JP2008180743A - Upper respiratory airway insertion practicing device - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a simple and practicable upper respiratory airway insertion practicing device enabling an operator to understand a proper method of inserting an upper respiratory airway and improve skill by accurately reproducing troubles caused when the upper respiratory air way is inserted. <P>SOLUTION: This upper respiratory airway insertion practicing device comprises: a pharynx groove part 2 of an upwardly opened recessed shape in cross section; a palate plate 3 vertically formed at one end of the pharynx groove part 2 and having a flat surface-shaped or a recessed surface-shaped palate surface; a rhinopharynx 8 opened near the connection part of the palate plate 3 to the pharynx groove part 2; and a soft palate piece 4 suspended to the rhinopharynx 8. <P>COPYRIGHT: (C)2008,JPO&INPIT

Description

  The present invention relates to an insertion practice device for an upper airway airway that is inserted into a human upper airway such as a laryngeal mask airway and performs artificial respiration.

  A tubular device that couples the ventilator and the patient's airway to ventilate the lungs is commonly referred to as an Airway. In the past, endotracheal intubation, in which an airway is inserted into the trachea from the laryngeal mouth under monitoring by a laryngoscope, has been frequently used. However, endotracheal intubation may be difficult to insert into the trachea. Furthermore, endotracheal intubation, in which an airway is inserted into a trachea that normally contains only gas, is highly invasive to the human body, and there is a risk that the blood flow in the trachea will be impaired and the airway epithelium will be damaged. In addition, the laryngoscope and muscle relaxant used during endotracheal intubation may cause various complications.

  Therefore, in recent years, the upper airway airway that stays in the upper airway and does not enter the trachea has been developed, such as the Laryngeal Mask Airway and the esophageal closed airway.

  The laryngeal mask airway is the earliest in clinical use and the most popular of several types of upper airway airways. FIG. 7 is a view showing a state where the laryngeal mask airway is mounted on a patient. In FIG. 7, 100 is a laryngeal mask airway, and 200 is a patient's head. The laryngeal mask airway 100 includes an airway tube 101, a cuff 102, and an inflating tube 103.

  The airway tube 101 is a tube that couples a ventilator (not shown) and the larynx 201 to ventilate the air in the lung, and is inserted from the oral cavity 202 to reach the lower part of the pharynx 203. The cuff 102 is an annular air sac that surrounds the tip of the airway tube 101. The cuff 102 is in close contact with the wall surface of the pharynx 203, and the larynx 201 and the airway tube 101 are airtightly coupled. It functions as a seal that prevents leakage into the esophagus 204 and pharynx 203. The cuff 102 is inserted into the pharynx 203 in a degassed and deflated state and positioned at a normal position, and then inflated by injecting air with a pump (not shown) through the inflator tube 103. Further, when the airway tube 101 is removed from the pharynx 203, the air in the cuff 102 is discharged through the inflating tube 103. 205 is an anterior dentition, 206 is a hard palate, 207 is a soft palate, 208 is a nasopharynx, 209 is a epiglottis, 210 is a laryngeal vestibule, and 211 is a trachea.

  When the laryngeal mask airway 100 is inserted into the patient's pharynx 203, the back of the cuff 102 is pressed against the hard palate 206 with an appropriate force and direction, and the tip of the cuff 102 is attached to the hard palate 206. Then, it slides along the curve of the hard palate 206 and the soft palate 207, guides to the lower part of the pharynx 203, and pushes in until the operator feels that the cuff 102 hits the bottom of the pharynx 203.

  Thus, the airway tube 101 is inserted into the patient's pharynx 203 by the operator, but it is difficult to practice an appropriate insertion method simply by reading the explanation of the insertion technique. The reason is that the strength of the force required to bring the cuff 102 into close contact with the hard palate 206 and the direction in which the force that changes according to the insertion process is applied are not sufficiently understood only by the verbal explanation. If improper insertion is performed, the cuff 102 is inserted at an undesirable position, causing various problems. For example, if the cuff 102 enters the laryngeal vestibule 210 or the nasopharynx 208, the airway tube 101 and the trachea 211 are not coupled, making ventilation difficult. Further, if the cuff 102 is not inserted sufficiently, the air flowing through the airway tube 101 leaks to the pharynx 203 and the esophagus 204, so that efficient ventilation cannot be performed. Also, repeated insertion and removal for accurate positioning of the cuff 102 causes trauma and harmful reflections. Therefore, it is necessary for the surgeon to acquire a technique that allows the cuff 102 to be accurately positioned by groping, and training equipment has been proposed.

For example, Patent Literature 1 discloses an auxiliary instrument for performing insertion training of the laryngeal mask airway 100 using a doll for tracheal intubation training disclosed in Patent Literature 2 and the like. Patent Document 3 discloses a doll for performing insertion training for the laryngeal mask airway 100.
Japanese Utility Model Publication No. 7-33350 JP 59-30582 A JP 2000-214765 A JR Brimacombe et al. Original, supervised by Keisuke Amaha, “All about Laryngeal Mask” Diagnosis and Treatment Company, 1998

  Since the dolls disclosed in Patent Document 1 (hereinafter referred to as “conventional dolls”) faithfully reproduce the shapes of the larynx 201, the trachea 211, and the like, it is possible to experience an experience similar to real endotracheal intubation. Although there is an advantage, since the face and skin are also reproduced, there is a problem that the apparatus is large and expensive. In addition, since it is difficult for the conventional doll to confirm the insertion process with the naked eye, understanding of the behavior of the airway tube 101 in the pharynx 203 and the deformation of the cuff 102 is hindered.

In addition, since the conventional doll is originally intended for training of endotracheal intubation, it is not sufficient for training of the laryngeal mask airway 100, and it is difficult for an operator to understand an accurate insertion method. Furthermore, there is a problem that the following troubles peculiar to the laryngeal mask airway 100 are not faithfully reproduced and a sufficient practice effect cannot be obtained.
(1) A trouble in which the cuff 102 that hits the pharynx 203 is turned over through the hard palate 206 and the soft palate 207, and enters the nasopharynx 208.
(2) A problem in which the cuff 102 is turned inside the pharynx 203 and the cuff 102 is placed in a state where the edge of the cuff 102 is turned over.
(3) Trouble that tip of cuff 102 hits front tooth row 205 and tip edge of cuff 102 is turned over.
(4) Trouble that the tip of the cuff 102 gets into the laryngeal vestibule 210 due to inappropriate formation preparation or insertion procedure of the cuff 102 before insertion.

  Further, in the conventional doll, the soft palate 207 is made of a hard material, and the shape of the soft palate 207 in a state where a human stands up (a state in which the tip of the soft palate 207 hangs down in the foot direction due to gravity) is modeled. When the laryngeal mask airway 100 is inserted with this doll, the cuff 102 is guided by the model of the soft palate 207 and smoothly guided to the lower part of the pharynx 203. On the other hand, since the insertion of the actual laryngeal mask airway 100 is performed with the patient lying down, the tip of the soft palate 207 hangs down toward the back of the head. In addition, since the soft palate 207 is relaxed due to a decrease in patient consciousness or administration of a muscle relaxant, it deforms when the laryngeal mask airway 100 is pressed. For this reason, the laryngeal mask airway 100 is not smoothly guided to the pharynx 203 and enters the nasopharynx cavity 208. That is, there is a problem that such a phenomenon cannot be accurately reproduced with a conventional doll.

  The present invention has been made in view of such circumstances, and can easily reproduce the trouble that occurs when the upper airway airway is inserted, allowing the operator to understand an appropriate insertion method. An object is to provide a practical upper airway airway insertion practice device.

  The first configuration of the upper airway airway insertion practice device of the present invention is a pharyngeal groove portion having a concave cross-sectional shape with an open upper surface, and is erected at one end of the pharyngeal groove, and is planar or concave. A palatal member having a palatal surface, a nasopharyngeal opening that opens in the vicinity of the connecting portion of the palatal member to the pharyngeal groove, and a soft palate piece that hangs down from the nasopharyngeal opening.

  According to this configuration, human organs that exist in the insertion path of the upper airway airway are modeled to a necessary and sufficient level for practicing insertion of the upper airway airway, so that effective practice of insertion of the upper airway airway is possible become.

  When the hard palate has a high arch (large curvature), it is difficult to slide the cuff along the hard palate, so a slight lateral approach is used to make the upper airway airway approach the mouth slightly diagonally. If the palate surface is formed in a concave shape simulating a human palate, the behavior of the upper airway airway can be accurately reproduced when performing the slight lateral approach. Here, the concave shape means a shape in which both a horizontal cross section and a vertical cross section are curved, and a central portion is recessed with respect to a peripheral portion, and a horizontal cross sectional shape of a palate member is a frontal face of a human hard palate. The vertical cross-sectional shape simulates the curvature in the sagittal plane.

  The palate surface of the palate member may be formed in a flat shape instead of a concave surface. This is because the arch (curvature) of the human hard palate has individual differences and may be simulated on a flat surface. In addition, if the corner of the concave section of the pharyngeal groove is rounded and the cross-sectional shape of the pharyngeal groove is formed in a U-shape, the cross-sectional shape of the human pharynx can be simulated more accurately, thus improving the practice effect. .

  The 2nd structure of the upper airway airway insertion practice apparatus of this invention WHEREIN: The said soft palate piece is comprised by a flexible member in the said 1st structure, It is characterized by the above-mentioned.

  According to this configuration, since the soft palate piece is made of a flexible member, it is possible to reproduce the trouble that the upper airway airway pushes up the soft palate and strays into the nasopharynx, thereby improving the practice effect. Here, the flexible member is not limited to rubber. A material capable of reproducing the flexibility of the human soft palate can be appropriately selected and used.

  The 3rd structure of the upper airway airway insertion practice apparatus of this invention is equipped with the pharyngeal front board which covers a part of said pharyngeal groove part in the said 1st or 2nd structure.

  According to this configuration, the pharyngeal front plate that simulates the anterior wall of the human pharynx is provided, and the partial cross section of the pharyngeal groove is closed, so the trouble that the cuff is bent in the pharynx can be reproduced and the practice effect is improved. To do.

  The 4th structure of the upper airway airway insertion practice apparatus of this invention is equipped with a laryngeal piece in the said pharyngeal front board in the said 3rd structure.

  According to this configuration, the laryngeal piece is provided on the pharyngeal front plate to simulate the human larynx, so that the cuff stops striking against the larynx and the insertion process can be confirmed by touch, improving the practice effect.

  A fifth configuration of the upper airway airway insertion practice device of the present invention is characterized in that, in the fourth configuration, the laryngeal piece has a lumen.

  According to this configuration, since the laryngeal piece has a lumen and simulates the human laryngeal cavity, the trouble that the cuff gets into the larynx can be reproduced, and the practice effect is improved.

  A sixth configuration of the upper airway insertion practice device according to the present invention is characterized in that, in the first to fifth configurations, the palate member has a dentition-like projection on an upper end.

  According to this configuration, the upper end of the palate member is provided with a dentition-like projection to simulate a human anterior dentition, so it is possible to accurately reproduce the cuff turnover in the oral cavity that is likely to occur in a human body with anterior teeth. The effect is improved.

  The seventh configuration of the upper airway airway insertion practice device of the present invention is the sixth configuration, wherein a plurality of the dentate protrusions having different shapes or dimensions are provided, and the dentate protrusions are formed on the palate member. On the other hand, it is connected detachably.

  There are individual differences in the shape and size of the dentition, and some or all of the teeth may be missing. When there are no teeth at all, the upper airway airway is easily brought into close contact with the hard palate, so that the insertion becomes easy. On the other hand, if the teeth are long or if the teeth are non-uniform, it is difficult to make the upper airway airway adhere to the hard palate, and proper insertion becomes difficult. According to this configuration, since the plurality of dentate protrusions having different shapes or dimensions can be attached / detached / replaced, anatomical individual differences such as tooth shape / size, presence / absence of teeth, and insertion of the upper airway airway associated therewith Differences in difficulty are reproduced, and practice according to the difficulty becomes possible.

  According to an eighth configuration of the upper airway insertion practice device of the present invention, in the first to seventh configurations, the palate member is connected to the pharyngeal groove portion so as to be rotatable and fixed around the connection portion. It is characterized by being.

  According to this configuration, the palatal member is connected to the pharyngeal groove so as to be freely rotatable and fixed, so that the insertion practice can be performed by simulating the difference in the angle of the head and neck of the patient, and the practice effect is improved. To do.

  According to a ninth configuration of the upper airway insertion practice device of the present invention, in the first to eighth configurations, a plurality of palate members having different shapes or sizes are provided, and the palate member is configured to be connected to the pharyngeal groove portion. It is connected detachably.

  There are individual differences in the shape and dimensions of the hard palate, and patients with large curvature of the hard palate and patients with significant irregularities on the hard palate surface have insufficient cuff pressure on the hard palate. Have difficulty. According to this configuration, the palat members having different shapes and dimensions can be replaced and practice can be performed while changing the conditions from an easy-to-insert form to a difficult form, so the practice effect is improved.

  According to a tenth configuration of the upper airway airway insertion practice device of the present invention, in the first to ninth configurations, a plurality of the soft palate pieces having different shapes, sizes, or hardnesses are provided. It is detachably connected to the member.

  There are individual differences in the shape and hardness of the soft palate, and the hardness of the soft palate varies depending on the level of consciousness of the patient and the drug administered. According to this configuration, since the difference in the level of difficulty in insertion due to such individual differences and consciousness levels can be reproduced, the practice effect is improved.

  The eleventh configuration of the upper airway airway insertion practice device of the present invention is characterized in that, in the first to tenth configurations, a part or all of the component members are made of a transparent member.

  According to this configuration, since a part or all of the component member is formed of the transparent member, the behavior of the airway tube and the deformation of the cuff in the upper airway airway insertion practice device can be directly observed, and the practice effect is improved.

  As described above, the upper airway airway insertion practice device of the present invention is necessary and sufficient for organs related to the insertion of the upper airway airway among the organs from the human oral cavity to the larynx for the upper airway airway insertion practice. Therefore, it is possible to accurately reproduce the trouble that occurs when the upper airway airway is inserted, and to make the surgeon understand the appropriate insertion method and improve the skill. Further, since the upper airway insertion practice device of the present invention is composed of relatively simple parts, it is easy to manufacture, can be provided at low cost, and contributes to the popularization of the upper airway airway.

  The best mode for carrying out the present invention will be described below with reference to the drawings.

  FIG. 1 is a three-side view of an upper airway airway insertion practice device showing an embodiment of the present invention, where (a) is a side view, (b) is a plan view, and (c) is a front view. FIG. 2 is a perspective view of the upper airway airway insertion practice device. FIG. 3 is a diagram showing the relationship between the upper airway airway insertion practice device and the human respiratory organ. As shown in FIGS. 1 and 2, the upper airway airway insertion practice device 1 includes a pharyngeal groove 2, a palate plate 3, a soft palate piece 4, a pharyngeal front plate 5, and a laryngeal piece 6.

  The pharyngeal groove portion 2 is a groove-shaped hard plastic member that simulates the human pharynx 203, and the bottom surface corresponds to the rear wall of the pharynx 203 and the side surface corresponds to the side wall of the pharynx 203. Further, since the corner portion between the bottom surface and the side surface of the pharyngeal groove portion 2 is rounded, the cross-sectional shape of the pharyngeal groove portion 2 is U-shaped, simulating the cross-sectional shape of the human pharynx 203. Further, the groove width of the pharyngeal groove portion 2 is made substantially the same as the diameter of the human pharynx 203. The pharyngeal groove 2 also serves as the base of the upper airway airway insertion practice device 1.

  The palate plate 3 is a hard plastic member provided with a spoon-like concave curved surface that is erected at the end of the pharyngeal groove 2 and simulates the human hard palate 206, and imitates the front teeth row 205 of the upper jaw on the upper end. A nasopharyngeal opening 8 simulating a human nasopharyngeal cavity 208 is opened at the lower end, that is, in the vicinity of the connection portion with the pharyngeal groove 2. A rubber soft palate piece 4 simulating a human soft palate 207 is attached to the nasopharyngeal opening 8 to block a part of the nasopharyngeal opening 8. A recess having a depth corresponding to the thickness of the soft palate piece 4 is formed around the nasopharyngeal opening 8, and the soft palate piece 4 is fitted into the recess. In addition, the material of the soft palate piece 4 is not limited to rubber, and various materials having appropriate flexibility for simulating the human soft palate 207 can be selected.

  The pharyngeal front plate 5 is a transparent acrylic plate that simulates the front wall of the human pharynx 203 (more precisely, the rear surface of the tongue and the region including the tongue base), and covers a part of the pharyngeal groove 2 and has a closed cross section. Is forming.

  The laryngeal piece 6 is a hard plastic small lump bonded and fixed to the pharyngeal front plate 5, and simulates the larynx 201 protruding from the human pharynx 203.

  FIG. 4 is a perspective view showing a modification of the upper airway airway insertion practice device 1. This modification is characterized in that the laryngeal piece 6 is formed with a lumen 9 simulating the cavity of the human larynx 201, that is, the cavity from the laryngeal vestibule 210 to the trachea 211. This lumen 9 can reproduce the trouble that the cuff 102 gets into the larynx 201.

  FIG. 5 is a perspective view showing a state where the laryngeal mask airway 100 is correctly inserted into the upper airway airway insertion practice device 1. As shown in FIG. 5, the cuff 102 of the laryngeal mask airway 100 is positioned at a position that wraps the laryngeal piece 6. Thus, a state (see FIG. 7) in which the laryngeal mask airway 100 is airtightly coupled to the human larynx 201 is simulated.

  FIG. 6 is a side view showing another modified example of the upper airway airway insertion practice device 1. In this modification, the pharyngeal groove 2 and the palatal plate 3 are configured as separate parts, and the palatal plate 3 is pivotally supported by the pharyngeal groove 2 so that the angle formed by the palate plate 3 and the pharyngeal groove 2 can be changed. Reference numeral 10 denotes a wing nut for fixing the palate plate 3 at an arbitrary angle. The means for fixing the palate plate 3 at an arbitrary angle is not limited to the wing nut 10. Various known means can be appropriately selected and used.

  When inserting the laryngeal mask airway 100, the neck is bent so that the head protrudes (sniffing position) so that the axis of the oral cavity 202 and the pharynx 203 is 90 ° or more. Due to differences in physique and the like, the angle formed by the axes of the oral cavity 202 and the pharynx 203 is not necessarily 90 °. Therefore, if the insertion angle of the laryngeal mask airway 100 is practiced by variously changing the angle formed by the palate plate 3 and the pharyngeal groove 2, the practice effect is further improved.

  There are individual differences in the shape and size of the front tooth row 205, and some or all of the teeth may have dropped out. If the projection 7 is detachably attached to the palate plate 3 and a plurality of dentition-like projections 7 having different sizes and shapes are provided and the insertion practice is performed while replacing the dentition-like projection 7, the practice under different conditions can be achieved. Because it can, practice effect improves. Further, if the dentition protrusion 7 is removed, it is possible to simulate a patient in which all the teeth have fallen. In addition, what is necessary is just to select well-known fastening means suitably, such as a clip using a screw or a spring, as a means to connect the dentition-like protrusion 7 to the palate board 3 detachably.

  In addition, the size and shape of the hard palate 206 varies from person to person, and varies greatly depending on the patient. In addition, the insertion of the laryngeal mask airway 100 is performed by pressing the cuff 102 against the hard palate 206 and sliding the cuff 102 along the arched curve of the hard palate 206. Therefore, the difficulty level of inserting the laryngeal mask airway 100 changes. Therefore, if a plurality of palate plates 3 having different dimensions and shapes are prepared and practiced for insertion while exchanging the palatal plate 3, practice under different conditions can be performed, so that the practice effect is improved.

  In addition, the size and shape of the soft palate 207 vary among individuals and varies greatly depending on the patient. Furthermore, the hardness of the soft palate 207 varies depending on the patient's level of consciousness and the administered drug. That is, if the patient's level of consciousness is low, the soft palate 207 is relaxed and softened. Further, the risk of the cuff 102 entering the nasopharynx 208 changes depending on the size, shape, or hardness of the soft palate 207. Therefore, if a plurality of soft palate pieces 4 having different dimensions, shapes, and hardnesses are prepared and practiced for insertion while exchanging the soft palate pieces 4, it is possible to practice under different conditions, so that the practice effect is improved.

  The soft palate piece 4 is fitted and fixed in the recess formed in the palate plate 3 by the elasticity of the soft palate piece 4 itself, but supplementarily using an adhesive, a double-sided tape, and a hook-and-loop fastener. 3 may be detachably connected.

  Moreover, although the example which comprised the upper airway airway insertion practice apparatus 1 by the hard plastic, the acrylic board, etc. was shown in the present Example, the material of the upper airway airway insertion practice apparatus which concerns on this invention is not restricted to these. . Various materials can be appropriately selected and used. For example, if a material capable of reproducing the softness of the actual pharynx 203 or the like is used for the pharyngeal groove portion 2, the palate plate 3, the pharyngeal front plate 5, the laryngeal piece 6, and the like, a more realistic insertion practice becomes possible. If not only the pharyngeal front plate 5 but also other components are made of a transparent material, the behavior of the airway tube 101 and the deformation of the cuff 102 can be more easily observed.

  Further, it goes without saying that the upper airway airway insertion practice device according to the present invention can be used not only for the laryngeal mask airway, but also for other upper airway airway practice (for example, an esophageal closed airway).

It is a three-view figure of the upper airway airway insertion practice apparatus which shows the Example of this invention. It is a perspective view of the said upper airway airway insertion practice apparatus. It is a figure which shows the relationship between the said upper airway airway insertion practice apparatus and a human respiratory organ. It is a perspective view which shows the modification of an upper airway airway insertion practice apparatus. It is a perspective view which shows the state which inserted the upper airway airway correctly in the upper airway airway insertion practice apparatus. It is a side view which shows another modification of an upper airway airway insertion practice apparatus. It is a figure which shows the state which mounted | wore the patient with the laryngeal mask airway.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Upper airway airway insertion training apparatus 2 Pharyngeal groove part 3 Palate plate 4 Soft palate piece 5 Pharyngeal front plate 6 Laryngeal piece 7 Dental process 8 Nasopharyngeal opening 9 Lumen 10 Wing nut 100 Laryngeal mask airway 101 Airway tube 102 Cuff 103 Inflation tube 200 Patient's head 201 Larynx 202 Oral cavity 203 Pharynx 204 Esophagus 205 Anterior dentition 206 Hard palate 207 Soft palate 208 Nasopharynx 209 Larynx 210 Larynx vestibule 211 Trachea

Claims (11)

A pharyngeal groove having a concave cross-sectional shape with an open upper surface;
A palate member standing at one end of the pharyngeal groove, and having a flat or concave palate surface;
A nasopharyngeal opening that opens in the vicinity of the connecting portion with the pharyngeal groove of the palate member;
An upper airway airway insertion practice device comprising a soft palate piece depending on the nasopharyngeal opening.   The upper airway airway insertion practice device according to claim 1, wherein the soft palate piece is formed of a flexible member.   The upper airway airway insertion practice device according to claim 1, further comprising a pharyngeal front plate that covers a part of the pharyngeal groove.   The upper airway airway insertion practice device according to claim 3, wherein the pharyngeal front plate includes a laryngeal piece.   The upper airway airway insertion practice device according to claim 4, wherein the laryngeal piece has a lumen.   The upper airway insertion practice device according to any one of claims 1 to 5, wherein the palate member has a dentition-like protrusion at an upper end. While having a plurality of the dentition-like projections having different shapes or dimensions,
The upper airway airway insertion practice device according to claim 6, wherein the dentition protrusion is detachably connected to the palate member.   The upper airway airway insertion practice device according to any one of claims 1 to 7, wherein the palate member is connected to the pharyngeal groove portion so as to be rotatable and fixed around the connection portion. . A plurality of palate members having different shapes or dimensions;
The upper airway airway insertion practice device according to any one of claims 1 to 8, wherein the palate member is detachably connected to the pharyngeal groove. With a plurality of soft palate pieces having different shapes, dimensions or hardness,
The upper airway airway insertion practice device according to any one of claims 1 to 9, wherein the soft palate piece is detachably connected to the palate member. The upper airway airway insertion practice device according to any one of claims 1 to 10, wherein a part or all of the constituent members are made of a transparent member.

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