the apparatus
    • A61M2205/35—Communication
    • A61M2205/3576—Communication with non implanted data transmission devices, e.g. using external transmitter or receiver
    • A61M2205/3592—Communication with non implanted data transmission devices, e.g. using external transmitter or receiver using telemetric means, e.g. radio or optical transmission
    • 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
    • A61M2205/00—General characteristics of the apparatus
    • A61M2205/50—General characteristics of the apparatus with microprocessors or computers
    • A61M2205/502—User interfaces, e.g. screens or keyboards
    • 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
    • A61M2209/00—Ancillary equipment
    • A61M2209/06—Packaging for specific medical equipment

Definitions

  • the invention relates to the technical field of medical instruments, in particular to a dual-visual dual-positioning tracheal intubation set combined with a visual laryngoscope and a visual guide core, which is especially suitable for rapid intubation of patients with difficult airways.
  • tracheal intubation is required for critically ill patients, especially those with respiratory arrest and general anesthesia, to help patients breathe.
  • Tracheal intubation refers to the technique of inserting a special tracheal tube into the trachea through the glottis, which can provide the best conditions for airway patency, ventilation and oxygen supply, airway suction and prevention of aspiration.
  • endotracheal intubation is a necessary means to maintain respiratory function. Medical staff must deliver endotracheal intubation to the patient's trachea in a short period of time to provide respiratory support. Therefore, how to quickly and effectively Tracheal intubation has become a key issue in patient care.
  • Direct-view laryngoscope also known as direct laryngoscope, fiber optic laryngoscope or ordinary laryngoscope, is low in cost and durable. Although it is widely used in clinical practice, there are certain limitations and deficiencies in clinical use. 1. There are certain requirements for the patient's position. During intubation, the patient is required to use the supine position and the head tilted back.
  • the patient's mouth axis, pharyngeal axis, and laryngeal axis are three axes and one line; , protruding incisors, hypertrophy of the tongue, high throat, obesity, stubby neck, restricted mandibular movement, restricted cervical spine mobility and other special body types, or cervical spine injuries and unable to tilt the head back, etc.
  • the glottis is often not seen, so blind intubation can only be performed; blind intubation is somewhat tentative, and repeated stimulation to the throat can cause local mucosal hemorrhage, edema, or even laryngospasm and glottis.
  • Tight closure, etc. will cause great damage to the airway, further increasing the difficulty of tracheal intubation; blind probing intubation is easy to mistakenly insert into the esophagus, causing aspiration complications, low intubation success rate or even intubation failure; 2.
  • To expose the glottis in three axes and one line it is often necessary to excessively expose the oropharynx, and it is necessary to increase the lifting force of the lens handle, which may easily cause damage to the lips, teeth, tongue, and pharynx; Laryngoscope lift is prone to cardiovascular reactions during intubation; 4.
  • the thickness of the direct-view laryngoscope blade is large, and the mouth opening must be large (generally more than 3cm) before it can be placed in the oral cavity, and the mouth opening is limited. Not applicable for patients (mouth opening less than 3cm).
  • Video laryngoscope There are two types of video laryngoscopes used in clinical practice. The first type has a lens curvature similar to that of a direct-view laryngoscope, except that a visual device is added, and its intubation method is similar to that of a direct-view laryngoscope.
  • the pharynx is physiologically curved, and the angle of view is turned forward by about 60 degrees (different manufacturers have different design angles), the angle of view is moved forward, and the tracheal intubation does not require excessive head and neck tilt, and the glottis can be exposed without the need for the three axes of the mouth, pharynx, and larynx.
  • video laryngoscopes can increase the exposure of the glottis in difficult airways by 1 to 2 or even 3 levels, which solves most of the problems of difficult airways under general anesthesia.
  • video laryngoscopes used clinically belong to this type, and the video laryngoscope described below in the present invention is this type of laryngoscope.
  • Video laryngoscope makes it easier to expose the glottis, but there are some limitations and deficiencies in clinical use: 1.
  • Video laryngoscope is easy to expose the glottis, but intubation into the glottis is more complicated and difficult than direct-view laryngoscope, This is because in order to prevent the front part of the lens from blocking the lens and to prevent the tube from blocking the lens when the catheter enters the lens, the curvature of the lens is relatively large, and the corresponding front end of the tracheal tube must have a relatively large bending angle; when the tracheal tube is inserted into the glottis, the mouth, pharynx, The laryngeal triaxial is not in a line but bends at a large angle.
  • the tip of the tube first presses forward against the anterior wall of the subglottic laryngeal chamber, and then bends downward before entering the glottis and trachea.
  • the intubation resistance is large, and the resistance of tracheal intubation may be This causes the tip of the endotracheal tube to slip out of the glottis, and the endotracheal tube is often not smoothly inserted into the glottis even with an adjustable tip guide; when intubating with a direct-view laryngoscope, the eyes are outside the mouth, and the line of sight is directed at the tip of the tube. It is inserted into the glottis, and the video laryngoscope moves the eye to the display screen.
  • the human eye and the field of view are not consistent. After the parallax occurs, it can be seen that there is no income. Therefore, although it is easier to see the glottis field of view, it is more difficult to judge the tube.
  • the relationship between the tip and the glottis may easily cause difficulty in intubation or even misinsertion into the esophagus; 2.
  • the video laryngoscope lens has a large curvature, which is easy to expose the glottis but difficult to intubate. Therefore, the guide core of the video laryngoscope is generally relatively rigid. It is easy to cause accidental pharynx, larynx, and vocal cord damage; 3.
  • the visual laryngoscope can only observe the oral cavity and glottis position.
  • the tracheal tube When the catheter enters the glottis, the tracheal tube often blocks the lens of the video laryngoscope, which cannot fully achieve the visual effect, and may be inserted into the esophagus by mistake. , resulting in a lower success rate of intubation; 5.
  • the video laryngoscope is the same as the direct-view laryngoscope, the thickness of the lens is large, and the mouth opening must be large (generally more than 3cm) before it can be placed in the oral cavity. For patients with limited mouth opening ( The mouth opening is less than 3cm) not applicable.
  • Visual guide core There are many names of visual guide cores used in clinical practice, such as visual tube core, video light rod, catheter-type visual laryngoscope, etc.
  • the present invention uniformly uses the insertion into the tracheal tube to guide tracheal intubation
  • the guide core with camera device is collectively referred to as the visual guide core.
  • the commonly used visual guide cores in clinical practice include the formable visual guide core and the rigid non-plastic visual guide core; the rigid non-plastic visual guide core is generally shaped in advance according to the physiological curvature of the oropharynx, and cannot be used during use.
  • the advantage of individualized reshaping is that the guide core is hard, and the guide core will not be deformed during intubation.
  • the guide core Since the guide core does not need to be repeatedly bent and reshaped, the guide core is not easily damaged.
  • the disadvantage is that individual reshaping cannot be performed.
  • the hard guide core is easy to damage the oral mucosa, epiglottis, around the glottis, vocal cords and other tissues; the advantages and disadvantages of the shapeable visual guide core are the opposite.
  • the left thumb grabs the patient's lower incisor and lifts the mandible and tongue upward to expand the pharyngeal space, and the right hand holds the visual guide core and inserts it into the oral cavity for tracheal intubation.
  • the assistant can assist to hold the patient's lower jaw to facilitate tracheal intubation.
  • the visual guide core does not require high mouth opening, and can solve the tracheal intubation problem of most patients with difficult airway with too small mouth opening.
  • the method of raising the lower jaw and tongue of the patient to expand the pharyngeal space requires the patient to have no occlusal ability, but in actual clinical work, especially emergency intubation patients often do not receive general anesthesia, Muscle loosening, the patient retains the ability of spontaneous breathing and occlusal.
  • the thumb cannot be inserted into the patient's mouth, so that the visual guide core intubation method cannot be used; 2.
  • Use the left thumb to grasp the patient's lower incisor and lift the mandible and tongue upward.
  • the epiglottis and glottis exposed by the body method are ineffective, and in patients with general anesthesia or critically ill patients without spontaneous breathing, due to muscle relaxation and aggravated tongue retraction, the difficulty of exposing the epiglottis and glottis is further exacerbated. Obstruction, and sometimes there is not enough space to enter the guide core. At this time, even if there is an assistant to support the patient's jaw to facilitate the operator to expose the patient's epiglottis and glottis, it is often impossible to fully expose the epiglottis and glottis, resulting in difficult intubation operations; 3.
  • the visual guide core When the visual guide core is used for tracheal intubation, the epiglottis is often blocked and the glottis cannot be displayed. It is necessary to bypass or cross the epiglottis from the side of the epiglottis. The intubation operation is difficult, resulting in a long intubation time, and the tracheal intubation cannot be completed quickly. The tube or even intubation fails; 4. The shapeable visual guide core is often easily deformed because the guide core is too soft, resulting in difficulty in intubation; the hard non-shapeable visual guide core often fails to form part of the guide core.
  • the guide core is too hard, and it is easy to damage the oral mucosa, epiglottis, surrounding glottis, vocal cords and other tissues during operation, causing bleeding or edema, and aggravating the difficulty of tracheal intubation.
  • Light stick The light stick is completely blind insertion because it only depends on the light transmission strength to judge the position of the glottis, which is likely to cause damage to the lips, teeth, tongue, pharynx, glottis, trachea and other parts, which will cause great damage to the human body. , and it is inaccurate to judge that the glottis has entered the glottis simply by the light of the larynx, there may be misinsertion into the esophagus, and the success rate of intubation is low.
  • Fiberoptic bronchoscope It can be used for endotracheal intubation of various difficult airways, but there are also certain limitations and deficiencies in clinical use: 1. The tube is soft, and it takes time and labor to adjust the direction in the oral cavity, and the operation is difficult and must be It takes a long time to operate. In emergency rescue, tracheal intubation often cannot be completed quickly; 2. Due to the soft tube of fiberoptic bronchoscope, the operation is difficult, the operation time is long, and the patient is often required to cooperate awake. Fiberoptic bronchoscope is not suitable for emergency tracheal intubation in rescuing patients; 3. Fiberoptic bronchoscope equipment is complex, expensive, bulky, complicated to sterilize, and expensive to apply, and most departments in the hospital are not equipped.
  • Most monitors are not routinely installed with end-tidal carbon dioxide monitoring. After the installation is completed, it will take a long time to check the end-tidal carbon dioxide waveform for 4 times. Mis-insertion of esophagus may cause very serious and irreversible consequences; 2. If the ventilator assists ventilation at a rate of 12 times per minute, it will take 20 seconds to check the end-expiratory carbon dioxide waveform for 4 times. Pulling out the catheter and ventilator mask to assist ventilation will take longer.
  • the exhaled breath may be Insufflation into the patient's stomach, or the patient taking carbonate-containing drugs or food for a short period of time, can cause carbon dioxide waveforms or false positives in the colorimetric detection device in the first few ventilations of the tracheal tube inserted into the esophagus. Looking at the waveform is still inconsistent with the waveform of the endotracheal tube in the trachea, but it takes a certain time to judge; 6. Special attention should be paid to the fact that this method cannot judge whether the insertion depth of the endotracheal tube is appropriate.
  • Advanced techniques such as fiberoptic bronchoscopy to directly see the tracheal ring and carina are reliable indicators for judging that the tube is located in the trachea, and video laryngoscopy to see the tracheal tube between the vocal cords is also very reliable.
  • the equipment of fiberoptic bronchoscope is complex, expensive, bulky, complicated to sterilize, and expensive to apply, and most departments in the hospital are not equipped with it; patients often do not have enough places to place video laryngoscopes in their oral cavity after endotracheal tube intubation and tooth pad fixation.
  • the depth of tracheal intubation for adults should be that the tip of the catheter is about 3-5cm above the carina. If it is too deep, it may move inward and enter the bronchus for some reasons, such as pneumoperitoneum during laparoscopic gynecological surgery. It was found that the displacement may be up to 3 ⁇ 5cm. A too shallow air bladder may become trapped in the glottis causing glottis damage, or the tube may slide out of the glottis due to head and neck rotation or flexion. Therefore, depth positioning should consider whether the patient will move the head and neck position, whether it will affect the position of the diaphragm, etc.
  • the tube was intentionally inserted too deep into one bronchus, and then the tube was withdrawn while auscultating for breath sounds, and then withdrawn 1-2 cm (depending on height) when the breath sounds of both lungs were heard symmetrical.
  • CT The accuracy of lung CT is very high. If it is CT, it can be clear that the tracheal tube is in the trachea, and the depth of tracheal tube insertion can be determined at the same time. However, CT is all checking the position and depth of the tracheal tube at the same time. There is no clinical use of CT. to determine the position and depth of the endotracheal tube.
  • the commonly used tools for clinical tracheal intubation are: direct-view laryngoscope, video-laryngoscope, visual guide core, fiberoptic bronchoscope, light rod, etc., but there are certain limitations and deficiencies in the clinical use of these tools; Anatomical changes and individual differences, doctors cannot see the surrounding glottis and other reasons, it is still difficult to complete tracheal intubation in a short time or even intubation fails for some difficult airways, especially the technical experience of tracheal intubation Insufficient doctors; too long tracheal intubation time or even failure of tracheal intubation makes the patient lose the best rescue opportunity, causes serious injury to the patient or even the death of the patient, and brings medical risks to the hospital, so it is necessary to further improve the existing intubation. Only by using tools can meet clinical needs, improve intubation speed and intubation success rate, and reduce medical risks.
  • the present invention provides a dual-visual and dual-positioning tracheal intubation set combined with a visual laryngoscope and a visual guide core to overcome the problem of
  • the shortcomings of the prior art are especially suitable for rapid intubation of difficult airways, which makes the operation of endotracheal intubation easier, enables beginners to quickly master endotracheal intubation, and also can quickly determine whether the endotracheal tube is located in the trachea and whether the tracheal tube is located in the trachea. Whether the catheter insertion depth is appropriate.
  • the operation of the suit is easy to grasp, convenient for popularization among medical staff, and can overcome the deficiencies of the prior art and reduce medical risks.
  • the feature of this set is that the combination includes two parts: a visual laryngoscope 1 and a visual guide core 2 .
  • the video laryngoscope 1 includes a display screen 11 , a handle 12 , a laryngoscope blade 13 , and a camera device 14 .
  • the video laryngoscope display screen 11 can simultaneously or independently receive the images transmitted by the video laryngoscope 1 and the visual guide core 2; according to different models and different application scenarios, the display screen 11 can be fixed on the video laryngoscope handle 12. If the display screen 11 is placed outside the handle 12 alone, the display screen 11 can be connected to the handle 12 through a wireless device such as WiFi or Bluetooth for image transmission.
  • a wireless device such as WiFi or Bluetooth for image transmission.
  • the video laryngoscope handle 12 has a switch, a data line interface, a power supply module and an integrated circuit; the data line interface is connected with a power supply device or a display screen through a data line; if the display screen 11 is placed outside the handle 12 alone, the handle 12 A wireless device such as WiFi or Bluetooth is built in to transmit the image of the camera device to the display screen 11 .
  • the laryngoscope blade 13 of the video laryngoscope There is a camera device 14 at the rear of the laryngoscope blade 13 of the video laryngoscope, and a lighting lamp is provided on the side of the camera device.
  • the image is transmitted to the display screen 11;
  • the laryngeal blade 13 is a lens that is curved in accordance with the physiological curvature of the oropharynx.
  • the curvature of the lens is relatively large.
  • the present invention adopts a dual-view and dual-positioning method.
  • the glottis is exposed, and the observation of the catheter entering the glottis during tracheal intubation mainly relies on the visual guide core. It is not necessary to consider that the tube blocks the lens when the catheter enters the lens, so the curvature of the laryngeal blade is smaller than that of the general visual laryngoscope.
  • the supine position can be used with the head tilted back. At this time, the patient's mouth axis, pharyngeal axis, and laryngeal axis are three axes and one line. Laryngoscopy is more complicated and difficult to solve this problem.
  • the visual guide core 2 can be divided into a plastic guide core and a rigid non-plastic guide core according to different models and different application scenarios;
  • the guide core includes a handle 21, a hollow tube (including the handle end 22 of the hollow tube) and the camera device end 23 of the hollow tube), a limiter 24, and a camera device 26; one end of the visible guide core handle 21 is connected to the handle end 22 of the hollow tube; a switch is provided inside the handle 21 , data line interface, integrated circuit and power module, the data line interface is connected with the power supply device or the display screen through the data line; according to different models and different application scenarios, the handle 21 and the video laryngoscope display screen 11 are connected through the data line for image transmission Or image transmission is performed through wireless devices such as WiFi and Bluetooth; if it is wirelessly connected, the handle 21 has a built-in wireless device such as WiFi or Bluetooth to send the image of the camera device to the display screen 11 .
  • the hollow tube (including the handle end 22 of the hollow tube and the camera device end 23 of the hollow tube) can be divided into a formable hollow tube and a rigid non-plastic hollow tube according to different models and different application scenarios.
  • the camera device end 23 of the hollow tube is provided with a camera device 26, and a lighting lamp is provided on the side of the camera device. Transferred to the display screen 11; a limiter 24 is sleeved on the outer peripheral surface of the hollow tube.
  • the stopper 24 is in the shape of a truncated cone, and the big end of the stopper is close to the handle 21.
  • the stopper keeps the distance between the outer end face of the hollow tube and the outer end face of the tracheal tube at about 10mm, so that the camera device 26 does not expose the tracheal tube. In addition, avoid injury to the patient.
  • the commonly used video laryngoscope has a large curvature of the lens, and it is not necessary to tilt the head and neck excessively for tracheal intubation. It is easy and simple to expose the glottis.
  • the video laryngoscope can easily and clearly expose the glottis in clinical use. , but intubation into the glottis is more complicated and difficult than direct-view laryngoscopy.
  • the present invention adopts a dual-view and dual-positioning method.
  • the purpose of the video laryngoscope is to expose the glottis, and the observation of the catheter entering the glottis during tracheal intubation mainly relies on the visual guide core, and it is not necessary to consider the tube when the catheter enters the lens. Block the lens, so the curvature of the laryngoscope blade is smaller than that of the general visual laryngoscope.
  • the sniff position can be used during tracheal intubation. During intubation, the mouth axis, pharyngeal axis, and laryngeal axis are three axes and one line.
  • the tube resistance is small, and even if there is secretions adhering to the lens of the camera device, the glottis can be clearly seen, and the tracheal intubation can be directly viewed. To further complicate and difficult this problem and secretions adhering to the lens cause the problem of blurred vision.
  • the laryngoscope of the video laryngoscope of the present invention conforms to the physiological curvature of the oropharynx, so that the viewing angle is turned forward by about 60 degrees, and the viewing point is moved forward.
  • the glottis can also be exposed by one line of three axes of the larynx, and due to the visible feature of the guide core, the glottis can be found by placing it under the epiglottis. When the glottis is opened, the catheter is inserted, and it is not necessary to fully expose the glottis with a laryngoscope.
  • the angle is poor, which reduces the difficulty of feeding the tube during tracheal intubation.
  • the present invention can make full use of the respective advantages of the visual laryngoscope and the direct-view laryngoscope while avoiding some disadvantages of the visual laryngoscope and the direct-view laryngoscope, and can obviously improve the success rate of intubation and reduce complications.
  • the invention adopts a dual-visual and dual-positioning method, and a visual laryngoscope is used to expose the glottis, and the observation of the catheter entering the glottis during tracheal intubation mainly relies on the visual guide core, which solves the problem that the visual laryngoscope is difficult to judge the tip of the tracheal catheter.
  • the present invention adopts a video laryngoscope to expose the glottis, which solves the problem that the thumb needs to be inserted into the patient's mouth when the visual guide core is used for tracheal intubation and the problem of difficulty in exposing the epiglottis and the glottis;
  • the invention adopts a video laryngoscope to expose the glottis, and the video laryngoscope pushes the tongue body away during tracheal intubation, and the visual guide core has a larger space to enter the oral cavity to reduce damage and increase the success rate of intubation.
  • the invention can independently use a visual guide core for tracheal intubation for some patients with difficulty in opening the mouth, thereby solving the difficult problem of tracheal intubation for patients with difficulty in opening the mouth.
  • the present invention can determine whether the endotracheal tube is located in the trachea and whether the insertion depth of the endotracheal tube is appropriate through the shapeable visual guide core, and solves the problems of whether the endotracheal tube is located in the trachea and whether the insertion depth of the endotracheal tube is appropriate after the current clinical endotracheal intubation.
  • the stopper on the visual guide core After the visual guide core is lubricated, put the endotracheal tube on the visual guide core, adjust the stopper on the visual guide core to keep the tube head of the visual guide core about 1cm away from the tip of the endotracheal tube, so that the The device and other components will not be exposed to damage the mucosal tissue of the patient, and at the same time, it can also avoid contact with contaminants such as sputum and saliva to a certain extent, which will affect the image effect.
  • the patient adopts the sniffing position with the head tilted back in the supine position.
  • a small number of patients such as short nail-chin distance, small mandible, protruding incisors, hypertrophic tongue, high throat, obesity, stubby neck, restricted mandibular movement, and restricted cervical spine movement
  • the left hand holds a video laryngoscope, and the three anatomical landmarks are sequentially exposed with the help of the video laryngoscope: uvula, epiglottis, and vocal tract. door.
  • the right hand is equipped with a visual guide tracheal tube, insert the tracheal tube into the oral cavity, and the visual guide core camera device will display the image of the situation inside the oral cavity on the display screen in real time, for the operator to locate the secondary glottis and see.
  • the glottis pushes the tracheal tube into the trachea, pulls out the visual guide core, adjusts the depth of the tracheal tube, fixes the tracheal tube, and completes the intubation.
  • the dental pad can be fixed with the ventilator and the shapeable visual guide core can be used again to confirm whether the tracheal tube is located in the trachea and whether the insertion depth of the tracheal tube is appropriate.
  • the ventilator-assisted ventilation can be used again to confirm whether the tracheal tube is located in the trachea through the plastic visual guide core. Whether the insertion depth is appropriate, whether there is a tracheal tube balloon herniation, whether there is sputum in the main bronchus, etc.
  • a visual guide core can be used for tracheal intubation without using a laryngoscope. After the visual guide core is lubricated, put the endotracheal tube on the visual guide core, and adjust the stopper on the visual guide core; turn on the power of the visual guide core and the display screen, and make sure that the visual guide core can be seen on the display screen.
  • the image transmitted by the core; set the body position, insert the tracheal tube with the visible guide core into the oral cavity, and the camera device will display the image of the situation inside the oral cavity on the display screen in real time, so that the operator can find the glottis.
  • the glottis can be found by placing it under the epiglottis. When the glottis is opened, the endotracheal tube is pushed into the trachea, the visual guide core is pulled out, the depth of the endotracheal tube is adjusted, the endotracheal tube is fixed, and the intubation is completed. Using this method does not require high degree of mouth opening, even if the degree of mouth opening is only 0 Intubation of difficult airways of about .5cm becomes simple and accurate.
  • the present invention adopts a dual-visual and dual-positioning method combining a visual laryngoscope and a visual guide core, and can quickly guide the camera device of the visual laryngoscope to the position of the glottis by positioning the visual laryngoscope, and then through the visual guide
  • the camera device of the core performs accurate secondary positioning of the glottis, and can quickly intubate the patient to ensure the success rate of tracheal intubation. It can also be confirmed through the visual guide core whether the tracheal tube is located in the trachea and whether the insertion depth of the tracheal tube is appropriate. .
  • a visual guide core can be used alone for endotracheal intubation.
  • the dual-visual and dual-positioning endotracheal intubation set can realize the visualization of the whole process of endotracheal intubation, without the risk of mistakenly inserting the esophagus, which is convenient for doctors to determine the depth and position of endotracheal intubation, and greatly improves endotracheal intubation. operability and safety, reducing medical risks.
  • the present invention adopts dual visual and dual positioning methods, and through the positioning of the visual laryngoscope, the visual laryngoscope camera device can be quickly guided to the glottis position, and then the visual guide core camera device is used for accurate glottal two.
  • the secondary positioning realizes the whole process of real-time visual guidance during the tracheal intubation operation. It is easy to operate, the intubation speed is fast, the success rate of one-time intubation is high, and there is no risk of misinsertion into the esophagus, which greatly improves the tracheal intubation.
  • the operability and safety can effectively improve the timeliness of intubation, reduce medical risks, help beginners to get started, and are suitable for clinical application.
  • the present invention can clarify whether the endotracheal tube is located in the trachea and whether the insertion depth of the endotracheal tube is appropriate through the shapeable visual guide core, and solves whether the endotracheal tube is located in the trachea and whether the insertion depth of the endotracheal tube is appropriate after the current clinical endotracheal intubation. question.
  • the curvature of the lens is relatively large;
  • the purpose is to expose the glottis, and the observation of the catheter entering the glottis during tracheal intubation mainly relies on the visual guide core. It is not necessary to consider that the tube blocks the lens when the catheter enters the lens, so the curvature of the laryngeal blade is compared with the general visual laryngeal.
  • the scope is smaller, and the supine position can be used when the tracheal intubation is performed with the head tilted back.
  • the patient's oral axis, pharyngeal axis, and laryngeal axis are three axes and one line, which solves the problem that the visual laryngoscope is easy to expose the glottis, but the intubation enters the sound. Doors are more complex and difficult than direct-view laryngoscopy.
  • the purpose of the video laryngoscope is to expose the glottis, and the observation of the catheter entering the glottis during tracheal intubation mainly relies on the visual guide core, which solves the problem that the video laryngoscope is difficult to determine the tip of the tracheal tube and the glottis. relationship issues.
  • the laryngoscope blade of the video laryngoscope of the present invention adopts the curvature that conforms to the physiological curvature of the oropharynx, so that the viewing angle is turned forward by about 60 degrees, and the viewpoint is moved forward, which is conducive to the exposure of the glottis, so when encountering a few such as a Patients with difficult airway due to short chin distance, small mandible, protruding incisors, hypertrophic tongue, high throat, obesity, stubby neck, restricted mandibular movement, restricted cervical movement, etc.
  • the three axes of the patient's mouth axis, pharyngeal axis, and laryngeal axis are not in line, but because the angle of view of the laryngoscope is turned forward by about 60 degrees and the viewpoint is moved forward, the glottis can still be displayed, which solves the problem of the glottis exposure of the direct-view laryngoscope. Difficulty and problems requiring overexposure of the oropharynx.
  • the glottis can be found by placing it under the epiglottis, and the tracheal tube can be inserted when the glottis is opened. It is not necessary to fully expose the glottis with a laryngoscope. Endotracheal intubation solves the problem of tracheal intubation in very few patients with difficult airways whose glottis cannot be displayed by video laryngoscope.
  • the present invention uses a visual laryngoscope to expose the glottis, which solves the problem of needing to put the thumb into the patient's mouth and the difficulty of exposing the epiglottis and the glottis when the visual guide core is used for tracheal intubation.
  • the present invention uses a visual laryngoscope to expose the glottis, and the visual laryngoscope pushes the tongue body away during tracheal intubation, and the visual guide core has a larger space to enter the oral cavity to reduce damage and increase the success rate of intubation.
  • a visual guide core can be used alone for tracheal intubation, which solves the problem of tracheal intubation in patients with difficult mouth opening.
  • FIG. 1 is a schematic structural diagram of the present invention.
  • Video laryngoscope 11. Display screen; 12.
  • Video laryngoscope handle ; 13.
  • Video laryngoscope blade ; 14.
  • Video laryngoscope camera device ; 2.
  • Method 1 For most patients with non-difficult airways whose glottis can be clearly exposed by direct-view laryngoscope, the supine position can be used for tracheal intubation.
  • the left hand-held video laryngoscope reveals three anatomical landmarks in turn: the uvula, the epiglottis, and the glottis. If there is secretions adhering to the lens If the glottis is unclear, the tracheal intubation can also be directly viewed; 4.
  • the tracheal tube with the visual guide core is inserted into the oral cavity in the right hand, and the camera device of the visual guide core can display the image of the situation inside the oral cavity in real time on the display screen , for the operator to accurately find the glottis a second time, see the opening of the glottis, push the tracheal tube into the trachea, pull out the plastic guide core, adjust the depth of the tracheal tube, fix the tracheal tube, and the intubation is completed; 5. The intubation is completed. After that, the tooth pads are fixed and the ventilator is connected to assisted ventilation.
  • the shapeable visual guide core can be used to confirm whether the tracheal tube is located in the trachea and whether the insertion depth of the tracheal tube is appropriate; 6.
  • the ventilator can also be used to assist ventilation, and the plastic visual guide core can be used again to confirm whether the tracheal tube is located in the trachea, whether the tracheal tube insertion depth is appropriate, and whether There are problems such as tracheal tube balloon herniation and main bronchial sputum caused by main bronchial blockage.
  • Method 2 For a few special body types such as short nail-chin distance, small mandible, protruding incisors, hypertrophic tongue, high throat, obesity, stubby neck, restricted mandibular movement, restricted cervical spine movement, etc. or cervical spine injuries, the head cannot be tilted back, etc. For patients with difficult airway due to reasons, it is not necessary to emphasize the three axes and one line if the glottis cannot be clearly exposed by the direct-view laryngoscope: 1. After the visual guide core is lubricated, put the tracheal tube on the plastic visual guide core, and adjust the visual guide core.
  • the tip of the shapeable guide core is kept about 1cm away from the tip of the endotracheal tube, so that the components such as the camera device will not be exposed and damage the mucosal tissue of the patient, and it can also be To a certain extent, avoid contact with dirt such as sputum and saliva, which will affect the image effect; 2. Turn on the power of the video laryngoscope and the visual guide core, and make sure that the video laryngoscope and the visual guide can be seen on the display screen at the same time. 3. As long as the patient's condition allows, the sniffing level can be used during tracheal intubation.
  • the patient should be well positioned to reduce The three-axis angle difference between the mouth axis, the pharyngeal axis, and the laryngeal axis reduces the difficulty of intubation during tracheal intubation; however, if the sniffing position cannot be used due to cervical spine injury and other reasons, the patient's safe position should be maintained; 4.
  • the left hand holds the video throat
  • the mirror reveals three anatomical landmarks in turn: uvula, epiglottis, and glottis.
  • the tracheal tube with a visual guide core in the right hand is inserted into the oral cavity.
  • the camera device of the visual guide core displays the image of the inside of the oral cavity on the display screen in real time. , for the operator to accurately find the glottis a second time, see the opening of the glottis, push the tracheal tube into the trachea, pull out the plastic guide core, adjust the depth of the tracheal tube, fix the tracheal tube, and the intubation is completed; 5. The intubation is completed. After that, the tooth pads are fixed and the ventilator is connected to assisted ventilation. Then, the shapeable visual guide core can be used to confirm whether the tracheal tube is located in the trachea and whether the insertion depth of the tracheal tube is appropriate; 6.
  • the ventilator When the ventilator is assisted During ventilation, if the patient has agitation, shortness of breath, decreased blood oxygen saturation, etc., the ventilator can also be used to assist ventilation, and the plastic visual guide core can be used again to confirm whether the tracheal tube is located in the trachea, whether the tracheal tube insertion depth is appropriate, and whether There are problems such as tracheal tube balloon herniation and main bronchial sputum caused by main bronchial blockage.
  • Method 3 For the very few patients with difficult airways whose glottis cannot be clearly exposed by video laryngoscope, as long as the patient's condition allows, the patient's position should also be placed to reduce the three-axis angle difference between the oral axis, the pharyngeal axis, and the laryngeal axis, and reduce the trachea. Difficulty of feeding tube during intubation: 1.
  • the visual guide core After the visual guide core is lubricated, put the tracheal tube on the plastic visual guide core, adjust the stopper on the visual guide core and shape the visual guide core, so that the The tube head of the shapeable guide core is kept at a distance of about 1cm from the tip of the tracheal tube, so that components such as the camera device will not be exposed to damage the patient's mucosal tissue, and at the same time, it can also avoid contact with contaminants such as sputum and saliva to a certain extent.
  • Image effect 2. Turn on the power of the video laryngoscope and the visual guide core, and make sure that the images transmitted by the video laryngoscope and the visual guide core can be seen on the display screen at the same time; 3.
  • the visual guide core is used to determine the entry of the intubation into the glottis; the tracheal tube with the visual guide core in the right hand is inserted into the oral cavity, and the camera device of the visual guide core displays the image of the situation inside the oral cavity on the display screen in real time for operation. If the glottis is blocked by the epiglottis, the visual guide core needs to bypass the epiglottis or cross the epiglottis downward. Due to the visible characteristics of the guide core, the glottis can be found by placing it under the epiglottis.
  • the shaped visual guide core confirms whether the endotracheal tube is located in the trachea and whether the insertion depth of the endotracheal tube is appropriate; 6.
  • the ventilator can also be assisted While ventilating, the plastic visual guide core is used to determine whether the tracheal tube is located in the trachea, whether the insertion depth of the tracheal tube is appropriate, whether there is a tracheal tube balloon herniation, and whether there is sputum in the main bronchus that causes the main bronchus to block.
  • Method 4 For some difficult airway patients who have difficulty in opening the mouth and cannot be placed in the video laryngoscope, the visual guide core can be used for tracheal intubation without using the laryngoscope.
  • the sniff position can be used during tracheal intubation. Patients with special difficult airways do not need to overemphasize the olfactory position, but the three-axis angle difference between the oral axis, pharyngeal axis, and laryngeal axis should be minimized to reduce the difficulty of intubation during tracheal intubation: 1.
  • Visual guide core is lubricated and the trachea is removed
  • the catheter is sheathed on the shapeable visual guide core, the stopper on the visual guide core is adjusted and the visual guide core is shaped, so that the tip of the plastic guide core is kept about 1cm away from the tip of the endotracheal tube.
  • the components such as the camera device will not be exposed to damage the mucosal tissue of the patient, and at the same time, it can also avoid contact with dirt such as sputum and saliva to a certain extent, which will affect the image effect; 2. Turn on the power of the visual guide core and the power of the display screen, and confirm The image transmitted by the visual guide core can be seen on the display screen; 3.
  • the sniff position can be used during tracheal intubation, even if the standard sniff position cannot be reached, the mouth, pharynx, and larynx cannot be reached. It is necessary to put the patient in a good position to reduce the three-axis angle difference between the oral axis, the pharyngeal axis, and the laryngeal axis, and reduce the difficulty of feeding the tube during tracheal intubation; however, if the olfactory position cannot be used due to cervical spine injury, the patient's position is maintained. Safe position; 4.
  • the left thumb grabs the patient's lower incisor and lifts the mandible and tongue upward to expand the pharyngeal space, and inserts a tracheal tube with a visual guide core into the oral cavity. Raise the patient’s jaw to facilitate the operator to find the glottis exposure after the epiglottis.
  • the epiglottis blocks the glottis, the glottis cannot be displayed. It is necessary to bypass the epiglottis from the side or cross the epiglottis downward. Due to the visible feature of the guide core, it is placed under the epiglottis.
  • the glottis can be found without the need to fully expose the glottis with a laryngoscope.
  • the endotracheal tube is pushed into the trachea, the plastic visual guide core is pulled out, the depth of the endotracheal tube is adjusted, the endotracheal tube is fixed, and the intubation is completed; If the glottis cannot be displayed because the plastic visual guide core is too soft, use a rigid non-plastic visual guide core to complete tracheal intubation; Then, while the ventilator assists ventilation, the plastic visual guide core can be used again to confirm whether the endotracheal tube is located in the trachea and whether the endotracheal tube insertion depth is appropriate; 6.
  • the ventilator can also be used to assist ventilation, and the plastic visual guide core can be used again to confirm whether the tracheal tube is located in the trachea, whether the tracheal tube insertion depth is appropriate, whether there is a tracheal tube balloon herniation, and whether there is main bronchial sputum. Fluid, etc., can cause problems such as blockage of the main bronchus. Using this method does not require high degree of mouth opening, even if the degree of mouth opening is only 0 Intubation of the difficult airway around .5cm becomes simple and accurate.
  • the present invention is not limited to the specific embodiments described above, but extends to various modifications of the videolaryngoscope and visual guide core combination dual-vision, dual-positioning endotracheal intubation technique of the appended claims. It should be understood by those skilled in the art that the technical solutions of the present invention can be modified or equivalently replaced without departing from the spirit and scope of the technical solutions of the present invention, which should be included in the video laryngoscope and visual guide core combination of the present invention.
  • the dual-visual, dual-positioning endotracheal intubation technical claims are within the scope.
  • the clinical video laryngoscope is widely used, and the visual guide core is also used in a small part. It is very easy for the current industrial level to transmit the images of the video laryngoscope and the visual guide core to the same display screen, so it has industrial practicality. sex.

Abstract

一种可视喉镜（1）和可视导芯（2）组合的双可视双定位气管插管套装，进行气管插管时将气管导管套在可视导芯（2）上，通过可视喉镜（1）可快速地引导声门位置，再通过可视导芯（2）摄像装置（26）进行精确地声门二次定位，对部分张口困难的患者可单独采用可视导芯（2）进行气管插管。采用双可视、双定位技术，可以克服现有气管插管技术的不足，实现气管插管过程全程可视化，易操作，插管速度快，一次插管成功率高。

Description

可视喉镜和可视导芯组合的双可视双定位气管插管套装 技术领域
本发明涉及医用器械的技术领域，特别是涉及一种可视喉镜和可视导芯组合的双可视双定位气管插管套装，特别适用于困难气道患者的快速插管。
 背景技术
在临床上对危重患者特别是呼吸终止的病患、全麻患者需要进行气管插管来帮助患者呼吸。气管插管是指将一特制的气管导管经声门置入气管的技术，这一技术能为气道通畅、通气供氧、呼吸道吸引和防止误吸等提供最佳条件。对于某些危重患者、全麻患者而言，气管插管是维持呼吸功能的必要手段，医护人员必须在短时间内将气管导管送至病患的气管内以提供呼吸支持，因此如何快速有效地气管插管便成了患者救治的关键问题。临床上经常遇到一些气管插管困难的患者，采用普通气管插管方法导致气管插管时间过长甚至气管插管失败，使患者失去最佳抢救时机，给患者造成严重伤害甚至导致患者死亡，给医院带来医疗风险。
目前临床气管插管常用的工具有：直视喉镜、可视喉镜、可视导芯、纤支镜、光棒等等，但这些工具临床使用中都存在一定的局限和不足。尽管有足够的技术，但经常由于解剖学上的变化以及个体化差异，因医生无法看到声门周围情况等各种原因，对某些困难气道仍难以短时间内完成气管插管甚至插管失败，尤其是气管插管技术经验不足的医生。
一、直视喉镜：直视喉镜也称为直接喉镜、光纤喉镜或者普通喉镜，其成本低，结实耐用。虽然临床大量使用，但在临床使用中也存在一定的局限和不足。1.对患者体位有一定要求，插管时要求患者采用仰卧位后头后仰的嗅物位，这时患者口轴线、咽轴线、喉轴线三轴一线；对于少数如甲颏距离短、小下颌、门齿突出、舌体肥大、高喉头、肥胖、颈项粗短、下颌活动受限、颈椎活动受限等特殊体型或者颈椎损伤不能头后仰等原因的困难气道患者，无法达到三轴一线时，在气管插管过程中经常看不到声门，只能进行盲插；盲探插管有一定的试探性，对咽喉部位的多次刺激可造成局部黏膜出血、水肿甚至喉痉挛、声门紧闭等，对气道损伤大，进一步增加气管插管的难度；盲探插管易误插入食道，引起误吸并发症，插管成功率低甚至插管失败；2. 直视喉镜为了做到三轴一线以暴露声门，常常需要过度暴露口咽部，需要增加镜柄上提力量，容易造成唇、齿、舌、咽损伤；3. 直视喉镜为了暴露声门需要用力上提喉镜，插管过程中上提喉镜容易产生心血管反应；4.直视喉镜镜片厚度较大，张口度必须较大(一般要3cm以上)才能置入口腔，对张口度受限患者（张口度小于3cm）不适用。
二、可视喉镜：临床上使用可视喉镜包括2种，第一种镜片曲度和直视喉镜类似，只不过加装可视装置，其插管方法和直视喉镜类似要求三轴一线或者接近三轴一线，但是由于有可视装置，有利于医生对声门的观察，其优点和缺点同直视喉镜；另外一种可视喉镜镜片曲度较大，符合口咽部生理弯曲，使视角向前转60 度左右（不同厂家设计角度不一致），视点前移，进行气管插管无需头颈过度后仰，无需口、咽、喉三轴一线即可显露声门，暴露声门简单，多项研究表明可视喉镜相比直视喉镜能使困难气道的声门显露提升 1 ～ 2 级甚至提升3级，解决了全身麻醉的很大部分困难气道的气管插管问题，大部分临床使用的可视喉镜都是属于这一种，本发明下面所述的可视喉镜为这种喉镜。可视喉镜使声门暴露更容易，但在临床使用中也存在一定的局限和不足：1. 可视喉镜暴露声门容易但是插管进入声门比直视喉镜更加复杂、困难，这是由于为了避免镜片前段部分遮挡镜头以及防止导管进入到镜头处时管子挡住镜头，所以镜片曲度较大，相应的气管导管前端弯曲角度必须较大；气管导管插入声门时口、咽、喉三轴不在一线而是呈大角度弯曲，管尖先向前顶住声门下喉室前壁，然后向下折弯后才能进入声门和气管，插管阻力大，气管插管的阻力可能导致气管导管的管尖滑出声门，即使用尖端可调节导芯也经常不能顺利将气管导管置入声门；当使用直视喉镜插管时，眼睛在口外，视线看着导管尖端直接插入声门内，而可视喉镜则将眼睛移到显示屏，人眼与视野之间并非一致，出现视差后可见非所得，所以虽然更容易看到声门视野，却更不容易判断管子尖端与声门的关系，容易造成插管困难甚至误插入食道；2.可视喉镜镜片曲度较大，暴露声门容易但插管困难，所以可视喉镜导芯一般都采用比较硬的导丝或者专用硬导芯，过硬的导芯容易导致意外的咽、喉、声带损伤；3. 可视喉镜也只能观察到口腔和声门位置，在行气管插管时，在气管导管进入声门的时候气管导管经常会挡住可视喉镜镜头，不能完全达到可视效果，可能存在误插入食道；4. 口腔分泌物多的患者存在分泌物粘附镜头引起看声门不清，导致插管成功率较低；5. 可视喉镜与直视喉镜一样，镜片厚度较大，张口度必须较大(一般要3cm以上)才能置入口腔，对张口度受限患者（张口度小于3cm）不适用。
三、可视导芯：临床上应用可视导芯名称很多，比如可视管芯、视频光棒、导管式可视喉镜等等，本发明统一把插入气管导管内用于引导气管插管的带摄像装置导芯统称为可视导芯。临床上常用可视导芯包括可塑形可视导芯和硬质不可塑形可视导芯；硬质不可塑形可视导芯一般是按照口咽部生理弯曲提前塑形好，使用时不可进行个体化再次塑形，其优点是导芯较硬，插管时导芯不会变形，导芯由于不用反复折弯塑形，导芯不易损坏，其缺点是不能进行个体化再次塑形，导芯较硬容易损伤口腔粘膜、会厌、声门周围、声带等组织；可塑形可视导芯优缺点与之相反。进行气管插管时，左手拇指抓扣患者下切牙并向上提起下颌及舌体以扩大咽腔间隙，右手持可视导芯插入口腔进行气管插管，必要时可由助手协助托起患者下颌以利于操作者找到会厌后的声门暴露。可视导芯对张口度要求不高，可以解决大部分张口度过小的困难气道患者的气管插管问题，但在临床使用中也存在一定的局限和不足：1. 采用左手拇指抓扣患者下切牙并向上提起下颌及舌体以扩大咽腔间隙的方法要求患者无咬合能力的前提下进行，但在实际临床工作中，特别是急诊插管患者经常由于病情不允许没有进行全麻、肌松，患者扔保留自主呼吸和咬合能力，这时就不能把拇指伸进患者口中使之无法应用可视导芯插管方法；2. 采用左手拇指抓扣患者下切牙并向上提起下颌及舌体的方法暴露会厌和声门效果差，同时全麻或者危重无自主呼吸的患者由于肌肉松弛加重舌后坠进一步加剧暴露会厌和声门的困难程度，可视导芯插入的视野窄，路径受到阻碍，有时甚至没有充分空间进入导芯，这时即使有助手协助托起患者下颌方便操作者暴露患者会厌和声门，也经常没办法充分暴露会厌和声门，造成插管操作困难；3.可视导芯行气管插管时经常会遇会厌阻挡无法显示声门，需从会厌侧旁绕过或者向下越过会厌，插管操作难度大，导致插管时间较长，不能快速完成气管插管甚至插管失败；4.可塑形可视导芯经常由于导芯过软导致导芯容易变形，导致插管困难；硬质不可塑形可视导芯经常由于导芯不可塑形因此对部分患者不适合，同时导芯过硬在操作时容易损伤口腔粘膜、会厌、声门周围、声带等组织，造成出血或者水肿，加重气管插管困难程度。
四、光棒：光棒由于仅靠透光强弱判断声门位置，完全是一种盲插，很可能造成唇、齿、舌、咽、声门、气管等部位损伤，对人体损伤较大，并且单纯通过喉部光亮判断已经入声门较为不准确，可能存在误插入食道，插管成功率低。
五、纤维支气管镜：可用于各种困难气道的气管插管，但在临床使用中也存在一定的局限和不足：1. 管子软，在口腔内调节方向时费时费力，操作难度大，必须要有丰富临床操作经验，操作时间较长，在急诊抢救时，气管插管经常不能快速完成； 2. 由于纤支镜管子软，操作难度大，操作时间较长，经常需要患者清醒配合，所以纤支镜不太适合用于抢救患者的紧急气管插管；3. 纤维支气管镜设备复杂、昂贵，体积大，消毒复杂，应用成本高，医院绝大部分科室没有配备。
综上所述，以上各种气管插管方法对于特殊体型患者的困难气道经常出现难以短时间内完成气管插管甚至气管插管失败，而且如果操作不当还可能给患者造成伤害，甚至让患者丧失抢救机会，因此需要进一步加以改进现有插管工具，方能满足临床需要，提高插管速度和插管成功率，降低医疗风险。
气管插管成功后，涉及到两个问题：1.气管导管是否位于气管内；2.气管导管插入深度是否合适。
确认气管导管在气管内临床常用下列方法。
一、金标准——呼气末二氧化碳波形和数值：气管插管后，前四次呼吸能连续监测到呼出的二氧化碳，那么是可信的。但在临床使用中也存在一定的局限和不足：1.绝大部分监护仪没有常规安装呼气末二氧化碳监测，等安装完，再等查看4次呼吸末二氧化碳波形的话需要较长时间，如果是误插食管可能会造成非常严重的、不可挽救等后果；2.假如呼吸机按照每分钟12次频率辅助通气，那么查看4次呼吸末二氧化碳波形的话需要20秒，如果是误插食管那么再予拔出导管、呼吸机面罩辅助通气，那么需要时间更长，对于重症、严重缺氧的患者而言这么长的时间没有给氧可能会造成非常严重的、不可挽救等后果；3.某些心跳停止的患者，由于没有气体交换，因此即使导管在气管内，也不能显示二氧化碳波形或者二氧化碳压很低；4.出现气管导管打折或者梗阻、气管导管气囊未充气或破裂、二氧化碳采样管堵塞或泄漏或打折或未连接、严重支气管痉挛等情况下，即使气管导管在气管内也可以出现不能显示二氧化碳波形或者二氧化碳压很低；5.如果有口对口人工呼吸或者球囊面罩辅助通气可能将呼出气吹入患者胃内，或者患者短时间内服用了含碳酸盐的药物或食物，可导致插入食管的气管导管采样前几次通气出现二氧化碳波形或者显色法检测装置出现假阳性，当然如果注意查看波形的话还是和气管导管在气管内波形是不一致的，但这需要一定时间才能判断；6.要特别注意该方法不能判断气管导管插入深度是否合适。
二：气管导管内随着呼吸有规律性的水雾，如果气管导管插入食管则有雾气也没有随呼吸的规律运动。但在实际临床工作中，从导管蒙上水汽来判断气管导管在气管内并不可靠，如果胃胀气明显的话实际上如果气管导管插入食管有时还是会有雾气随呼吸的规律运动；而且如果室温比较高导致气管导管内呼出气体温度和室温温差小或者患者气道比较干燥的话，气管导管内经常没有随着呼吸有规律性的水雾或者水雾很少。
三：听呼吸音，同时要听上腹部对照，只有肺部呼吸音强，上腹部有微弱传导音才对；在听呼吸音，也不能只是在上胸部听，应该更注重听肺泡音，气道内的呼吸音比较容易传导，即使插入一侧主支气管也往往可以双肺都听到呼吸音，但是肺泡音肯定是听不到。但在临床使用中也存在一定的局限和不足：1.如果患者有自主呼吸，即使是气管导管误插食管，肺泡音也是可以听到的；2.如果是气管导管误插食管的话如果把听诊器靠近气管导管附近有时还是可以听到呼吸音而误认为气管导管已经插入的气管内；3.如果患者有明显肺气肿或者严重肺部病变的话呼吸音经常不明显，肺泡音经常听不到，甚至听不懂呼吸音；4.危重患者经常因为心功能不全或者肺部感染等因素而在肺部可闻及湿罗音，肺部听诊湿罗音可严重干扰对肺泡音的判断。
四：高级的技术，比如纤支镜直接看到气管环及隆突是判断导管位于气管内的可靠指标，可视喉镜看到气管导管在声带之间也是很可靠的。但是纤维支气管镜设备复杂、昂贵，体积大，消毒复杂，应用成本高，医院绝大部分科室没有配备；患者在插气管导管并进行牙垫固定后口腔经常是没有足够位置放置视频喉镜的地方，即使把可视喉镜放进口腔，由于声带周围软组织遮挡，也很难明确看到气管导管在声带之间，所以大部分情况下无法应用视频喉镜确认气管导管在气管内。
气管插管的深度成年人应该是导管尖端在隆突上大约3~5cm，过深则可能因某些原因向内移位进入支气管，比如腹腔镜妇科手术时气腹挤压膈肌上移，有人发现最多可能移位3~5cm。过浅气囊可能卡在声门造成声门损伤，也可能因头颈转动或屈曲导致管子滑出声门。因此深度定位要考虑患者是否会移动头颈位置，是否会影响膈肌的位置等。
关于气管导管插入深度是否合适，临床常用下列方法。
一：按照身高粗测，有很多的办法，比如用管子沿着患者的面部测量大约定个长度，或者鼻尖到耳垂的距离再加其一半长度等等，这样的测算，大概是男性以170为中间值，插入23cm左右。女性以160为中间值，插入21cm左右。
二：根据头面部的解剖学数据，按照一些公式算一下。
三：用个体的眼睑裂到胸骨上切迹的间距作为每个个体自身的实际插管深度。患者不垫枕头水平卧位，闭眼，用尺子测量上述间距的长度。
四：针对儿童适用。小孩子的身高也应该与其体表的某些解剖标志的数据成比例，是否也适合上述方法没有确定。儿童，可用以下公式来估计插入所需深度：导管深度=[年龄+2] ÷ 12，但是即使是相同的年龄，孩子的身高也差异甚大，因此应根据每个孩子的自身情况决定插管深度。对于幼龄儿童，由于气管长度较短，管子移动很容易脱管或进入支气管内。有人提出，插管后有意先插入过深到一侧支气管内，然后一边听诊呼吸音，一边后退管子，当听到双肺呼吸音对称时再退出1~2cm（根据身高）即可。
上述四种方法是经验性的，经常存在由于个体差异而导致气管插入的深度不合适。所以临床更常用如下方法。
五：在两侧腋中线听诊两肺呼吸运动是否对称，如果左肺在插管后呼吸音降低，那么可能插入右主支气管，缓慢退出气管导管直到两侧听诊呼吸音对称(即左右两肺对称)。
六：在气管插管后，用胸部透视检查患者的肺部情况，并确认气管导管上不透X线的标示线尖端在气管中段，而不是在左、右主支气管。但对于鉴别是否插入食管，X线透视检查并不可靠。
七：肺部CT准确性很高，如果是CT就可以明确气管导管在气管内，并且同时确定气管导管插入深度，但CT都是在检查同时看气管的导管位置和深度，临床没有专门用CT来确定气管导管的位置和深度。
八：定气管插管深度纤支镜是最好的，但是纤维支气管镜设备复杂、昂贵，体积大，消毒复杂，应用成本高，医院绝大部分科室没有配备。
以上确定气管导管是否位于气管内以及气管导管插入深度是否合适的各种方法均存在一定的缺点，如果气管导管插入深度不合适甚至气管导管误入食管可能会给患者造成严重伤害甚至导致患者死亡。因此需要进一步加以改进现有插管工具，更好的明确气管导管是否位于气管内以及气管导管插入深度是否合适，满足临床需要，降低医疗风险。
 技术问题
目前临床气管插管常用的工具有：直视喉镜、可视喉镜、可视导芯、纤支镜、光棒等等，但这些工具临床使用中都存在一定的局限和不足；经常由于解剖学上的变化以及个体化差异，医生无法看到声门周围情况等各种原因，对某些困难气道仍难以短时间内完成气管插管甚至插管失败，尤其是气管插管技术经验不足的医生；气管插管时间过长甚至气管插管失败，使患者失去最佳抢救时机，给患者造成严重伤害甚至导致患者死亡，给医院带来医疗风险，因此需要进一步加以改进现有插管工具，方能满足临床需要，提高插管速度和插管成功率，降低医疗风险。
气管插管成功后，涉及到两个问题：1.气管导管是否位于气管内，2.气管导管插入深度是否合适；目前临床上确定气管导管是否位于气管内以及气管导管插入深度是否合适的各种方法均存在一定的缺点；如果气管导管插入深度不合适甚至气管导管误入食管可能会给患者造成严重伤害甚至导致患者死亡，因此需要进一步加以改进现有插管工具，更好的明确气管导管是否位于气管内以及气管导管插入深度是否合适，满足临床需要，降低医疗风险。
 技术解决方案
为了改进现有插管工具，提高插管速度和插管成功率，降低医疗风险，本发明提供一种可视喉镜和可视导芯组合的双可视、双定位气管插管套装以克服现有技术的不足，特别适用于困难气道的快速插管，使气管插管的操作更加简便，使得初学者也能快速掌握气管插管，同时也能快速确定气管导管是否位于气管内以及气管导管插入深度是否合适。本套装操作容易掌握，便于在医护人员中推广普及，可以克服现有技术的不足，降低医疗风险。
本套装其特征是：该组合包括可视喉镜1和可视导芯2两个部分。
所述可视喉镜1包括显示屏11、手柄12、喉镜片13、摄像装置14。
所述可视喉镜显示屏11可以同时或者单独接收可视喉镜1和可视导芯2传送过来的图像；根据不同型号、不同应用场景，显示屏11可固定在可视喉镜手柄12上或者单独置于手柄12之外以方便观看，如果显示屏11单独置于手柄12之外时可以通过WiFi或者蓝牙等无线装置和手柄12连接进行图像传送。
所述可视喉镜手柄12有开关、数据线接口、电源模块以及集成电路；数据线接口通过数据线与供电装置或显示屏连接；如果显示屏11单独置于手柄12之外时则手柄12内置WiFi或者蓝牙等无线装置以便把摄像装置的图像发送到显示屏11。
所述可视喉镜喉镜片13尾部有摄像装置14，在摄像装置侧设有照明灯，摄像装置的数据线缆穿过喉镜片13内部进入手柄12内部并与集成电路连接并经集成电路把图像传送到显示屏11；所述喉镜片13为符合口咽部生理曲度弯曲的镜片。一般的可视喉镜为了避免镜片前段部分遮挡镜头以及防止导管进入到镜头处时管子挡住镜头，所以镜片曲度较大，本发明采用双可视、双定位方法，可视喉镜的目的是暴露声门，而气管插管时对导管进入声门的观察主要依靠可视导芯，不必考虑导管进入到镜头处时管子挡住镜头，所以喉镜片的曲度相比一般可视喉镜小一些，气管插管时可采用仰卧位后头后仰的嗅物位，这时患者口轴线、咽轴线、喉轴线三轴一线，解决了可视喉镜暴露声门容易但是插管进入声门比直视喉镜更加复杂、困难这个问题。
所述可视导芯2可依据不同型号、不同应用场景分为可塑形导芯和硬质不可塑形导芯；所述导芯包括手柄21、中空管（包括中空管的手柄端22和中空管摄像装置端23二个部分）、限位器24、摄像装置26；所述可视导芯手柄21的一端与中空管的手柄端22相联接；所述手柄21内部设置开关、数据线接口、集成电路以及电源模块，数据线接口通过数据线与供电装置或显示屏连接；根据不同型号和不同应用场景，手柄21和可视喉镜显示屏11通过数据线连接进行图像传送或者通过WiFi、蓝牙等无线装置进行图像传送；如果是无线连接时则手柄21内置WiFi或者蓝牙等无线装置以便把摄像装置的图像发送到显示屏11。
所述中空管（包括中空管的手柄端22和中空管摄像装置端23二个部分）可依据不同型号、不同应用场景分为可塑形中空管和硬质不可塑形中空管；所述中空管摄像装置端23设置有摄像装置26，在摄像装置侧设有照明灯，中空管上摄像装置的数据线缆25穿过中空管和手柄21集成电路连接并把图像传送到显示屏11；所述中空管外周面上套接有限位器24。
所述限位器24呈圆台状，限位器的大端靠近手柄21，限位器使中空管外端面和气管导管外端面距离始终保持在10mm 左右，使摄像装置26不露出气管导管之外，避免损伤患者。
目前临床常用的可视喉镜使用镜片曲度较大，进行气管插管无需头颈过度后仰，暴露声门容易简单，但由于设计问题，在临床使用中可视喉镜暴露声门容易而清楚，但是插管进入声门比直视喉镜更加复杂困难。本发明采用双可视、双定位方法，可视喉镜的目的是暴露声门，而气管插管时对导管进入声门的观察主要依靠可视导芯，不必考虑导管进入到镜头处时管子挡住镜头，所以喉镜片的曲度相比一般可视喉镜小一些，气管插管时可采用呈嗅物位，插管时口轴线、咽轴线、喉轴线三轴一线，气管插管时送管阻力小，即使有分泌物粘附摄像装置的镜头引起看声门不清也可以直视下行气管插管，解决了可视喉镜暴露声门容易但是插管进入声门比直视喉镜更加复杂、困难这个问题和分泌物粘附镜头引起看声门不清的问题。
本发明可视喉镜的喉镜片符合口咽部生理弯曲，使视角向前转60 度左右，视点前移，对少部分特殊的困难气道患者不必过度强调嗅物位，无需口、咽、喉三轴一线也可显露声门，而且由于导芯可视的特点，将它放在会厌下便可找到声门，声门打开时即插入导管，不需要用喉镜充分暴露声门，所以哪怕可视喉镜无法显示声门也可以在可视下进行气管插管，解决了直视喉镜的声门暴露困难和需要过度暴露口咽部的问题，当然这种情况下气管插管送管时会相对困难，所以只要患者情况允许的话，哪怕不能达到标准的嗅物位，无法达到口、咽、喉三轴一线，也要摆好患者体位，减少口轴线、咽轴线、喉轴线三轴角度差，降低气管插管时送管的难度。本发明可以充分利用可视喉镜和直视喉镜的各自优点同时避免可视喉镜和直视喉镜部分缺点，可以明显提高插管成功率，减少并发症。
本发明采用双可视、双定位方法，采用可视喉镜暴露声门，而气管插管时对导管进入声门的观察主要依靠可视导芯，解决了可视喉镜难以判断气管导管尖端与声门的关系的问题；本发明采用可视喉镜暴露声门，解决了可视导芯行气管插管时需要把拇指伸进患者口中的问题和会厌、声门暴露困难的问题；本发明采用可视喉镜暴露声门，行气管插管时可视喉镜把舌体推开，可视导芯有较大的空间进入口腔减少损伤和增加插管成功率。
本发明对部分张口困难病人可单独采用可视导芯进行气管插管，解决了张口困难病人的气管插管难题。
本发明可通过可塑形可视导芯明确气管导管是否位于气管内和气管导管插入深度是否合适，解决了目前临床上气管插管后气管导管是否位于气管内和气管导管插入深度是否合适的问题。
进行气管插管时可按以下步骤进行。
1. 可视导芯润滑后将气管导管套在可视导芯上，调整可视导芯上的限位器让可视导芯的管头保持在距离气管导管尖端内大约1cm 处，这样摄像装置等部件就不会外露损伤患者粘膜组织，同时也可在一定程度上避免与痰液唾液等污物接触，影响图像效果。
2. 打开可视喉镜和可视导芯的电源，确定在显示屏上可以同时看到可视喉镜和可视导芯传送的图像。
3.患者采用仰卧位后头后仰的嗅物位，对于少数如甲颏距离短、小下颌、门齿突出、舌体肥大、高喉头、肥胖、颈项粗短、下颌活动受限、颈椎活动受限等特殊体型或者颈椎损伤不能头后仰等原因的困难气道患者不必过度强调三轴一线，左手持可视喉镜，借助可视喉镜依次显露三个解剖标志：悬雍垂、会厌、声门。
4. 右手持套有可视导芯气管导管，将气管导管插入口腔，可视导芯摄像装置将口腔内部的情况影像实时地显示到显示屏上，供操作者二次声门定位，看到声门顺势将气管导管推进气管内，抽出可视导芯，调整气管导管深度，固定气管导管，插管完成。
5. 插管完成牙垫固定后可以一边呼吸机辅助通气一边再次通过可塑形可视导芯明确气管导管是否位于气管内以及气管导管插入深度是否合适。
6. 在呼吸机辅助通气时如果患者出现躁动、呼吸急促、血氧饱和度下降等情况时也可以一边呼吸机辅助通气一边再次通过可塑形可视导芯明确气管导管是否位于气管内、气管导管插入深度是否合适、是否有气管导管气囊疝入、是否有主支气管痰液等引起主支气管堵塞等问题。
7.对部分张口困难的患者，如果无法放入可视喉镜，则可以不使用喉镜单独采用可视导芯进行气管插管。可视导芯润滑后将气管导管套在可视导芯上，调整可视导芯上的限位器；打开可视导芯和显示屏的电源，确定在显示屏上可以看到可视导芯传送的图像；摆好体位，将套有可视导芯的气管导管插入口腔，摄像装置将口腔内部的情况影像实时地显示到显示屏上，供操作者找到声门，由于导芯可视的特点，将它放在会厌下便可找到声门，看到声门打开顺势将气管导管推进气管内，抽出可视导芯，调整气管导管深度，固定气管导管，插管完成。采用这种方法对张口度要求不高，即使张口度只有0 .5cm左右较小的困难气道气管插管变得简单准确。
本发明采取可视喉镜和可视导芯组合的双可视、双定位方法，通过可视喉镜定位，可将可视喉镜的摄像装置快速引导到声门位置，再通过可视导芯的摄像装置进行声门精准的二次定位，对患者快速进行气管插管，确保气管插管的成功率，而且可以通过可视导芯明确气管导管是否位于气管内以及气管导管插入深度是否合适。对部分张口困难的患者可单独采用可视导芯进行气管插管。该双可视、双定位气管插管套装，可实现气管插管过程全程可视化，不会有误插入食管的风险，方便医生对气管插管的深度和位置的确定，极大地提高了气管插管的可操作性和安全性，降低医疗风险。
 有益效果
1. 本发明采用双可视、双定位方法，通过可视喉镜定位，可将可视喉镜摄像装置快速地引导到声门位置，再通过可视导芯摄像装置进行精准的声门二次定位，实现了气管插管操作过程中的全程实时可视引导，易操作，插管速度快，一次插管成功率高，不会有误插入食管的风险，极大地提高了气管插管的可操作性和安全性，有效提高了插管的时效性，降低医疗风险，有利于新手入门，适合在临床推广应用。
2.本发明可通过可塑形可视导芯明确气管导管是否位于气管内和气管导管插入深度是否合适，解决了目前临床上气管插管后气管导管是否位于气管内和气管导管插入深度是否合适的问题。
3. 一般的可视喉镜为了避免镜片前段部分遮挡镜头以及防止气管导管进入到镜头处时管子挡住镜头，所以镜片曲度较大；本发明采用双可视、双定位方法，可视喉镜的目的是暴露声门，而气管插管时对导管进入声门的观察主要依靠可视导芯，不必考虑导管进入到镜头处时管子挡住镜头，所以喉镜片的曲度相比一般可视喉镜小一些，气管插管时可采用仰卧位后头后仰的嗅物位，这时患者口轴线、咽轴线、喉轴线三轴一线，解决了可视喉镜暴露声门容易但是插管进入声门比直视喉镜更加复杂、困难这个问题。
4.  由于气管插管时可采用嗅物位，所以如果有分泌物粘附镜头引起看声门不清也可以直视下行气管插，解决了分泌物粘附镜头引起看声门不清的问题。
5. 当使用喉镜片较直的直视喉镜插管时，眼睛在口外，视线看着导管尖端直接插入声门内，而可视喉镜则将眼睛移到显示屏上，人眼与视野之间并非一致，出现视差后可见非所得，所以虽然更容易看到声门视野，却更不容易判断管子尖端与声门的关系，容易造成插管困难甚至误插入食道；本发明采用双可视、双定位方法，可视喉镜的目的是暴露声门，而气管插管时对导管进入声门的观察主要依靠可视导芯，解决了可视喉镜难以判断气管导管尖端与声门的关系的问题。
6. 本发明的可视喉镜的喉镜片采用符合口咽部生理弯曲的曲度，使视角向前转60 度左右，视点前移，有利于声门的暴露，因此在遇到少数如甲颏距离短、小下颌、门齿突出、舌体肥大、高喉头、肥胖、颈项粗短、下颌活动受限、颈椎活动受限等特殊体型或者颈椎损伤不能头后仰等原因的困难气道患者，这时患者口轴线、咽轴线、喉轴线三轴不在一线，但是由于喉镜片的视角向前转60 度左右，视点前移，所以仍可以显示声门，解决了直视喉镜的声门暴露困难和需要过度暴露口咽部的问题。
7.  本发明由于导芯可视的特点，将它放在会厌下便可找到声门，声门打开时即可插入气管导管，不需要用喉镜充分暴露声门，也可以在可视下进行气管插管，解决了极少数的可视喉镜也无法显示声门的困难气道患者的气管插管问题。
8.本发明采用可视喉镜暴露声门，解决了可视导芯行气管插管时需要把拇指伸进患者口中的问题和会厌、声门暴露困难的问题。
9.  本发明采用可视喉镜暴露声门，行气管插管时可视喉镜把舌体推开，可视导芯有较大的空间进入口腔减少损伤和增加插管成功率。
10. 对部分张口困难患者可单独采用可视导芯进行气管插管，解决了张口困难患者的气管插管问题。
 附图说明
图1为本发明的结构示意图。图中1. 可视喉镜；11. 显示屏；12. 可视喉镜手柄；13.可视喉镜镜片；14. 可视喉镜摄像装置；2. 可视导芯；21.可视导芯手柄；22. 中空管的手柄端；23. 中空管摄像装置端；24. 限位器；25. 可视导芯摄像装置的数据线缆；26.可视导芯摄像装置。
 本发明的最佳实施方式
使用本发明所述的可视喉镜和可视导芯组合的双可视、双定位气管插管套装，按照患者的不同情况可采用不同的气管插管方法，没有通用于所有患者的最佳实施方式，但是对大部分非困难气道患者采用下述具体实施方式的方式一是比较好的实施方式。
 本发明的实施方式
使用本发明所述的可视喉镜和可视导芯组合的双可视、双定位气管插管套装，按照患者的不同情况可采用不同的气管插管方法。
方式一、对于多数直视喉镜可清楚暴露声门的非困难气道的患者，气管插管时可采用仰卧位后头后仰的嗅物位，插管时口轴线、咽轴线、喉轴线三轴一线：1. 可视导芯润滑后将气管导管套在可塑形可视导芯上，调整可视导芯上的限位器并对可视导芯进行塑形，让可塑形导芯的管头保持在距离气管导管尖端内大约1cm 处，这样摄像装置等部件就不会外露损伤患者粘膜组织，同时也可在一定程度上避免与痰液唾液等污物接触，影响图像效果；2.打开可视喉镜和可视导芯的电源，确定在显示屏上可以同时看到可视喉镜和可视导芯传送的图像；3.在嗅物位下使用可视喉镜，借助头部、体位的改变，使口轴线、咽轴线、喉轴线三轴线重叠，这时左手持可视喉镜依次显露三个解剖标志：悬雍垂、会厌、声门，如果有分泌物粘附镜头引起看声门不清也可以直视下行气管插管；4.右手持套着可视导芯的气管导管插入口腔，可视导芯的摄像装置将口腔内部的情况影像实时地显示到显示屏上，供操作者精确地二次找到声门，看到声门打开顺势将气管导管推进气管内，抽出可塑形导芯，调整气管导管深度，固定气管导管，插管完成；5.插管完成后进行牙垫固定、接呼吸机辅助通气，然后就可以一边呼吸机辅助通气一边再次通过可塑形可视导芯明确气管导管是否位于气管内以及气管导管插入深度是否合适；6.在呼吸机辅助通气时如果患者出现躁动、呼吸急促、血氧饱和度下降等情况时也可以一边呼吸机辅助通气一边再次通过可塑形可视导芯明确气管导管是否位于气管内、气管导管插入深度是否合适、是否有气管导管气囊疝入、是否有主支气管痰液等引起主支气管堵塞等问题。
方式二、对于少数如甲颏距离短、小下颌、门齿突出、舌体肥大、高喉头、肥胖、颈项粗短、下颌活动受限、颈椎活动受限等特殊体型或者颈椎损伤不能头后仰等原因的困难气道患者，直视喉镜不能清楚暴露声门则不必强调三轴一线：1. 可视导芯润滑后将气管导管套在可塑形可视导芯上，调整可视导芯上的限位器并对可视导芯进行塑形，让可塑形导芯的管头保持在距离气管导管尖端内大约1cm 处，这样摄像装置等部件就不会外露损伤患者粘膜组织，同时也可在一定程度上避免与痰液唾液等污物接触，影响图像效果；2.打开可视喉镜和可视导芯的电源，确定在显示屏上可以同时看到可视喉镜和可视导芯传送的图像；3. 只要患者情况允许的话，气管插管时可采用嗅物位，哪怕不能达到标准的嗅物位，无法达到口、咽、喉三轴一线，也要摆好患者体位，减少口轴线、咽轴线、喉轴线三轴角度差，降低气管插管时送管的难度；但是如果由于颈椎损伤等原因不能采用呈嗅物位则保持患者的安全体位；4. 左手持可视喉镜依次显露三个解剖标志：悬雍垂、会厌、声门，右手持套着可视导芯的气管导管插入口腔，可视导芯的摄像装置将口腔内部的情况影像实时地显示到显示屏上，供操作者精确地二次找到声门，看到声门打开顺势将气管导管推进气管内，抽出可塑形导芯，调整气管导管深度，固定气管导管，插管完成；5.插管完成后进行牙垫固定、接呼吸机辅助通气，然后就可以一边呼吸机辅助通气一边再次通过可塑形可视导芯明确气管导管是否位于气管内以及气管导管插入深度是否合适；6.在呼吸机辅助通气时如果患者出现躁动、呼吸急促、血氧饱和度下降等情况时也可以一边呼吸机辅助通气一边再次通过可塑形可视导芯明确气管导管是否位于气管内、气管导管插入深度是否合适、是否有气管导管气囊疝入、是否有主支气管痰液等引起主支气管堵塞等问题。
方式三、对于极少数可视喉镜也不能清楚暴露声门的困难气道患者，只要患者情况允许的话，也要摆好患者体位，减少口轴线、咽轴线、喉轴线三轴角度差，降低气管插管时送管的难度：1. 可视导芯润滑后将气管导管套在可塑形可视导芯上，调整可视导芯上的限位器并对可视导芯进行塑形，让可塑形导芯的管头保持在距离气管导管尖端内大约1cm 处，这样摄像装置等部件就不会外露损伤患者粘膜组织，同时也可在一定程度上避免与痰液唾液等污物接触，影响图像效果；2.打开可视喉镜和可视导芯的电源，确定在显示屏上可以同时看到可视喉镜和可视导芯传送的图像；3. 只要患者情况允许的话，哪怕不能达到标准的嗅物位，无法达到口、咽、喉三轴一线，也要摆好患者体位，减少口轴线、咽轴线、喉轴线三轴角度差，降低气管插管时送管的难度；但是如果由于颈椎损伤等原因不能采用呈嗅物位则保持患者的安全体位；4. 左手持可视喉镜依次显露悬雍垂、会厌，这类患者不能显露声门甚至不能显露悬雍垂、会厌，插管确定进入声门主要依靠可视导芯；右手持套着可视导芯的气管导管插入口腔，可视导芯的摄像装置将口腔内部的情况影像实时地显示到显示屏上，供操作者找到声门，如果遇会厌阻挡无法显示声门，可视导芯需从会厌侧旁绕过或者向下越过会厌，由于导芯可视的特点，将它放在会厌下便可找到声门，不需要用喉镜充分暴露声门，看到声门打开顺势将气管导管推进气管内，抽出可塑形导芯，调整气管导管深度，固定气管导管，插管完成；如果由于可塑形导芯过软导致无法显示声门，则改用硬质不可塑形导芯完成气管插管；5.插管完成后牙垫固定、接呼吸机辅助通气，然后就可以一边呼吸机辅助通气一边再次通过可塑形可视导芯明确气管导管是否位于气管内以及气管导管插入深度是否合适；6.在呼吸机辅助通气时如果患者出现躁动、呼吸急促、血氧饱和度下降等情况时也可以一边呼吸机辅助通气一边再次通过可塑形可视导芯明确气管导管是否位于气管内、气管导管插入深度是否合适、是否有气管导管气囊疝入、是否有主支气管痰液等引起主支气管堵塞等问题。
方式四、对部分张口困难无法放入可视喉镜的困难气道患者，则可以不使用喉镜单独采用可视导芯进行气管插管，气管插管时可采用嗅物位，对少部分特殊的困难气道患者不必过度强调嗅物位，但应尽量减少口轴线、咽轴线、喉轴线三轴角度差，降低气管插管时送管的难度：1. 可视导芯润滑后将气管导管套在可塑形可视导芯上，调整可视导芯上的限位器并对可视导芯进行塑形，让可塑形导芯的管头保持在距离气管导管尖端内大约1cm 处，这样摄像装置等部件就不会外露损伤患者粘膜组织，同时也可在一定程度上避免与痰液唾液等污物接触，影响图像效果；2. 打开可视导芯的电源、显示屏电源，确定在显示屏上可以看到可视导芯传送的图像；3. 只要患者情况允许的话，气管插管时可采用嗅物位，哪怕不能达到标准的嗅物位，无法达到口、咽、喉三轴一线，也要摆好患者体位，减少口轴线、咽轴线、喉轴线三轴角度差，降低气管插管时送管的难度；但是如果由于颈椎损伤等原因不能采用呈嗅物位则保持患者的安全体位；4. 进行气管插管时，左手拇指抓扣患者下切牙并向上提起下颌及舌体以扩大咽腔间隙，手持套着可视导芯的气管导管插入口腔，必要时可由助手协助托起患者下颌以利于操作者找到会厌后的声门暴露，遇会厌阻挡无法显示声门，需从会厌侧旁绕过或者向下越过会厌，由于导芯可视的特点，将它放在会厌下便可找到声门，不需要用喉镜充分暴露声门，看到声门打开顺势将气管导管推进气管内，抽出可塑形可视导芯，调整气管导管深度，固定气管导管，插管完成；如果由于可塑形可视导芯过软导致无法显示声门，则改用硬质不可塑形可视导芯完成气管插管；5.插管完成后进行牙垫固定、接呼吸机辅助通气，然后就可以一边呼吸机辅助通气一边再次通过可塑形可视导芯明确气管导管是否位于气管内以及气管导管插入深度是否合适；6.在呼吸机辅助通气时如果患者出现躁动、呼吸急促、血氧饱和度下降等情况时也可以一边呼吸机辅助通气一边再次通过可塑形可视导芯明确气管导管是否位于气管内、气管导管插入深度是否合适、是否有气管导管气囊疝入、是否有主支气管痰液等引起主支气管堵塞等问题。采用这种方法对张口度要求不高，即使张口度只有0 .5cm左右较小的困难气道气管插管变得简单准确。
本发明不限定于上述特定的实施方案，而是扩展至所附的权利要求书的可视喉镜和可视导芯组合的双可视、双定位气管插管技术的多种改型。本领域的技术人员应当理解，可以对本发明的技术方案进行修改或者等同替换，而不脱离本发明技术方案的精神和范围，其均应涵盖在本发明的可视喉镜和可视导芯组合的双可视、双定位气管插管技术权利要求范围当中。
 工业实用性
目前临床可视喉镜广泛使用，可视导芯也有少部分使用，将可视喉镜和可视导芯的图像传输到同一个显示屏对目前的工业水平是很容易的，所以具有工业实用性。

Claims (7)

  1. 一种气管插管套装，其特征是：所述的气管插管套装包括可视喉镜和可视导芯，可视喉镜和可视导芯为2个分离的部件，以方便进行气管插管时一手持可视喉镜一手持套有可视导芯的气管导管，显示屏作为可视喉镜的一部分，可固定在可视喉镜手柄上或者通过WiFi或蓝牙无线装置和可视喉镜连接进行图像传送，可视导芯和显示屏通过数据线连接或者通过 WiFi或蓝牙无线装置进行图像传送。
  2. 根据权利要求1 所述的气管插管套装，其特征是：该套装采用可视喉镜和可视导芯组合的双可视、双定位气管插管技术。
  3. 根据权利要求1 所述的气管插管套装，其特征是：该套装的可视喉镜包括显示屏、手柄、喉镜片、摄像装置；进行气管插管时左手持可视喉镜，借助可视喉镜依次显露三个解剖标志悬雍垂、会厌、声门；可视喉镜可暴露声门并观察和定位声门。
  4. 根据权利要求1 所述的气管插管套装，其特征是：该套装的可视导芯包括手柄、中空管、限位器、摄像装置，可视导芯可依据不同型号、不同应用场景分为可塑形可视导芯和硬质不可塑形可视导芯；进行气管插管时将可视导芯润滑后将气管导管套在可视导芯上，调整可视导芯上的限位器让可视导芯的摄像头端保持在距离气管导管尖端内大约1cm 处，左手持可视喉镜暴露并定位声门后，右手持套有可视导芯的气管导管，看到声门进行第二次声门定位后顺势将气管导管推进气管内，气管插管后可视导芯可观察到气管结构、组织进行气管定位；可视导芯可全程观察气管插管过程并观察和定位声门、气管。
  5. 根据权利要求1 所述的气管插管套装，其特征是：显示屏为可视喉镜的一部分，显示屏可固定在可视喉镜手柄上或者单独置于可视喉镜手柄之外以方便观看，如果显示屏单独置于可视喉镜手柄之外时可以通过WiFi或蓝牙无线装置和可视喉镜手柄连接进行图像传送；可视导芯手柄和显示屏通过数据线连接进行图像传送或者通过WiFi或蓝牙无线装置进行图像传送；显示屏上可以同时显示或者单独显示可视喉镜和可视导芯传送的图像，以方便采用双可视双定位技术进行气管插管时图像观察。
  6. 根据权利要求1 所述的气管插管套装，其特征是：该套装的可视喉镜喉镜片采用符合口咽部生理弯曲的曲度，其喉镜片曲度比一般可视喉镜曲度小一些以方便采用嗅物位时进行气管插管。
  7. 根据权利要求1 所述的气管插管套装，其特征是：采用可塑形可视导芯明确气管插管完成后气管导管是否位于气管内和气管导管插入深度是否合适。
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