JP2013176466A - Mask for non-invasive positive-pressure ventilation coping with endoscope - Google Patents

Mask for non-invasive positive-pressure ventilation coping with endoscope Download PDF

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JP2013176466A
JP2013176466A JP2012042291A JP2012042291A JP2013176466A JP 2013176466 A JP2013176466 A JP 2013176466A JP 2012042291 A JP2012042291 A JP 2012042291A JP 2012042291 A JP2012042291 A JP 2012042291A JP 2013176466 A JP2013176466 A JP 2013176466A
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endoscope
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nppv
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Saori Miyagawa
沙織 宮川
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Kitasato Institute
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Abstract

PROBLEM TO BE SOLVED: To provide a mask for non-invasive positive-pressure ventilation (NPPV) coping with an endoscope, which allows execution of a surgery while assisting respiration safely without giving pains, as a method of forming a gastrostoma in a patient with advanced respiratory muscle weakness while confirming an operating position with an endoscope.SOLUTION: An NPPV mask coping with an endoscope includes a connection port for an inhalation/exhalation tube of an artificial respirator and an endoscope insertion port, and airtightly covers a nose and a mouth part. An endoscope and its cable inserted from the endoscope insertion port to the stomach smoothly pass through the insertion port when inserting them, and when the endoscope reaches the stomach, airtightness of the endoscope cable and the endoscope insertion port is maintained.

Description

本発明は、胃瘻造設術施工時に使用する内視鏡対応非侵襲的陽圧換気用マスクに関する。さらに詳しく言えば、咽頭筋（呼吸筋）の筋力低下により食事を経口摂取することが不可能な患者に、呼吸補助を行いながら、内視鏡にて術位を確認しながら栄養状態を維持するための胃瘻造設術を実施する際に用いる内視鏡対応非侵襲的陽圧換気用マスクに関する。   The present invention relates to an endoscope-compatible non-invasive positive pressure ventilation mask used at the time of gastrostomy construction. More specifically, maintain nutritional status while confirming the surgical position with an endoscope while providing respiratory assistance to patients who are unable to take food orally due to weakness of the pharyngeal muscles (respiratory muscles). The present invention relates to an endoscopic-compatible noninvasive positive pressure ventilation mask used when performing gastrostomy for the purpose.

運動ニューロン病のように、進行性の全身筋萎縮を呈する患者は、咽頭筋の筋力低下により次第に食事を経口で摂取することが不可能となる。栄養状態を維持する目的で、胃瘻を造設することがあるが、その際には経内視鏡的経皮的に胃瘻が造設される。内視鏡的に手術を行う際、内視鏡操作そのものや、手術に伴う痛みの緩和目的で鎮静処置を行うが、使用する鎮静剤は、鎮静作用と共に薬物により強弱はあるものの筋弛緩作用をも有している。そのため、呼吸筋筋力低下を呈する患者に鎮静剤を使用すると呼吸抑制が生じる。苦痛、疼痛緩和を行うためには十分量の鎮静剤を使用する必要があるが、そのための鎮静剤を十分に使用することが難しく、また患者によってはごく少量の鎮静剤を使用しても呼吸状態が悪化し、胃瘻造設を中止せざるを得ないこともあった。   Patients with progressive generalized muscle atrophy, such as motor neuron disease, gradually become unable to take food orally due to weakness of the pharyngeal muscles. A gastrostoma may be constructed for the purpose of maintaining a nutritional state. In this case, the gastrostomy is constructed transendoscopically percutaneously. When performing surgery endoscopically, sedation is performed for the purpose of endoscopic operation itself and for pain relief associated with surgery. Also have. Therefore, respiratory suppression occurs when a sedative is used in patients who exhibit respiratory muscle weakness. It is necessary to use a sufficient amount of sedative to relieve pain and pain, but it is difficult to use a sufficient amount of sedative, and depending on the patient, even if a very small amount of sedative is used, breathing The condition worsened, and gastrostomy had to be stopped.

これまで、呼吸筋筋力低下の進行した患者における内視鏡による観察下での胃瘻造設方法（内視鏡造設法と略記する。）としては、(1)鼻のみを覆うマスク（鼻マスク）により内視鏡を施行する方法、(2)経静脈的鎮静薬は使用せず、皮下への局所麻酔薬のみ使用する内視鏡造設法などが行われることがあった。
(1)の鼻マスクでは口から空気が漏れ、十分な換気が行えるとは言い難く、また(2)の皮下への局所麻酔薬の使用では痛みの緩和が不十分となるなどの問題点が生じていた。
さらに、放射線を使用した胃瘻造設(radiologically-guided gastrostomy)の報告があるが、穿刺部位が限られることやチューブが抜けやすいなどの欠点があり、また通常の施設で行うことができる方法ではない（European Journal of Neurology 2012, 19: 360-375；非特許文献１）。 Up to now, gastrostomy construction method (abbreviated as endoscopic construction method) under observation with endoscope in patients with advanced respiratory muscle weakness, (1) Mask that covers only nose (nasal mask) In some cases, an endoscopic method is used, and (2) an endoscopic construction method that uses only a local anesthetic under the skin without using a intravenous sedation.
It is difficult to say that the nasal mask of (1) leaks air from the mouth and allows sufficient ventilation, and the use of local anesthetics under the skin of (2) causes insufficient pain relief. It was happening.
Furthermore, there are reports of gastrostomy (radiologically-guided gastrostomy) using radiation, but there are drawbacks such as limited puncture sites and easy tube removal, and it is not a method that can be performed in normal facilities (European Journal of Neurology 2012, 19: 360-375; Non-Patent Document 1).

European Journal of Neurology 2012, 19: 360-375European Journal of Neurology 2012, 19: 360-375

本発明の課題は、呼吸筋筋力低下の進行した患者に内視鏡にて術位を確認しながら胃瘻を造設する方法として、より安全で苦痛を感じさせず、呼吸補助を行いながら手術を行う方法を実施するための内視鏡対応非侵襲的陽圧換気療法用（noninvasive positive pressure ventilation）マスク（以下、内視鏡対応ＮＰＰＶマスクと略記することがある。）を提供することにある。   The object of the present invention is to construct a gastrostoma while confirming the surgical position with an endoscope for a patient who has progressed in reducing respiratory muscle strength, making it safer and less painful and performing surgery while providing respiratory assistance It is an object of the present invention to provide an endoscopic-compatible noninvasive positive pressure ventilation mask (hereinafter sometimes abbreviated as an endoscopic-compatible NPPV mask) for carrying out the method of performing the above. .

呼吸筋筋力低下が進行した患者に対し、人工呼吸療法として行われる非侵襲的陽圧換気療法（noninvasive positive pressure ventilation；ＮＰＰＶ)は、可能な限り密閉できるように作成されたマスクを鼻、口を覆うように顔に被せ、呼吸補助器（呼吸器）から陽圧空気を送り込むことにより患者の呼吸補助を行う方法であるが、本発明者は、この呼吸補助器を使用しながら内視鏡にて術位を確認しながら栄養状態を維持するための胃瘻造設術ができれば、術中に呼吸抑制が予期される患者においても有効ではないかと考えて鋭意検討した。
現行のＮＰＰＶマスクは、空気を送り込むチューブを接続する穴（呼吸器接続口）が設けられているのみであり、内視鏡には対応できない。そこで、シリコンやプラスチック製のＮＰＰＶ用マスクに内視鏡用の穴（内視鏡の挿入口）を別に開け、内視鏡及びそのケーブルの挿入・操作時にできる限り陽圧空気が漏れないような工夫を行い本発明を完成した。
すなわち、本発明は以下の内視鏡対応ＮＰＰＶマスクを提供する。 Non-invasive positive pressure ventilation (NPPV), which is used as an artificial respiration therapy for patients who have developed respiratory muscle weakness, has a mask made so that it can be sealed as much as possible. It is a method of covering a face so as to cover and breathing assistance of a patient by sending positive pressure air from a respiratory assistance device (respiratory device), but the present inventor is using an endoscope while using this respiratory assistance device. Therefore, if gastrostomy for maintaining nutritional status was confirmed while confirming the surgical position, it was considered that it would be effective even in patients expected to have respiratory depression during the operation.
The current NPPV mask is only provided with a hole (respirator connection port) for connecting a tube through which air is fed, and is not compatible with an endoscope. Therefore, a hole for endoscope (endoscope insertion port) is opened separately in an NPPV mask made of silicon or plastic so that positive pressure air does not leak as much as possible when inserting and operating the endoscope and its cable. The present invention was completed by devising.
That is, the present invention provides the following endoscope-compatible NPPV mask.

１．人工呼吸器の吸呼気用チューブ接続口と内視鏡挿入口とを備え、鼻及び口部を気密的に覆う内視鏡対応非侵襲的陽圧換気用（ＮＰＰＶ）マスク。
２．鼻先近傍、鼻骨部近傍、両頬部及び口の周囲を気密的に覆う前項１に記載の内視鏡対応ＮＰＰＶマスク。
３．塩化ビニール樹脂、スチロール樹脂、メタクリル樹脂、ポリカーボネート及びポリスルホンから選択される硬質プラスチックからなる本体部と前記本体の裾部に接合され患者の顔面に密着して隙間を生じない軟質塩化ビニール樹脂、低密度ポリエチレン及びシリコーンゴムから選択される材料とからなる前項１または２に記載の内視鏡対応ＮＰＰＶマスク。
４．内視鏡挿入口から胃部に挿入される内視鏡及びそのケーブルが、その挿入時には円滑に挿入口を通り、内視鏡が胃部に達したときには内視鏡ケーブルと内視鏡挿入口との気密性が保持される（内部が陽圧状態に維持される）前項１〜３のいずれかに記載の内視鏡対応ＮＰＰＶマスク。
５．前記人工呼吸器の内視鏡挿入口部が伸縮性の材料で構成され、内視鏡及びそのケーブルの円滑な挿入と、内視鏡が胃部に達したとき内視鏡ケーブルと内視鏡挿入口との気密性が確保される前項４に記載の内視鏡対応ＮＰＰＶマスク。
６．前記伸縮性の材料がゴムであり、前記ゴム材料に内視鏡及びそのケーブルが通る内視鏡及びそのケーブルの外径よりも小さい径の孔を設けて、内視鏡及びそのケーブルとマスクとの気密性を保持する前項５に記載の内視鏡対応ＮＰＰＶマスク。
７．前記伸縮性の材料がゴムであり、前記ゴム材料に内視鏡及びそのケーブルが通る切れ目を入れて、内視鏡及びそのケーブルとマスクとの気密性を保持する前項５に記載の内視鏡対応ＮＰＰＶマスク。
８．人工呼吸器の吸呼気用チューブ接続口と内視鏡挿入口が別個に設けられている前項１〜７のいずれかに記載の内視鏡対応ＮＰＰＶマスク。
９．把持部材によりマスクを固定して、患者の顔面とマスクを気密に保持する前項１〜７のいずれかに記載の内視鏡対応ＮＰＰＶマスク。
１０．把持部材がマスクを顔面に固定するベルトである前項９に記載の内視鏡対応ＮＰＰＶマスク。
１１．把持部材がマスクに取り付けたストラップである前項９に記載の内視鏡対応ＮＰＰＶマスク。 1. An endoscopic-compatible non-invasive positive pressure ventilation (NPPV) mask that includes a breathing tube connection port of an artificial respirator and an endoscope insertion port and covers the nose and mouth in an airtight manner.
2. 2. The endoscope-compatible NPPV mask according to item 1 above, which airtightly covers the vicinity of the nose tip, the vicinity of the nasal bone, both cheeks and the mouth.
3. A soft vinyl chloride resin that is bonded to the body of the hard plastic selected from vinyl chloride resin, styrene resin, methacrylic resin, polycarbonate, and polysulfone and the hem of the main body, and does not create a gap, and has a low density. 3. The endoscope-compatible NPPV mask according to item 1 or 2, comprising a material selected from polyethylene and silicone rubber.
4). The endoscope inserted into the stomach from the endoscope insertion port and its cable pass smoothly through the insertion port when inserted, and when the endoscope reaches the stomach, the endoscope cable and the endoscope insertion port The endoscope-compatible NPPV mask according to any one of the preceding items 1 to 3, wherein airtightness is maintained (the interior is maintained at a positive pressure state).
5. The endoscope insertion port of the ventilator is made of a stretchable material, and the endoscope and its cable can be inserted smoothly, and when the endoscope reaches the stomach, the endoscope cable and the endoscope. The endoscope-compatible NPPV mask according to item 4, wherein airtightness with the insertion port is ensured.
6). The stretchable material is rubber, the endoscope through which the endoscope and its cable pass, and a hole having a diameter smaller than the outer diameter of the cable, the endoscope, its cable and mask, 6. The endoscope-compatible NPPV mask according to 5 above, which maintains the airtightness of the endoscope.
7). The endoscope according to item 5 above, wherein the stretchable material is rubber, and a cut is made through the endoscope and the cable through the rubber material to maintain airtightness between the endoscope and the cable and the mask. Compatible NPPV mask.
8). 8. The endoscope-compatible NPPV mask according to any one of the preceding items 1 to 7, wherein a breathing tube connection port and an endoscope insertion port of the ventilator are separately provided.
9. 8. The endoscope-compatible NPPV mask according to any one of the preceding items 1 to 7, wherein the mask is fixed by a gripping member and the patient's face and the mask are kept airtight.
10. 10. The endoscope-compatible NPPV mask according to 9 above, wherein the gripping member is a belt that fixes the mask to the face.
11. The endoscope-compatible NPPV mask according to item 9, wherein the gripping member is a strap attached to the mask.

人工呼吸器の吸呼気用チューブ接続口と内視鏡挿入口とを備え、鼻と口部を気密的に覆う本発明の内視鏡対応非侵襲的陽圧換気用（ＮＰＰＶ）マスクを使用することによって、呼吸筋麻痺の進行した筋萎縮性側索硬化症患者に、安全に経皮的経内視鏡的に胃瘻造設を実施することができる。   Use the endoscope-compatible noninvasive positive pressure ventilation (NPPV) mask of the present invention, which has an inhalation tube connection port and an endoscope insertion port of a ventilator and covers the nose and the mouth in an airtight manner Accordingly, it is possible to safely perform percutaneous transendoscopic gastrostomy for a patient with amyotrophic lateral sclerosis in which respiratory muscle paralysis has progressed.

本発明の内視鏡対応ＮＰＰＶマスクの一例の斜視図である。It is a perspective view of an example of the NPPV mask for endoscopes of the present invention. ＮＰＰＶマスクの斜視図である。It is a perspective view of an NPPV mask.

以下添付図面を参照して、本発明の内視鏡対応ＮＰＰＶマスクについて説明する。
本発明の内視鏡対応ＮＰＰＶマスクは、これまで呼吸筋筋力が低下した患者に非侵襲的陽圧換気療法（ＮＰＰＶ）を実施するために使用されている呼吸補助器接続口のみを有するマスクに、胃瘻造設術実行時に胃内部を観察する内視鏡及びそのケーブルを、陽圧状態を保持しながら挿入・操作する孔（内視鏡挿入口）を設けたことを特徴とする。 Hereinafter, an endoscope-compatible NPPV mask of the present invention will be described with reference to the accompanying drawings.
The endoscopic-compatible NPPV mask of the present invention is a mask having only a respiratory assistance port that has been used to perform non-invasive positive pressure ventilation therapy (NPPV) in patients whose respiratory muscle strength has been reduced so far. The endoscope is characterized in that it has a hole (endoscope insertion port) through which an endoscope for observing the inside of the stomach when performing gastrostomy and its cable are inserted and operated while maintaining a positive pressure state.

図２は、正面に呼吸補助器接続口を有し、両側面（５ａ，５ｂ）と頂部(６)にマスクを顔面に固定する把持部材のベルト（７）を取り付けた既製のＮＰＰＶマスク例の斜視図である。   FIG. 2 shows an example of an off-the-shelf NPPV mask that has a breathing assist device connection port on the front surface, and is attached to both sides (5a, 5b) and the top (6) with a gripping member belt (7) that fixes the mask to the face. It is a perspective view.

図１は、患者の鼻先近傍、鼻骨部近傍、両頬部及び口の周囲を気密的に覆う断面が略ドーム状に形成され、人工呼吸器の吸呼気用チューブ接続口（１）と内視鏡挿入口（２）とを備えた、本発明による内視鏡対応非侵襲的陽圧換気用（ＮＰＰＶ）マスクの一例の斜視図である。   FIG. 1 shows the cross section of the patient's nose tip, nasal bone region, both cheeks, and the mouth, which is hermetically covered in a dome shape, and is connected to the breathing tube connection port (1) of the ventilator and the endoscope. 1 is a perspective view of an example of an endoscope-compatible non-invasive positive pressure ventilation (NPPV) mask according to the present invention having a mirror insertion opening (2). FIG.

本例では、図２の患者の鼻及び口の位置にあるＮＰＰＶマスクの正面の空気挿入口を内視鏡及びそのケーブル挿入口として使用し、人工呼吸器の吸呼気用チューブ接続口をマスクの側部に別途設けている。   In this example, the air inlet in front of the NPPV mask at the patient's nose and mouth in FIG. 2 is used as the endoscope and its cable inlet, and the breathing tube connection port of the ventilator is used as the mask. Separately provided on the side.

マスクの材料は、顔面に固定するときに接触面で患者に刺激（痛み）を与えず、気密性が保たれ、かつ人工呼吸器の吸呼気用チューブを接続する穴を開ける際に加工し易いものであればよく、非侵襲的陽圧換気療法用のマスクと同じ材料を用いることができる。   Mask material does not cause irritation (pain) to the patient at the contact surface when fixed to the face, is kept airtight, and is easy to process when drilling holes to connect the breathing tube of the ventilator Any material can be used, and the same material as the mask for noninvasive positive pressure ventilation therapy can be used.

このような材料として、例えば、塩化ビニール樹脂、スチロール樹脂、メタクリル樹脂、ポリカーボネート、ポリスルホン等の透明な硬質プラスチックから選択される外形が卵形の本体部と、本体の裾部に接合され患者の顔面に密着して隙間を生じない軟質塩化ビニール樹脂、低密度ポリエチレン、シリコーンゴム等とからなるものが挙げられる。   As such a material, for example, an outer shape selected from transparent hard plastics such as vinyl chloride resin, styrene resin, methacrylic resin, polycarbonate, polysulfone, etc. is joined to the oval main body and the hem of the main body and the patient's face And those made of soft vinyl chloride resin, low-density polyethylene, silicone rubber, etc. that are in close contact with each other and do not generate gaps.

内視鏡挿入口から胃に挿入される内視鏡及びそのケーブルは、空気が漏れることなく円滑に挿入でき、かつ挿入時及び内視鏡で胃を観察する操作時において内視鏡ケーブルと内視鏡挿入口との気密性が保持される必要がある。本発明者らは図１に示すような、ＮＰＰＶマスクの空気挿入口であった箇所にゴム製の指袋（３）を嵌め、ゴム輪(４)で嵌め込み部を締め付けた（補強した）後、指袋の先端部に小さい穴(図示せず。)を開けてそこから内視鏡及びそのケーブルを挿入することにより、後述の実施例に示すごとく胃瘻造設術を成功裏に行うことが出来た。気密性を保つ他の方法としては、例えば、ＮＰＰＶマスク正面の空気挿入口に肉厚のゴム材料を嵌め込み、前記ゴム材料に内視鏡及びそのケーブルが通る切れ目を入れるか、あるいは前記ゴム材料に内視鏡及びそのケーブルの外径よりも小さい径の孔を設ける方法も挙げられる。   The endoscope and its cable inserted into the stomach through the endoscope insertion port can be smoothly inserted without air leakage, and the endoscope cable and the internal cable can be inserted during the insertion and the operation of observing the stomach with the endoscope. The airtightness with the endoscope insertion port needs to be maintained. As shown in FIG. 1, the present inventors fitted a rubber finger bag (3) in a place that was an air insertion port of an NPPV mask, and tightened (reinforced) the fitting portion with a rubber ring (4). By opening a small hole (not shown) in the tip of the finger bag and inserting the endoscope and its cable from there, the gastrostomy can be successfully performed as shown in the examples described later. It was. As another method of maintaining the airtightness, for example, a thick rubber material is fitted into the air insertion port in front of the NPPV mask, and a cut is made through the endoscope and its cable, or the rubber material is cut into the rubber material. A method of providing a hole having a diameter smaller than the outer diameter of the endoscope and its cable is also mentioned.

患者に対する内視鏡による観察下での胃瘻造設は大旨以下のように行われる。
本発明の内視鏡対応ＮＰＰＶマスクの吸呼気用チューブ接続口に、人工呼吸器に連結し、患者の顔面の所定の位置（鼻及び口）を覆うようにマスクを被せ、気密性が保持されるように把持部材により患者の頭部で固定する。内視鏡及びそのケーブルをＮＰＰＶマスク正面の挿入口に嵌装したゴム部材の孔に差し込み患者の胃まで内視鏡を挿入し、内視鏡で観察しながら胃瘻造設を実施する。実施例に記載の通り、呼吸筋麻痺の進行した筋萎縮性側索硬化症（Amyotrophic Lateral; ＡＬＳ）の２７名の患者に、本発明のマスクを使用し経皮的経内視鏡的胃瘻造設を行ったが、一例を除き、安全に処置を行うことができ、また鎮静作用も十分に得ることが確認できた。 The gastrostomy for the patient under observation with an endoscope is performed as follows.
The breathing tube connection port of the endoscope-compatible NPPV mask of the present invention is connected to a ventilator and covered with a mask so as to cover a predetermined position (nose and mouth) of the patient's face, thereby maintaining airtightness. The patient's head is fixed by a gripping member. The endoscope and its cable are inserted into a hole in a rubber member fitted in the insertion port in front of the NPPV mask, the endoscope is inserted into the patient's stomach, and gastrostomy is performed while observing with the endoscope. As described in the Examples, 27 patients with Amyotrophic Lateral (ALS) with advanced respiratory muscle paralysis were used for percutaneous transendoscopic gastrostomy using the mask of the present invention. However, with the exception of one example, it was confirmed that treatment could be performed safely and that a sufficient sedative effect was obtained.

筋萎縮性側索硬化症（Amyotrophic Lateral; ＡＬＳと略記）治療ガイドラインでは、％肺活量（％ＶＣ）が５０％以下になる前に胃瘻を造設することが推奨され、胃瘻造設の危険性は％ＶＣが３０〜５０％では中等度、３０％以下では高度とされている。
そこで、本発明のマスクを使用し、ＡＬＳ患者に胃瘻造設を行う時期の呼吸機能、及びＡＬＳの呼吸機能低下患者にＮＰＰＶ併用下で胃瘻造設を実施することを試みた。
ＮＰＰＶマスクの空気挿入口にゴム製の指袋を嵌め、ゴム輪で嵌め込み部を補強し、指袋の先端に小さい穴を開けてそこから内視鏡及びそのケーブルを挿入する内視鏡対応のマスクを作成し、このマスクを胃瘻造設の危険性が中等度（％ＶＣ３０〜５０％）以下の患者の胃瘻造設時に使用した。胃瘻造設はＡＬＳ患者は３７例（男性１４例、女性２３例、年齢：５７．９±１３．５才）に実施した。 The Amyotrophic Lateral (ALS) treatment guidelines recommend that gastrostomy be established before the% vital capacity (% VC) falls below 50%, and the risk of gastrostomy Is considered moderate when% VC is 30-50% and high when 30% or less.
Therefore, using the mask of the present invention, an attempt was made to perform gastrostomy with NPPV in combination with respiratory function at the time of gastrostomy for ALS patients and patients with reduced respiratory function of ALS.
Fit the rubber finger bag into the air insertion port of the NPPV mask, reinforce the fitting part with a rubber ring, make a small hole at the tip of the finger bag, and insert the endoscope and its cable from there A mask was prepared and used at the time of gastrostomy for patients with moderate risk of gastrostomy (% VC 30-50%) or less. Gastrostomy was performed in 37 ALS patients (14 males, 23 females, age: 57.9 ± 13.5 years).

各患者について術前呼吸機能の測定（換気機能検査、血液ガス検査、鼻腔吸気圧（ＳＮＩＰ）、自覚症状、夜間ＳｐＯ2（経皮的動脈血酸素飽和度）モニター）を実施し、術中の安全性と疼痛管理（血圧・脈拍・ＳｐＯ2、自他覚症状、意識状態の確認）を行った。
３７例のうち、％ＶＣに関しては、％ＶＣ＞５０％１１例、３０％＜％ＶＣ＜５０％１３例、％ＶＣ＜３０％４例であった（測定不能２例、データなし７例）。ＰａＣＯ2（炭酸ガス分圧、正常値は３５〜４５ｍｍＨｇ）についてはＰａＣＯ2＜４５ｍｍＨｇ ２２例、４５ｍｍＨｇ＜ＰａＣＯ2＜５０ｍｍＨｇ ９例、ＰａＣＯ2＞５０ｍｍＨｇ ６例であり、本来胃瘻造設が可能なガイドライン上の基準である％ＶＣ ５０％以上を満たした症例は全体の３７％、ＰａＣＯ2 ４５ｍｍＨｇ以下は全体の５９％であり、両者を満たしたＮＰＰＶ不要患者は３７例中９例であり、ＮＰＰＶを併用する基準を満たした症例は２７例であった。このうち術前にＮＰＰＶを使用したのは１６例、胃瘻造設時だけＮＰＰＶを使用したのが１１例であった。このうち、前者８例、後者４例が術中ＳｐＯ2低下(＜８８％)をきたしたが、ずれも酸素投与及びＩＰＡＰ（inspiratory positive airway pressure）の調整により安全に対応できた。 Measurement of preoperative respiratory function (ventilatory function test, blood gas test, nasal inspiratory pressure (SNIP), subjective symptoms, night SpO 2 (percutaneous arterial oxygen saturation) monitor) for each patient, and intraoperative safety And pain management (confirmation of blood pressure / pulse / SpO 2 , subjective symptoms and consciousness).
Among 37 cases,% VC> 50% 11 cases, 30% <% VC <50% 13 cases,% VC <30% 4 cases (2 cases incapable of measurement, 7 cases without data) . For PaCO 2 (carbon dioxide partial pressure, normal value is 35 to 45 mmHg), PaCO 2 <45 mmHg 22 cases, 45 mmHg <PaCO 2 <50 mmHg 9 cases, PaCO 2 > 50 mmHg 6 cases, and guidelines for gastrostomy 37% of the cases satisfying 50% or more of the above standard% VC, and 59% of the total of PaCO 2 45 mmHg or less, and 9 out of 37 NPPV-free patients satisfying both were NPPV. There were 27 cases that met the criteria for combined use. Of these, 16 patients used NPPV prior to surgery, and 11 patients used NPPV only during gastrostomy. Among them, the former 8 cases and the latter 4 cases had a decrease in SpO 2 during operation (<88%), but the deviation could be handled safely by adjusting oxygen administration and IPAP (inspiratory positive airway pressure).

以上の通り、前処置で誤嚥をきたした1例を除き、％ＶＣ３０％以下の４例を含む全例で、本発明のマスクを用いることにより漏れがなく有効な換気を得られ、十分な鎮静をかけながら疼痛なく安全に胃瘻造設を施行することができた。   As described above, except for one case that caused aspiration in the pretreatment, in all cases including 4 cases of% VC30% or less, effective ventilation without leakage was obtained by using the mask of the present invention. We were able to safely perform gastrostomy without pain while applying sedation.

１ 吸呼気用チューブ接続口
２ 内視鏡挿入口
３ ゴム製の指袋
４ ゴム輪
５ａ，５ｂ マスク側面
６ マスク頂部
７ ベルト DESCRIPTION OF SYMBOLS 1 Tube connection port for exhalation 2 Endoscope insertion port 3 Rubber finger bag 4 Rubber ring 5a, 5b Mask side surface 6 Mask top 7 Belt

Claims (11)

人工呼吸器の吸呼気用チューブ接続口と内視鏡挿入口とを備え、鼻及び口部を気密的に覆う内視鏡対応非侵襲的陽圧換気用（ＮＰＰＶ）マスク。   An endoscopic-compatible non-invasive positive pressure ventilation (NPPV) mask that includes a breathing tube connection port of an artificial respirator and an endoscope insertion port and covers the nose and mouth in an airtight manner. 鼻先近傍、鼻骨部近傍、両頬部及び口の周囲を気密的に覆う請求項１に記載の内視鏡対応ＮＰＰＶマスク。   The endoscope-compatible NPPV mask according to claim 1, wherein the vicinity of the nose tip, the vicinity of the nasal bone portion, both cheeks, and the mouth are hermetically covered. 塩化ビニール樹脂、スチロール樹脂、メタクリル樹脂、ポリカーボネート及びポリスルホンから選択される硬質プラスチックからなる本体部と前記本体の裾部に接合され患者の顔面に密着して隙間を生じない軟質塩化ビニール樹脂、低密度ポリエチレン及びシリコーンゴムから選択される材料とからなる請求項１または２に記載の内視鏡対応ＮＰＰＶマスク。   Soft vinyl chloride resin, low density that adheres to the patient's face and does not create gaps between the main body made of hard plastic selected from vinyl chloride resin, styrene resin, methacrylic resin, polycarbonate and polysulfone and the hem of the main body The NPPV mask for endoscope according to claim 1 or 2, comprising a material selected from polyethylene and silicone rubber. 内視鏡挿入口から胃部に挿入される内視鏡及びそのケーブルが、その挿入時には円滑に挿入口を通り、内視鏡が胃部に達したときには内視鏡ケーブルと内視鏡挿入口との気密性が保持される（内部が陽圧状態に維持される）請求項１〜３のいずれかに記載の内視鏡対応ＮＰＰＶマスク。   The endoscope inserted into the stomach from the endoscope insertion port and its cable pass smoothly through the insertion port when inserted, and when the endoscope reaches the stomach, the endoscope cable and the endoscope insertion port The endoscope-compatible NPPV mask according to claim 1, wherein the airtightness of the endoscope is maintained (the inside is maintained in a positive pressure state). 前記人工呼吸器の内視鏡挿入口部が伸縮性の材料で構成され、内視鏡及びそのケーブルの円滑な挿入と、内視鏡が胃部に達したとき内視鏡ケーブルと内視鏡挿入口との気密性が確保される請求項４に記載の内視鏡対応ＮＰＰＶマスク。   The endoscope insertion port of the ventilator is made of a stretchable material, and the endoscope and its cable can be inserted smoothly, and when the endoscope reaches the stomach, the endoscope cable and the endoscope. The endoscope-compatible NPPV mask according to claim 4, wherein airtightness with the insertion port is ensured. 前記伸縮性の材料がゴムであり、前記ゴム材料に内視鏡及びそのケーブルが通る内視鏡及びそのケーブルの外径よりも小さい径の孔を設けて、内視鏡及びそのケーブルとマスクとの気密性を保持する請求項５に記載の内視鏡対応ＮＰＰＶマスク。   The stretchable material is rubber, the endoscope through which the endoscope and its cable pass, and a hole having a diameter smaller than the outer diameter of the cable, the endoscope, its cable and mask, The endoscope compatible NPPV mask according to claim 5, wherein the airtightness of the endoscope is maintained. 前記伸縮性の材料がゴムであり、前記ゴム材料に内視鏡及びそのケーブルが通る切れ目を入れて、内視鏡及びそのケーブルとマスクとの気密性を保持する請求項５に記載の内視鏡対応ＮＰＰＶマスク。   The endoscope according to claim 5, wherein the stretchable material is rubber, and a cut is made through the rubber material to pass the endoscope and the cable thereof to maintain airtightness between the endoscope and the cable and the mask. NPPV mask for mirror. 人工呼吸器の吸呼気用チューブ接続口と内視鏡挿入口が別個に設けられている請求項１〜７のいずれかに記載の内視鏡対応ＮＰＰＶマスク。   The NPPV mask for endoscope according to any one of claims 1 to 7, wherein a tube connection port for exhalation of an artificial respirator and an endoscope insertion port are separately provided. 把持部材によりマスクを固定して、患者の顔面とマスクを気密に保持する請求項１〜８のいずれかに記載の内視鏡対応ＮＰＰＶマスク。   The NPPV mask for endoscope according to any one of claims 1 to 8, wherein the mask is fixed by a gripping member to hold the patient's face and the mask in an airtight manner. 把持部材がマスクを顔面に固定するベルトである請求項９に記載の内視鏡対応ＮＰＰＶマスク。   The endoscope compatible NPPV mask according to claim 9, wherein the gripping member is a belt for fixing the mask to the face. 把持部材がマスクに取り付けたストラップである請求項９に記載の内視鏡対応ＮＰＰＶマスク。   The endoscope compatible NPPV mask according to claim 9, wherein the gripping member is a strap attached to the mask.
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JP7121028B2 (en) 2016-11-07 2022-08-17 シンプリシティ、エアウェイ、インコーポレイテッド Positive pressure ventilation oral care module

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