CN110575154B

CN110575154B - Stomach tube for monitoring chest pressure

Info

Publication number: CN110575154B
Application number: CN201910857740.XA
Authority: CN
Inventors: 杨兵厂; 龚妮; 唐四元; 秦春香; 焦晶晶; 杨明施; 胡桂
Original assignee: Central South University; Third Xiangya Hospital of Central South University
Current assignee: Central South University; Third Xiangya Hospital of Central South University
Priority date: 2019-09-11
Filing date: 2019-09-11
Publication date: 2022-03-18
Anticipated expiration: 2039-09-11
Also published as: CN110575154A

Abstract

A gastric tube for monitoring thoracic pressure, comprising a tube body, one end of the tube body is connected with a main joint; the tube body has a main cavity, a first sub-cavity, a second sub-cavity and a third sub-cavity independent of each other a sub-cavity, the main joint communicates with the main cavity, and the outer wall of the main joint is fixed with a first joint in communication with the first sub-cavity and a second joint in communication with the second sub-cavity; on the pipe body A first balloon and a second balloon are sheathed; a monitoring probe located between the second balloon and the main joint is arranged on the tube body; the monitoring probe includes a light emitting element and a photoelectric conversion element; and a light source , a gas injection joint, a pressure measuring element and a micro-processing unit, the micro-processing unit is electrically connected with the photoelectric conversion element, the light source, the display unit and the pressure measuring element respectively. The present invention indirectly realizes the monitoring of thoracic cavity pressure through monitoring of esophageal pressure, greatly reduces the difficulty of measuring thoracic cavity pressure, and the monitoring process is simple and easy, and can greatly reduce the cost of thoracic cavity pressure monitoring.

Description

Stomach tube for monitoring chest pressure

Technical Field

The invention relates to a stomach tube for monitoring thoracic cavity pressure, and belongs to the field of medical measurement or monitoring instruments.

Background

Whether breathing spontaneously or passively, gas entering the alveoli must simultaneously oppose the elastic recoil of the lung and chest wall. The thoracic cavity is between the chest wall and the lungs, and thoracic pressure (intrathoracic pressure) is an important monitoring parameter to distinguish the mechanical properties of the lungs from the chest wall. However, it is not easy to obtain directly clinically, therefore, esophageal pressure is often used as a substitute value for indirectly reflecting thoracic pressure, so as to distinguish the stress contribution of lung and chest wall in the respiratory process, such as lung and chest wall elasticity, inspiratory effort and respiratory work. Early esophageal pressure studies were mostly focused on spontaneous breathing. In recent years, it has been found that transpulmonary pressure based on esophageal pressure monitoring for patients with Acute Respiratory Distress Syndrome (ARDS), representing the stress to which the lungs are subjected during Mechanical Ventilation (MV), is one of the important factors responsible for ventilator-associated lung injury (VILI). Meanwhile, research shows that due to the inhomogeneous lesion of the lung of the ARDS patient, the cross-lung pressure is applied to guide individualized MV parameter setting, the outcome of the ARDS patient can be improved, a multi-center research is started in 2014 in North America at present, and the main observation index is whether the 28-day mortality of the ARDS patient can be reduced or not by monitoring and guiding lung ventilation through the cross-lung pressure compared with standard treatment, so that the prognosis of the patient is improved. Therefore, esophageal pressure monitoring has attracted extensive attention for clinical MV research. However, esophageal pressure monitoring has certain technical requirements, and the measurement result is influenced by various factors, such as the balloon volume, the position, the esophageal wall elasticity, the weight of mediastinal organs and the like of the esophageal pressure monitoring catheter, so that the monitoring technology is mainly used for basic research and is not clinically and routinely applied.

The transpulmonary pressure monitoring makes us step into an individual era for the treatment of ARDS, but the number of hospitals capable of transpulmonary pressure monitoring in China is only two at present, and the reasons for the two hospitals are as follows: the process of determining the position of the catheter is complex and inconvenient to operate and develop. At present, no corresponding catheter is produced in China, import (cooper) is completely relied on, and only part of high-end ventilators can detect the catheter.

Disclosure of Invention

Aiming at the defects of the prior art, the invention provides a stomach tube for monitoring thoracic cavity pressure so as to indirectly monitor the thoracic cavity pressure.

In order to solve the technical problems, the technical scheme of the invention is as follows:

a stomach tube for monitoring chest pressure comprises a tube body, wherein one end of the tube body is connected with a main joint; the pipe body is provided with a main cavity, a first sub cavity, a second sub cavity and a third sub cavity which are mutually independent, the main joint is communicated with the main cavity, a first joint communicated with the first sub cavity, a second joint communicated with the second sub cavity and a third joint communicated with the third sub cavity are fixed on the outer wall of the main joint, a first valve is installed on the first joint, and a second valve is installed on the second joint;

the tube body is sleeved with a first balloon communicated with the first sub cavity and a second balloon communicated with the second sub cavity, and the second balloon is positioned between the first balloon and the main joint;

a monitoring probe positioned between the second balloon and the main joint is arranged on the pipe body, and the distance between the monitoring probe and the second balloon is not more than 2 cm; the monitoring probe comprises a light emitting element for emitting a light signal and a photoelectric conversion element for receiving the light signal reflected by the esophagus and converting the light signal into an electric signal;

further comprising a light source for inputting a light signal to the light emitting element;

the gas injection joint is used for being connected with the first joint or the second joint and injecting gas or liquid into the corresponding sub-cavity;

the load cell is used for monitoring the pressure in the first sub-cavity or the second sub-cavity, and is arranged in the gas injection joint;

a display unit for displaying the monitoring data; and

and the micro-processing unit is electrically connected with the photoelectric conversion element, the light source, the display unit and the load cell respectively.

Further, the distance between the first balloon and the second balloon is 5-10 cm.

The light source and the micro-processing unit are integrated on the monitoring integrated interface, and an interface end of the monitoring integrated interface is electrically connected with the display unit.

Furthermore, the output end of the light source is connected with the light emitting element through a first optical fiber, and the first optical fiber sequentially passes through the third joint and the third sub cavity to reach the position of the light emitting element; the micro-processing unit is connected with the photoelectric conversion element through a first lead wire, and the first lead wire sequentially penetrates through the third joint and the third sub-cavity to reach the position of the photoelectric conversion element. Preferably, the light emitting element is a second optical fiber integrally connected with the first optical fiber.

Further, the tube body is made of a transparent material, and the monitoring probe is packaged in the wall of the tube body.

Furthermore, the included angle between the incidence direction of the light emitting element and the cross section of the tube body is 10-30 degrees, and 15-20 degrees is preferred.

Further, the photoelectric conversion element is a photodiode.

Further, the valve is a one-way valve that can only open into the sub-cavity. The one-way valve is arranged at the inlet end of the corresponding joint, and the gas injection joint can be in butt joint with the one-way valve and is communicated with the corresponding sub cavity. Optionally, the gas injection fitting is threadably connected to the check valve.

Optionally, the one-way valve is a multi-lumen gastric tube or a common one-way valve for three-lumen gastric tubes, such as the multi-lumen gastric tube described in patent CN 205759116U.

Optionally, the load cell is a conventional miniature pressure sensor, such as the miniature high-sensitivity pressure sensor of patent CN 103534568B.

Further, the distance between the first balloon and one end, far away from the main joint, of the pipe body is 10-20 cm.

Further, be equipped with a plurality of side openings with the main cavity body intercommunication on the body, a plurality of side openings are located the one side that the main joint was kept away from to first sacculus.

Optionally, the electronic device further comprises an input unit electrically connected with the micro-processing unit to input the relevant instruction, and the micro-processing unit receives the instruction and then sends the relevant action instruction to other components.

The micro-processing unit controls the light source to emit optical signals with certain wavelength and intensity, the optical signals are transmitted to the light emitting element to be emitted, and part of light is reflected and received by the photoelectric conversion element to be converted into electric signals; the electric signal is further transmitted to a micro-processing unit in real time for analysis and processing. When the light signal emitted by the light emitting element irradiates the inner wall of the esophagus (i.e. the surface of the mucosa of the esophagus), a part of light transmits through the mucosa tissue and is absorbed by hemoglobin and the like in blood in capillaries, the other part of light is reflected, the reflected light is received by the photoelectric conversion element to form an electric signal with certain intensity, and the intensity of the reflected light changes along with the change of blood flow in the capillaries. When the esophagus mucosa is pressed, the blood flow in the capillary vessel of the mucosa is reduced, the transmitted and absorbed light energy is reduced, and the intensity of the reflected light is increased, so that the pressure on the esophagus wall and the intensity of the reflected light have a positive correlation corresponding relation in a certain range.

Generally speaking, the smaller the distance between the monitoring probe and the second balloon is, the more accurate the corresponding relation between the reflected light intensity and the esophageal pressure or the thoracic cavity pressure is; and the normal use of the gastric tube is not influenced by the worry that the installation part of the monitoring probe is convex.

The thoracic cavity pressure monitoring device indirectly monitors the thoracic cavity pressure by monitoring the esophageal pressure, greatly reduces the measuring difficulty of the thoracic cavity pressure, has simple and easy monitoring process, and can greatly reduce the monitoring cost of the thoracic cavity pressure.

Drawings

Fig. 1 is a schematic view showing the structure of a gastric tube according to a first embodiment of the present invention.

Fig. 2 is a schematic diagram of the working principle of the monitoring probe according to the first embodiment of the invention.

FIG. 3 is a graph of the intensity of reflected light plotted against pressure for a first embodiment of the present invention.

Fig. 4 is a schematic view of the control of a gastric tube according to a first embodiment of the present invention.

Fig. 5 is a cross-sectional view of a section of a tubular body of the present invention between a primary connector and a second balloon.

Fig. 6 is a schematic cross-sectional view of a section of a further tubular body of the invention between a primary connector and a second balloon.

FIG. 7 is a diagram showing a state in which a second joint and a gas-injection structure of the present invention are to be connected.

FIG. 8 is a view showing a state where a second joint according to the present invention is in communication with a gas-injection structure.

Fig. 9 is a schematic view of a second check valve of the present invention.

Wherein, 1-a tube body, 2-a first balloon, 3-a second balloon, 4-a monitoring probe, 5-a side hole, 6-a first sub cavity, 7-a second sub cavity, 8-a main joint, 9-a first joint, 10-a first valve, 11-a second joint, 111-an external thread, 12-a second valve, 13-a third joint, 14-a first lead wire, 15-a monitoring integrated interface, 16-a second lead wire, 17-an air injection joint, 171-an internal thread, 172-a third one-way valve, 173-a hard ring, 174-a hard cylinder, 18-a pressure measuring element, 19-a third sub cavity, 20-a main cavity, 21-a microprocessing unit, 22-a light source, 23-a display unit and 24-an input unit, 25-esophageal wall, I₀Reflected light intensity, I₁Reflected light intensity, I₂-transmitted light intensity.

Detailed Description

The following description describes alternative embodiments of the invention to teach one of ordinary skill in the art how to make and use the invention. Some conventional aspects have been simplified or omitted for the purpose of teaching the present invention. Those skilled in the art will appreciate that variations or substitutions from these embodiments will fall within the scope of the invention.

As shown in fig. 1, a gastric tube for monitoring thoracic cavity pressure comprises a tube body 1, wherein one end of the tube body 1 is connected with a main joint 8; the pipe body 1 is provided with a main cavity 20, a first sub-cavity 6, a second sub-cavity 7 and a third sub-cavity 19 which are independent of each other, the main joint is communicated with the main cavity 20, a first joint 9 communicated with the first sub-cavity, a second joint 11 communicated with the second sub-cavity and a third joint 13 communicated with the third sub-cavity are fixed on the outer wall of the main joint 20, a first valve 10 is installed on the first joint 9, and a second valve 12 is installed on the second joint 11;

a first balloon 2 communicated with the first sub cavity and a second balloon 3 communicated with the second sub cavity are sleeved on the pipe body 1, and the second balloon 3 is positioned between the first balloon 2 and the main joint 8;

the monitoring probe 4 positioned between the second balloon 3 and the main joint 8 is arranged on the tube body, and the distance between the monitoring probe 4 and the second balloon 3 is not more than 0.1 cm; the monitoring probe comprises a light emitting element 401 for emitting a light signal and a photoelectric conversion element 402 for receiving the light signal reflected back by the esophagus and converting the light signal into an electrical signal;

a light source 22 for inputting a light signal to the light emitting element;

a gas injection joint 17 for connecting with the first joint or the second joint and injecting gas or liquid into the corresponding sub-cavity; the gas injection joint 17 is connected with the micro-processing unit 21 through a second lead wire 16;

a load cell 18 for monitoring the pressure level in the first or second sub-chamber, said load cell 17 being disposed within the gas injection fitting 17;

a display unit 23 for displaying the monitoring data; and

and a micro-processing unit 21, the micro-processing unit 21 being electrically connected to the photoelectric conversion element 402, the light source 22, the display unit 23, and the load cell 18, respectively. The micro-processing unit 21 may be a conventional PLC controller or CPU. The display unit 23 may be a conventional LED display screen or an LCD display screen.

The distance between the first balloon 2 and the second balloon 3 is 8 cm.

The monitoring system further comprises a monitoring integrated interface 15, the light source 22 and the micro-processing unit 21 are integrated on the monitoring integrated interface 15, and an interface end of the monitoring integrated interface 15 is electrically connected with the display unit 23. Optionally, as an alternative, the system further includes a monitoring integrated interface 15, the light source 22 is integrated on the monitoring integrated interface 15, and an interface end of the monitoring integrated interface 15 is electrically connected to the display unit 23 and the microprocessor unit.

The output end of the light source 22 is connected with the light emitting element 401 through a first optical fiber, and the first optical fiber sequentially passes through the third joint and the third sub cavity to reach the position of the light emitting element 401; the micro-processing unit 21 is connected to the photoelectric conversion element 402 through a first lead wire 14, and the first lead wire 14 sequentially passes through the third joint and the third sub-cavity to reach the position of the photoelectric conversion element 402. Preferably, the light emitting element 401 is a second optical fiber integrally connected with the first optical fiber.

The tube body 1 is made of transparent materials, and the monitoring probe 4 is packaged in the wall of the tube body.

The incident direction of the light emitting element 401 forms an angle theta of 30 degrees with the cross section of the tube 1.

The photoelectric conversion element 402 is a photodiode. The valve is a one-way valve which can only be opened towards the inside of the sub-cavity.

The distance between the first balloon 2 and one end of the tube body 1 far away from the main joint 8 is 15 cm.

Be equipped with 3 side openings 5 with main cavity 20 intercommunication on

body

1, 3 side openings 5 are located one side that main joint 8 was kept away from to first sacculus 2.

The electronic device further comprises an input unit 24 electrically connected with the micro-processing unit so as to input related instructions, and the micro-processing unit receives the instructions and then sends related action instructions to other components.

Referring to fig. 5, the pipe is a circular pipe, and the first sub-cavities, the second sub-cavities and the third sub-cavities are distributed in the wall of the pipe and are uniformly distributed along the circumferential direction. As an alternative, referring to fig. 6, the tubular body is a circular tube, and the inner cavity of the circular tube is divided into a main cavity with a relatively large cross-sectional area and a first sub-cavity, a second sub-cavity and a third sub-cavity with a relatively small cross-sectional area.

Referring to fig. 7 and 8, the gas injection joint 17 includes a hollow body with two open ends, the inlet section of the body is provided with a third one-way valve 172 which can be opened towards the outlet end of the body, the outlet end of the body is provided with an internal thread 171, a hard ring 173 perpendicular to the central axis of the body is arranged on the inner wall between the internal thread 171 and the third one-way valve 172, a hard cylinder 174 extending in a direction away from the third one-way valve 172 is arranged on the hard ring 173, optionally, a load cell is arranged on the inner wall of the body between the hard ring and the third one-way valve, optionally, the load cell is a pressure measuring valve integrally arranged with the gas injection joint 17, and the specific principle can refer to patent CN 201510415386.7. Correspondingly, the second connects the outer wall to be equipped with interior screw-thread fit's external screw thread 111, and when gas injection connects 17 and the second and connects the cooperation butt joint, a stereoplasm section of thick bamboo stretches into in the second connects to with the second check valve back-up, make the second connect and gas injection connect the intercommunication, the setting of screw thread can make both keep stable intercommunication state, the pressure size that load cell monitored this moment is second sacculus internal pressure size promptly. Further, referring to fig. 9, the second one-way valve is a one-way valve, which is uniformly circumferentially split, and the arc-shaped protrusion of the valve axially faces one end of the second joint close to the main joint. Accordingly, the first check valve and the third check valve may also adopt a similar structure.

When in use, the specific method is as follows:

(1) cannula positioning: the stomach tube is inserted into the stomach by about 50cm through the nasal cavity, 10ml-20ml of water or air is injected into the first balloon through the first one-way valve, and the stomach tube is pulled back slightly until obvious resistance is felt. The first balloon is now positioned at the cardia opening and the second balloon is positioned opposite the esophageal mid-section 1/3.

(2) Calibration: connect gas injection joint and second check valve well, the public head of gas injection joint backs up the diaphragm of second check valve this moment, is the intercommunication between second sub-cavity and the gas injection mouth. The patient is instructed to hold his breath at the end of expiration, and the medical staff slowly injects air into the second balloon through the female head of the air injection connector. The second balloon gradually pressurizes the esophageal wall and blood flow in the esophageal wall capillaries gradually decreases. The pressure measuring element in the gas injection joint transmits the pressure value to the micro-processing unit in real time, and the monitoring probe synchronously transmits the intensity of the reflected light to the micro-processing unit. The micro-processing unit collects the pressure P data and the corresponding reflected light intensity I₁The data were mathematically modeled and a working curve was plotted (as shown in figure 3).

(3) Monitoring: after the calibration is completed, the medical staff restores the air pressure of the second balloon to the initial state value, and the patient recovers to normal breathing at the moment. The microprocessing unit monitors the intensity of the reflected light (unit: candela, candela) transmitted by the probe, and calculates and analyzes the pressure applied to the esophageal wall, namely the intrathoracic pressure (unit: mmHg) by calling the working curve.

Therefore, after calibration is completed, the intrathoracic pressure of the patient can be monitored in real time.

The foregoing examples are set forth to illustrate the present invention more clearly and are not to be construed as limiting the scope of the invention, which is defined in the appended claims to which the invention pertains, as modified in all equivalent forms, by those skilled in the art after reading the present invention.

Claims

1. A gastric tube for monitoring pleural pressure, comprising a tube body (1), one end of the tube body (1) is connected with a main joint (8); it is characterized in that the tube body (1) has mutual An independent main cavity (20), a first sub-cavity (6), a second sub-cavity (7) and a third sub-cavity (19), the main joint communicates with the main cavity (20), so The outer wall of the main joint (20) is fixed with a first joint (9) in communication with the first sub-cavity, a second joint (11) in communication with the second sub-cavity, and a second joint (11) in communication with the third sub-cavity. Three joints (13), a first valve (10) is installed on the first joint (9), and a second valve (12) is installed on the second joint (11);

A first balloon (2) communicating with the first sub-cavity and a second balloon (3) communicating with the second sub-cavity are sleeved on the tube body (1), and the second balloon ( 3) between the first balloon (2) and the main joint (8);

The tube body is provided with a monitoring probe (4) located between the second balloon (3) and the main joint (8), and the distance between the monitoring probe (4) and the second balloon (3) does not exceed 2 cm ; the monitoring probe comprises a light emitting element (401) for emitting a light signal and a photoelectric conversion element (402) for receiving the light signal reflected back by the esophagus and converting the light signal into an electrical signal;

Also includes a light source (22) for inputting an optical signal to the light emitting element;

A gas injection joint (17) for connecting with the first joint or the second joint and injecting gas or liquid into the corresponding sub-cavity;

a load-measuring element (18) for monitoring the pressure in the first sub-cavity or the second sub-cavity, the load-measuring element (18) being arranged in the gas injection joint (17);

a display unit (23) for displaying monitoring data; and

a micro-processing unit (21), the micro-processing unit (21) is electrically connected to the photoelectric conversion element (402), the light source (22), the display unit (23) and the load-measuring element (18), respectively;

The method of using the gastric tube comprises the following steps:

(1) Intubation positioning: Insert the gastric tube into the stomach through the nasal cavity, inject 10ml-20ml of water or air into the first balloon through the first valve (10), and gently pull the gastric tube back until there is a clear sense of resistance. stop at the time of movement, so that the first balloon (2) is positioned at the cardia orifice, and the corresponding position of the second balloon (3) is positioned at the middle 1/3 of the esophagus;

(2) Calibration: The patient is instructed to hold his breath at the end of expiration, and the medical staff slowly injects air into the second balloon (3) through the female head of the insufflation connector (17); Pressurized, the blood flow in the capillaries of the esophageal wall is gradually reduced; the pressure measuring element (18) located in the gas injection joint transmits the pressure value to the microprocessor unit (21) in real time, and the monitoring probe (4) transmits the reflected light intensity synchronously to the micro-processing unit (21); the micro-processing unit (21) establishes a mathematical model between the collected pressure P data and the corresponding reflected light intensity I ₁ data, and draws a working curve;

(3) Monitoring: After the calibration is completed, the medical staff restores the air pressure of the second balloon (3) to the initial state value, and the patient has resumed normal breathing at this time;

The micro-processing unit (21) calculates and analyzes the pressure on the esophagus wall, that is, the thoracic cavity pressure, by calling the working curve of the reflected light intensity transmitted from the monitoring probe (4).

In this way, after the calibration is completed, real-time monitoring of the patient's thoracic pressure can be realized.

2 . The gastric tube according to claim 1 , wherein the distance between the first balloon ( 2 ) and the second balloon ( 3 ) is 5-10 cm. 3 .

3. The gastric tube according to claim 1, further comprising a monitoring integrated interface (15), the light source (22) and the microprocessing unit (21) are integrated on the monitoring integrated interface (15), the The interface end of the monitoring integrated interface (15) is electrically connected with the display unit (23).

4 . The gastric tube according to claim 3 , wherein the output end of the light source ( 22 ) and the light emitting element ( 401 ) are connected by a first optical fiber, and the first optical fiber passes through the third joint, The third sub-cavity reaches the position where the light emitting element (401) is located; the micro-processing unit (21) and the photoelectric conversion element (402) are connected through a first lead wire (14), and the first lead wire (14) ) pass through the third joint and the third sub-cavity in sequence to reach the position where the photoelectric conversion element (402) is located.

5 . The gastric tube according to claim 1 , wherein the tube body ( 1 ) is made of transparent material, and the monitoring probe ( 4 ) is packaged in the wall of the tube body. 6 .

The gastric tube according to any one of claims 1-5, characterized in that the angle (θ) between the incident direction of the light emitting element (401) and the cross section of the tube body (1) is 10-30 °.

7. The gastric tube according to any one of claims 1-5, wherein the photoelectric conversion element (402) is a photodiode.

8 . The gastric tube according to claim 1 , wherein the valve is a one-way valve that can only be opened into the sub-cavity. 9 .

9 . The gastric tube according to claim 1 , wherein the distance between the first balloon ( 2 ) and the end of the tube body ( 1 ) far away from the main joint ( 8 ) is 10-20 cm. 10 . .

10. The gastric tube according to any one of claims 1-5, characterized in that, the tube body (1) is provided with a plurality of side holes (5) communicating with the main cavity (20), and the plurality of side holes (5) communicate with the main cavity (20). The side hole (5) is located on the side of the first balloon (2) away from the main joint (8).