CN111514396A

CN111514396A - Double-vein kettle external circulation system capable of automatically adjusting treatment dosage

Info

Publication number: CN111514396A
Application number: CN202010275914.4A
Authority: CN
Inventors: 彭小贝; 赵双平
Original assignee: Xiangya Hospital of Central South University
Current assignee: Xiangya Hospital of Central South University
Priority date: 2020-04-09
Filing date: 2020-04-09
Publication date: 2020-08-11

Abstract

The invention relates to the field of medical equipment, and discloses a double-vein kettle external circulation system capable of automatically adjusting therapeutic dose. The method comprises the following steps: the device comprises a first venous pot and a second venous pot, wherein a pipeline clamp is arranged on the side wall of the venous pot through an input pipeline, two liquid supplementing ports are arranged at the upper part of the venous pot, replacement liquid can be fed from the liquid supplementing ports, a sampling port is arranged on a pipeline at the back of the venous pot, a one-way safety control valve device is arranged behind the sampling port, the device is used for inputting the weight of a patient before treatment starts and measuring the HCT value in blood and the target treatment dose before the machine is started through an infrared automatic hematocrit online measuring system, the HCT value in the blood at the input end is measured through the infrared automatic hematocrit online measuring system after the treatment starts, and the HCT value is automatically transmitted to a machine control system to calculate the current actual treatment dose and the actual filtration fraction.

Description

Double-vein kettle external circulation system capable of automatically adjusting treatment dosage

Technical Field

The invention relates to the field of medical instruments, in particular to a double-vein kettle external circulation system capable of automatically adjusting treatment dosage.

Background

Continuous Renal Replacement Therapy (CRRT), also known as Continuous Blood Purification (CBP), is a generic term for all blood purification therapies that perform solute exchange and water removal by diffusion and/or convection at slow blood and/or dialysate flow rates. The principle is to imitate the filtration principle of glomeruli, and the solute can be removed by two ways, namely convection and dispersion. The extracorporeal circulation of CRRT consists of circulating pipeline and filter, and arterial blood or venous blood is led via the circulating pipeline into semipermeable membrane filter with excellent permeability, so that the water content in plasma and the solute dissolved in the plasma are eliminated in dispersive and/or convective mode, i.e. the water content and solute are eliminated via the concentration gradient and/or pressure gradient across the semipermeable membrane. Substances smaller than the pores of the filter membrane are filtered out (including the substances needed by the body and the unwanted substances) and meanwhile, the substances needed by the body are delivered into the body in the form of replacement fluid so as to maintain the internal environment stable. The treatment range of CRRT is expanded from simply improving the treatment effect of severe ARF to first aid treatment of various clinically common critical cases (severe trauma, infection, burn, severe pancreatitis, SIRS, MODS, etc.), and is one of the most commonly used blood purification techniques in critical care rescue. Therapeutic doses are an objective index of CRRT solute clearance effectiveness. However, in clinical practice, the ratio of the actual therapeutic dose of CRRT to the preset value and the relevant factors are not clear, and in practice, CRRT often does not reach the preset therapeutic dose for various reasons. Dysfunction at any part of the extracorporeal circulation of CRRT may cause the function failure of the whole extracorporeal circulation, and the shortened life span is one of the important factors affecting the achievement of CRRT therapeutic dose.

In the prior art, the HCT value before the patient is put on the machine is usually input in advance in the current design of the continuous blood purification machine before treatment, the calculated FF is only a reference value, the result is often inaccurate, the HCT value after an actual filter is obviously higher than that before the filter, the risk of blood coagulation of the filter and a venous kettle is increased due to the overhigh HCT value, and the actual value cannot be measured in the prior art and can only be estimated through a calculation formula. The sampling port at the vein end of the conventional blood purification pipeline is arranged in front of the venous pot behind the filter, and when citric acid is used for anticoagulation, the blood sample in the sampling port behind the filter is collected to monitor the concentration of serum calcium ions so as to evaluate the coagulation condition of the filter; the anticoagulation effectiveness of the venous pot could not be monitored. The most common sites of coagulation in clinical treatment today are filters and venous kettles. The venous pot in the pipeline has the characteristics of a filter screen structure, a blood-air interface exists in the treatment process, and blood flowing through the filter is concentrated and the HCT value in the blood is increased due to the ultrafiltration effect, so that particularly when the calcium ion concentration in the blood of the venous pot is higher than that of the filter in the treatment process of using calcium-containing replacement liquid, blood clots are more easily generated to cause the coagulation of the venous pot. Once the venous kettle coagulates, treatment cannot continue. Most of continuous blood purification devices used in the current market are provided with four pumps, namely a blood pump, a front dilution replacement liquid pump, a rear dilution replacement liquid pump and a waste liquid pump. The key to achieving therapeutic doses is the success of the entire continuous blood purification treatment. Usually, the machine sets the pre-and post-dilution replacement fluid rate and the dehydration rate, and the machine calculates the therapeutic dose at these rates. Achievement of therapeutic dose is affected by factors such as filtration fraction and unscheduled outages such as changing fluid bags, handling alarms, surgery or examination. Too high a filtration fraction increases the risk of clotting in the filter and venous pot, resulting in unscheduled shutdowns, affecting the achievement of therapeutic doses.

Disclosure of Invention

In order to solve the technical problems that in the prior art, a venous pot is easy to coagulate blood and cannot be replaced and the actual treatment dosage in the treatment process cannot be dynamically evaluated, the invention provides a double-venous pot external circulation system capable of automatically adjusting the treatment dosage, which is realized by the following technical scheme:

a double-vein kettle external circulation system capable of automatically adjusting therapeutic dose comprises an external circulation device and a control device;

the extracorporeal circulation apparatus includes: the lower ends of the first venous kettle and the second venous kettle are both of filter screen structures, two fluid infusion ports are respectively arranged at the upper ends of the first venous kettle and the second venous kettle, a second replacement fluid bag is connected with one of the fluid infusion ports through a pipeline, a peristaltic pump is arranged on the connecting pipeline to feed replacement fluid into the first venous kettle or the second venous kettle, the side walls of the first venous kettle and the second venous kettle are respectively communicated with an input pipeline through two pipelines, pipeline clamps are respectively arranged on the two pipelines, the pipelines of the first venous kettle and the second venous kettle behind the pipeline clamps are jointly connected into the input pipeline, the input pipeline is provided with a pinch valve near the pipeline clamps to control the blood flow direction, the rear pipelines of the first venous kettle and the second venous kettle are respectively provided with a sampling port, and a one-way safety control valve is respectively arranged behind the sampling ports, the pipeline of the first venous pot and the pipeline of the second venous pot behind the one-way safety control valve are jointly connected to the output pipeline, and a bubble detector and a venous clamp are sequentially arranged on the output pipeline close to the one-way safety control valve;

the control device comprises a software control system and an infrared automatic hematocrit online measuring system, wherein the infrared automatic hematocrit online measuring system is arranged on an input pipeline close to an input inlet and is used for inputting the weight of a patient before treatment and measuring the HCT value and the target treatment dose in blood before loading, a machine measures the HCT value in the blood at the input end through the infrared automatic hematocrit online measuring system after treatment starts, and the HCT value and the target treatment dose are automatically transmitted to the machine control system to calculate the current actual treatment dose and the actual filtration fraction;

the software control system comprises: comprises therapeutic dose calculation and setting software and filtration fraction calculation software, and the liquid flow at each position is obtained by setting parameters of a peristaltic pump.

Further, input pipeline is being kept away from pinch valve department and is being equipped with sample connection and filter in proper order, the filter is close to the upper end position and passes through the pipeline intercommunication with the dislysate bag and be equipped with the peristaltic pump on the pipeline, the filter is close to the lower extreme position and passes through the waste liquid pipe with the waste liquid bag and be connected and be equipped with peristaltic pump and sample connection on the waste liquid pipe.

Furthermore, the input pipeline is communicated with the anticoagulant bag through a pipeline after being close to the infrared automatic hematocrit on-line measuring system, a peristaltic pump is arranged on the pipeline, and an anticoagulant fluid infusion port is arranged on the pipeline and close to the input pipeline.

Further, the input pipeline is connected with the arterial pot between the automatic red blood cell specific volume on-line measuring system of infrared ray and the filter, the arterial pot upper end is equipped with two fluid infusion ports, be equipped with sampling port and peristaltic pump in proper order between the automatic red blood cell specific volume on-line measuring system of infrared ray and arterial pot, the arterial pot communicates with filter, first replacement liquid bag respectively through two fluid infusion ports, and is equipped with the peristaltic pump on arterial pot and first replacement liquid bag intercommunication pipeline.

Furthermore, the output pipeline is communicated with the calcium supplement bag through a pipeline at a position close to the output port, a peristaltic pump is arranged on the pipeline, and a calcium supplement liquid port is arranged at a position close to the connection position of the pipeline and the output pipeline.

Compared with the prior art, the invention has the beneficial effects that:

(1) the automatic Hematocrit (HCT) on-line measuring system and the treatment dosage feedback regulation control system are positioned at the front end of the input pipeline, before the treatment is started, the weight of a patient and the HCT value in blood measured before the machine are input into a machine software control system, a preset target treatment dose (ml/Kg/min) and a filtration fraction upper limit are required, after the treatment is started, the HCT value in the blood is measured by the input end measured by an infrared automatic Hematocrit (HCT) on-line measuring system and is automatically transmitted to a machine control system, the speed of the peristaltic pump connected with the first replacement fluid bag and the second replacement fluid bag is fed back and adjusted on the premise of not exceeding the upper limit value of the filtration fraction without manual calculation, the filter performance and clotting status can be evaluated by matching the optimal infusion rate of total volume of replacement fluid and the pre-and post-dispense ratio. The control device overcomes the defect that the original machine cannot dynamically evaluate the actual treatment dosage in the treatment process, avoids unnecessary waste of replacement liquid and reduces the medical cost.

(2) The double venous pot design can be suitable for various blood purification treatment modes without calcium and containing calcium replacement liquid, and each venous pot forms a liquid-gas plane instead of a blood-gas plane, so that blood coagulation of the venous pot is avoided. And can switch to the second venous kettle when first venous kettle takes place the blood coagulation and continue the treatment, avoid increasing treatment risk and patient's expense, increase medical personnel work load because venous kettle blood coagulation leads to the change of whole extracorporeal circulation pipeline.

(3) The sampling port is arranged behind the venous pot, and a blood sample can be collected through the sampling port, so that the calcium ion concentration of the blood in the venous pot can be monitored, and the anticoagulation effectiveness of the venous pot can be evaluated.

(4) The venous pot has the advantages of blood and liquid feeding ports: the blood feeding port is arranged on the side wall, and the liquid feeding port is arranged on the upper part of the venous pot to form a liquid plane, so that the plane of contact between blood and air can be reduced, and the risk of generating thrombus is avoided.

(5) The software has the advantages that: the software control system is characterized in that the standard target treatment dosage is preset, the actual hematocrit is automatically calculated by the online measurement system, the current actual Filtration Fraction (FF) and the actual treatment dosage are calculated, the infusion speed of the replacement fluid is adjusted to match the optimal front-back dilution ratio on the premise of guaranteeing the adjustment of the upper limit value of the safe filtration fraction target (set by software) according to the actual difference between the current actual Filtration Fraction (FF) and the actual treatment dosage, the waste of the replacement fluid can be reduced on the premise of guaranteeing the achievement of the target treatment dosage and the reduction of the blood coagulation chance of an extracorporeal circuit, and the medical cost is reduced.

Drawings

Fig. 1 is a schematic structural diagram of an embodiment of the present invention.

Wherein, the specific reference numbers are: an input pipeline-1, an infrared measurement system-2, an anticoagulant fluid infusion port-3, an input port-4, a peristaltic pump-5, an arterial pot-6, a filter-7, a dialysate bag-8, a sampling port-9, a waste liquid pipe-10, a waste liquid bag-11, an output port-12, a pinch valve-13, a pipeline clamp-14, a first venous pot-15, a fluid infusion port-16, a one-way safety control valve-17, a second venous pot-18, a bubble detector-19, a venous clamp-20, a first replacement liquid bag-21, a second replacement liquid bag-22, an anticoagulant bag-23, a calcium supplement bag-24, a calcium supplement fluid infusion port-25 and an output pipeline-26.

Detailed Description

To further illustrate the technical solution of the present invention, the following detailed description will be made with reference to the accompanying drawings and specific embodiments:

example 1

As shown in figure 1, the external circulation system of the double-vein kettle capable of automatically adjusting the therapeutic dose comprises an external circulation device and a control device;

the extracorporeal circulation apparatus includes: a first vein pot 15 and a second vein pot 18, the lower ends of the first vein pot 15 and the second vein pot 18 are both of filter screen structure, the upper ends of the first vein pot 15 and the second vein pot 18 are respectively provided with two fluid infusion ports 16, a second replacement fluid bag 22 is connected with one of the fluid infusion ports 16 through a pipeline, a peristaltic pump 5 is arranged on the connecting pipeline for feeding replacement fluid into the first vein pot 15 or the second vein pot 18, the side walls of the first vein pot 15 and the second vein pot 18 are respectively communicated with an input pipeline 1 through two pipelines, the two pipelines are respectively provided with a pipeline clamp 14, the pipeline behind the pipeline clamp 14 of the first vein pot 15 and the second vein pot 18 is commonly connected into the input pipeline 1, the input pipeline 1 is provided with a clamp 13 near the pipeline clamp 14 for controlling the blood flow direction, the rear pipelines of the first vein pot 15 and the second vein pot 18 are respectively provided with a sampling port 9, the sampling ports 9 are used for collecting blood, therefore, the calcium ion concentration of the venous pot blood is monitored, and the anticoagulation effectiveness of the venous pot is evaluated. A one-way safety control valve 17 is respectively arranged behind the sampling port 9, the pipelines of the first venous pot 15 and the second venous pot 18 behind the one-way safety control valve 17 are jointly connected to an output pipeline 26, and a bubble detector 19 and a venous clamp 20 are sequentially arranged on the output pipeline 26 close to the one-way safety control valve 17;

the control device comprises a software control system and an infrared automatic hematocrit online measuring system 2, the infrared automatic hematocrit online measuring system 2 is arranged at the position, close to the input port 4, of the input pipeline 1 and used for inputting the weight of a patient before treatment and measuring the HCT value and the target treatment dose in blood before loading, and after treatment, the machine measures the HCT value in the blood at the input end through the infrared automatic hematocrit online measuring system 2 and automatically transmits the HCT value to the machine control system to calculate the current actual treatment dose and the actual filtration fraction; the on-line measuring system of the automatic red blood cell specific volume (HCT) through infrared rays is positioned at the front end of the connecting pipe at the arterial end. Before the treatment is started, the weight of the patient is input into a machine software control system, and the HCT value in blood and the target treatment dose (ml/Kg/min) are measured before the machine is started. After treatment begins, the machine measures the HCT value in blood at the input end through an infrared automatic Hematocrit (HCT) online measuring system, and automatically transmits the HCT value to a machine control system to calculate the current actual treatment dosage and the actual Filtration Fraction (FF).

The software control system comprises: comprises therapeutic dose calculation and setting software and filtration fraction calculation software, and the liquid flow at each position is obtained by setting parameters through a peristaltic pump 5. The standard target therapeutic dose (ml/Kg/min) is preset, and then the infusion speed of the replacement fluid is adjusted below the upper limit value of the safe filtration fraction target (set by software) so as to match the optimal front-back dilution ratio, so that the waste of the replacement fluid can be reduced on the premise of ensuring the target therapeutic dose and reducing the chance of blood coagulation of an extracorporeal circuit, and the medical cost is reduced.

Specifically, the input pipeline 1 is sequentially provided with a sampling port 9 and a filter 7 at a position far away from the pinch valve 13, the position of the filter 7 close to the upper end is communicated with the dialysate bag 8 through a pipeline and is provided with a peristaltic pump 5, the position of the filter 7 close to the lower end is connected with the waste liquid bag 11 through a waste liquid pipe 10, and the waste liquid pipe 10 is provided with the peristaltic pump 5 and the sampling port 9.

Specifically, the input pipeline 1 is communicated with an anticoagulant bag 23 through a pipeline after being close to the infrared automatic hematocrit online measuring system 2, a peristaltic pump 5 is arranged on the pipeline, and an anticoagulant fluid infusion port 3 is arranged on the pipeline and close to the input pipeline 1.

Specifically, the input pipeline 1 is connected with an arterial pot 6 between the infrared automatic hematocrit online measuring system 2 and the filter 7, two fluid infusion ports 16 are arranged at the upper end of the arterial pot 6, a sampling port 9 and a peristaltic pump 5 are sequentially arranged between the infrared automatic hematocrit online measuring system 2 and the arterial pot 6, the arterial pot 6 is respectively communicated with the filter 7 and the first replacement fluid bag 21 through the two fluid infusion ports 16, and the peristaltic pump 5 is arranged on a pipeline for communicating the arterial pot 6 with the first replacement fluid bag 21.

Specifically, the output pipeline 26 is communicated with the calcium supplement bag 24 through a pipeline at a position close to the output port 12, the peristaltic pump 5 is arranged on the pipeline, and the pipeline is provided with a calcium supplement liquid port 25 at a position close to the connection with the output pipeline 26.

The working principle is as follows:

an input pipeline 1 is connected with the arterial end of a blood purification catheter through an input port 4, the blood of a patient is led out to an arterial pot 6 by the drive of a peristaltic pump 5, the HCT value in the blood is measured by an input end through an infrared automatic hematocrit online measuring system 2, the blood is automatically transmitted to a machine control system to calculate the current actual treatment dosage and the actual Filtration Fraction (FF), an anticoagulant bag 23 is driven by the peristaltic pump 5 on the pipeline to input anticoagulant from an anticoagulant fluid infusion port 3 to the input pipeline 1, pre-dilution replacement fluid in a first replacement fluid bag 21 enters an arterial pot 6 through a fluid infusion port 16 under the drive of the peristaltic pump 5 on the pipeline to be mixed with the blood, the mixed blood enters a filter 7 from bottom to top, a pinch valve 13 controls the blood flow direction, and controls the blood to flow into two venous pots by opening a pipeline clamp 14, only one venous pot needs to be connected, if the pipeline clamp 14 of a second venous pot 18 is opened, the line clamp 14 of the first venous pot 15 is closed, and blood flows into the second venous pot 18, the blood feeding port is arranged on the side wall, the liquid feeding port is arranged on the upper part of the venous pot, and a liquid plane is formed, so that the plane of contact between the blood and air can be reduced, and the risk of thrombus is avoided. The pipe of the second replacement fluid bag 22 is connected with the second venous pot 18 through any one of the fluid infusion ports 16 on the second venous pot 18, at this time, the post-diluted replacement fluid in the second replacement fluid bag 22 flows into the second venous pot 18 through the fluid infusion port 16 on the second venous pot 18 under the drive of the peristaltic pump 5 on the pipe thereof, and is mixed with the blood, when the second venous pot 18 is coagulated, the one-way safety control valve 17 and the pipe clamp 14 on the pipe thereof can be closed, the one-way safety control valve 17 can not be opened again after being closed to prevent the thrombus from entering the pipe, the treatment safety is ensured, the blood flow direction is controlled by the pinch valve 13, at the same time, the pipe clamp 14 and the one-way safety control valve 17 on the pipe of the first venous pot 15 are opened, the blood flow enters the first venous pot 15 from the side pipe, the fluid infusion port 16 on the second venous pot 18 is simultaneously disconnected, and is connected to any one of the fluid infusion ports 16 on the first venous pot 15, and the mixed blood sequentially passes through the one, The bubble detector 19 and the vein clip 20 are connected with the vein end of the blood purification catheter from the output pipeline 26 through the output port 12 and input into the body of a patient, meanwhile, the calcium agent in the calcium agent bag 24 is driven by the peristaltic pump 5 on the pipeline and enters the output pipeline 26 through the calcium agent liquid supplementing port 25, the dialysate in the dialysate bag 8 enters the filter 7 from top to bottom under the drive of the peristaltic pump 5 on the pipeline, the waste liquid enters the waste liquid bag 11 under the drive of the pipeline peristaltic pump 5 where the waste liquid pipe 10 is located, the sampling port 9 on the waste liquid pipe 10 is used for collecting waste liquid samples in the treatment process so as to track the waste liquid condition at any time, the sampling ports 9 are respectively arranged on the rear pipelines of the first vein pot 15 and the second vein pot 18 and used for collecting blood, thereby monitoring the calcium ion concentration of the blood in the vein pot and evaluating the anticoagulation effectiveness of the vein pot.

Claims

1. A double-vein kettle external circulation system capable of automatically adjusting therapeutic dose is characterized by comprising an external circulation device and a control device;

the extracorporeal circulation apparatus includes: the venous transfusion device comprises a first venous pot (15) and a second venous pot (18), the lower ends of the first venous pot (15) and the second venous pot (18) are both of filter screen structures, the upper ends of the first venous pot (15) and the second venous pot (18) are respectively provided with two fluid infusion ports (16), a second replacement fluid bag (22) is connected with one of the fluid infusion ports (16) through a pipeline, a peristaltic pump (5) is arranged on the connecting pipeline, replacement fluid is fed into the first venous pot (15) or the second venous pot (18), the side walls of the first venous pot (15) and the second venous pot (18) are respectively communicated with an input pipeline (1) through two pipelines, pipeline clamps (14) are respectively arranged on the two pipelines, the first venous pot (15) and the second venous pot (18) are jointly connected into the input pipeline (1) after the pipeline clamps (14), and a pinch valve (13) is arranged at the position close to the pipeline clamps (14) of the input pipeline (1) to control the blood flow direction, the rear pipelines of the first venous pot (15) and the second venous pot (18) are respectively provided with a sampling port (9), a one-way safety control valve (17) is respectively arranged behind the sampling ports (9), the pipelines of the first venous pot (15) and the second venous pot (18) behind the one-way safety control valve (17) are jointly connected to an output pipeline (26), and a bubble detector (19) and a venous clamp (20) are sequentially arranged on the output pipeline (26) close to the one-way safety control valve (17);

the control device comprises a software control system and an infrared automatic hematocrit online measuring system (2), wherein the infrared automatic hematocrit online measuring system (2) is arranged at a position, close to an input port (4), of an input pipeline (1) and used for inputting the weight of a patient before treatment and measuring the HCT value and the target treatment dose in blood before loading, a machine measures the HCT value in the blood at the input end through the infrared automatic hematocrit online measuring system (2) after treatment starts, and the HCT value and the target treatment dose are automatically transmitted to the machine control system to calculate the current actual treatment dose and the actual filtration fraction;

the software control system comprises: comprises therapeutic dose calculation and setting software and filtration fraction calculation software, and the liquid flow at each part is obtained by setting parameters through a peristaltic pump (5).

2. The circulation system according to claim 1, characterized in that the input pipeline (1) is provided with a sampling port (9) and a filter (7) in sequence at a position far away from the pinch valve (13), the filter (7) is communicated with the dialysate bag (8) through a pipeline at a position close to the upper end and is provided with a peristaltic pump (5) on the pipeline, the filter (7) is connected with the waste liquid bag (11) through a waste liquid pipe (10) at a position close to the lower end and is provided with the peristaltic pump (5) and the sampling port (9) on the waste liquid pipe (10).

3. A cycle according to claim 2, wherein the inlet line (1) is connected to the anticoagulant bag (23) by a line immediately after the infrared automatic hematocrit measurement system (2), on which a peristaltic pump (5) is provided, and an anticoagulant infusion port (3) is provided on the line close to the inlet line (1).

4. The circulation system according to claim 3, wherein the input pipeline (1) is connected with an arterial pot (6) between the infrared automatic hematocrit online measurement system (2) and the filter (7), two fluid infusion ports (16) are arranged at the upper end of the arterial pot (6), a sampling port (9) and a peristaltic pump (5) are sequentially arranged between the infrared automatic hematocrit online measurement system (2) and the arterial pot (6), the arterial pot (6) is respectively communicated with the filter (7) and the first replacement fluid bag (21) through the two fluid infusion ports (16), and the peristaltic pump (5) is arranged on a communication pipeline between the arterial pot (6) and the first replacement fluid bag (21).

5. A circulation system according to claim 4, characterized in that the outlet line (26) is connected to the bag (24) near the outlet (12) by a line provided with a peristaltic pump (5) and a port (25) for replenishing the calcium preparation near the connection to the outlet line (26).