CN109172984A - A kind of Combined double-chamber bronchial catheter - Google Patents
A kind of Combined double-chamber bronchial catheter Download PDFInfo
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- CN109172984A CN109172984A CN201810961046.8A CN201810961046A CN109172984A CN 109172984 A CN109172984 A CN 109172984A CN 201810961046 A CN201810961046 A CN 201810961046A CN 109172984 A CN109172984 A CN 109172984A
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- 238000005452 bending Methods 0.000 claims abstract description 8
- 238000002347 injection Methods 0.000 claims description 32
- 239000007924 injection Substances 0.000 claims description 32
- 230000001154 acute effect Effects 0.000 claims description 3
- 241000293849 Cordylanthus Species 0.000 claims 1
- 210000000621 bronchi Anatomy 0.000 abstract description 43
- 238000000034 method Methods 0.000 abstract description 8
- 238000003780 insertion Methods 0.000 abstract description 5
- 230000037431 insertion Effects 0.000 abstract description 5
- 230000009286 beneficial effect Effects 0.000 abstract 1
- 239000007789 gas Substances 0.000 description 30
- 210000004072 lung Anatomy 0.000 description 28
- 238000009423 ventilation Methods 0.000 description 15
- 238000005516 engineering process Methods 0.000 description 6
- 238000002627 tracheal intubation Methods 0.000 description 5
- 230000000903 blocking effect Effects 0.000 description 4
- 230000028327 secretion Effects 0.000 description 4
- 239000008280 blood Substances 0.000 description 3
- 210000004369 blood Anatomy 0.000 description 3
- 238000010586 diagram Methods 0.000 description 3
- 230000009977 dual effect Effects 0.000 description 3
- 230000000694 effects Effects 0.000 description 3
- 238000002955 isolation Methods 0.000 description 3
- 210000000214 mouth Anatomy 0.000 description 3
- 230000029058 respiratory gaseous exchange Effects 0.000 description 3
- 238000001356 surgical procedure Methods 0.000 description 3
- 206010002091 Anaesthesia Diseases 0.000 description 2
- 230000037005 anaesthesia Effects 0.000 description 2
- 210000003323 beak Anatomy 0.000 description 2
- 239000000243 solution Substances 0.000 description 2
- 210000000115 thoracic cavity Anatomy 0.000 description 2
- 206010003694 Atrophy Diseases 0.000 description 1
- UGFAIRIUMAVXCW-UHFFFAOYSA-N Carbon monoxide Chemical compound [O+]#[C-] UGFAIRIUMAVXCW-UHFFFAOYSA-N 0.000 description 1
- 206010021143 Hypoxia Diseases 0.000 description 1
- 208000008589 Obesity Diseases 0.000 description 1
- 230000037444 atrophy Effects 0.000 description 1
- 239000002775 capsule Substances 0.000 description 1
- 239000002131 composite material Substances 0.000 description 1
- 230000006835 compression Effects 0.000 description 1
- 238000007906 compression Methods 0.000 description 1
- 230000007547 defect Effects 0.000 description 1
- 239000003546 flue gas Substances 0.000 description 1
- 230000035876 healing Effects 0.000 description 1
- 208000018875 hypoxemia Diseases 0.000 description 1
- 208000015181 infectious disease Diseases 0.000 description 1
- 239000007788 liquid Substances 0.000 description 1
- 239000000463 material Substances 0.000 description 1
- 238000005399 mechanical ventilation Methods 0.000 description 1
- 210000004400 mucous membrane Anatomy 0.000 description 1
- 235000020824 obesity Nutrition 0.000 description 1
- 230000036407 pain Effects 0.000 description 1
- 201000003144 pneumothorax Diseases 0.000 description 1
- 230000002980 postoperative effect Effects 0.000 description 1
- 230000002685 pulmonary effect Effects 0.000 description 1
- 231100000241 scar Toxicity 0.000 description 1
- 238000000926 separation method Methods 0.000 description 1
- 210000003437 trachea Anatomy 0.000 description 1
- 230000007704 transition Effects 0.000 description 1
Classifications
-
- 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. ventilators; Tracheal tubes
- A61M16/04—Tracheal tubes
- A61M16/0402—Special features for tracheal tubes not otherwise provided for
- A61M16/0404—Special features for tracheal tubes not otherwise provided for with means for selective or partial lung respiration
-
- 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. ventilators; Tracheal tubes
- A61M16/04—Tracheal tubes
- A61M16/0486—Multi-lumen tracheal tubes
Landscapes
- Health & Medical Sciences (AREA)
- Pulmonology (AREA)
- Emergency Medicine (AREA)
- Engineering & Computer Science (AREA)
- Anesthesiology (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Hematology (AREA)
- Life Sciences & Earth Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Media Introduction/Drainage Providing Device (AREA)
Abstract
本发明提供一种组合式双腔支气管导管，涉及医疗器械技术领域。它包括主导管，主导管连接有相对主导管可上下移动的副导管，主导管靠近下端部连接有主导管套囊，副导管靠近下端部连接有副导管套囊，主导管管径为5‑7mm，副导管管径为3‑5mm，主/副导管内壁均连接有主导管抗折弯层。本发明解决了现有技术中对一些特殊患者常规经口途径插入传统双腔管非常困难，不但对患者损伤大，且失败率高的技术问题。本发明有益效果为：两个不同管径的单腔支气管导管，可以分别插入到目标支气管，导管可根据患者气道情况灵活调整双腔管的组合结构和部位，简化了传统双腔管的插管和定位技术。导管抗折弯，在使用中始终保持通畅，使用安全方便，对患者气道损伤更轻微。
The invention provides a combined double-lumen bronchial catheter, which relates to the technical field of medical devices. It includes a main conduit, the main conduit is connected with an auxiliary conduit that can move up and down relative to the main conduit, the main conduit is connected with a main conduit cuff near the lower end, and the auxiliary conduit is connected with an auxiliary conduit cuff near the lower end, and the main conduit has a diameter of 5‑ 7mm, the diameter of the auxiliary duct is 3‑5mm, and the inner wall of the main and auxiliary ducts are connected with the anti-bending layer of the main duct. The invention solves the technical problems in the prior art that it is very difficult to insert a traditional double-lumen tube through the oral route for some special patients, not only causes great damage to the patient, but also has a high failure rate. The beneficial effects of the invention are as follows: two single-lumen bronchial catheters with different diameters can be inserted into the target bronchus respectively, and the catheter can flexibly adjust the combined structure and position of the double-lumen catheter according to the airway condition of the patient, which simplifies the insertion of the traditional double-lumen catheter. Tube and positioning techniques. The catheter is resistant to bending, and is always kept unobstructed during use, which is safe and convenient to use, and causes less damage to the patient's airway.
Description
Technical field
Invention is related to the field of medical instrument technology, more particularly, to a kind of auxiliary surgical for lung isolation one-lung ventilation technology
Help apparatus structure.
Background technique
One-lung ventilation refers to what thoracic surgery patient was only ventilated using No operation side lung by special tracheal catheter
Method or means.There are three types of one-lung ventilation technologies at present: placing double-lumen catheter；Bronchus is combined using single-lumen bronchial tube
Disabler；Conventional endotracheal tubes are put into side main bronchus.Wherein double-lumen catheter is most widely used.Chinese patent Shen
Please publication No. CN108187206A, data of publication of application on June 22nd, 2018, entitled " a kind of dual cavity bronchus vessel and control
The patent application of method " discloses a kind of dual cavity bronchus vessel structure.Including two left bronchus casings side by side and right branch
Tracheal tube；Left bronchus catheter is slidably sleeved in left bronchus casing；Right bronchial catheter, slideably
It is set in right bronchus casing；Air bag is set in the outside of double lumen endobronchial tube casing；Multiple square grooves, it is axially disposed
In left bronchus catheter and right bronchial catheter outer wall；Square sliding block, setting cover tube wall in double lumen endobronchial tube, are located on air bag
Side, the relative position of can match with groove fixed left bronchus catheter and right bronchial catheter；Band is set in sliding block pair
Outside the double lumen endobronchial tube casing answered；Left air bag is set in the lower end of left bronchus catheter；Right air bag is set in right bronchus and leads
The lower end of pipe.Although the structure provides ventilation side and may be selected, and the dual cavity bronchus vessel that its catheter length is adjustable, but
It is or is not applied for some particular patients 's, such as: children, runty adult, neck tubbiness, obesity, difficulty in opening mouth etc..
It is for these particular patients 's, i.e., still partially thick using tradition F32 double lumen tube, patient airway cannot be inserted into.Convenient oral approach is inserted
It is extremely difficult to enter such double lumen tube, not only damage is big, and failure rate is high.In addition, for the case of tracheotomy, if from
Incision of trachea is disposed into because not yet healing forms scar sinus to notch completely, and double lumen tube is relatively thick and stiff, may both damage tracheae
Stoma and air flue mucous membrane can be not achieved due to the too long closed airbag that may make main airway of conduit exposed parts stays in outside tracheae again
The effect of closed airway leads to air flue gas leakage, and mechanical ventilation fails in art.If inserted using the common right bronchus of tracheal catheter row
On the one hand pipe and one-lung ventilation may block superior lobe of right lung opening because the air bag of common tracheal catheter is cylindrical and longer
So as to cause hypoxemia in art, it on the other hand can not also attract the blood that may be backflowed when left Lung operation to knuckle and tracheae in time
Liquid and other secretion and cause right bronchus accidentally to be inhaled or pollution, cannot achieve the effect that the satisfied separation of double lungs and purpose.If
Selection is oral or tracheotomy mouth is placed in single-lumen bronchial tube, then guides the merging left branch gas of bronchus blocking device row through Bronchofiberscope
Blockage, although relatively simple right bronchial cannula be it is excellent, this method can not carry out double lungs independent ventilation simultaneously, and because internal diameter compared with
Small bronchus blocking device conduit not only makes the art side collapse of lung or opens slowly again again, generally requires manual compression, vacuum suction
And the methods of breathing circuit is disconnected to assist, influence procedure.Although main air passage can be utilized by unclamping blanking plug cuff
Progress positive airway pressure replies immediately art side lung fastly to be opened, but the method can lead to blood and secretion pollution, backflow or miss under sucking
The strong lung of vertical side.Further, since the lumen of blanking plug conduit is very thin, make side lung distal end secretion attraction difficulty of performing the operation, even if sharp
With the lumen attract, also easily by blood and secretion blocking cause art side lung drain and attract it is unsmooth, it is postoperative to easily lead to lung
The severe complications such as infection.
Summary of the invention
It is extremely difficult to the traditional double lumen tube of some particular patients ' convenient oral approach insertion in the prior art in order to solve, no
But patient is damaged greatly, and the technical problem that failure rate is high, the present invention provide a kind of Combined double-chamber bronchial catheter, reach both
Meet the technical requirements of complete lung isolation, and can lung rapid atrophy in side is opened again, laterobronchus of performing the operation attracts simultaneously at any time convenient for performing the operation
It can be using a variety of requirements such as CPAP ventilation and the purpose of one-lung ventilation simple to operate, damage is few.
The technical solution of invention is: a kind of Combined double-chamber bronchial catheter, it includes main pipe, and main pipe is connected with phase
To main pipe secondary conduits moving up and down, main pipe is connected with main pipe cuff close to lower end, and secondary conduits are close to lower end
It is connected with secondary conduits cuff, main pipe caliber is 5-7mm, and secondary conduits caliber is 3-5mm, and it is anti-that leading inside pipe wall is connected with main pipe
Bending layer.Composite structure and the position of double lumen tube can be adjusted flexibly when clinical application according to patient airway situation, enormously simplify
The complicated intubation and location technology of traditional double lumen tube.Can safe ready for 4 years old and the above children and the short and small patient of stature
One-lung ventilation is isolated with lung, is damaged to patient airway slighter.Conduit warping resistance, if overcome for the first time be intubated it is unsuccessful after
It influences the defect of second of intubation and guarantees that air flue is unobstructed always in art.Length of tube is dominated compared with traditional classical double lumen endobronchial tube
Conduit is shorter, reduces ventilation dead space, can improve solve children and particular patients ' (such as difficult airway, it is extremely fat, of short and small stature,
Tracheotomy or colostomy patient etc.) one-lung ventilation, which can make 4 years old and the above children and above-mentioned particular patients ' be convenient, peace
Thoracic surgery is completed under the complete lung isolation technology of one-lung ventilation entirely.
Preferably, the lower end surface of secondary conduits is the inclined-plane for forming acute angle with pipe central axes；Convenient and suitable closure right lung
Bronchus.
Preferably, secondary conduits cuff length L is 8-12mm；Be more suitable block right lung bronchus.
Preferably, secondary conduits lower end surface and the shortest distance H in secondary conduits cuff lower end are 8-12mm；Secondary conduits cuff
As close as possible to secondary conduits end face, be conducive to the bronchus for blocking right lung.
Preferably, leading pipe outer wall is equipped with guide sleeve, guide sleeve and secondary conduits are socketed；Facilitate major and minor conduit to connect, adjusts
It is simple to save secondary conduits position.
Preferably, the lower end of main pipe is at beak shape；Facilitate intubation.
Preferably, main pipe cuff is cylindrical, edge is equipped with the groove of cylindrical body, and groove matches with secondary conduits；
Facilitate secondary conduits to be intubated, reduces patient's damage and intubation pain.
Preferably, leading tube wall is equipped with main pipe gas injection slot, main pipe gas injection close to main pipe warping resistance layer side wall
Slot is connected to main pipe cuff；Guarantee that main pipe gas injection slot is unimpeded.
Preferably, secondary conduits inner wall is connected with secondary conduits warping resistance layer；Secondary conduits bending is prevented, operation is facilitated.
Preferably, secondary conduits tube wall is equipped with secondary conduits gas injection slot, secondary conduits gas injection slot is secondary close to secondary conduits warping resistance layer
Conduit gas injection slot is connected to secondary conduits cuff；Guarantee that secondary conduits gas injection slot is unimpeded.
Compared with prior art, advantageous effect of the invention is: the single lumen endobronchial tube of two different tube diameters can be distinguished
It is inserted into target bronchial, in actual application, the combination knot of double lumen tube can be adjusted flexibly in conduit according to patient airway situation
Structure and position enormously simplify the intubation and location technology of traditional double lumen tube.Conduit warping resistance, remains in use
It is unobstructed, it is ensured that clinical use safety.It is conveniently used for 4 years old and the above children and particular patients ' (such as difficult airway, extremely fat, body
Material is short and small, tracheotomy or colostomy patient etc.) one-lung ventilation be isolated with lung, patient airway is damaged slighter.
Detailed description of the invention
Attached drawing 1 is connection schematic diagram of the present invention；
Attached drawing 2 is A-A cross-sectional view in Fig. 1；
Attached drawing 3 is B-B cross-sectional view figure in Fig. 1；
Attached drawing 4 is the schematic diagram that the present invention is used for right side Lung operation；
Attached drawing 5 is the schematic diagram that the present invention is used for left side Lung operation.
In figure: 1- main pipe；2- secondary conduits；3- tracheae；4- right principal bronchus；5- right superior lobar bronchus；On the left lung of 6-
Leaf bronchus；7- left principal bronchus；11- main pipe gas injection slot；12- main pipe cuff；The lower end 13-；14- guide sleeve；15- master
Conduit warping resistance layer；21- secondary conduits gas injection slot；22- secondary conduits cuff；The lower end surface 23-；24- secondary conduits warping resistance layer；51- is right
Lung superior lobar branch tracheostomy；61- left superior lobar bronchus opening；121- groove.
Specific embodiment
Below with reference to the embodiments and with reference to the accompanying drawing the technical solution to invention is described in further detail.
Embodiment 1:
As shown in Figure 1,2 and 3, a kind of Combined double-chamber bronchial catheter, is made of main pipe 1 and secondary conduits 2.Main pipe 1 is managed
Diameter is 7mm.1 inner wall of main pipe is connected with main pipe warping resistance layer 15.Main pipe warping resistance layer 15 is thin anti-twist wire guide
Structure.Main pipe warping resistance layer 15 is located in 1 wall of main pipe.The lower end 13 of main pipe 1 is beak shape, i.e., symmetrical two sides
Longer, two sides of adjacent symmetric are shorter.Long, end face interconnecting piece is arc surface transition.Main pipe 1 is close to lower end 13
Outer wall is connected with main pipe cuff 12.Main pipe cuff 12 is gas cell.It is cylindrical after 12 top off of main pipe cuff.It is main
The axis parallel of conduit cuff 12 central axes and main pipe 1.12 central axes of main pipe cuff and the central axes of main pipe 1 are left
A distance.12 edge of main pipe cuff is equipped with the groove 121 of cylindrical body.The central axes of groove 121 and the central axes of main pipe 1
In parallel.It is slightly larger than the outer diameter of secondary conduits 2 between groove 121.The tube wall of main pipe 1 is equipped with main pipe gas injection slot 11.Main pipe
Gas injection slot 11 is close to 15 side wall of main pipe warping resistance layer.Main pipe gas injection slot 11 is recommended as cylinder hollow structure, along main pipe 1
Axis direction arrangement.11 lower end of main pipe gas injection slot is connected to main pipe cuff 12.11 upper end of main pipe gas injection slot with refer to
Standard Luer interface (i.e. gas injection port) the (not shown) connection for showing air bag, i.e., connect with main pipe gas injection port.1 outer wall of main pipe
Equipped with guide sleeve 14.There are two guide sleeves.One guide sleeve 14 is located at close to 1 upper surface of main pipe.When main pipe 1 is inserted into patient
After tracheae 3, another guide sleeve 14 is located at outside patient oral cavity close to Hp position.Guide sleeve 14 and secondary conduits 2 are socketed.Secondary conduits
2 calibers are 3.5mm.The lower end surface 23 of secondary conduits 2 is elliptical aperture.Oval hole face is to form the oblique of acute angle with 2 central axes of secondary conduits
Face.Secondary conduits 2 are connected with secondary conduits cuff 22 close to lower part.Secondary conduits cuff 22 is cylindrical or round table-like.Secondary conduits cuff
22 length are L, L 10mm.2 lower end surface 23 of secondary conduits and the shortest distance in 22 lower end of secondary conduits cuff are H, H 10mm.It is secondary
2 inner wall of conduit is connected with secondary conduits warping resistance layer 24.Secondary conduits warping resistance layer 24 is located in 2 wall of secondary conduits.Secondary conduits warping resistance
Layer 24 is thin anti-twist wire guide structure.2 tube wall of secondary conduits is equipped with secondary conduits gas injection slot 21.Secondary conduits gas injection slot 21 is recommended as
Cylinder hollow structure is arranged along 2 central axes direction of secondary conduits.Secondary conduits gas injection slot 21 is close to 24 side wall of secondary conduits warping resistance layer.
21 lower end of secondary conduits gas injection slot is connected to secondary conduits cuff 22.21 upper end of secondary conduits gas injection slot has pilot balloon with another
Standard Luer interface (not shown) connection, i.e., connect with secondary conduits gas injection port.
As shown in figure 4, when right lung needs to perform the operation: secondary conduits 2 being inserted into guide sleeve 14, are embedded in groove 121.By dominating
Pipe 1 drives secondary conduits 2 to be inserted into tracheae 3.When main pipe cuff 12 enters tracheae 3 and left principal bronchus 7 and the company of right principal bronchus 4
It connects above place's (i.e. knuckle) at about 40-50mm, the stopping of main pipe 1 moves down.Secondary conduits 2 continue to move down insertion right principal bronchus 4.When
Secondary conduits cuff 22 stops moving down close to the position of right superior lobar bronchus 5.Secondary conduits 2 are adjusted, the lower end surface of secondary conduits 2 is made
23 are located at the top about 5-10mm of right superior lobar bronchus opening 51, pass through main pipe gas injection port and secondary conduits gas injection port respectively
It is inflated to main pipe cuff 12 and secondary conduits cuff 22.After appropriate gas injection, main pipe cuff 12 blocks tracheae 3, secondary conduits cuff
22 block right bronchus 4.When doctor performs the operation to merging 2 side lung of secondary conduits, patient then passes through main pipe 1 and connects anesthesia respirator
Ventilation retains autonomous respiration.
As shown in figure 5, when left pulmonary needs to perform the operation: driving secondary conduits 2 to be inserted into tracheae 3 by main pipe 1.When leading pipe sleeve
Capsule 12 enters above tracheae 3 and left principal bronchus 7 and 4 junction of right principal bronchus (i.e. knuckle) at about 40-50mm, main pipe
1 stops moving down, and secondary conduits 2 continue to move down insertion left principal bronchus 7.When secondary conduits cuff 22 enters the about 30- of left principal bronchus 7
At 40mm, stop moving down.Since left principal bronchus 7 is elongated, (bronchus lobaris superior sinister opening 61 is away from grand ridge about 50mm；And right main branch gas
4 tubbiness of pipe, right superior lobar bronchus opening 51 is away from grand ridge about 10-25mm), secondary conduits 2 are inserted into the distance phase of left principal bronchus 7
It is more when to than insertion right principal bronchus 4.Secondary conduits 2 are adjusted, so that the elliptical aperture of the lower end surface 23 of secondary conduits 2 is located on left lung
Leaf bronchus is open at 61 top 10-15mm, respectively by main pipe gas injection port and secondary conduits gas injection port to main pipe cuff 12
It is inflated with secondary conduits cuff 22, blocks tracheae 3 and left principal bronchus 7 respectively.Doctor, will when being inserted into 2 side Lung operation of secondary conduits
Secondary conduits folder closes or opens logical atmosphere, reaches operation side lung stuffiness and then withers, convenient for the purpose of surgical procedure, patient is then passed through
Main pipe 1 connects anesthesia respirator ventilation or retains autonomous respiration.
Claims (10)
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201810961046.8A CN109172984A (en) | 2018-08-22 | 2018-08-22 | A kind of Combined double-chamber bronchial catheter |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| CN201810961046.8A CN109172984A (en) | 2018-08-22 | 2018-08-22 | A kind of Combined double-chamber bronchial catheter |
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| Publication Number | Publication Date |
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| CN109172984A true CN109172984A (en) | 2019-01-11 |
Family
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| CN201810961046.8A Pending CN109172984A (en) | 2018-08-22 | 2018-08-22 | A kind of Combined double-chamber bronchial catheter |
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Cited By (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN110694157A (en) * | 2019-10-16 | 2020-01-17 | 南京医科大学附属逸夫医院 | Double-cavity bronchial catheter |
| CN111388827A (en) * | 2020-04-21 | 2020-07-10 | 绵竹市人民医院 | Special tracheal catheter for plugging bronchial cannula |
| CN111658938A (en) * | 2020-04-30 | 2020-09-15 | 南通市第一人民医院 | Double-cavity bronchial catheter for manually adjusting bending direction of auxiliary vent pipe |
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|---|---|---|---|---|
| CN110694157A (en) * | 2019-10-16 | 2020-01-17 | 南京医科大学附属逸夫医院 | Double-cavity bronchial catheter |
| CN111388827A (en) * | 2020-04-21 | 2020-07-10 | 绵竹市人民医院 | Special tracheal catheter for plugging bronchial cannula |
| CN111658938A (en) * | 2020-04-30 | 2020-09-15 | 南通市第一人民医院 | Double-cavity bronchial catheter for manually adjusting bending direction of auxiliary vent pipe |
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Application publication date: 20190111 |
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| RJ01 | Rejection of invention patent application after publication |