JP6101643B2 - Endotracheal tube - Google Patents

Description

  The present invention relates to an endotracheal tube used for endotracheal intubation, and particularly to an endotracheal tube suitable for retrograde intubation.

  Endotracheal intubation is performed for the purpose of securing the respiratory tract of patients who have difficulty breathing by themselves or managing artificial respiration in anesthesia. In endotracheal intubation, as shown in FIG. 5, a pillow 99 is placed under the head 80 of a patient who lies on his back, the neck 81 is bent backward, and the lower jaw 82 is raised. Next, the patient's mouth is opened by a cross finger method or the like, and the laryngoscope 91 is inserted. The laryngoscope 91 has a blade 91a inserted into the patient's mouth and a handle 91b connected to the rear end of the blade 91a. By applying the tip of the blade 91a of the laryngoscope 91 to the laryngeal valley 71b and pressing it forward and upward as viewed from the operator, the larynx 71 is moved upward, and the handle 91b is further lifted along the axial direction. The lower jaw 82 is pushed up by 91a, and the space in the oral cavity 84 is expanded. In the past, the present applicant has proposed a laryngoscope that can easily perform laryngeal deployment without requiring arm strength or skill (see Patent Document 1).

  When the larynx 70 is deployed in this way, the trachea 73 can be confirmed through the glottis 72, so the endotracheal tube 100 is advanced along the blade 91a of the laryngoscope 91 and passed through the glottis 72 to enter the endotrachea. The tip of the tube 100 is inserted into the trachea 73.

  Here, as shown in FIG. 6, the general endotracheal tube 100 includes a resin tube body 110 that is gently curved in accordance with the shape from the oral cavity 84 to the larynx 70. A joint portion 121 connected to a resuscitation bag or a ventilator is provided at the proximal end (the end on the operator side) of the tube main body 110. The opening at the end of the opposite distal portion of the tube main body 110 is referred to as a bevel opening 111 because it is inclined with respect to the axial direction of the tube main body. Further, the endotracheal tube 100 includes a type having a through-hole called a Murphy eye 112 on the side wall opposite to the bevel opening 111 at the distal portion. The Murphy eye 112 is for ensuring ventilation when the bevel opening 111 is blocked by secretions or the like. Further, a balloon-like cuff 122 is provided in the vicinity of the bevel opening 111, and air is supplied to the cuff 122 through a branch tube 125 from an inlet 124 provided with an inflation valve 123 that is a one-way valve. Can be injected. Further, the pressure of the cuff 122 can be confirmed by a pilot balloon 126 provided between the inflation valve 123 and the branch tube 125.

  When the endotracheal tube 100 having the above configuration is inserted into the trachea 73, a stylet (not shown) is passed through the tube body 110 to prevent deformation, and after the bevel opening 111 has passed through the glottis 72, the stylet And the laryngoscope 91 is removed. Then, air is injected from the injection port 124 and the cuff 122 is inflated and brought into close contact with the inner wall of the trachea 73, thereby preventing air leakage from the gap between the tube body 110 and the inner wall of the trachea 73. In this state, oxygen can be ventilated through the endotracheal tube 100 and lung pressure can be controlled by sending oxygen from a resuscitation bag or a ventilator connected to the joint part 121.

  However, when the larynx is deployed, the glottis are not always visible. The classification of the visual field when the larynx is deployed according to how the glottis are visible includes the classification of Colemac and Lehain. In this classification, Grade 1, the epiglottis, most of the glottis, and arytenoid cartilage are visible, the epiglottis, the arytenoid cartilage is visible, but the glottis is visible only at the posterior end or almost invisible. Is graded 3 and grade 4 is invisible. The greater the numerical value of the grade, the more difficult the endotracheal intubation, and the endotracheal intubation for Grade 3 and Grade 4 is much more difficult.

  When endotracheal intubation is difficult in this way, a technique called “retrograde intubation” may be used. In this retrograde intubation, first, as shown in FIG. 7 (a), the needle 95a of the syringe 95 is punctured so as to percutaneously penetrate the annular thyroid ligament 75, and near the vocal fold ligament 76 where the glottis 72 is located. The tip of the needle 95a is opened. Next, the syringe cylinder 95 b is removed from the needle 95 a, the thread T is passed through the needle 95 a, advanced in the direction of the mouth, passed through the glottis 72, and guided to the oral cavity 84. At this time, by trying the above-mentioned laryngeal deployment using a laryngoscope, the tip of the thread T can be pulled out from the oral cavity 84 as shown in FIG.

  The tip of the thread pulled out from the oral cavity 84 in this manner is inserted into the tube body 110 from the bevel opening 111 of the endotracheal tube as shown in FIG. 8A, and the tip of the thread T is opened at the proximal portion. Pull out from part 113. Alternatively, the tip of the thread T is pulled out from the Murphy eye 112 as shown in FIG. Thereby, the thread T inserted through the tube main body 110 or a part thereof passes from the outside of the mouth, through the oral cavity 84, the pharynx 85, and the larynx 70, through the glottis 72 in the middle of the larynx 70, and into the trachea 73. It enters and penetrates to the outside of the skin 89 through the puncture hole 77 by the injection needle.

  Therefore, by moving the endotracheal tube forward while lightly pulling both ends of the thread, the intraductal tube guided by the thread can pass through the glottis. In this case, the larynx is deployed using a laryngoscope, and the stylet is inserted into the endotracheal tube for easy operation. When the bevel opening of the endotracheal tube is sufficiently inserted into the trachea, the thread is cut in the vicinity of the puncture hole and pulled out from the mouth side. In this way, endotracheal intubation can be performed even when the glottis are not visible even when the larynx is deployed.

  However, when retrograde intubation is performed as described above, when the endotracheal tube is advanced along the thread, the bevel opening may hit an intermediate organ or be caught as illustrated in FIG. It was. Here, FIG. 9A shows a state in which the bevel opening 111 of the endotracheal tube hits the epiglottis 71, and FIG. 9B shows that the bevel opening 111 is the arytenoid cartilage 78 or the tearing epiglottis fold. 79 shows a state of being caught at 79. FIG. 9 illustrates the case where the mouth side end of the thread T is pulled out from the Murphy eye 112.

  In this way, when normal endotracheal intubation with visual recognition of the glottis is difficult, the retrograde intubation is attempted as an extremely effective means, but the bevel opening hits or gets caught in the midway organ. If this happens, there is no means for inserting the endotracheal tube into the trachea, which may lead to a life-threatening situation for the patient.

Japanese Patent No. 5285732

  Therefore, in view of the above circumstances, the present invention reduces the possibility that the opening of the distal portion will hit or get caught in an intermediate organ when the endotracheal tube is inserted into the trachea by retrograde intubation. It is an object to provide an endotracheal tube.

In order to solve the above-mentioned problems, an endotracheal tube according to the present invention is described as follows: “ Retrograde performing endotracheal intubation using a thread drawn from the oral cavity through the glottis through a puncture hole that penetrates the annular thyroid ligament percutaneously. An endotracheal tube used for sex intubation, which is one of the tube main body , the opening at both ends of the tube main body , a bevel opening that is inclined with respect to the axial direction of the tube main body , and It has a long hole portion for inserting the thread, and the long hole portion is formed at a tip of the bevel opening portion from a tube end opening that is opened in a peripheral wall of the bevel opening portion. The inside of the side wall penetrates in a tunnel shape from the side wall to the side wall opening that opens at least outward, and the length is 5 mm to 20 mm .

  The endotracheal tube of this configuration uses the bevel opening on the side where the long hole portion is formed among the opening portions at both ends as the distal portion side. When retrograde intubation is performed, the thread pulled through the glottis through the needle of the syringe percutaneously through the annular thyroid ligament and pulled out to the mouth, the slot from the tube end opening of the endotracheal tube Inserted through the long hole and pulled out from the side wall opening. Then, by advancing the endotracheal tube toward the back of the mouth while gently pulling both ends of the thread, the endotracheal tube is guided and advanced by the thread, so that the endotracheal tube can pass through the glottis. At that time, the long hole through the thread is formed at the tip of the inclined bevel opening, so that the tip of the bevel opening always faces the traveling direction of the endotracheal tube guided by the thread. Yes. Thereby, when retrograde intubation is performed, the endotracheal tube can be advanced and inserted into the trachea without the bevel opening colliding with or being caught by an organ on the way.

  In addition, the “side wall opening” of the long hole portion is an opening from the side wall to the outside and the inside, as described later, even if it opens from the side wall only to the outside. There may be.

In addition to the above configuration, the endotracheal tube according to the present invention further includes “a Murphy eye that passes through the side wall on the bevel opening side, and the side wall opening opens to an inner peripheral wall of the Murphy eye. Can be. "

  In the endotracheal tube having this configuration, the thread inserted from the tube end opening into the elongated hole portion can be pulled out to the outside of the tube main body via the Murphy eye. And the endotracheal tube of this structure comprises a Murphy eye penetrating the side wall of the tube body, so that even when the bevel opening is blocked by secretions or the like, Can be ventilated. In addition, the side wall opening communicated with the Murphy eye is configured to open outward and inward from the side wall.

  As described above, as an effect of the present invention, when the endotracheal tube is inserted into the trachea by retrograde intubation, the risk that the distal opening may hit or get caught in an organ in the middle is reduced. An in-tube tube can be provided.

It is a perspective view of the bevel opening part vicinity of the endotracheal tube which is 1st embodiment of this invention. It is the (a) top view seen from right above the side wall opening of the endotracheal tube of FIG. 1, (b) side view corresponding to FIG. 2 (a), and (c) front view. It is a figure explaining the usage method of the endotracheal tube of FIG. It is a perspective view of the bevel opening vicinity vicinity of the endotracheal tube which is 2nd embodiment of this invention. It is explanatory drawing of endotracheal intubation. It is explanatory drawing of the conventional endotracheal tube. It is a figure explaining retrograde intubation. FIG. 8 is a diagram for explaining retrograde intubation following FIG. 7. It is a figure explaining the problem of the conventional retrograde intubation.

  Hereinafter, the endotracheal tube 1 which is 1st embodiment of this invention is demonstrated using FIG. 1 thru | or FIG.

  The basic configuration of the endotracheal tube 1 is the same as the conventional endotracheal tube 100 described above with reference to FIG. 6, and is one of a resin tube main body 10 and openings at both ends of the tube main body 10. A bevel opening 11 that is inclined with respect to the axial direction of the tube body 10, a cuff (not shown) provided in the vicinity of the bevel opening 11, a branch tube connected to the cuff, An inflation valve for supplying air to the cuff via the branch tube, a pilot balloon provided between the inflation valve and the branch tube, and the other of the openings at both ends of the tube body 10; It has a resuscitation bag and a joint connected to a ventilator.

  The difference between the endotracheal tube 1 and the conventional endotracheal tube 100 is that, as shown in FIGS. 1 and 2, the end of the tube opened to the peripheral wall 15 of the bevel opening 11 at the forefront of the bevel opening 11. From the opening 21 to the side wall opening 22 opening outward from the side wall of the tube body 10, there is a long hole portion 20 that penetrates the inside of the side wall in a tunnel shape.

  More specifically, a part of the side wall of the tube body 10 is thicker than the other part on the side of the bevel opening 11, and the long hole part 20 is disposed inside the side wall having a large thickness. It penetrates. The long hole portion 20 extends straight from the tube end opening 21 in the peripheral wall 15 of the bevel opening portion 11 in parallel with the axial direction of the tube main body 10 and toward the outer surface of the side wall, and opens outward from the side wall. The side wall opening 22 is formed.

  The inner diameter of the tube main body 10 can be set to 6 mm to 9 mm, similar to the conventional endotracheal tube. In the tube main body 10 having such an inner diameter, the inner diameter of the long hole portion 20 needs to be large enough to insert the thread and smoothly move the inserted thread. Here, a nylon thread for suture, a catheter, a metal wire or the like can be used as the thread, but it has flexibility and moderate elasticity, is thin but strong, and can be obtained at low cost. Nylon yarn is particularly suitable. Since the thickness of the nylon thread is about 0.3 mm, when the nylon thread is used as a thread, the inner diameter of the long hole portion 20 is preferably 0.5 mm to 2 mm.

  Further, the inner diameter of the long hole portion 20 is expanded in a funnel shape toward the tube end opening 21 in the vicinity of the tube end opening 21.

  On the other hand, if the length of the long hole portion 20 is too long, the frictional resistance with the inner wall of the long hole portion 20 becomes large and it is difficult to move the thread, and if it is too short, the angle of inclination from the tube end opening 21 toward the side wall opening 22 Is larger, and the thread tends to be bent at the tube end opening 21 and the side wall opening 22, so that it is preferable to set the thickness to 5 mm to 20 mm.

  When the endotracheal tube 1 is used for retrograde intubation, as shown in FIG. 3, the intraoral tube 84 is passed through the glottis 72 from the puncture hole 77 of the injection needle punctured so as to penetrate the annular thyroid ligament percutaneously. The thread T drawn outward is inserted into the long hole portion 20 from the tube end opening 21 of the endotracheal tube 1 and pulled out from the side wall opening 22. At this time, since the long hole portion 20 is enlarged in the vicinity of the tube end opening 21 toward the tube end opening 21, the thread T can be easily inserted into the long hole portion 20.

  Then, with the patient's upper jaw 82 raised and the larynx 70 deployed, the endotracheal tube 1 is advanced backward while gently pulling both ends of the thread T. Thereby, the endotracheal tube 1 can be advanced along the thread T, and the endotracheal tube 1 guided by the thread T can pass through the glottis 72.

  And since the long hole part 20 which has passed the thread | sled T is formed in the forefront of the bevel opening part 11 which inclined, the foremost part of the bevel opening part 11 has always faced the advancing direction of the endotracheal tube 1. Thereby, the bevel opening 11 can smoothly advance the endotracheal tube 1 and insert it into the trachea 73 without hitting or catching an intermediate organ such as the epiglottis, arytenoid cartilage, and nasopharyngeal fold. it can.

  In order to further advance the endotracheal tube 1 inserted into the trachea 73 and insert the bevel opening 11 deeper than the puncture hole 77, the thread T bends from the puncture hole 77 toward the bevel opening 11. There is a need. If a thread made of a material having high flexibility such as nylon thread is used as the thread, the thread is easily bent, so that the endotracheal tube 1 can be inserted deeply into the trachea 73 without any problem. Further, a thread having high flexibility such as nylon thread has an advantage that the glottis 72 are not damaged when passing through the glottis 72.

  Next, the endotracheal tube 2 of the second embodiment will be described with reference to FIG. The endotracheal tube 2 according to the second embodiment is different from the endotracheal tube 1 according to the first embodiment in that it further includes a Murphy eye 12 penetrating the side wall on the bevel opening 11 side. 22 is a point communicating with the Murphy Eye 12.

  More specifically, the Murphy eye 12 has an elliptical shape that is long in the axial direction of the tube main body 10, and a side wall opening 22 of the long hole portion 20 is opened on the inner peripheral wall thereof. In FIG. 4, a mode in which the side wall opening 22 is opened on the inner peripheral surface at a position corresponding to the major axis of the elliptical Murphy eye 12 is not limited to this. The side wall openings 22 may be opened at other positions.

  The endotracheal tube 2 of the second embodiment can also be used for retrograde intubation in the same manner as the endotracheal tube 1 of the first embodiment. Like the endotracheal tube 1, the bevel opening 11 is in the middle. The endotracheal tube 2 can be smoothly inserted into the trachea without hitting or getting caught in the organ.

  In addition, in the endotracheal tube 2, the Murphy eye 12 also serves as an opening for drawing the thread inserted through the long hole portion 20 outward from the side wall. Thus, the long hole penetrating the inside of the side wall on the bevel opening 11 side while exhibiting the original effect of the Murphy eye 12 that ensures ventilation when the bevel opening 11 is blocked with secretions or the like. A unique effect of guiding the traveling direction of the endotracheal tube 2 to the thread passing through the portion 20 can be exhibited.

  Although the present invention has been described with reference to the preferred embodiments, the present invention is not limited to the above-described embodiments, and various improvements and design changes can be made without departing from the scope of the present invention. It is.

  For example, in the above-described embodiment, the case where the endotracheal tube includes a cuff has been exemplified. However, the present invention can be applied even to an endotracheal tube without a cuff. Further, the present invention can be applied to an endotracheal tube in which a suction line is added to the upper part of the cuff.

1, 2 Endotracheal tube 10 Tube body 11 Bevel opening 12 Murphy eye 20 Long hole 21 Tube end opening 22 Side wall opening

Claims (2)

An endotracheal tube used for retrograde intubation in which endotracheal intubation is performed using a thread drawn from the oral cavity through the glottis through a puncture hole that percutaneously penetrates the annular thyroid ligament,
The tube body is one of the opening portions at both ends of the tube body , and includes a bevel opening portion that is inclined with respect to the axial direction of the tube body , and a long hole portion through which the thread is inserted. And
From the tube end opening that opens to the peripheral wall of the bevel opening, to the side wall opening that opens at least outward from the side wall of the tube main body, at the forefront of the bevel opening An endotracheal tube that penetrates the inside of the side wall in a tunnel shape and has a length of 5 mm to 20 mm . Further comprising a Murphy eye penetrating the side wall on the bevel opening side;
The endotracheal tube according to claim 1, wherein the side wall opening is opened in an inner peripheral wall of the Murphy eye.

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