JP4424902B2 - Bronchoscope insertion type bronchial blocker guidance system using single lumen intubation tube - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to a bronchial blocker guidance system for use in performing isolated lung ventilation using a single lumen intubation tube.
[0002]
[Prior art]
In pulmonary diseases, esophageal cancer, and surgery for thoracic aortic aneurysms that require general anesthesia, the airway is secured by an intubation tube inserted into the trachea, and artificial respiration management is performed. In this case, artificial ventilation management by one lung, that is, separate lung ventilation is required. For the separated lung ventilation, a method using a double lumen tube in which two lumens are combined and a method using a bronchus blocker that blocks the bronchus with a balloon are mainly used. Of these, the double-lumen tube has a curvature at the tip, so that the intubation technique is difficult, and there are reports that airway damage has occurred, and there is a problem that the diameter of the double-lumen tube cannot be inserted in patients with narrow airways.
[0003]
The bronchial blocker also has a luminal structure, and the affected lung collapses when released after blocking. At present, there are several types of products that are specially devised, mainly single lumen intubation tubes with bronchial blockers. However, in each case, a blocker and a bronchoscope are inserted in parallel into the lumen of the intubation tube, guided to the left or right bronchus under direct vision, and then air is injected into the balloon to perform blocking. Because of the side-by-side insertion, the inner diameter of the blocker tube is limited to a small one and often it takes a long time to obtain sufficient lung collapse.
[0004]
On the other hand, if the lumen of the blocker is enlarged, the outer diameter inevitably increases, and only a single lumen intubation tube having a certain diameter or larger can be used to insert the bronchoscope in parallel. In addition, if a significant portion of the lumen of the single lumen intubation tube is occupied by a blocker that expands the lumen, poor ventilation is caused and the possibility of placing a large burden on the patient increases. Furthermore, since the friction increases when the bronchoscope is removed, the blocker position may be shifted or the intubation tube itself may move. Therefore, a situation may occur in which the bronchial blocker or the intubation tube cannot be maintained at an appropriate position.
[0005]
[Problems to be solved by the invention]
The present invention has been made paying attention to the above points, and its problem is to consolidate the mechanisms necessary for separated lung ventilation into a bronchial blocker, and to smoothly perform advanced separated lung ventilation even when using a single lumen intubation tube. It is to be able to enforce. Another object of the present invention is to provide a bronchial blocker integrated with a bronchoscope. Another object of the present invention is to prevent the movement of the bronchoscope integrated with the bronchial blocker.
[0006]
In order to solve the above-mentioned problems, the present invention uses a single lumen intubation tube, and for a bronchial blocker used when performing separated lung ventilation , a bronchial blocker having a cuff at the distal end is connected to the single lumen intubation tube through a connector. was inserted into the lumen, is inserted a small diameter bronchoscope into the bronchial blocker, bronchoscope tip was placed as can observe the forward bronchial blocker tip protruding from the distal end of the single lumen intubation tube, fine After insertion of the bronchoscope of diameter, positioning means is used in combination with the bronchoscope and the bronchoblocker in order to keep the distal end of the small bronchoscope at the desired position so that it protrudes from the tip of the bronchoblocker. Under the observation of a bronchoscope with the same movement and preceding the blocker cuff Check the block position by the cuff, to allow enforce separation lung ventilation, bronchial blocker, comprises a plug for the lumen closed at the base end portion, so as to obtain a lung collapse and pneumatic retained by this desorption This is a measure taken. It is sufficient that the diameter of the lumen of the blocker is maintained at a size that allows insertion of a thin bronchoscope.
[0007]
DETAILED DESCRIPTION OF THE INVENTION
The bronchial blocker according to the present invention uses a single lumen intubation tube and is used when performing separated lung ventilation. A single lumen intubation tube is a flexible tube made of synthetic resin that can be orally and nasally intubated into the trachea. An endotracheal cuff or the like is disposed and the tip is an opening. The cuff means an inflatable and deflateable gasp, also called a balloon or a blocker. The endotracheal cuff is in communication with a ventilation portion, and a connection portion for injecting and dispensing air such as a syringe is provided at the end.
[0008]
The single lumen intubation tube is not just a pipe, but because it has a similar single lumen structure, the structure is simple compared to other intubation tubes such as a double lumen tube, it is easy to handle, and it has a relatively small diameter, The risk of squeezing the vocal cords and causing vocal fold edema or vocal luxation is low. The present invention opens the way to further use such a single lumen intubation tube.
[0009]
The bronchial blocker is a flexible tube-shaped shaft made of synthetic resin that is passed through the intubation tube, and has a blocker cuff at its tip, which is inserted into the bronchus from the intubation tube to expand the cuff. To block the bronchi. In addition, on the proximal end side, some means for causing the lungs to collapse by deaeration after blocking is provided. The bronchial blocker has a ventilation part for injecting and extracting air to the blocker cuff, and a connecting part for means for injecting and extracting air such as a syringe is provided at the base end part in the same manner as the endotracheal cuff. ing.
[0010]
A small-diameter bronchoscope is inserted into the bronchial blocker, and its tip is arranged so that the front can be observed at the tip of the bronchial blocker. As a result, the movements of the bronchoscope and the bronchial blocker become the same, and the target bronchus can be reached directly under the observation of the bronchoscope preceding the blocker cuff so that the bronchi can be easily obstructed. Therefore, lobar bronchial block, which has been considered difficult in the past, is possible, and a minimum lung block can be obtained, which can provide an advantageous state for the patient in the lung block. Moreover, rapid lung collapse is expressed by a bronchial blocker having a lumen into which a bronchoscope can be inserted, and suction of essentials and blood in the block lung can be performed as necessary and sufficiently.
[0011]
A thin bronchoscope that can be applied in the present invention is a small diameter in comparison with a commonly used bronchoscope. If the outer diameter of a normal bronchoscope is several millimeters, it is smaller than that. It is. For example, a child bronchoscope diverted or a child whose outer diameter is scaled down to the same size as that for a child has a suitable outer diameter of several tens of percent for an adult.
[0012]
After insertion of the small-diameter bronchoscope, positioning means are used in combination to keep the positional relationship within the bronchial blocker in a predetermined relationship. This produces the effect of simplifying the procedure. Further, the bronchial blocker can be provided with a line extending from the proximal end portion to the distal end portion, and a configuration in which the mobility of the distal end portion is increased by an operation at the proximal end portion can be obtained. Furthermore, in order to assist the guidance of the blocker cuff by the bronchoscope, a tip angle bent in advance to a required angle can be given to the bronchial blocker. In addition, the proximal end portion of the bronchial blocker is provided with a removable plug for closing the lumen, and this plug is used as a means for obtaining collapse of the lung and retention of aeration by detachment after the block.
[0013]
【Example】
Hereinafter, the present invention will be described in more detail with reference to the illustrated embodiments. In FIG. 1, 10 is a single lumen intubation tube, 20 is a bronchial blocker, and 30 is a bronchoscope.
[0014]
The single lumen intubation tube 10 has a curved and flexible single-cavity tubular structure made of a transparent synthetic resin, and has a connector connection port 11 on the proximal end side and an opening 12 on the distal end side. . There is also a side opening 13 on the back side of the tip opening 12. Around the tube near the distal end is an inflatable / inflatable endotracheal cuff 14 made of a synthetic resin. The cuff 14 has a ventilation portion 15 communicating with a pilot balloon 16 provided at the proximal end and a one-way valve. 17 can be inflated and shrunk by inflowing / outflowing air from a connecting portion having a portion 17 with a syringe or the like (not shown). Reference numeral 18 denotes a connector, and 19 denotes an adapter that connects the connector 18 and the connection port 11 of the intubation tube 10.
[0015]
The bronchial blocker 20 is an all-tube-shaped shaft made of a transparent synthetic resin, has flexibility, and has a plug 21 for occluding a lumen that can be attached to and detached from the proximal end portion. A blocker cuff 22 is provided. The blocker cuff 22 is in communication with a vent 23, and air is injected and dispensed by a syringe or the like from a connecting portion having a pilot balloon 24 and a one-way valve 25 provided at the base end of the blocker cuff 22.・ Can be shrunk. The bronchial blocker 20 has a lumen into which a small-diameter bronchoscope 30 can be inserted, and the lumen serves as an exhaust path during deaeration after blocking or during secretion lung ventilation. Used as a discharge channel.
[0016]
The bronchial blocker 20 has a filament 26 that extends from the proximal end side to the distal end. The filament 26 extends to the ventilation portion 23 on the proximal end side, and the distal end portion is pulled by pulling this portion. Increases mobility. The filament 26 is made of a strong material such as so-called Tegs. The bronchial blocker 20 has a generally loosely bent shape. In order to assist the bronchoscope 30 in guiding the blocker cuff 22, a bronchial blocker 20 'having a tip angle 27 bent in advance to a required angle is prepared. (FIG. 1).
[0017]
The bronchoscope 30 has a diameter smaller than that of a standard product for adults. In the embodiment, the bronchoscope for children having a diameter (outer diameter) of 2.4 mm is applied to the intubation tube 10 having an inner diameter of 7.5 mm. Yes. The bronchoscope 30 has a distal end portion 31 that bends flexibly and has an eyepiece portion 32 on the proximal end side. Reference numeral 33 denotes an operation unit for bending the tip 31. Needless to say, the small-diameter bronchoscope 30 is longer than the bronchial blocker 20, and the distal end has a length protruding from the distal end of the blocker cuff, and the bronchial blocker 20 is also larger than the single lumen intubation tube 10. long.
[0018]
The positioning means 35 is located on the proximal side of the bronchoscope 30 so that the positional relationship of the bronchoscope 30 is fixed at a desired position where the distal end objective 34 of the small-diameter bronchoscope 30 exits from the distal end of the bronchoblocker 20. (FIG. 2B). Further, when the bronchoscope 30 is inserted into the bronchial blocker 20 ′ having the tip angle 27 shown in FIG. 1, the tip 31 of the bronchoscope 30 is extended and inserted (see the broken line in FIG. 3), and the tip objective unit 34 is inserted into the bronchus. After exiting from the tip of the blocker 20, it is directed in a desired direction (see FIG. 3). In the present invention having such a configuration, the small bronchoscope 30 is inserted into the bronchial blocker 20, and the bronchial blocker 20 in that state is combined with the single lumen intubation tube 10 (see FIG. 4). ).
[0019]
In the application of the system according to the present invention, only the single lumen intubation tube 10 is endotracheally intubated, the anesthesia tube is removed from the intubation tube 10 during artificial respiration by the artificial respirator 40, and the single lumen intubation tube 10 is removed. The bronchial blocker 20 is inserted into the lumen, and the above-mentioned serpentine tube is connected to the intubation tube 10 by the attached connector 18 (see FIG. 5). Next, the cuff 22 of the bronchial blocker 20 is inserted to the target site under the observation of the bronchoscope 30. During this time, patient ventilation is maintained through the intubation tube 10.
[0020]
If it is confirmed by the bronchoscope 30 that the blocker cuff 22 has reached a position that seems to be good, an appropriate amount of air is injected into the blocker cuff 22 by a syringe, and the blocker side cuff 22 confirms the disappearance of the ventilation sound on the block side. Degas the cuff 22 and confirm that the ventilation sound can be heard again. Subsequently, the bronchoscope 30 is removed with care so as not to change the position of the bronchial blocker 20, and a plug 21 is placed at the proximal end of the bronchial blocker 20 until necessary. When it is necessary to collapse the affected lung, the plug 21 of the bronchial blocker 20 is opened and left open for as long as necessary. When the lung is reinflated, the plug 21 is opened and the air in the cuff is removed. Careful and done under constant pressure. By repeating the above procedure as necessary, the affected lung can be degassed and expanded many times.
[0021]
FIG. 5 shows an example in which the left bronchus 41 is bent abnormally due to an aortic aneurysm, and it is extremely difficult to guide the patient having such a case with the normal bronchial blocker 20. Therefore, in the present invention, a method using a bronchial blocker 20 ′ having a tip angle 27 has been developed. In carrying out this method, the tip angle 27 of the bronchial blocker 20 is extended and a small-diameter bronchoscope 30 is installed. After insertion into the single lumen intubation tube 10 (shown in FIG. 3), the left bronchus 41 is oriented so as to return to the tip angle 27. Thereby, even when there are extreme individual differences in the left bronchus 41 and the right bronchus 42, the blocker cuff 22 can be accurately guided to the target position.
[0022]
As described above, in the present invention, the bronchial blocker 20, 20 'is inserted together with the bronchoscope 30, so that the target bronchus or a branch thereof can be guided in the same manner as the bronchoscopy, and the bronchial blocker 20 can be easily obtained. 20 'can be placed. Therefore, it can be implemented without the need for advanced technology, and operation alone is sufficient. In addition, since the present invention only requires a bronchoscope 30 to which the present invention can be applied, the cost is far lower than that of existing products.
[0023]
【The invention's effect】
Since the present invention is constructed and operates as described above, the mechanism necessary for the separated lung ventilation is concentrated in the bronchial blocker, so that a high degree of separated lung ventilation is smoothly performed even when a single lumen intubation tube is used. In particular, the movement of the bronchoscope is not hindered, and the blocker cuff can be accurately guided to the target position.
[Brief description of the drawings]
FIG. 1 is an exploded view showing instrument elements used in a bronchoscope insertion type bronchoblocker guidance system using a single lumen tube according to the present invention.
FIG. 2 (a) is an enlarged view of a distal end portion of a bronchial blocker.
(B) The enlarged view of the bronchus blocker which abbreviate | omitted the intermediate part similarly.
FIG. 3 is an explanatory view showing the movement of the distal end portion of the bronchial blocker.
4 is an explanatory view showing a combination of the instrument elements of FIG. 1. FIG.
FIG. 5 is an explanatory diagram showing an application state to a human body.

Claims (3)

A bronchial blocker that is used when performing separate lung ventilation using a single lumen intubation tube. A bronchial blocker with a cuff at the tip is inserted into the lumen of the single lumen intubation tube through the connector, and into the bronchial blocker. is inserted a small diameter bronchoscope bronchoscope tip was placed so as to observe the anterior bronchial blocker tip protruding from the distal end of the single lumen intubation tube, after bronchoscope insertion of small diameter, the bronchial blocker On the other hand, it uses positioning means to keep the distal end of the small-diameter bronchoscope at the desired position so that it comes out of the end of the bronchial blocker, so that the movement of the bronchoscope and bronchial blocker is the same, and precedes the blocker cuff Under the observation of the bronchoscope to check the block position by the cuff, To allow enforce Hanarehai ventilation, bronchial blocker, single lumen intubation tube, characterized in that comprising a stopper for the lumen closed at the base end portion, and this desorbed to obtain a lung collapse and pneumatic holding bronchoscope insertable bronchial blocker guidance system was used. Bronchial blocker has a filament through from the proximal end to the distal end, a single lumen intubation tube according to claim 1, wherein configured to increase the mobility of the tip by the operation at the proximal end Used bronchoscope insertion type bronchoblocker guidance system. To assist the induction of blocker cuff by bronchoscopy, bronchial blocker, bronchoscope insertable bronchial blocker induced system using claim 1 single lumen intubation tube according imparted with point angle bent in advance required angle.

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