Background technology
When general anesthesia is controlled breathing, respiratory insufficiency, respiratory failure clinically, be used for emergency resuscitation, open air flue etc., all need to use endotracheal intubation, this technology is the essential anaesthesia technologies of section office such as Anesthesia Department, ICU, emergency department, neonate department, and relevant medical worker must grasp.
The approach that tracheal intubation is inserted according to endotracheal tube, is divided into oral trachea cannula, nasal trachea cannula and through tracheostoma intubate.According to whether utilizing laryngopharyngeal mirror photopic vision bottleneck throat to dissect, be divided into photopic vision intubation and blind tracheal intubation method.Along with scientific and technological progress, under various visible laryngoscopes intubate as: Airtraq and Shikani, the application of the technology such as branchofiberoscope guide cannula has solved the intubate problem of all difficulties air flues substantially.But still exist in the middle of practical application, respectively there is drawback.Per os and per nasal photopic vision tracheal intubation, be all that operator exposes pharyngeal dissection to the open air with laryngopharyngeal mirror, appears glottis, under direct-view, by endotracheal tube, sent glottis, inserts trachea.Yet to fully expose glottis to the open air, and conduit is moved ahead along desirable target direction, often can run into all difficulties.Traditional solution is exactly the harder intubate of quality to be led to core be inserted in conduit, and one changes the degree of crook of catheter tip, and tip is upwarped, and two improve conduit keeps the ability of direction to resistive drag force.But when conduit is smoothly by after glottis, the catheter core of hard need to be pulled out by force, be operated relative violence, easily cause damage.The special tracheal intubatioies such as Airtraq, Shikani and branchofiberoscope guide cannula, substantially can solve various difficult intubations, but complex operation involve great expense, and are not suitable for all patients, especially basic medical unit.
Nasal trachea cannula, endotracheal tube need to be by entering trachea after nostril, nasal vestibule, cavum nasi proprium, choana, nasopharynx part, pars oralis pharyngis, glottis.When conduit is by nostril, nasal vestibule, cavum nasi proprium, choana, nasopharynx part conventionally, be that blind spy operates, and at nasal vestibule and nasal cavity and nasal cavity and two physiological bendings of nasopharynx part existence, because common endotracheal tube tip direction can not arbitrarily be controlled, cause these two physiological bendings to become to cause the key of blind tracheal intubation difficulty and damage.
Notification number is CN2810640Y, patent name is that the patent of < < flexible trauma-free tracheal catheter > > discloses a kind of endotracheal tube, catheter tip is slightly softer than traditional tube wall, bent at its tip, pull finger ring and can make top curved, can simplify intubate process, reduce damage, facilitate clinical practice.But have certain weak point: 1, the position of catheter tip bending is definite not, during operation, the flexibility of integral duct all can be affected, and in limited space, operant activity is limited.2, catheter tip is slightly soft, and after the end of operation of top bending, the ability of conduit recovery original form is definite not.3, conduit is slightly soft, without effectively supporting, is easily subject to the impact of surrounding tissue and is out of shape, and affects effective ventilation space, if the change of position in art (as simple head height position), conduit are by physiological bending (as trachea crotch), violence intubate etc.Deformation of guide tube, ventilation space diminishes, and airway resistance raises, and especially, in the situation that airway secretions increases, sputum aspirator tube cannot normally pass through, and may cause mortality risk.4, maneuver during blind spy nasal intubation and draw ring operation contradiction are difficult to realize simultaneously.5, catheter tip is only slightly soft, and pilot is walked in tube wall longer, pulls bracelet, wants to make tip to upwarp, and needs larger strength to realize, the unavoidable quick-fried power of excessive strength.6, the flexibility at A/C tip is constant, and finger will haul that finger ring is motionless just can be accomplished always, lacks control assembly.
Summary of the invention
According to above-mentioned weak point, the object of this invention is to provide a kind of tip and can regulate degree of crook, the endotracheal tube of blind spy per os, per nasal under visual or magnetic force guiding.
For achieving the above object, technical scheme of the present invention is: a kind of most advanced and sophisticated controllable type endotracheal tube, it comprises conduit, catheter proximal end is provided with inclined-plane opening, in the side near catheter proximal end, be provided with side mouth, in the conduit periphery by proximal hole, be provided with air bag, conduit front side wall is provided with airway, the front opening of airway is connected with air bag front inner wall inner side, the end of airway is provided with unidirectional inflation inlet, the end of conduit is provided with respiratory cycle cohesive end, on conduit front side wall, be also provided with the cavity passing through for airway, the conduit in air bag centre position is provided with flexible software, the front end of airway is fixed on the catheter wall of catheter tip direction of flexible software, conduit is provided with hands handle near the position of respiratory cycle cohesive end, handle is provided with airway fixture, the outside of a rear inner side side corresponding to conduit of handle is provided with the latch cooperatively interacting.
Preferably: the inside of described flexible software is provided with resilient supporting unit.
Preferably: described resilient supporting unit is spring or support ring.
Preferably: between the inclined-plane opening of described conduit and side mouth, be provided with paramagnetic device.
Preferably: described handle is provided with handle.
Preferably: described airway fixture is the draw-in groove being arranged on handle.
Preferably: described draw-in groove is arranged on the front side wall of handle upper end and/or on the handle of handle.
Preferably: described handle internal diameter is the thin inversed taper platform shape in thick lower end, upper end.
Preferably: described handle, at its lower end is provided with sphenoid.
Preferably: described handle upper end inwall and the distance between conduit outer wall are greater than the latch tooth depth of twice.
Beneficial effect of the present invention is: the present invention is provided with flexible software by the catheter interior in balloon positions, and be connected with airway, the degree of crook of realizing catheter tip by traction airway is controlled, by the breather fixture on handle, realize bending position and fix, can improve successful intubation.The paramagnetic device of catheter tip, possesses magnetic force induction, during blind spy operation, Magnet is placed at glottis place in vitro, be conducive to catheter tip and automatically identify glottis, avoided the undue dependence to various laryngoscopes in the past, the present invention is simple to operate, safe and reliable, cheap, be applicable to conventional cannula and difficult intubation.
The specific embodiment
Below in conjunction with specific embodiment, the present invention will be further described.
A kind of most advanced and sophisticated controllable type endotracheal tube as shown in Figure 1, it comprises conduit 1, conduit 1 front end is provided with inclined-plane opening 2, in the side near conduit 1 front end, is provided with side mouth 3, in conduit 1 periphery by proximal hole 3, is provided with air bag 4.When air bag 4 is flat, do not inflate, air bag 4 is by inflating after glottis.Conduit 1 front side wall is provided with airway 5.The front opening of airway 5 is connected with air bag 4 front inner wall inner sides, and the end of airway 5 is provided with inflation inlet 6.The place of a shown in Fig. 1 airway 5 tube walls and air bag 4 inwalls combine together, and airway 5 stretches out from conduit 1 front side wall b, through handle 10, end at inflation inlet 6.The end of conduit 1 is provided with respiratory cycle cohesive end 7, is also provided with the cavity 8 passing through for airway 5 on conduit 1 sidewall.Cavity 8 inwalls require to have lubrication, and while pulling, resistance is little.The conduit 1 of air bag 4 positions is provided with flexible software 9, and the inside of flexible software 9 is provided with resilient supporting unit 12, and wherein, resilient supporting unit is spring or support ring.The front end of airway 5 is fixed on the catheter wall of flexible software 9 catheter tip directions, conduit 1 is provided with handle 10 near the position of respiratory cycle cohesive end 7, handle 10 is provided with airway fixture, handle 10 is also provided with handle 13, and the outside of an outer inner side side corresponding to conduit 1 of handle 10 is provided with the latch 11 cooperatively interacting.Airway fixture is the draw-in groove being arranged on handle 10, draw-in groove can be arranged on handle 10 upper end sidewalls or on the handle 13 of handle 10, but, for airway 5 is better fixing, draw-in groove can be arranged on handle 10 upper end sidewalls simultaneously and the handle 13 of handle on.As shown in Figure 4, handle 10 internal diameters are the thin inversed taper platform shape in thick lower end, upper end.Handle 10 lower ends are provided with sphenoid.As shown in Figure 3, the distance L 1 between handle 10 upper end inwalls and conduit 1 outer wall is greater than the latch 11 tooth depth L2 of twice.Between the inclined-plane opening of conduit and side mouth, be provided with paramagnetic device 14.During operation, a Magnet is placed in glottis position in vitro, and when paramagnetic device 14 senses magnetic, natural torsion, so that catheter proximal end is identified glottis automatically.
One, the effect of air bag: 1, air bag 4 can seal respiratory tract, makes gas exchange be realized by endotracheal tube; 2,, after inflation, air bag 4 can support inner flexible software 9 and not give a discount, not crooked; 3, as shown in Figure 3, thinner air bag inwall is a part for conduit outer wall 101, and catheter tip, conduit and middle flexible software 9 are had to certain effect that is connected and fixed.
Two, the effect of airway: 1, give airway 5 gas injections or venting by inflation inlet 6, the airway 5 of hollow is delivered to gas or pump out air bag 4, inflation inlet 6 pins gas, realize air bag 4 fixedly position and sealing respiratory tract effect and the air bag 4 of finding time while finishing of endotracheal tube 5, in order to tube drawing; 2, as connecting wire, be optionally fixed in handle airway fixture, while making to carry on handle 10, can pull airway 5, make catheter tip a point outer wall stressed, thereby make flexible software 9 bendings, realize catheter tip and upwarp.
The cross-sectional view at flexible software position as shown in Figure 2, flexible software 9 is long is preferably 1.5cm, is positioned at the centre position of air bag 4, can be divided into three parts: inwall, silica gel sheath, outer wall.Inwall: thin and soft, be the intrinsic part of endotracheal tube, built-in fixing resilient supporting unit 12, for example spring, or isolated fixing some support rings, requires horizontal resistance to compression and anti-deformation ability reliable.Preferably endless spring, because endless spring also possesses the ability of longitudinal recovery shape, is conducive to, after catheter tip discounting bending operation, can recover conduit original form, and can not cause mechanical damage to conduit.Spring length is preferably 2.5cm, centered by flexible software 9, in conductive pipe 1 both sides, front and back tube wall, respectively extends 0.5cm, plays a supporting role.As be support ring, only need and the same length of flexible software 9.The long preferred 1.5cm of silica gel sheath, longitudinally there is supporting role, keep catheter length constant, laterally easily crooked discounting, require the thickness of inwall and silica gel sheath to be added the gross thickness that equals endotracheal tube tube wall, advise flexible software position realize bending be firmly less than endotracheal tube body realize bending firmly 1/2.Outer wall is air bag inwall, inside has airway 5 to pass through, and is opened on air bag 4 inwall inner sides, and airway 5 outer walls and air bag inwall combine together, near catheter tip direction, are positioned at flexible software 9 tip direction 0.5cm places, outer.Air bag inner wall outside is outer wall, and the position and endotracheal tube 5 outer walls that connect proximal hole 3 with catheter tip are bonded together, and form together the outer wall that endotracheal tube is new.As shown in Figure 2,101 is conduit outer wall, and 102 is effective conduit ventilation cavity, and 103 is pipe inner wall, and 401 is the air bag space after inflation.
The cross-sectional view of handle part is as shown in Figure 3 known, and handle 10 is long is preferably 3cm, and handle internal diameter is the thin inversed taper platform shape in thick lower end, upper end, is enclosed within endotracheal tube outer wall.The preferred 0.5cm of hypomere, is cylinder wedge shape, is beneficial to and puts oral cavity downwards under, and most advanced and sophisticated omiting timed, and injured tissue, can not do bite-block.The preferred 2cm in stage casing, is the engagement region of bite-block, is also the handgrip part of handle, requires firmlyer, stings not broken.Middle upper end is preferably 0.3cm, is provided with handle, is the retention device of bite-block upper end, and handle is provided with draw-in groove, is used for fixedly airway of screens.The preferred 1.2cm in upper end, is bite-block immobilization with adhesive tape region, when bite-block effect length endotracheal tube insertion depth (as nasal intubation), after having utilized handle, handle can be exited and is discarded by respiratory cycle cohesive end.Upper end inwall is provided with latch, and preferably 0.5cm is wide, and 1.5cm is long.The overall diameter that the interior diameter of handle upper end deducts endotracheal tube is greater than the twice degree of depth of latch, i.e. L1 > 2L2, to press the c time of ordering, latch can be dislocated.The interior diameter of handle, at its lower end is less than overall diameter and the twice gasbag ektexine sum of endotracheal tube, can effectively prevent that handle from coming off into glottis along conduit.A gap or weak area are stayed in the suggestion of handle, at its lower end medial wall, and width size is corresponding with the latch on endotracheal tube rear wall, and when needs are discarded handle, handle can be removed by conduit upper end respiratory cycle cohesive end.
Operating procedure is as follows:
Visual operation:
As tracheal intubation.Airway 5 is fixed in breather fixture, left hand progressively exposes glottis to the open air with laryngopharyngeal mirror, and the right hand is got most advanced and sophisticated controllable type single-lumen bronchial tube, catheter diameter 7.5mm No. 7.5, total length 33cm, with middle finger and the third finger, hold handle 10, it is standby that forefinger is put in c point, and thumb props up respiratory cycle cohesive end 7, when pars oralis pharyngis is arrived at endotracheal tube 5 tips, thumb is firmly pressed d point downwards, and handle 10 tractive airways 5 are relatively upwards stretched, and airway 5 pulls conduit 1 tip to upwarp.When conduit 1 bent at its tip arrives suitable position, make conduit 1 by glottis, press c point, the interior screens of latch 11 departs from, and conduit 1 recovers original form, and conduit is inserted to the suitable degree of depth, the fixing point c that decontrols airway 5, by inflation inlet 6 gas injections, opens air bag 4.Downslide handle 10, sends handle 10 into oral cavity, and by dental articulation, with immobilization with adhesive tape, respiratory cycle cohesive end 7 connects respiratory cycle, controls and breathes.
As nasal intubation.Fully na-sal cavity surfaces anesthesia, vasoconstrictive, after expansion nasal cavity is processed, airway 5 is fixed in breather fixture, left hand fixing head position, the right hand is got most advanced and sophisticated controllable type single-lumen bronchial tube, catheter diameter 6.5mm, total length 33cm No. 6.5, hand-held conduit middle and lower part, conduit 1 is most advanced and sophisticated by nostril, nasal vestibule, arrive cavum nasi proprium, by the first physiological bending.When conduit 1 arrives the second physiological bending of nasal cavity and nasopharynx part; conventionally can meet obstructions; now the right hand is held handle 10 with middle finger and the third finger; thumb props up respiratory cycle cohesive end 7; thumb is firmly pressed d point downwards; handle 10 tractive airways 5 are relatively upwards stretched, conduit 1 bent at its tip to suitable degree.The right hand is held conduit middle and lower part again, attempts making conduit descending, if met obstructions again, and can repeatable operation, until conduit 1 bent at its tip to suitable position, makes catheter proximal end adapt to the dissection of nasal cavity, fixing latch 11 positions, descending conduit.When conduit 1 tip is by resistance point, unclamp latch 11, recover catheter shape descending, when catheter tip arrives pars oralis pharyngis, if busy, visit intubate and encounter difficulties, left hand is held laryngopharyngeal mirror, progressively exposes glottis to the open air, the right hand is held handle 10 by middle finger and the third finger, forefinger is put in that c point is standby, and thumb props up respiratory cycle cohesive end 7, and thumb is firmly pressed d point downwards, handle 10 tractive airways 5 are relatively upwards stretched, and airway 5 pulls conduit 1 tip to upwarp.By left rotation and right rotation conduit with send up and down conduit, make catheter tip pass through glottis, press c point, the interior screens of latch 11 departs from, conduit recovers original form, conduit is inserted to the suitable degree of depth, decontrol airway 5, by inflation inlet 6 gas injections, open air bag 4, with immobilization with adhesive tape, respiratory cycle cohesive end 7 is connected to respiratory cycle, control and breathe.
Blind spy operation:
As tracheal intubation: the right hand is got most advanced and sophisticated controllable type magnetic force guiding single-lumen bronchial tube No. 7.5, catheter diameter 7.5mm, total length 33cm, airway 5 is fixed in breather fixture, make a gesture of measuring in vitro catheter tip direct oral cavity and arrive near the approximate depth of larynx, endotracheal tube is inserted to the same degree of depth through the blind spy in oral cavity standby.Left hand is placed Magnetitum near external glottis, the right hand is held handle 10 with middle finger and the third finger, it is standby that forefinger is put in c point, thumb props up respiratory cycle cohesive end 7, thumb is firmly pressed d point downwards, handle 10 tractive airways 5 are relatively upwards stretched, and airway 5 pulls conduit 1 tip to upwarp.When conduit 1 bent at its tip arrives suitable position, the right hand is adjusted catheter tip direction and the degree of depth, make it approach glottis approximate location as far as possible, now magnetic force is responded to, when magnetic force reaches maximum, and have when slightly affecting and clashing into sense, illustrate that endotracheal tube tip has arrived near glottis, connect End-tidal carbon dioxide detection probe, press breast portion, if any normal waveform, occur, illustrate and enter glottis, left hand is removed Magnetitum, the right hand is pressed c point, the interior screens of latch 11 departs from, conduit 1 recovers original form, conduit is inserted to the suitable degree of depth, decontrol the fixing point c of airway 5, by inflation inlet 6 gas injections, open air bag 4.Downslide handle 10, sends handle 10 into oral cavity, and by dental articulation, with immobilization with adhesive tape, respiratory cycle cohesive end 7 connects respiratory cycle, controls and breathes.
As nasal intubation:
Fully na-sal cavity surfaces anesthesia, vasoconstrictive, after expansion nasal cavity is processed, airway 5 is fixed in breather fixture, left hand fixing head position, the right hand is got most advanced and sophisticated controllable type magnetic force guiding single-lumen bronchial tube, catheter diameter 6.5mm No. 6.5, total length 33cm, make a gesture of measuring in vitro near the approximate depth of catheter tip nostril arrives larynx, hand-held conduit middle and lower part, conduit 1 is most advanced and sophisticated by nostril, nasal vestibule, arrive cavum nasi proprium, by the first physiological bending.When conduit 1 arrives the second physiological bending of nasal cavity and nasopharynx part; conventionally can meet obstructions; near now Magnetitum being placed in to oral cavity soft palate, fix, the right hand is adjusted depth of catheter, when sensation magnetic force is responded to; illustrate that catheter tip is attracted by Magnetitum; produced the camber of applicable physiological bending, descending conduit gradually, when catheter tip is by after resistance; while arriving pars oralis pharyngis, remove Magnetitum.Endotracheal tube is inserted to the same degree of depth through the blind spy in nostril standby.Left hand is placed Magnetitum near external glottis, the right hand is held handle 10 with middle finger and the third finger, it is standby that forefinger is put in c point, thumb props up respiratory cycle cohesive end 7, thumb is firmly pressed d point downwards, handle 10 tractive airways 5 are relatively upwards stretched, and airway 5 pulls conduit 1 tip to upwarp.When conduit 1 bent at its tip arrives suitable position, the right hand is adjusted catheter tip direction and the degree of depth, make it approach glottis approximate location as far as possible, now magnetic force is responded to, when magnetic force reaches maximum, and have when slightly affecting and clashing into sense, illustrate that endotracheal tube tip has arrived near glottis, connect End-tidal carbon dioxide detection probe, press breast portion, if any normal waveform, occur, illustrate and enter glottis, left hand is removed Magnetitum, the right hand is pressed c point, the interior screens of latch 11 departs from, conduit 1 recovers original form, conduit is inserted to the suitable degree of depth, decontrol the fixing point c of airway 5, by inflation inlet 6 gas injections, open air bag 4.Downslide handle 10, sends handle 10 into oral cavity, and by dental articulation, with immobilization with adhesive tape, respiratory cycle cohesive end 7 connects respiratory cycle, controls and breathes.