CN104383618B - Hemodialysis filter allowing simultaneous front and back liquid supplementing - Google Patents
Hemodialysis filter allowing simultaneous front and back liquid supplementing Download PDFInfo
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- CN104383618B CN104383618B CN201410729502.8A CN201410729502A CN104383618B CN 104383618 B CN104383618 B CN 104383618B CN 201410729502 A CN201410729502 A CN 201410729502A CN 104383618 B CN104383618 B CN 104383618B
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/14—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis
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Abstract
The invention discloses a hemodialysis filter allowing simultaneous front and back liquid supplementing. The hemodialysis filter comprises a liquid supplement outlet, a first liquid supplement pump, a second liquid supplement pump, a blood pump and a control device; the first liquid supplement pump and the second liquid supplement pump are both connected to the liquid supplement outlet; the first liquid supplement pump is connected with an arteriosus pot; the second liquid supplement pump is connected with a venous pot; the blood pump is connected with the arteriosus pot; the control device is used for controlling the speed of the first and second liquid supplement pumps so as to control the speed of front liquid supplement, the speed of back liquid supplement and total speed of liquid supplement for the liquid supplemented to both the arteriosus pot and the venous pot. The hemodialysis filter has the advantages that front liquid supplementing and back liquid supplementing can be completed at the same time according a proportion for hemodialysis therapy, the liquid supplement proportion and liquid supplement volume are automatically adjusted according to physiological status of a patient and various operating indexes during the therapy, and optimal therapeutic effect is achieved.
Description
Technical field
The present invention relates to dialysis machine technical field, more particularly, to a kind of hemodialysis that can simultaneously carry out before and after's fluid infusion
Filtering machine.
Background technology
Hemofiltration (HF) technology is the blood pressure by machine (pump) or patient itself, so that blood is flowed through in extracorporeal circuit
One filter, leaches big quantity of fluid and solute in the presence of filtration pressure, i.e. ultrafiltrate (ultrafiltrate), supplements meanwhile
The electrolyte solution similar to plasma lipid composition, i.e. displacement liquid (substitute), to reach the purpose of blood purification.Same
One time, traditional Hemofiltration for Treatment can be only done front fluid infusion (tremulous pulse kettle fluid infusion) or rear fluid infusion (venous chambers fluid infusion) wherein
Plant treatment meanss it is impossible to proportionally complete front fluid infusion, rear fluid infusion Hemofiltration for Treatment simultaneously.
Hemodiafiltration (HDF) is then the Comprehensive Treatment handss that one kind combines hemodialysis (HD) and hemofiltration (HF)
Section.On the basis of Hemofiltration for Treatment, hemodialysis filter can also pass through internal blood drainage to external, through one
In the dialyser being made up of hollow fibre, the blood electrolyte solution similar to concentration containing body (dialysis solution) is hollow one by one
Inside and outside fiber, mass exchange is carried out by disperse/convection current, remove internal metabolic waste, maintain electrolyte and acid-base balance；With
When remove excessive in vivo moisture.Equally, during hemodiafiltration, traditional Therapeutic Method can only carry out one kind
Fluid infusion mode, i.e. front fluid infusion or rear fluid infusion
Traditional hemodialysis filter can only carry out one of front fluid infusion or rear fluid infusion hemodiafiltration, specifically former
As described in Figure 1, fluid infusion, after outlet 1 is drawn, through fluid infusion pump 2, connects to tremulous pulse kettle 5 (as shown in solid lines in fig. 1) or connects reason
It is connected to venous chambers 6 (as shown in phantom in Figure 1), and the speed of fluid infusion can not be changed over the course for the treatment of.Before lacking
The flow relocity calculation method of fluid infusion simultaneously afterwards, traditional hemodialysis filter can be only done hemofiltration or the blood of single fluid infusion
Dialysis filtration is treated.
Accordingly, it would be desirable to develop a kind of new hemodialysis filter, to solve the above-mentioned technical problem of prior art presence.
Content of the invention
For technical problem present in prior art, it is an object of the invention to provide before and after one kind can be carried out simultaneously
The hemodialysis filter of fluid infusion.
For achieving the above object, technical scheme is as follows：
A kind of hemodialysis filter that can simultaneously carry out before and after's fluid infusion, described hemodialysis filter includes：
One fluid infusion outlet；
It is connected to the first fluid infusion pump and the second fluid infusion pump, described first fluid infusion pump and the tremulous pulse kettle of described fluid infusion outlet
Connect, described second fluid infusion pump is connected with venous chambers；
It is connected to the blood pump of described tremulous pulse kettle；And
Control device, for controlling the rotating speed of described first fluid infusion pump and described second fluid infusion pump to control simultaneously to described
The front fluid infusion flow velocity of tremulous pulse kettle and venous chambers fluid infusion, rear fluid infusion flow velocity and fluid infusion overall flow rate.
Optionally, described control device controls 0.7 times that described fluid infusion overall flow rate is patients blood plasma's water flow velocity.
Optionally, described blood plasma water flow velocity is calculated by below equation and obtains：
Blood plasma water flow velocity=effectively Hemodynamic environment * (1-Hct/100) * Fp；
Wherein, the described blood pump flow velocity of effective Hemodynamic environment is multiplied by corresponding offset and obtains；Hct/100 is blood volume in patients hundred
Divide ratio, described blood volume percentage ratio obtains through on-line measurement or biochemistry detection, and Fp accounts for plasma fraction ratio for water.
Optionally, described hemodialysis filter includes dialyser or has the dialyser interface for connecting dialyser.
Optionally, the initial described front fluid infusion flow velocity of described control device control is：
Front fluid infusion flow velocity=(dehydration overall flow rate-FF* blood plasma water flow velocity)/FF；
Wherein, described dehydration overall flow rate is the flow velocity through dialyser institute filtered solution from blood samples of patients, and FF is filtration point
Number.
Optionally, the value of described filtration fraction is between 0.3-0.5.
Optionally, described control device monitors the transmembrane pressure of described dialyser, when described transmembrane pressure is higher than 300mmHg,
Increase described front fluid infusion flow velocity, fluid infusion flow velocity after corresponding minimizing；When transmembrane pressure is less than 250mmHg, fluid infusion flow velocity after increase, phase
Front fluid infusion flow velocity should be reduced.
Optionally, the amplitude of described front fluid infusion flow velocity increase and decrease is 5-10ml/min.
Optionally, described first fluid infusion pump and described second fluid infusion pump are peristaltic pump.
Optionally, the dialysis fluid side of described dialyser be provided with for detect described dialysis fluid side dialysate pressure first
Hydrostatic sensor, the waste liquid side of described dialyser is provided with the second hydraulic sensing for detecting described waste liquid side dialysate pressure
Device；The arterial end of described dialyser is provided with the first baroceptor for detecting described arterial end blood pressure, described
The vein end of parser is provided with the second baroceptor for detecting described vein end blood pressure, and described control device passes through
The detected value obtaining baroceptor described in hydrostatic sensor and two described in two respectively calculates described transmembrane pressure as follows：
Transmembrane pressure=0.5* [(pressure value of pressure value+the first baroceptor of the first baroceptor)-(first liquid
The pressure value of pressure value+the second hydrostatic sensor of pressure sensor)] plasma colloid osmotic pressure.
The beneficial effects of the present invention is, the hemodialysis filter that can simultaneously carry out before and after's fluid infusion of the present invention, can
To complete front fluid infusion, rear fluid infusion hemodiafiltration according to a certain percentage simultaneously, and given birth to according to patient over the course for the treatment of
Fluid infusion ratio and amount infused before and after reason state, operations index adjust automatically, to reach the therapeutic effect of optimum, enable patient
Enough safer, be efficiently completed hemodiafiltration process.
Brief description
Fig. 1 is the structural representation of the hemodialysis filter of prior art.
Fig. 2 is the structural representation of embodiment of the present invention hemodialysis filter.
Specific embodiment
Embody feature of present invention will describe in detail in the following description with the exemplary embodiments of advantage.It should be understood that this
Invention can have various changes in different embodiments, and it is all without departing from protection scope of the present invention, and theory therein
Bright and accompanying drawing is inherently illustrated as being used, and is not used to limit the present invention.
Fig. 2 is the hemodialysis filter structural representation of the embodiment of the present invention, as shown in Fig. 2 the embodiment of the present invention
Hemodialysis filter, its main working parts bag expands the first fluid infusion pump 2, the second fluid infusion pump 3 and blood pump 7 etc., can include
Parser 4, or include the dialyser interface connecting dialyser.
Wherein, fluid infusion pump is properly termed as replacing liquid pump again.
The hemodialysis filter that before and after's fluid infusion can simultaneously be carried out of the embodiment of the present invention, can be simultaneously to tremulous pulse kettle 5
Carry out fluid infusion according to a certain percentage with venous chambers 6, and over the course for the treatment of, sound can be adjusted according to the change of patient's transmembrane pressure
The ratio of arteries and veins kettle fluid infusion.
As shown in Fig. 2 for the setting completing tremulous pulse kettle 5, venous chambers 6 fluid infusion simultaneously, invention increases the second fluid infusion
Pump 3, and with respect to the first fluid infusion pump 3, the second fluid infusion pump 3 can be independently completed the functions such as control, feedback, warning.Additionally, being
The ratio of fluid infusion before and after can accurately determining out, and the work(completing fluid infusion ratio adjust automatically before and after in the course of the work
Can, the present invention is also respectively provided with the first hydrostatic sensor 81 and the second liquid in the dialysis fluid side of dialyser 4 and waste liquid side respectively
Pressure sensor 82, to detect that dialysis solution passes in and out the pressure of dialyser 4；And divide in the vein end of dialyser 4 and arterial end respectively
First baroceptor 92 and the second baroceptor 91 are not set, to measure the pressure that blood passes in and out dialyser 4.
The hemodialysis filter of the embodiment of the present invention comprises two fluid infusion pumps (displacement liquid pump), more conventional single direction
The mode of (venous chambers or tremulous pulse kettle) fluid infusion is compared, and the hemodialysis filter of the embodiment of the present invention can carry out tremulous pulse kettle and quiet
The function of arteries and veins kettle fluid infusion simultaneously.Two fluid infusion pumps (displacement liquid pump) are peristaltic pump, and the speed of two fluid infusion pumps adjusts interval can
For 0-600ml/min, operating rate can be set respectively, be respectively provided with speed and automatically calibrate, velocity feedback, shutdown of uncapping, shake manually
Functions such as blood backs, when there is operation irregularity, can report to the police, and take and report to the police accordingly with blood filtering machine linkage
Operation and alarm release operation.When occurring to have a power failure, the battery that the hemodialysis filter of the embodiment of the present invention is built-in is permissible
For two fluid infusion pumps 2,3 power at least 30 minutes, after 30 minutes operator still can using hand crank carry out blood back with
And pipeline assembling and disassembling operation.
The hemodialysis filter of the embodiment of the present invention, the pipeline being used is disposable fluid infusion dedicated line.Fluid infusion
(displacement liquid) exports after 1 (or claim displacement liquid outlet) flow out from fluid infusion, respectively through the first fluid infusion pump 2 and 3 liang of the second fluid infusion pump
Bar path, a road is injected into the fluid infusion port of tremulous pulse kettle 5, and another road is injected into the fluid infusion port of venous chambers, completes tremulous pulse kettle 5 He
The hemofiltration of venous chambers 6 fluid infusion simultaneously or hemodiafiltration mode.
In addition, the hemodialysis filter of the embodiment of the present invention, also include control device (not shown), for controlling
First fluid infusion pump 2 and the rotating speed of the second fluid infusion pump 3, with control simultaneously to tremulous pulse kettle 5 and venous chambers 6 fluid infusion front fluid infusion flow velocity,
Fluid infusion flow velocity and fluid infusion overall flow rate afterwards.Here, to tremulous pulse kettle 5 fluid infusion be front fluid infusion, to venous chambers 6 fluid infusion be rear fluid infusion,
And front fluid infusion flow velocity and rear fluid infusion flow velocity and be equal to fluid infusion overall flow rate.
The hemodialysis filter of the embodiment of the present invention, determines front fluid infusion flow velocity, rear fluid infusion flow velocity by way of following
And fluid infusion overall flow rate.
With regard to the setting of initial fluid infusion flow velocity in front and back, there is below equation 1 first：
QBlood plasma water flow velocity=QEffectively Hemodynamic environment* (1-Hct/100) * Fp (formula 1)
Wherein：Effectively Hemodynamic environment QEffectively Hemodynamic environmentRepresent, corresponding offset can be multiplied by with the flow velocity of blood in blood pump 7 and obtain
?；Hct is blood volume in patients, and on-line measurement or biochemistry detection can be selected to obtain；Fp accounts for plasma fraction ratio (volume for water
Than), may be referred to the relevant parameter of document record, also can carry out biochemistry detection acquisition.The blood plasma water flow velocity Q of patientBlood plasma water flow velocity
Represent, by formula 1, can be by QBlood plasma water flow velocityCalculate.
After the blood plasma water flow velocity obtaining patient, fluid infusion overall flow rate can be obtained by formula 2.
QFluid infusion overall flow rate=0.7*QBlood plasma water flow velocity(formula 2)
Wherein：Fluid infusion overall flow rate QFluid infusion overall flow rateRepresent, the summation of the flow velocity of fluid infusion before and after expression, according to formula 2, you can root
According to blood plasma water flow velocity, obtain fluid infusion overall flow rate.Further, for calculating front fluid infusion flow velocity and rear fluid infusion flow velocity, need by with
Under formula 3：
QDehydration overall flow rate=QFluid infusion overall flow rate+QUltrafiltration flow velocity(formula 3)
Wherein：QDehydration overall flow rateIt is the flow velocity from blood samples of patients through 4 filtered solutions of dialyser；QUltrafiltration flow velocityTreated for patient
The flow velocity that in journey, unnecessary water is excluded, is specified setting value；Therefore according to formula 3, QTotal dehydration flow velocityCan calculate.Then root
According to below equation 4, front fluid infusion flow velocity can be calculated, use QFront fluid infusion flow velocityRepresent.
QFront fluid infusion flow velocity=(QDehydration overall flow rate-FF*QBlood plasma water flow velocity)/FF (formula 4)
Wherein：FF be filtration fraction, can between 0.3-0.5 value；Therefore, QFront fluid infusion flow velocity, that is, tremulous pulse kettle fluid infusion flow velocity can
To calculate.Front fluid infusion flow velocity obtain after, can by below equation 5 acquisition after fluid infusion flow velocity, use QFluid infusion flow velocity afterwardsRepresent.
QFluid infusion flow velocity afterwards=QFluid infusion overall flow rate-QFront fluid infusion flow velocity(formula 5)
Therefore, QFluid infusion flow velocity afterwards, that is, venous chambers fluid infusion flow velocity can calculate.
Above-mentioned be initial before and after fluid infusion flow velocity setting, and over the course for the treatment of, the hemodialysis filter of the embodiment of the present invention
Cross the control device of machine, monitor transmembrane pressure, according to the change of transmembrane pressure, in front and back's fluid infusion flow velocity is adjusted.
First, transmembrane pressure obtains according to below equation 6：
[(pressure value of pressure value+the first baroceptor of the first baroceptor)-(the first hydraulic pressure passes TMP=0.5*
The pressure value of pressure value+the second hydrostatic sensor of sensor)] plasma colloid osmotic pressure
(formula 6)
Wherein：TMP is transmembrane pressure, the pressure value of the second baroceptor 91, the pressure value of the first baroceptor 92, the
The pressure value of one hydrostatic sensor 81 and the pressure value of the second hydrostatic sensor 82, are monitor value.And plasma colloid osmotic pressure
For constant, generally choose 25mmHg.Therefore, transmembrane pressure can calculate, and over the course for the treatment of keep real-time detection and
Real-time update.
Over the course for the treatment of：
When TMP is higher than 300mmHg, fluid infusion flow velocity 5-10ml/min before increase, fluid infusion flow velocity 5-10ml/ after corresponding minimizing
min.Control device controls the first fluid infusion pump 2 to increase corresponding rotating speed, controls the second fluid infusion pump 3 to reduce corresponding rotating speed simultaneously,
Keep fluid infusion overall flow rate constant.
When TMP is less than 250mmHg, fluid infusion flow velocity 5-10ml/min after increase, fluid infusion flow velocity 5-10ml/ before corresponding minimizing
min.Control device controls the second fluid infusion pump 3 to increase corresponding rotating speed, controls the first fluid infusion pump 2 to reduce corresponding rotating speed simultaneously,
Keep fluid infusion overall flow rate constant.
The whether action between 250-300mmHg of above-mentioned detection transmembrane pressure, can be according to the detection frequency setting
Carry out.The hemodialysis filter of the present invention it is also possible to set, after initial front fluid infusion flow velocity and rear fluid infusion flow velocity determine,
Over the course for the treatment of, it is not adjusted.
The hemodialysis filter of the present invention, proportionally can complete front fluid infusion, rear fluid infusion hemodiafiltration simultaneously
Treatment, and during according to patient physiological condition, operations index adjust automatically fluid infusion ratio and amount infused, to reach
Excellent therapeutic effect, safer, be efficiently completed hemodiafiltration process.
Artisan will appreciate that without departing from the present invention's disclosed in appended claims of the invention
The change made in the case of scope and spirit and retouching, all belong within the scope of the claims of the present invention.
Claims (8)
1. a kind of hemodialysis filter that can simultaneously carry out before and after's fluid infusion is it is characterised in that described hemodialysis filter
Including：
One fluid infusion outlet；
It is connected to the first fluid infusion pump and the second fluid infusion pump of described fluid infusion outlet, described first fluid infusion pump is with tremulous pulse kettle even
Connect, described second fluid infusion pump is connected with venous chambers；
It is connected to the blood pump of described tremulous pulse kettle；And
Control device, for controlling the rotating speed of described first fluid infusion pump and described second fluid infusion pump to control simultaneously to described tremulous pulse
The fluid infusion ratio of kettle and venous chambers fluid infusion, front fluid infusion flow velocity, rear fluid infusion flow velocity and fluid infusion overall flow rate；
Wherein, described control device controls 0.7 times that described fluid infusion overall flow rate is patients blood plasma's water flow velocity；
Described blood plasma water flow velocity is calculated by below equation and obtains：
Blood plasma water flow velocity=effectively Hemodynamic environment * (1-Hct/100) * Fp；
Wherein, the described blood pump flow velocity of effective Hemodynamic environment is multiplied by corresponding offset and obtains；Hct/100 is blood volume in patients percentage
Described blood volume percentage ratio obtains ratio through on-line measurement or biochemistry detection, and Fp accounts for plasma fraction ratio for water.
2. the hemodialysis filter of before and after's fluid infusion can be carried out as claimed in claim 1 it is characterised in that described blood simultaneously
Liquid dialysis filtration machine includes dialyser or has the dialyser interface for connecting dialyser.
3. the hemodialysis filter of before and after's fluid infusion can be carried out as claimed in claim 2 it is characterised in that described control simultaneously
Device processed controls the initial described front fluid infusion flow velocity to be：
Front fluid infusion flow velocity=(dehydration overall flow rate-FF* blood plasma water flow velocity)/FF；
Wherein, described dehydration overall flow rate is the flow velocity through dialyser institute filtered solution from blood samples of patients, and FF is filtration fraction.
4. the hemodialysis filter of before and after's fluid infusion can be carried out as claimed in claim 3 it is characterised in that described filter simultaneously
The value crossing fraction is between 0.3-0.5.
5. the hemodialysis filter of before and after's fluid infusion can be carried out as claimed in claim 2 it is characterised in that described control simultaneously
The transmembrane pressure of dialyser described in device monitoring processed, when described transmembrane pressure is higher than 300mmHg, increases described front fluid infusion flow velocity, phase
Fluid infusion flow velocity after should reducing；When transmembrane pressure is less than 250mmHg, fluid infusion flow velocity after increase, fluid infusion flow velocity before corresponding minimizing.
6. the hemodialysis filter of before and after's fluid infusion can be carried out as claimed in claim 5 it is characterised in that before described simultaneously
The amplitude of fluid infusion flow velocity increase and decrease is 5-10ml/min.
7. the hemodialysis filter of before and after's fluid infusion can be carried out as claimed in claim 1 it is characterised in that described simultaneously
One fluid infusion pump and described second fluid infusion pump are peristaltic pump.
8. the hemodialysis filter of before and after's fluid infusion can be carried out as claimed in claim 5 it is characterised in that described simultaneously
The dialysis fluid side of parser is provided with the first hydrostatic sensor for detecting described dialysis fluid side dialysate pressure, described dialyser
Waste liquid side be provided with the second hydrostatic sensor for detecting described waste liquid side dialysate pressure；The arterial end of described dialyser
Be provided with the first baroceptor for detecting described arterial end blood pressure, the vein end of described dialyser be provided with for
Detect the second baroceptor of described vein end blood pressure, described control device passes through to obtain respectively hydraulic sensing described in two
Described in device and two, the detected value of baroceptor calculates described transmembrane pressure as follows：
[(pressure value of pressure value+the first baroceptor of the first baroceptor)-(the first hydraulic pressure passes transmembrane pressure=0.5*
The pressure value of pressure value+the second hydrostatic sensor of sensor)] plasma colloid osmotic pressure.
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| CN106730086A (en) * | 2016-12-30 | 2017-05-31 | 北京迈淩医疗技术发展有限公司 | The filtering device for blood dialysis and its hemodiafiltration controlling organization of displacement liquid speed can be automatically adjusted |
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| CN203017461U (en) * | 2012-11-14 | 2013-06-26 | 王雪 | Continuous kidney replacement therapy device and system |
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| IT1320024B1 (en) * | 2000-04-07 | 2003-11-12 | Gambro Dasco Spa | METHOD FOR ADJUSTING THE INFUSION IN A DIALYSIS MACHINE AND DIALYSIS MACHINE FOR THE APPLICATION OF THE MENTIONED METHOD. |
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| US8372025B2 (en) * | 2005-09-22 | 2013-02-12 | Baxter International Inc. | Automation and optimization of CRRT treatment using regional citrate anticoagulation |
| US8211048B2 (en) * | 2006-02-22 | 2012-07-03 | Henry Ford Health System | System and method for delivery of regional citrate anticoagulation to extracorporeal blood circuits |
| JP2009285128A (en) * | 2008-05-29 | 2009-12-10 | Nikkiso Co Ltd | Blood purifier and method of forming liquid reservoir in drip chamber for priming liquid |
| CN101342389B (en) * | 2008-09-03 | 2010-06-02 | 荣维淳 | Full-automatic liquid preparation machine |
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| CN201186074Y (en) * | 2008-05-06 | 2009-01-28 | 重庆山外山科技有限公司 | Continuous blood purifying equipment with substitute fluid purifier |
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| CN203017461U (en) * | 2012-11-14 | 2013-06-26 | 王雪 | Continuous kidney replacement therapy device and system |
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