JP2003265599A - Hemocatharsis system - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a hemocatharsis system in which hemocatharsis operation can be more efficiently and safely performed with the least possible work load. <P>SOLUTION: A dialyzer 10, in which dialysis and/or filtration operation is performed by bringing the blood of a patient and dialyzing fluid flown in and out through a dialyzing fluid passages 18 and 20 into contact via a semipermeable membrane, is placed on blood circuits 12 and 14 in which the blood of the patient is circulated, a dialyzing fluid circulating device 22, which allows the dialyzing fluid to flow into and out of the dialyzer 10 through the dialyzing fluid passages 18 and 20, is placed, and moreover, a blood flow measuring means 26, in which the flow rate or flow of blood flowing in an arterialized vein in the shunt forming part of the patient is determined in a noninvasive way during dialysis and/or filtration operation of the blood in the dialyzer 10, is placed. <P>COPYRIGHT: (C)2003,JPO

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a blood purification system, and more particularly to an improved structure of a blood purification system that purifies blood of a patient by dialysis and / or filtration.

[0002]

BACKGROUND ART In recent years, various blood purification methods for purifying blood taken out from a patient's body and returning it to the body for the purpose of treating patients with renal failure and maintaining their lives have been studied and put to practical use. Hemodialysis / filtration devices, so-called artificial kidneys, have been widely used there. And
As a kind of this artificial kidney, a dialyzer provided on the blood circuit in which the blood of the patient is circulated, and a dialysate circulation device for inflowing (supplying) dialysate into the dialyzer and flowing out (discharging) from the dialyzer. Having, flowing into the dialyzer through the blood circuit and the dialysate flow device,
A blood purification system configured to purify blood by bringing the blood and the dialysate, which are allowed to flow out, into contact with each other through a predetermined semipermeable membrane in the dialyzer to perform dialysis and / or filtration operation. The system is known.

When performing blood purification with such an artificial kidney, in order to secure a blood flow volume necessary for extracorporeal circulation, an arterial / venous anastomosis operation is performed on an arm, a thigh or the like, so-called a shunt. To form. For example, in a site such as an arm, a vein located on the body surface side is joined (anastomized) to one of the arteries located deep in the body to bypass the blood flow and increase the blood flow volume of the vein. (To make a vein arterial), when taking blood out of the body, insert a needle into the shunt blood vessel (arterialized vein),
Do it while pulling with a blood pump. In this way, blood is taken out of the body through the shunt blood vessel, so that a blood flow of about 200 to 300 ml / min necessary for extracorporeal circulation is secured.

By the way, when such a blood purification system is used to purify a patient's blood by dialysis and / or filtration, a phenomenon occurs in which the blood pressure of the patient is suddenly lowered (decreased) for some reason. Occasionally, the patient's life is endangered.

Therefore, the above-described blood purification operation is
In many cases, it is carried out while frequently measuring the blood pressure of the patient, and when the blood pressure of the patient falls below a predetermined value, immediately, appropriate treatment capable of coping with the decrease in blood pressure is taken to check the blood pressure of the patient. The rise is being pursued.

However, in such a blood purification system, frequent measurement of the blood pressure of a patient while performing dialysis and / or filtration operation on the patient is an operator performing the blood purification operation. That is, it imposes an excessive work burden on nurses, doctors, and the like, and has an inherent problem that a lot of manpower is required for the blood purification operation.

[0007]

The present invention has been made in view of the circumstances as described above, and a problem to be solved by the present invention is to effectively detect a blood pressure fluctuation of a patient during a blood purification operation. Another object of the present invention is to provide a blood purification system that can perform a patient's blood purification operation more efficiently and advantageously with a reduced work burden on nurses, doctors, and the like.

[0008]

Under such circumstances, as a result of various studies to solve the above-mentioned technical problems, the present inventor has found that in an arterial vein (shunt blood vessel) at an arterial vein at a shunt formation site, which is different from the original artery. Focusing on the fact that the flow velocity or flow rate of blood returning to the heart corresponds well to arterial blood pressure, and measuring the flow velocity or flow rate of blood in such an arterial vein noninvasively It was found that the fluctuation of can be effectively grasped.

The present invention has been completed on the basis of the above findings, and its basic structure is to purify the blood of a patient by dialysis and / or filtration. In the system described above, (a) the blood is provided on a blood circuit in which the blood is circulated, and the blood is brought into contact with a dialysate flowing in and out through a dialysate flow path through a semipermeable membrane, A dialyzer for performing a dialysis and / or filtration operation; and (b) a dialysate flow device for performing inflow of the dialysate into the dialyzer and outflow of the dialysate from the dialyzer through the dialysate channel. (C) The flow rate or flow rate of the blood flowing through the shunt blood vessel downstream of the arterial / venous anastomosis of the patient is controlled during the dialysis and / or filtration operation of the blood in the dialyzer. And the blood flow measuring means for obtaining a blood, the
A blood purification system characterized by having.

That is, in such a blood purification system according to the present invention, blood flow measuring means is additionally provided to the conventional system, and the shunt is obtained by the blood flow measuring means. The flow rate or flow rate of blood returned to the heart through the arterialized vein at the site of formation will be measured.

Therefore, in the blood purification system according to the present invention as described above, the fluctuation of the blood pressure during the purification of the blood of the patient can be well grasped by the value obtained by the blood flow measuring means. , When blood pressure drops during blood purification and the flow velocity or flow rate of blood flowing through an arterialized vein (shunt blood vessel) is lower than a predetermined limit value (lower limit value). Then, when the patient's life is endangered due to the decrease in blood pressure, such a decrease in blood pressure is immediately detected, and appropriate measures can be taken to respond to such a decrease in blood pressure of the patient to a normal value. It can be raised. Further, the flow rate or flow rate of blood flowing through such an arterial vein can be measured relatively easily without the need for nurses, doctors, etc., and the dialysis and / or filtration operation can be performed. In the inside, since it is possible to continuously monitor the flow velocity and the flow rate, the frequent blood pressure measurement work performed in the conventional system is unnecessary, and thus,
The work load on operators such as nurses and doctors who purify blood can be reduced extremely advantageously.

Therefore, when the blood purification system according to the present invention as described above is used, when a blood pressure drop occurs in a patient who is purifying blood, a necessary treatment for the blood pressure drop in order to protect the life of the patient. Can be applied more appropriately, so that the blood purification operation of the patient can be performed with a reduced work load.
It is possible to implement it more effectively and advantageously.

According to one of the preferred embodiments of the blood purification system according to the present invention, the blood flow measuring means uses the ultrasonic Doppler method to detect the blood flowing through the arterialized vein at the shunt formation site. A detection unit that detects a blood flow velocity, or, together with such a detection unit, includes a calculation unit that calculates the blood flow rate in the arterialized vein based on the blood flow velocity detected by the detection unit. The Rukoto. As a result, it is possible to more reliably and easily grasp the change in the blood flow of the patient during blood purification, and thus the blood pressure change, and thus to perform the blood purification operation of the patient even more smoothly and advantageously. It can be implemented.

According to another desirable aspect of the blood purification system according to the present invention, when the value of the flow velocity or flow rate obtained by the blood flow measuring means is below a preset limit value, A configuration is further adopted in which a notification unit for automatically notifying it is further provided. In the blood purification system having such a configuration, the operator who performs the blood purification operation when the blood pressure is lowered such that the life of the patient defined by such a limit value may be dangerous ( Nurses and doctors) and patients can be informed that there is an urgent need to take measures to reduce blood pressure, and as a result, blood purification operations can be performed more safely. Of. Further, according to such a configuration,
Until the automatic notification is made by the notification means, it is possible to advantageously eliminate the need for the operator to confirm the measurement value of the blood flow measurement means or to measure the blood pressure of the patient. The work load of the above can be reduced more effectively.

Further, according to another preferred embodiment of the blood purification system according to the present invention, when the value of the flow velocity or the flow rate obtained by the blood flow measuring means falls below a preset limit value, In order to return such a value to the limit value or more, the inflow amount of the dialysate into the dialyzer and the outflow amount from the dialyzer by the dialysate flow device are controlled, and / or the blood in the blood circuit. There is provided at least one of a control device for controlling the circulation amount of the liquid, a replacement liquid device for automatically starting the replacement liquid for the patient, a supply means for automatically supplying a dialysate liquid having a high Na concentration to the dialysate flow passage. Is constructed and configured.

In the blood purification system having such a structure, the blood pressure is lowered during the purification of blood, and at the shunt formation site where the artery and vein of the patient are anastomosed, through the arterialized vein. When the flow velocity or flow rate of the blood flow returned to the heart falls below a predetermined limit value, appropriate measures to protect the patient's life, which can cope with such a decrease in blood pressure, are immediately carried out, Since the blood pressure of the patient is raised and the blood flow to the normal value is increased rapidly as a result, the blood purification operation can be performed even more safely, and the blood purification operation can be performed more safely. The work burden on the operator can be reduced more effectively.

According to another advantageous aspect of the blood purification system according to the present invention, when the value of the flow velocity or the flow rate obtained by the blood flow measuring means falls below a preset limit value. The blood pressure measuring means for automatically measuring the blood pressure of the patient is further provided. As a result, the blood pressure of the patient can be surely grasped before the treatment for the decrease in blood pressure, and as a result, it is possible to smoothly carry out the appropriate treatment that accurately corresponds to the decrease in blood pressure. It will be possible.

[0018]

BEST MODE FOR CARRYING OUT THE INVENTION In order to more specifically clarify the present invention, the configuration of a blood purification system according to the present invention will be described in detail below with reference to the drawings.

First, FIG. 1 is a system diagram showing a hemodialysis system, which is one embodiment of a blood purification system having a structure according to the present invention, for purifying blood of a patient by dialysis. In FIG. 1, 10
Is a dialyzer as a dialyzer (purifier) having a known structure, which is used for dialysis (purification) of blood. For example, a hollow fiber semipermeable membrane is housed inside a cylindrical box body. Is configured.

A blood supply channel 12 for guiding blood from the patient's body is connected to one end side of the dialyzer 10 in the axial direction, and the dialyzer 1 is connected to the other end side thereof.
At 0, the blood return flow path 14 for returning the purified blood into the patient's body is connected. That is, here
A blood circuit is constituted by the blood supply flow path 12, the blood circulation part in the dialyzer 10, and the blood return flow path 14. In addition, on the blood supply channel 12,
A blood pump 16 is provided, and the operation of the blood pump 16 allows blood to flow through the blood circuit, in other words, the blood supply flow path 12, the blood return flow path 14, and the dialyzer 10.

The dialyzer 10 is connected to a dialysate supply channel 18 for guiding the dialysate into the dialyzer 10 from its storage tank (not shown), and the dialyzer 10 is further connected through the blood supply channel 12. A dialysate discharge flow path 20 for guiding and discharging the dialysate brought into contact with blood into the inside of the system 10 through the semipermeable membrane to the outside of the system is connected. So here,
The dialysate supply flow path 18, the dialysate flow path in the dialyzer 10 and the dialysate discharge flow path 20 constitute a dialysate flow path.

On the flow paths of the dialysate supply flow path 18 and the dialysate discharge flow path 20, the known dialysate flow system 2 is provided.
2, the dialysate flow device 22 allows fresh dialysate introduced from the storage tank to flow (supply) into the dialyzer 10 through the dialysate supply channel 18, while the semi-permeable part of the dialyzer 10 is provided. The dialysate drainage containing waste products and excess water diffused and filtered from the blood side through the membrane is allowed to flow out (discharge) from the dialyzer 10 through the dialysate drainage channel 20. Is there.

Further, such a dialysate circulating device 22 is
The operating state is controlled by the control device 24, whereby the inflow amount of fresh dialysate into the dialyzer 10 and the outflow amount of dialysate drainage from the dialyzer 10 by the dialysate flow device 22. Can be adjusted arbitrarily.

That is, in the dialysate circulation device 22, the outflow amount of the dialysate drainage liquid from the dialyzer 10 is determined based on the water removal start signal output from the control device 24 and instructing the start of the water removal action. A dialyzer for fresh dialysate 1
It is possible to remove water in the dialyzer 10 by increasing the flow rate into the dialyzer 10 and adjust the water removal rate by the difference between the outflow rate of the dialysate effluent and the inflow rate of the fresh dialysate. And again,
The water removal action is stopped by making the outflow amount of the dialysate drainage liquid and the inflow amount of the fresh dialysate liquid equal based on the water removal stop signal output from the control device 24 to stop the water removal action. At the very least, the amount of water removed can be reduced to zero. Furthermore, in such a dialysate flow device 22,
Based on the start signal of the replacement fluid by the dialysate, which indicates the start of the dialysate pushing action outputted from the control device 24, the inflow amount of the fresh dialysate into the dialyzer 10 is changed from the dialysate drain dialyzer 10 to It is configured such that the dialysate can be pushed into the blood side through the semipermeable membrane in the dialyzer 10 by increasing the outflow amount of the dialysate.

Further, the control device 24 is constructed so as to be able to control the operation of the blood pump 16 provided on the blood supply flow path 12, and the operation control of the blood pump 16 by the control device 24 allows the blood pump 16 to operate. It is possible to increase or decrease the flow rate of blood in the blood supply flow channel 12, the blood flow channel in the dialyzer 10, and the blood return flow channel 14 which configure the circuit, in other words, the flow rate of blood in the dialyzer 10. It has become.

By the way, the above-described exemplary hemodialysis system does not exist in the conventional system.
A blood flow rate measuring device 26 as a blood flow measuring means is provided. The blood flow rate measuring device 26 is a probe 28 as a detection unit that detects the blood flow velocity of a blood vessel to be inspected by an ultrasonic Doppler method, and is electrically connected to the probe 28 and detected by the probe 28. It has a well-known structure having a main body 30 as a calculation unit for obtaining the blood flow rate of the blood vessel based on the value.

That is, in the blood flow rate measuring device 26, the probe 28 vibrates so that the transducer 28 (which is not shown) for transmitting ultrasonic waves and the reflected signal of the ultrasonic waves transmitted from the transducer are received. It has a built-in child (not shown),
With this probe 28, the blood flow velocity (linear velocity) of the blood vessel to be inspected can be detected at any time by utilizing the Doppler effect of ultrasonic waves continuously transmitted from the transducer. . It should be noted that the probe 28 is fixedly attached at the shunt formation site of the patient with the detection site at the tip of the probe 28 directed to an arbitrary site of the arterialized vein. The blood flow velocity of the blood returned to the heart flowing through the arterialized vein is adapted to be detected at any time during the dialysis (purification) of the patient's blood.

Specifically, as shown in FIG. 2, in the arm where the shunt is formed in the same manner as in the conventional art, the probe is directed to the skin above the arterialized vein toward the arterialized vein. 28 is fixedly attached using a suitable fixing means such as a belt or an adhesive tape so that the flow rate or the flow rate of blood flowing through the arterialized vein at the shunt formation site of the patient is continuous. Alternatively, the measurement can be performed after a predetermined time (intermittently). In other words, such a shunt is used for the vein 4 on the body surface side of the artery 2 in the deep part of the body at a site slightly closer to the heart from the wrist.
Are connected (anastomosis) and formed, the blood flow is bypassed at the anastomotic part 6 that is the connection, the blood flow volume of the vein 4 is increased, and the vein 4 is arterized, Therefore, when performing hemodialysis, the arterialized vein is punctured with a puncture needle to be connected to the blood supply channel 12 described above, and further pulled by the blood pump 16 to obtain about 200 to 300 ml / min. The blood is returned to the outside of the body with the blood flow rate of 1 and the blood return channel 14 is connected via a puncture needle at the site of the arterialized vein downstream of the site to which the blood supply channel 12 is connected. Thus, the extracorporeal circulation can be performed well. In the shunt formation site, the probe 28 is located upstream of the site where the blood supply flow path 12 is connected to the arterialized vein, in other words,
Since it is attached so as to face the site on the side close to the original site where the arteries and veins are joined, the flow rate of blood returned to the heart through such veins (4) or The flow rate is to be measured.

Further, the main body 30 of the blood flow measuring device 26
Is obtained by multiplying the flow velocity of the blood flowing through the arterialized vein 4 at the shunt formation site detected by the probe 28 by the average value of the cross-sectional area of the arterialized vein 4 stored in advance. The blood flow rate of the arterialized vein 4 is calculated and continuously obtained. The blood flow rate of the arterialized vein 4 thus obtained is displayed through a built-in printer, a monitor or the like (both not shown), and can be sequentially output to the control device 24. It is configured.

Here, in particular, as described above,
Measured by the blood flow measuring device 26 (determined),
When the blood flow rate of the arterialized vein 4 at the shunt formation site is input to the control device 24, a judgment unit (not shown) built in the control device 24 sets the blood flow rate to a preset limit value. (Lower limit value) is compared to determine whether the value is less than (lower than) the limit value. Only when it is determined that the blood flow rate of the arterialized vein 4 is less than the limit value, the alarm device 34 as an informing unit electrically connected to the control device 24 is provided. The operation is controlled, and the operation control of the dialysate circulation device 22 and the blood pump 16 can be performed.

More specifically, in such an exemplary hemodialysis system, a decrease in blood pressure during dialysis of blood causes a rapid decrease in the flow rate of blood flowing through the arterialized vein 4 at the shunt formation site, resulting in a patient's blood flow. A blood flow rate value that is larger than the blood flow rate in the arterialized vein 4 when the life is endangered by a predetermined amount is stored in the determination unit of the control device 24 as the limit value. ing.

In such a hemodialysis system, the blood flow rate in the arterialized vein 4 input from the blood flow rate measuring device 26 is determined by the judgment unit of the control device 24 as the above-mentioned limit value. When it is determined that the value is below the lower limit, that is, the value is below the lower limit, the control device 24 outputs an operation signal to the alarm device 34, and the alarm device 34 issues an alarm. At the same time, a decrease in the outflow amount of dialysate effluent from the dialyzer 10 by the dialysate flow device 22 and an increase in the inflow amount of fresh dialysate into the dialyzer 10 are performed simultaneously or among them. Either one of the
The difference between the outflow of dialysate drain and the inflow of fresh dialysate is reduced or equalized, or the difference between the outflow of dialysate drain and the inflow of fresh dialysate is negative. As a result, the water removing action is reduced or stopped, or the dialysate is moved to the blood side, the replacement fluid is performed with the dialysate, and further, the operation amount of the blood pump 16 is reduced, The amount of blood flowing into the dialyzer 10 can be reduced.

Thus, the blood flow measuring device 26 detects that the blood flow rate through the arterialized vein at the shunting site of the patient has decreased below a threshold value, thereby jeopardizing the life of the patient. The fact that the blood pressure has decreased to a certain extent is due to the operation of the alarm device 34 by the control device 24.
It is designed so that the patient, the operator of the hemodialysis system, etc. can be notified, and the amount of water removed can be reduced or eliminated by the control device 24, or the dialysate can be transferred to the blood side. The blood pressure of the patient is increased by the operation control of the dialysate flow device 22 to be pushed in and the operation control of the blood pump 16 that reduces the inflow of blood into the dialyzer 10. .

In this case, the operation control of the dialysate circulating device 22 for reducing the water removal amount to zero or forcing the dialysate into the blood side, which is executed by the controller 24, and the inside of the dialyzer 10. The operation control for the blood pump 16 that reduces the inflow of blood into the blood pump 16 is performed according to the operating conditions of the hemodialysis system, the condition of the patient, the reduction rate of the blood flow rate through the arterialized vein at the shunt formation site, and the like. Both, or any one of them is selected and performed, and the reduction amount of the water removal amount due to their operation control, the movement amount of the dialysate to the blood side, and the inside of the dialyzer 10 are performed. The decrease in the amount of blood inflow to the hemodialysis system depends on the operating conditions of the hemodialysis system, the condition of the patient, and the blood flow rate through the arterialized vein at the shunt formation site. Depending on the low speed or the like, is about to be suitably determined.

As described above, in the hemodialysis system having such an exemplary configuration, fluctuations in the blood flow rate of the arterialized vein at the shunt formation site of the patient during hemodialysis are detected by the blood flow rate measuring device 26 and the control device 24. Is constantly monitored,
The decrease in the patient's blood pressure to the extent that the patient's life is endangered is due to the decrease in the blood flow rate through the arterialized vein to the preset limit value (lower limit value) or less. Immediately after that, an alarm alerts the operator or nurse of the system, or the patient himself, and the procedure for increasing the blood pressure of the patient can be automatically performed. Therefore, the dialysis of the blood of the patient can be performed more safely, and during the dialysis of such blood,
The need for the nurses and doctors to check the measurement values by the blood flow rate measuring device 26 one by one can be advantageously eliminated, and the work burden on those nurses and doctors can be effectively reduced.

As described above, in the hemodialysis system of the present invention, the flow rate of blood flowing through the arterialized vein at the shunt formation site of the patient, and further the fluctuation of the blood flow rate calculated based on the flow rate of the blood flow Under the fact that blood pressure fluctuations are responded well and accurately, blood pressure fluctuations can be accurately determined based on such fluctuations in the flow velocity or flow rate of blood. In addition, in such a shunt formation site, there is an original artery as well as such an arterialized vein, but in such an artery, the relationship between blood pressure and blood flow rate is affected by the action of autonomic nerves and the like. Therefore, it is impossible to grasp the blood pressure fluctuation of the patient based on the blood flow rate of the artery. On the other hand, in an arterial vein, since there is no action of such an autonomic nerve, the blood pressure fluctuation directly corresponds to the flow velocity or flow rate of blood, so that the accurate blood pressure fluctuation in the patient can be effectively grasped. It will be possible.

Further, in the system having such a configuration,
When the flow rate or the flow rate of blood flowing through the arterialized vein at the shunt formation site during the dialysis of blood in the dialyzer 10 falls below the limit value, an alarm is issued by the alarm device 34, which is the hemodialysis. Since the system operator can be notified, for example, when the flow velocity or flow rate of blood in the arterialized vein becomes less than the limit value for some reason, the control device 24 Even when the operation control of the dialysate flow device 22 or the blood pump 16 is not performed, the operator of the hemodialysis system can manually perform the procedure for increasing the blood pressure of the patient, whereby The hemodialysis operation can be performed even more safely.

Further, in the illustrated hemodialysis system, during dialyzing blood in the dialyzer 10,
When the blood pressure is reduced to a life-threatening level, the flow velocity of the blood flowing through the arterialized vein at the shunt formation site, and further the flow rate falls below the limit value (lower limit value). The blood pump 16 is controlled to operate so that the amount of water removed is reduced to zero or the dialysate is pushed to the blood side, or the inflow of blood into the dialyzer 10 is reduced. Therefore, the blood pressure of the patient can be raised quickly and efficiently, so that the flow rate of blood flowing through the arterialized vein at the shunt formation site and the flow rate can be smoothly returned to normal values. And with it, the need for the operator of the system to bother with the intervention of increasing blood pressure can be eliminated, and work in the hemodialysis operation can be eliminated. Cancer-bearing, is as it can be more effectively reduced.

Furthermore, in the system exemplified here, the blood flow measuring device 26 uses the ultrasonic Doppler method to detect the blood flow velocity of the blood flowing through the arterialized vein at the shunt formation site. And a main body 30 for determining the flow rate of blood flowing through such a vein based on the blood flow velocity detected by the probe 28. The fluctuation of the blood flow rate in the vein at the formation site can be more surely and easily grasped, so that the dialysis operation of the blood of the patient can be performed more smoothly and safely.

The structure of a typical specific example of the present invention has been specifically described above, but it is merely an example, and the present invention describes such a specific example and description thereof. It is to be understood that there is no restriction imposed by.

For example, in the illustrated specific example, the dialyzer 10 is configured by accommodating a hollow fiber-shaped semipermeable membrane inside a cylindrical box body. However, any of various known structures of a dialyzer incorporated in a blood purification system can be appropriately adopted and used.

Further, in the illustrated system, the flow rate of the blood flowing through the arterialized vein at the shunt formation site of the patient is detected by the probe 28, and the blood flow rate is measured by the main body 30 based on the detected value. Of course, the flow velocity (linear velocity) of the blood detected by the probe 28 is used to compare the fluctuation with the blood pressure fluctuation in the patient, and the value should be below the lower limit value. It is also possible to adopt a configuration in which the blood pressure of the patient is recognized to be a value at which necessary measures should be taken, and further, the flow rate or flow rate of blood flowing through such an arterial vein can be adjusted. Even the device for measurement is not limited to the structure in the illustrated specific example, as long as the flow rate or flow rate of blood on the venous side can be obtained noninvasively. Its structure is not limited in particular.

Further, in the illustrated specific example, during the dialysis of blood in the dialyzer 10, the flow velocity or flow rate of blood flowing through the arterialized vein at the shunt formation site falls below its limit value (lower limit). At times, the dialysate circulation device 22 and the blood pump 16 are automatically controlled so that the blood pressure of the patient can be increased. However, such a blood flow rate or flow rate falls below a limit value. At this time, the operator of the system controls the operation of the dialysate circulation device 22 and the blood pump 16 based on the display of the blood flow rate measuring device 26, the display through the built-in printer, or the alarm of the alarm device 34. Of course, it can be done manually.

If the flow velocity or flow rate of the blood flowing through the arterialized vein becomes lower than the limit value, the procedure described above may be used as long as it is for increasing the blood pressure of the patient. The dropper is not limited to the one described above.For example, a dropper is provided as a replenisher for replenishing a patient, and when the dropout falls below the limit value, the dropper automatically or It is operated manually to start replacement fluid for a patient, or an auxiliary tank for storing a dialysate having a higher Na concentration than the dialysate supplied to the dialyzer 10 during normal blood dialysis is provided. Dialysate with high Na concentration from an auxiliary tank such as
It is also possible to automatically or manually supply into the dialyzer 10 through the dialysate flow device 22 or the like so as to increase the blood pressure of the patient.

At the shunt formation site of the patient,
Instead of, or in addition to, the various devices described above, which perform a procedure for increasing the blood pressure of a patient when the flow velocity or flow rate of blood flowing through an arterial vein falls below a limit value. It is also possible to provide a known blood pressure measuring device and measure the patient's blood pressure automatically or manually with such a blood pressure measuring device when the blood pressure falls below the limit value. Thereby, the blood pressure of the patient can be surely grasped before the treatment for the blood pressure decrease, and as a result, the blood pressure decrease amount is
It is possible to smoothly carry out appropriate measures that are accurately handled.

Further, in the illustrated specific example, the alarm means is constituted by the alarm device 34 which issues an alarm when the value measured by the blood flow rate measuring device 26 falls below the limit value, but the structure of this alarm means is also: Anything is not limited thereto, for example, simply by turning on or blinking a warning lamp or the like, it is also possible to adopt a structure for notifying that the measured value is below the limit value, Of course it is possible.

Further, in the illustrated system, the controller 24 controls the inflow amount of the fresh dialysate into the dialyzer 10 and the outflow amount of the dialysate drainage from the dialyzer 10 by the dialysate flow device 22. , The outflow amount is made larger than the inflow amount to remove water, and the water removal amount is adjusted by the difference between the outflow amount and the inflow amount, and such a difference is made zero. As a result, water removal is stopped, and by making such a difference negative, the dialysate is pushed to the blood side,
That is, the liquid replacement is performed, but the mechanism for reducing the water removal and performing the liquid replacement is not limited to this, and various known structures can be appropriately adopted. belongs to.

In addition, in the illustrated specific example, an example in which the present invention is applied to a hemodialysis system in which the blood of a patient is purified by a dialysis action is shown. It goes without saying that it can be advantageously used for any of the blood purification systems in which the purification of the blood of the patient is performed by dialysis or filtration, or dialysis and filtration.

Although not listed one by one, the present invention
It can be carried out in an embodiment in which various changes, modifications, improvements, etc. are added based on the knowledge of those skilled in the art, and such an embodiment does not depart from the gist of the present invention.
Both are included within the scope of the present invention,
Needless to say.

[0050]

As is apparent from the above description, in the blood purification system according to the present invention, when the blood pressure of the patient who is purifying the blood decreases, the blood pressure of the patient is reduced in order to protect the life of the patient. It is possible to deal more appropriately with the patients who need to treat the decrease, so that the patient's blood purification operation can be performed more efficiently and safely with a reduced work load. You can do it.

[Brief description of drawings]

FIG. 1 is a system diagram showing an example of a blood purification system according to the present invention.

FIG. 2 is an explanatory diagram showing a state in which a probe that is a blood flow state monitoring device according to the present invention is attached to an arm portion in which an inner shunt is formed.

[Explanation of symbols]

2 arteries 4 arterialized veins 4'cut and ligated veins 6 anastomotic part 10 dialyzer 12 blood supply flow path 14 blood return flow path 16 blood pump 18 dialysate supply flow path 20 dialysate discharge flow path 22 dialysate flow Device 24 Control device 26 Blood flow measuring device 28 Probe 30 Main body 34 Alarm device

─────────────────────────────────────────────────── ─── Continuation of front page (51) Int.Cl. ⁷ Identification code FI theme code (reference) A61B 5/0285 A61B 5/02 D 8/06 340H F term (reference) 4C017 AA08 AA11 AB02 AC23 BB01 BB02 BC11 CC01 FF30 4C077 AA05 AA12 BB01 EE01 EE03 HH03 HH13 HH15 JJ03 JJ13 JJ16 KK25 NN02 NN03 4C301 AA03 CC10 DD01 DD03 DD09 EE14 EE19 JB27 JB30 JB32 LL17 4C601 DD03 DD06 DE01 J02B4635 J47B46JB J47B34 J47B34 J47B34 J47 J34 J47B34J47B34

Claims (7)

[Claims] 1. A system for purifying blood of a patient by dialysis and / or filtration, which is provided on a blood circuit in which the blood is circulated, and the blood flows in through a dialysate flow path. The dialysate to be flowed out is contacted through a semipermeable membrane, and dialysis and / or
Alternatively, a dialyzer for performing a filtration operation, a dialysate flow device for inflowing the dialysate into the dialyzer and outflowing the dialysate from the dialyzer through the dialysate flow path, and an artery / vein of the patient. Blood flow measuring means for non-invasively determining the flow rate or flow rate of blood flowing through the shunt blood vessel downstream of the anastomosis portion during the dialysis and / or filtration operation of the blood in the dialyzer. Blood purification system. 2. The blood flow measuring means detects a blood flow velocity of blood flowing through a shunt blood vessel downstream of the arterial / venous anastomosis portion by an ultrasonic Doppler method, or together with such a detecting portion, The blood purification system according to claim 1, further comprising a calculation unit that calculates a blood flow rate in the shunt blood vessel based on the blood flow velocity detected by the detection unit. 3. A notification means is further provided for automatically notifying when a value of a flow velocity or a flow rate obtained by the blood flow measuring means falls below a preset limit value. Alternatively, the blood purification system according to claim 2. 4. The dialysate flow device so that when the value of the flow velocity or the flow rate obtained by the blood flow measuring means falls below a preset limit value, the value is returned to the limit value or more. The control device for controlling the inflow amount of the dialysate into the dialyzer or the outflow amount of the dialyzer and / or the circulation amount of the blood in the blood circuit is further provided. The blood purification system according to claim 3. 5. When the value of the flow velocity or the flow rate obtained by the blood flow measuring means falls below a preset limit value, a replacement fluid for the patient is returned so as to restore the value to the limit value or more. The blood purification system according to any one of claims 1 to 4, further comprising a fluid replacement device that starts automatically. 6. When the value of the flow velocity or flow rate obtained by the blood flow measuring means falls below a preset limit value, the Na value is set so as to restore the value to the limit value or more.
The supply means for automatically supplying a high-concentration dialysate to the dialysate channel is further provided.
The blood purification system according to any one of 1. 7. Blood pressure measuring means is further provided for automatically measuring the blood pressure of the patient when the value of the flow velocity or flow rate obtained by the blood flow measuring means falls below a preset limit value. The blood purification system according to any one of claims 1 to 6.