JP3141601B2 - CATHETER FOR TREATMENT OF LOCAL ANEMIA AND TREATMENT DEVICE USING THE SAME - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION The present invention relates to tubular tissue, particularly gastrointestinal tract, in an ischemic condition (referring to a local anemia condition in a living tissue, and particularly to a lack of oxygen caused by ischemia). The present invention relates to a local anemia treatment catheter for indwelling and applying oxygen to those tissue mucous membranes for treatment, and a treatment apparatus using the same.

[0002]

2. Description of the Related Art In the case of critically ill patients such as emergency patients and patients in an intensive care unit (ICU), after major surgery such as abdominal aortic aneurysm, after withdrawal from an auxiliary circulation device such as intra-arterial balloon pumping (IABP), or various other cases. When the infection decreases the ability of the body to supply oxygen to tissues, the tissues fall into an oxygen supply-dependent state. In such a case, it is known that intestinal mucosa is likely to be in an ischemic state due to impaired blood flow in the intestinal tract and the like. In such a state, the tissue becomes an acidosis state, the pH of a body fluid such as intestinal fluid decreases, and the function of the organ decreases. Then, similar effects begin to occur on vital organ functions such as the heart, kidneys, and liver, which are connected in a chain reaction by blood vessels such as the portal vein, and eventually die of multiple organ failure (MOF) It is likely to be the result. To cope with such problems, it is necessary to improve the management method of patients during and after surgery and patients with general severe condition. Conventionally, antibiotics ( Drug administration, such as intravenous administration of chronic hemofiltration (CHF), chronic hemofiltration dialysis (CHD)
F) and the like, and parenteral nutrition (TPN) therapy such as central parenteral nutrition (IVH), etc., and artificial blood in which oxygen is dissolved directly in the intestine to put oxygen into the intestinal mucosa. Has also been proposed.

[0003] However, there is a problem that the effect of the side effect of the drug is a problem, and it is difficult to predict when to leave the auxiliary circulatory device. The catheter has not yet obtained an effective therapeutic effect, and the intestine is inflated by artificial blood, making it difficult to circulate through the blood.The artificial blood in the intestine is contaminated with dirt, and the oxygen supply function is reduced. And artificial blood flows into areas other than the target site, resulting in poor oxygen application efficiency. In addition, as a method for examining the ischemic state and knowing the precursor thereof, a method using an endoscope or a Doppler blood flow meter, a fluorescent staining method, a carbon dioxide partial pressure in organs of the stomach and intestine using a catheter and the like are used. And a method of measuring the carbon dioxide ion concentration of arterial blood and calculating the pH of the organ wall using the measured values to determine the ischemic state (US Pat. No. 4,643,192).

[0004]

SUMMARY OF THE INVENTION The present invention has been made in view of the above-mentioned circumstances, and is intended to improve the ischemic state (oxygen-deficient state) of mucosal tissues of the stomach and intestines. An object of the present invention is to provide a catheter for treating local anemia, which can efficiently provide oxygen to the mucosal tissues of the stomach and intestine without soiling. Furthermore, the present invention provides a method for treating local anemia that can simplify the procedure by integrating the diagnostic part and the therapeutic part of the ischemic condition, and reduce the burden on the patient by minimizing the side effects. It is intended to provide a catheter.

[0005]

According to a first aspect of the present invention, there is provided a main tube having a liquid supply lumen and a liquid recovery lumen formed in a longitudinal direction thereof. One or more oxygen supply balloons provided on the outer wall of the distal end portion and / or the intermediate portion of the main tube and communicating with the liquid supply lumen and the liquid recovery lumen, respectively, and at the base end of the main tube, A liquid supply tube and a liquid recovery tube connected to the liquid supply lumen and the liquid recovery lumen, respectively, when the oxygen supply balloon is formed of a gas-permeable and liquid-impermeable synthetic resin and the liquid is flowed. of the resistance of the liquid recovery side flow channel is larger than the resistance of the flow path of the liquid supply side, the main Chu
Close to the oxygen supply balloon on the outer wall of the
One piece made of permeable and liquid-impermeable synthetic resin
Or a plurality of carbon dioxide gas concentration measurement balloons.
Each measurement balloon separately in the main tube
CO2 concentration via the formed CO2 concentration lumen
A catheter for treating local anemia, which is connected to a degree measurement tube, is employed. Further, as a second invention, a catheter for treating local anemia according to claim 1, a liquid supply pump connected upstream of a liquid supply tube of the catheter for treatment of local anemia, and an upstream of the liquid supply pump And a liquid container connected downstream of the liquid recovery tube of the catheter for treating local anemia,
The treatment apparatus employs a treatment device in which the liquid container has connection means with oxygen gas supply means.

[0006]

According to the structure of the first aspect of the present invention, a catheter for treating local anemia is inserted into a target, for example, the intestinal tract, and a means for circulating a liquid is connected to the catheter. When supplying a liquid having high oxygen solubility such as, the artificial blood circulates through the liquid circulation means → liquid supply tube → liquid supply lumen → oxygen supply balloon → liquid recovery lumen → liquid recovery tube → liquid circulation means, Since the resistance of the flow path on the liquid recovery side is greater than the resistance of the flow path on the liquid supply side, the oxygen supply balloon is inflated by the circulating artificial blood and adheres to the mucosal tissue of the intestinal tract. Since an oxygen concentration gradient and a carbon dioxide concentration gradient are generated between the mucosal tissue and the artificial blood in the oxygen supply balloon with the thin film of the oxygen supply balloon interposed therebetween, oxygen is supplied from the oxygenated balloon having a high concentration to the gas permeability of the oxygen supply balloon. It permeates through the liquid-impermeable membrane and into mucosal tissues. On the other hand, the carbon dioxide gas passes through the thin film from the highly concentrated mucosal tissue and transfers to artificial blood.

[0007]

Next, an embodiment of the present invention will be described with reference to the drawings. FIG. 1 is an explanatory diagram of the first invention, FIG. 2 is an explanatory diagram showing another embodiment of the first invention, and FIG.
FIG. 4 is an explanatory view of the second invention in an enlarged end view along the line A. As shown in FIGS. 1 and 2, the local anemia treatment catheter according to the first aspect of the present invention has a main tube 1 in which a liquid supply lumen 11 and a liquid recovery lumen 12 are formed in a longitudinal direction thereof. One or a plurality of oxygen supply balloons 2 are provided on the outer wall of the main tube 1 at the distal end and / or the intermediate portion. A liquid supply lumen 11 and a liquid recovery lumen 12 are opened inside the oxygen supply balloon 2.
1 and the main tube 1
Are connected to a liquid supply tube 3 and a liquid recovery tube 4, respectively. The oxygen supply balloon 2 is made of a gas-permeable and liquid-impermeable synthetic resin, and the resistance of the flow path on the liquid recovery side is larger than the resistance of the flow path on the liquid supply side.

The main tube 1 is usually a flexible tube made of a synthetic resin such as silicone rubber, polyurethane, polyvinyl chloride, polyamide, or a copolymer or blend containing at least one of these. The side wall of the tube 1 is formed with a liquid supply lumen 11 and a liquid recovery lumen 12 that run longitudinally in the longitudinal direction. The outer wall of the main tube 1 is provided with one or a plurality of oxygen supply balloons 2 from the distal end or the intermediate portion, or from the distal end to the intermediate portion, and the liquid supply lumen 11 and the liquid recovery lumen 12 are provided. Opened inside the oxygen supply balloon 2 and communicated with all of them, the base end of the main tube 1 is connected to the liquid supply tube 3 and the liquid recovery tube 4 respectively. The oxygen supply balloon 2 is made of a film formed of a gas-permeable and liquid-impermeable synthetic resin such as silicone rubber, polypropylene, polytetrafluoroethylene, polyalkylsulfone, di-tert-butyl fumarate, and aramid-silicone resin. Thus, by appropriately adjusting the number, length, and thickness of the balloons, it is possible to correspond to any part of the digestive tract such as the large intestine, duodenum, and small intestine. The liquid supplied to the oxygen supply balloon 2 is a liquid in which oxygen is highly dissolved or dispersed, and a liquid having excellent oxygen solubility and high safety is desirable. As such a liquid, artificial blood such as perfluorocarbon (PFC) is preferably used. The resistance of the flow path to the flow of the liquid is higher on the liquid recovery side including the liquid recovery lumen 12 and the liquid recovery tube 4 than on the liquid supply side including the liquid supply lumen 11 and the liquid supply tube 3. . As a method for increasing the resistance of the flow path on the liquid recovery side to the resistance of the flow path on the liquid supply side, the diameter of the liquid supply lumen 11 may be made larger than the diameter of the liquid recovery lumen 12, for example. The inner diameter may be made larger than the inner diameter of the flow path on the liquid recovery side, or the flow rate control means may be attached to the flow path on the liquid recovery side to limit the flow rate of the liquid.

If necessary, the main tube 1 is connected to a carbon dioxide concentration measuring balloon 5 for examining the degree of oxygen deficiency in the tissue before and after or during treatment as shown in FIG. A lumen 13 for measuring gas concentration and a drain lumen 14 for discharging the contents and the like of the treatment site may be formed. The carbon dioxide gas concentration measurement balloon 5 is made of a film formed of a gas-permeable and liquid-impermeable synthetic resin similar to the material for forming the oxygen supply balloon 2, and is provided on the outer wall of the main tube 1.
Is provided separately in the vicinity of The lumen 13 for measuring the concentration of carbon dioxide is connected to the tube 6 for measuring the concentration of carbon dioxide at the base end of the main tube 1 and the balloon 5 for measuring the concentration of carbon dioxide.
Is connected to a carbon dioxide concentration measuring tube 6 via a carbon dioxide concentration measuring lumen 13. The drain lumen 14 has one end opened at the base end of the main tube 1 and connected to a connection port (drain port) 7 with a suction means (not shown), and the other end connected to the distal end of the main tube 1. It is opened to the drain side hole 15 (including the tip). The drain side hole 15 is used for the main tube 1 if necessary.
May be additionally provided at an appropriate place other than the tip of the. still,
The carbon dioxide concentration measurement balloon 5 is a normal oxygen supply balloon 2
Are provided on both sides of the oxygen supply balloon 2, but are not particularly limited, and may be provided only on the distal end side or between the oxygen supply balloons 2. The lumen 13 for measuring carbon dioxide concentration and the tube 6 for measuring carbon dioxide concentration
Are provided in the same number as the carbon dioxide concentration measurement balloons 5. In the figure, reference numerals 16 and 17 denote side holes for connecting the liquid supply lumen 11 to the oxygen supply balloon 2 and side holes for connecting the liquid recovery lumen 12 to the oxygen supply balloon 2.

The liquid supply tube 3, the liquid recovery tube 4, and the carbon dioxide concentration measuring tube 6 are all made of the same synthetic resin as the main tube 1 or at least one of them.
A flexible tube formed of a copolymer or a blend comprising one of them, one end of which is connected to a liquid supply lumen 11, a liquid recovery lumen 12, and a carbon dioxide concentration measurement lumen 13, respectively. At the other end, connectors 31, 41, and 61 for connecting to a liquid supply unit, a liquid recovery unit, and a carbon dioxide concentration measuring device are attached. Incidentally, as the connectors 31, 41, 61, a three-way stopcock or the like capable of switching the flow path is preferable. In addition, an endoscope can be incorporated into the catheter for treating local anemia of the present invention. In this case, the endoscope can be inserted into the drain lumen 14 to observe the state of the treatment site.
Furthermore, a pH electrode, an oxygen electrode, a carbon dioxide electrode, a temperature sensor, and the like can be incorporated as needed to enable earlier confirmation of a disease state.

Next, a treatment apparatus according to the second aspect of the present invention will be described. As shown in FIG. 4, the treatment apparatus of the present invention comprises a catheter 10 for treating local anemia and a liquid obtained by dissolving oxygen in the catheter 10 at a high concentration (hereinafter referred to as an oxygen solution).
For example, it is composed of a roller pump 8 as a means for supplying artificial blood, an artificial blood reservoir 9 as a liquid container for storing the recovered oxygen solution S, and conduits 81, 91, and 92 connecting these. The reservoir 9 is further provided with a conduit 93 as connection means for connecting to oxygen gas supply means (not shown). In order to facilitate the dissolution of oxygen in the oxygen solution S, the opening of the conduit 93 is preferably arranged close to the bottom of the artificial blood reservoir 9 so that oxygen can be bubbled. A means (not shown) for stirring the oxygen solution S may be separately provided in the reservoir 9.

Next, the usage of the treatment apparatus of the present invention will be described. First, the catheter 1 is connected to the catheter 1 using a syringe or the like by using the connectors 31 and 41 of the liquid supply tube 3 and the liquid recovery tube 4 of the catheter 10 for treating local anemia.
As much air as possible is drained from the inside of the intestine, and if there is a content in the intestinal tract, the washing liquid is injected from the drain port 7 at an appropriate time to drain. Next, the catheter 10 is inserted into a target intestinal tract. The method of inserting the catheter 10 directly from the intestinal wall at the time of laparotomy, transnasally, orally,
An appropriate method is adopted according to the situation of the patient, such as a method of inserting into the colon from the anus and a method of percutaneous insertion using a laparoscope. When the roller pump 8 is driven, the oxygen solution S in the artificial blood reservoir 9 is sucked into the conduit 92, flows from the conduit 92 to the conduit 81, and flows into the liquid supply tube 3 of the local anemia treatment catheter 10. I do. Then, the liquid flows into the oxygen supply balloon 2 through the liquid supply lumen 11, and then flows into the liquid recovery lumen 12.
Then, it flows through the liquid collection tube 4 and the conduit 91 to be collected in the artificial blood reservoir 9. As described above, while the oxygen solution S circulates through the artificial blood reservoir 9 → the roller pump 8 → the local anemia treatment catheter 10 → the artificial blood reservoir 9, the oxygen solution S in the oxygen supply balloon 2 Oxygen is supplied to the mucous membrane (not shown) at the treatment site via the membrane 21 of the supply balloon 2. On the other hand, oxygen gas is supplied from the oxygen supply means to the artificial blood reservoir 9 through the conduit 93, and this oxygen is dissolved in the recovered oxygen solution S, and the oxygen solution S is reused. In addition, if necessary, physiological saline may be injected into and discharged from the carbon dioxide concentration measurement balloon 5 before or after or during the treatment, and the state of oxygen deficiency in the tissue may be investigated.
The circulation rate of the oxygen solution S is suitably about 4.0 ml / sec, but may be changed according to the situation.

[Experimental Example 1] A male adult dog was laparotomized under general anesthesia, a small incision was made in a part of the wall of the small intestine D, and a local anemia treatment catheter 10 as shown in FIG. 5 was inserted. rear,
The superior mesenteric artery connected to the inserted small intestine D was ligated, and the oxygen supply balloon 2 was filled with artificial blood (PFC emulsion) in which oxygen was dissolved to an oxygen partial pressure of about 600 mmHg, and about 4.0 ml / s.
While circulating at the speed of ec, the concentration of carbon dioxide in the small intestinal mucosal tissue is measured over time to calculate the pH, and two hours after the start of the treatment, a part of the mucous membrane is collected, and the state of the mucosal surface is scanned. Observation was performed with a microscope and a transmission electron microscope.
Table 1 shows the results. The diameter of the main tube 1 of the catheter 10 is 16 Fr (about 5.3 mm), and the sizes of the oxygen supply balloon 2, the carbon dioxide concentration measurement balloon 5, and the control balloon C for measuring the carbon dioxide concentration of the control portion are as follows. It is 15 mm in diameter × 50 mm in length, and both are formed of silicone rubber. From Table 1, it can be seen that the pH of the mucous membrane in contact with the oxygen supply balloon 2 has not been reduced, and the treatment with a local anemia treatment catheter prevents acidosis of the tissue, that is, an oxygen-deficient state. You can see that Observation of the small intestinal mucosa with a scanning electron microscope and a transmission electron microscope also shows that a therapeutic effect is observed.

[0014]

[Table 1]

[0015]

As apparent from the above description, the following effects can be obtained by employing the catheter for treating local anemia of the present invention. Since oxygen is supplied through the membrane by bringing the oxygen supply balloon into contact with the mucous membrane of the intestinal tract, oxygen can be supplied uniformly without obstruction of the intestinal tract or the influence of the patient's body position. By adjusting the size and number of each balloon, it is possible to correspond to various parts. Since the oxygen solution filled in the balloon is hardly contaminated, it can be reused by collecting it after use. By combining a balloon having a function of measuring the concentration of carbon dioxide in mucosal tissue and various sensors, it is possible to simultaneously predict and prevent a disease state. By providing the drain lumen, the inside of the intestinal tract can be washed, and the influence of intestinal contaminants can be avoided.

[Brief description of the drawings]

FIG. 1 is an explanatory view of a catheter for treating local anemia of the first invention.

FIG. 2 is an explanatory view showing another embodiment of the first invention.

FIG. 3 is an enlarged end view taken along line AA of FIG. 2;

FIG. 4 is an explanatory view of a treatment apparatus of the second invention.

FIG. 5 is a view for explaining a state in which a catheter for treating local anemia is inserted into the small intestine in Experimental Example 1.

[Explanation of symbols]

 Reference Signs List 1 main tube 11 lumen for liquid supply 12 lumen for liquid recovery 13 lumen for carbon dioxide concentration measurement 14 lumen for drain 2 oxygen supply balloon 3 liquid supply tube 4 liquid recovery tube 5 carbon dioxide concentration measurement balloon 6 carbon dioxide concentration measurement tube 7 drain Mouth 8 Roller pump 9 Artificial blood reservoir 10 Local anemia treatment catheter S Oxygen solution D Small intestine

──────────────────────────────────────────────────続 き Continued on the front page (58) Fields investigated (Int. Cl. ⁷ , DB name) A61M 1/00 A61M 25/00 A61M 31/00 A61M 37/00

Claims (5)

(57) [Claims] 1. A main tube in which a liquid supply lumen and a liquid recovery lumen are formed in a longitudinal direction thereof, and a main tube provided on an outer wall at a distal end and / or an intermediate portion of the main tube. One or more oxygen supply balloons respectively communicating with the liquid collection lumen, and a liquid supply tube and a liquid collection tube respectively connected to the liquid supply lumen and the liquid collection lumen at the base end of the main tube. The oxygen supply balloon is formed of a gas-permeable and liquid-impermeable synthetic resin, and the resistance of the flow path on the liquid recovery side when flowing the liquid is made larger than the resistance of the flow path on the liquid supply side , For supplying oxygen to the outer wall of the main tube
Closer to the balloon, more gas permeable and liquid impermeable
One or more carbon dioxide enriched
A balloon for measuring the carbon dioxide concentration.
Carbon dioxide concentration measurement separately formed on each main tube
Communicates with carbon dioxide concentration measurement tube via regular lumen
A catheter for treating local anemia, wherein the catheter is connected. 2. Separately forming a drain lumen which opens outwardly in the longitudinal direction to further oxygenation balloon and measuring carbon dioxide concentration balloon of the main tube, according to claim 1 in which the drain lumen connects drain tube communicating with
4. The catheter for treating local anemia according to claim 1. 3. A gas-permeable and liquid-impermeable synthetic resin selected from the group consisting of silicone rubber, polypropylene, polytetrafluoroethylene, polyalkylsulfone, di-tert-butyl fumarate, and aramid-silicone resin. Or claims consisting of a combination of two or more
3. The catheter for treating local anemia according to 1 or 2 . 4. The catheter for treating local anemia according to claim 1 , wherein the diameter of the liquid supply lumen is larger than the diameter of the liquid recovery lumen. 5. The local anemia treatment catheter according to claim 1, a liquid supply pump connected upstream of a liquid supply tube of the local anemia treatment catheter, and an upstream and locality of the liquid supply pump. A treatment apparatus comprising a liquid storage container connected downstream of a liquid recovery tube of an anemia treatment catheter, wherein the liquid storage container has a connection means with an oxygen gas supply means.