JP2001276216A - Blood dialysis filter - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a blood dialysis filter which enables the continuation of a blood purifying operation by further blocking the progress of any drop in blood pressure that may occur during the dialytic filtering of blood. SOLUTION: A dialyzer 2 is provided with a controller 30 to adjust the difference between the amount of a dialysis liquid delivered as replacing liquid in a replacing liquid pump 24 installed on a replacing liquid supply passage 22 and the amount of the dialysis liquid supplied to a dialysis supply passage 10 with a double plunger pump 14 and the controller 30 works to change the ratio between the blood dialyzing action and the blood filtering action in the dialyzer 2.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a hemodiafiltration apparatus, and more particularly to a blood pressure reduction (drop) of a patient during a purification operation including dialysis and filtration of blood without stopping the purification operation. The present invention relates to a hemodiafiltration device which can be dealt with dynamically.

[0002]

2. Description of the Related Art A variety of blood purification methods for purifying blood taken out of a patient's body and returning the blood to the body again have been studied for the treatment of patients with renal failure and maintenance of life. In practice, a dialyzer (dialyzer) is generally used as a purifier in which a semi-permeable membrane such as a hollow fiber-like cellulose membrane, cupraammonium rayon membrane, or polyacrylonitrile membrane is housed in a casing. For example, in the case of hemodialysis (HD), the blood is brought into contact with the dialysate through the semipermeable membrane of such a dialyzer,
Urea, uric acid and the like accumulated in the blood of the patient are removed by the movement of the substance by diffusion. In the case of hemofiltration (HF), a filtration operation through a membrane hole existing in the semipermeable membrane is performed. In addition, in the case of the hemodiafiltration (HDF) method, such blood dialysis and hemofiltration are simultaneously used to purify blood. It is done to do.

[0003] In such a blood purification operation,
As a device for performing the hemodiafiltration method, for example, as disclosed in JP-B-56-35496, a blood purifier having a semi-permeable membrane in a casing is used.
By controlling the amount of dialysate supplied to such a blood purifier and the amount of dialysate discharged therefrom while allowing blood to contact the dialysate through the semipermeable membrane, the blood In the purifier, hemodialysis and hemofiltration can be performed at the same time, and a dialysate circuit for flowing dialysate to the blood purifier and a blood circuit for flowing blood to the blood purifier are provided. A certain amount of dialysate
An apparatus is disclosed that is configured to compensate for blood filtration in a blood purifier so that it can be supplied as a replacement fluid or replacement replenisher.

[0004] By the way, in such a conventional blood purification method, during the blood purification operation, the patient may have a decrease in blood pressure (drop), which necessitates the stop of the blood purification operation. There was a problem. Various factors have been conventionally examined for the cause of such a decrease in blood pressure. However, the blood pressure is stable in the case of a blood filtration operation, for example, depending on the blood purification method. On the other hand, it is known that in the case of a hemodialysis operation or a hemodiafiltration operation, a decrease in blood pressure is caused.

[0005] In particular, in recent years, since the age of patients undergoing a blood purification operation has been further increased, a decrease in blood pressure during the blood purification operation is likely to be caused. If a significant decrease in blood pressure is predicted or actually occurs,
While continuing such a blood purification operation, appropriate measures are immediately taken to prevent the decrease in blood pressure or stabilize the blood pressure,
Furthermore, it is desired to recover blood pressure.

[0006]

The present invention has been made in view of such circumstances, and an object of the present invention is to solve the problem even if a decrease in blood pressure is caused during diafiltration of blood. It is an object of the present invention to provide a hemodiafiltration apparatus capable of preventing the further progress and stabilizing the blood pressure at least, so that the blood purification operation can be continued as it is.

[0007]

According to the present invention, a semipermeable membrane is housed in a casing, and blood is brought into contact with a dialysate through the semipermeable membrane to perform dialysis. A blood purifier configured to purify blood by filtration, a blood flow path for allowing blood to flow through the blood purifier, and a dialysate supply flow path for supplying a dialysate to the blood purifier A dialysate discharge channel for discharging the dialysate from the blood purifier; a replacement fluid supply channel connecting the dialysate supply channel and the blood channel; and a replacement fluid supply channel. A replacement liquid supply mechanism comprising a replacement liquid purification means and a replacement liquid supply means, for purifying a predetermined amount of dialysate guided from the dialysate supply flow path and supplying the purified dialysate to the blood flow path as a replacement liquid; An inlet flow provided in the supply flow path and the discharge flow path for the dialysate, And an outlet flow rate in the discharge channel, and a dialysate inflow and outflow amount adjustment mechanism for adjusting the difference to be equal to the amount of water removed from the body. Inlet flow rate of the dialysate to the dialysate supply flow path in the volume adjustment mechanism,
A controller is provided for adjusting the difference between the replacement liquid supply means provided on the replacement liquid supply flow path and the discharge amount of dialysate as a replacement liquid, and the blood dialysis effect in the blood purifier is provided by such a control device. The present invention provides a hemodiafiltration apparatus characterized in that the ratio between the blood diafiltration function and the blood filtration action can be changed.

That is, in the hemodiafiltration apparatus according to the present invention, the difference between the inlet flow rate of the dialysate supply flow path and the discharge rate of the replacement liquid feeding means by the dialysate inflow and outflow adjustment mechanism. When the blood pressure is reduced during the diafiltration of the blood or the blood pressure is actually reduced by the control device for adjusting the blood pressure, the inlet flow rate of the dialysate supply flow path and the discharge in the replacement liquid sending means are controlled. By reducing the difference between the blood volume and the blood dialysis effect in the blood purifier, the blood purification in the blood purifier can be performed mainly by the hemofiltration effect. It is possible to continue the blood purification operation as it is, with the aim of further suppressing, further inhibiting, and stabilizing the blood pressure, and When the pressure rises or stabilizes again, the control device enlarges the difference between the inlet flow rate of the dialysate supply flow path and the discharge amount of the replacement liquid supply means, thereby increasing the blood dialysis effect in the blood purifier. Can be increased again.

[0009] The present invention also provides a blood purifying method in which a semipermeable membrane is accommodated in a casing, blood is dialyzed by contacting the blood with a dialysate through the semipermeable membrane, and the blood is purified by filtration. A purifier, a blood flow path for allowing blood to flow through the blood purifier, a dialysate supply flow path for supplying dialysate to the blood purifier, and a dialysate for discharging dialysate from the blood purifier From the dialysate supply flow path by the replacement liquid supply means and the replacement liquid purification means provided on the replacement liquid supply flow path connecting the dialysate supply flow path and the blood flow path. A replacement fluid supply mechanism for purifying a predetermined amount of dialysate and supplying the replacement fluid to the blood flow channel, and a replacement fluid supply mechanism provided on the supply flow channel and the discharge flow channel of the dialysate; The inlet flow rate and the outlet flow rate in the discharge channel are simultaneously adjusted, and the difference is determined in the body. A hemodiafiltration apparatus including a dialysate inflow and outflow amount adjustment mechanism that is equal to the water removal amount of the dialysate. A control device for adjusting a difference between a discharge amount of a dialysate as a replacement fluid in the replacement fluid supply means provided on the replacement fluid supply flow path, and an inlet flow rate of the dialysate by the control device. The blood dialysis effect in the blood purifier is reduced by changing the discharge amount so as to approach the discharge amount in the replacement liquid sending means, so that the blood filtration operation can be mainly performed in the blood purifier. A feature of the present invention is also a hemodiafiltration apparatus that is characterized.

According to one preferred embodiment of the hemodiafiltration apparatus according to the present invention as described above, the difference between the inlet flow rate and the discharge rate is set to 0 to 20 by the control device.
It can be controlled so as to be reduced to 0 mL / min, whereby the blood purification operation in the blood purifier approaches the blood filtration operation, thereby effectively suppressing or preventing a decrease in blood pressure. Can stabilize blood pressure.

According to another preferred embodiment of the present invention, the control device controls the inlet flow rate of the dialysate into the dialysate supply flow path and the discharge rate of the dialysate as the replacement liquid into the blood flow path. Automatically or based on information about the patient's blood pressure and / or symptoms, or apply such control to the accumulated information about the patient's blood pressure and / or symptoms during previous dialysis. Based on this, it is configured to have a mechanism for performing the operation in a time-series manner and automatically, whereby an appropriate blood purification operation according to each patient can be advantageously realized.

According to still another preferred aspect of the present invention, the dialysate inflow and outflow adjustment mechanism includes a dialysate flow rate in the dialysate supply flow path and a dialysate flow rate in the dialysate discharge flow path. A dialysate in the dialysate supply channel, or a dialysate feed pump means for sending dialysate to the dialysate supply channel, and a dialysate in the dialysate supply channel. The flow rate of the dialysate in the dialysate discharge flow path and the flow rate of the dialysate in the dialysate discharge flow path are equalized, and at least the dialysate is supplied to the dialysate supply flow path. , The dialysate solution pump means and the flow rate equalization and solution pump mechanism
The amount of dialysate sent to the dialysate supply channel is controlled by the control device according to the present invention.

Furthermore, in the present invention, preferably, a plurality of the blood purifiers are arranged for individual hemodiafiltration operations of a plurality of patients, and the plurality of the blood purifiers are arranged with respect to the plurality of blood purifiers. The blood flow path and the dialysate supply flow path,
A dialysate discharge flow path is provided, and a replacement liquid supply flow path connecting the blood flow path and the dialysate supply flow path in each blood purifier is provided for each blood purifier. The replacement liquid supply flow path is connected to each blood flow path via one replacement liquid purification means, and a dialysate as a replacement liquid guided to each blood flow path is respectively processed by the one replacement liquid purification means. A configuration adapted to be purified is advantageously employed.

With this configuration, in the hemodiafiltration operation for a plurality of patients, only one replacement liquid purifying means is required to be provided in each of the replacement liquid supply passages, and the cost of the blood purification operation as a whole can be reduced. It can be done objectively.

[0015] In the apparatus for individual hemodiafiltration operation of a plurality of patients, desirably, each of the plurality of replacement liquid supply flow paths is provided in a flow path upstream of the replacement liquid purification means. In order that the flow rate of the replacement liquid and the flow rate of the replacement liquid in the downstream channel are the same, a flow rate equalizing / liquid sending pump means for sending the blood to the blood flow path is provided as the replacement liquid sending means, respectively. Configuration will be advantageously employed.

[0016]

BEST MODE FOR CARRYING OUT THE INVENTION Hereinafter, in order to clarify the structure of the present invention more specifically, a typical example of a hemodiafiltration apparatus according to the present invention will be described in detail with reference to the drawings. And

FIG. 1 is a system diagram showing an example of a hemodiafiltration apparatus according to the present invention.
Is a dialyzer (dialyzer) as a blood purifier, has a structure similar to that of the related art, and has a hollow fiber-shaped semipermeable membrane housed inside a cylindrical box. And
One end of the dialyzer 2 in the axial direction is connected to a blood supply flow path 4 for guiding blood from the patient's body, and the other end of the dialyzer 2 is purified (diafiltration). A blood return channel 6 for returning the collected blood to the body of the patient is connected. Thus, here, a blood flow path is configured by the blood supply flow path 4 and the blood return flow path 6, while the blood pump 8 is provided on the blood supply flow path 4,
The operation of the blood pump 8 allows the blood flow path and the dialyzer 2 to be operated.
Blood can be circulated inside.

The dialyzer 2 is connected to a dialysate supply channel 10 for guiding the dialysate from its storage tank (not shown) into the dialyzer 2. A dialysate discharge channel 12 is provided for discharging the dialysate that has been brought into contact with the blood through the permeable membrane, and for discharging the filtered substance (effluent) filtered from the blood side through the semipermeable membrane. . Here, the dialysate supply flow path 10
The dialysate flow path is constituted by the dialysate discharge flow path 12.

A double plunger pump 14 is provided on the dialysate supply flow path 10 and the dialysate discharge flow path 12.
4 is reciprocated by a driving device 16 as indicated by an arrow in the figure, whereby the flow rate of the dialysate supplied to the dialysate supply flow path 10 and the dialysis discharged through the dialysate discharge flow path 12 The liquid flow rate is configured to be the same. That is, here, the double plunger pump 14 and the driving device 16 constitute a flow rate equalizing / liquid feeding pump mechanism, and the suction / discharge amount of one plunger pump of the double plunger pump and the other plunger pump. The suction / discharge amount of each section is configured to be the same. Although not shown, a check valve is provided on each of the suction side and the discharge side of the plunger pump portion arranged on the dialysate supply flow path 10 of the double plunger pump 14, and such a plunger pump is provided. The dialysate is supplied to the dialyzer 2 side by the pump operation of the section, and the suction side and the discharge side of the plunger pump section arranged on the dialysate discharge flow path 12 of the double plunger pump 14. Each is provided with a check valve, and the dialysate discharged from the dialyzer 2 is allowed to flow out of the system by the pump operation of the plunger pump section.

The double plunger pump 14
A branch flow path 18 is connected to the dialysate discharge flow path 12 between the dialysis device 2 and the dialyzer 2, and a water removal pump 20 is provided on the branch flow path 18. By driving, a predetermined amount of water can be removed from the patient's body during hemodiafiltration by the dialyzer 2. Therefore, in this case, the mechanism for adjusting the inflow and outflow of dialysate in the present invention is constituted by the water removal pump 20 together with the double plunger pump 14 and the driving device 16 described above.

Further, a replacement fluid supply passage 22 is provided so as to connect the dialysate supply passage 10 and the blood return passage 6 between the double plunger pump 14 and the dialyzer 2. By the pump operation of the replacement liquid pump 24 as a replacement liquid sending means disposed on the liquid supply flow path 22, the dialysate supply flow path 10 passes through the replacement liquid filter 26,
The dialysate is supplied to the blood return flow path 6 as a replacement liquid, and is mixed with the blood returned to the body. Accordingly, the blood filtration amount in the dialyzer 2 is increased by the discharge amount of the replacement liquid pump 24. The replacement fluid filter 26 functions as a replacement fluid purifying means for purifying the dialysate supplied to the blood return flow path 6 as the replacement fluid, and, like the dialyzer 2, a film-like or tube-like replacement fluid. Is composed of a container containing a semi-permeable membrane in the form of a hollow fiber or a hollow fiber, by allowing the dialysate to pass through such a semi-permeable membrane,
The purification can be performed.

The operation of the replacement liquid pump 24 disposed on the replacement liquid supply flow path 22 and the operation of the driving device 16 for driving the double plunger pump 14 are controlled by the control device 30 and are thus controlled. Replacement liquid pump 24
The difference between the discharge amount of the dialysate as the replacement fluid in the above and the flow rate of the dialysate into the dialysate supply flow path 10 in the double plunger pump 14 can be adjusted. The operation of the driving device 16 is controlled by the device 30 in consideration of the discharge amount of the water removal pump 20, and the supply amount of the dialysate from one plunger pump section of the double plunger pump 14 to the dialysate supply passage 10. By reducing the (inlet flow rate), the supply amount of the dialysate is changed so as to approach the discharge amount of the replacement liquid pump 24, and the dialysate supply amount to the dialyzer 2 is reduced. , The hemodialysis effect of the dialyzer 2 can be maintained as it is.

Therefore, in a normal blood purification operation for dialysis and filtration of blood using a hemodiafiltration apparatus having such a structure, the blood pump 8 is applied to the dialyzer 2 by the blood pump 8 as in the conventional case. A predetermined amount of blood is circulated through a blood flow path composed of the supply flow path 4 and the blood return flow path 6, while the suction / discharge operation of one plunger pump section of the double plunger pump 14 driven by the driving device 16. (Pump operation), the dialysate supply channel 1
With respect to 0, a predetermined amount (for example, about 400 to 500 mL / min) of the dialysate is supplied, and the same amount of the dialysate (including the filtration substance) as the dialysate supply is supplied to the double plunger pump. By the pump operation of the other plunger pump section 14, the dialysate is discharged out of the system through the dialysate discharge channel 12, and the dialysate discharge channel 12 is provided on the branch channel 18. By the pump operation of the water removal pump 20, an amount of dialysate (for example, about 10 mL / min) equal to the desired amount of water removed from the body is discharged out of the system.

The dialysate guided from the dialysate supply channel 10 through the dialysate supply channel 22 that connects the dialysate supply channel 10 and the blood return channel 6 is used for pump operation of the dialysate pump 24. And a predetermined rate (for example, about 60 mL / min)
In the above, the dialyser 2 is supplied from the double plunger pump 14 to the dialyser 2 through the dialysate supply channel 10 from the place where it is supplied to the blood return channel 6. A dialysate having a reduced discharge amount is supplied, a dialysis action is performed on the blood through the semi-permeable membrane housed in the dialyzer 2, and a double plunger is passed through the dialysate discharge channel 12. In the dialyzer 2, the dialysis is performed in the dialyzer 2 because the dialysate (including the filtered substance) corresponding to the amount of the dialysate discharged by the pump 14 plus the amount of water removed by the water removal pump 20 is discharged out of the system. The volume of the discharged dialysate is larger than the volume of the fluid. Therefore, by the ultrafiltration effect through the semi-permeable membrane, the blood filtration operation is performed in parallel with the dialysis operation, thereby purifying the blood. Operation is to be allowed to proceed.

[0025] While the purification operation including the regular hemodialysis and filtration is being performed, a decrease in blood pressure (drop) of the patient is predicted for some reason.
Alternatively, when the blood pressure actually decreases, the control device 30
Accordingly, the operation of the driving device 16 is controlled, and thereby the difference between the discharge amount of the dialysate to the dialysate supply passage 10 by the double plunger pump 14 and the discharge amount of the replacement liquid pump 24 is reduced. As a result, the supply amount of the dialysate through the dialysate supply flow path 10 to the dialyzer 2 is reduced. While the hemodialysis effect via the permeable membrane is reduced, the dialysate discharge operation of the double plunger pump 14 through the dialysate discharge flow channel 12 is not zero even though the discharge amount is reduced. Therefore, the blood filtering operation is maintained as it is at least in an amount corresponding to the discharge amount of the replacement liquid pump 24, and the blood purification operation by the blood filtering operation is performed in the dialyzer 2. It's and thus be allowed to proceed mainly.

As described above, in the dialyzer 2, the blood purification operation mainly based on the hemofiltration rather than the hemodialysis is performed, so that the blood purification operation in the conventional hemofiltration method (HF) is performed. Similarly, since the blood pressure can be effectively stabilized, the blood pressure can be prevented from lowering, and the blood pressure can be expected to recover, it is not necessary to stop the blood purification operation on the patient. The operation can continue.

In order to switch from such a blood purification operation based on the diafiltration operation of blood to a blood purification operation mainly based on the blood filtration operation, the drive unit 16 of the double plunger pump 14 is controlled by the control device 30. And / or the operation control of the replacement fluid pump 24 is appropriately performed. Advantageously, the supply amount of the dialysate to the dialysate supply channel 10 by the double plunger pump 14 and the replacement fluid pump 2
The operation of the driving device 16 and / or the replacement liquid pump 24 is controlled such that the difference from the discharge amount of No. 4 is generally 0 to 200 mL / min, preferably 0 to 100 mL / min, The difference between the supply amount of the dialysate to the dialysate supply flow path 10 by the double plunger pump 14 and the discharge amount of the replacement liquid pump 24 is reduced. In this way, the difference between the dialysate supply amount from the double plunger pump 14 to the dialysate supply flow path 10 and the discharge amount of the replacement liquid pump 24 is reduced, so that the hemodialysis action in the dialyzer 2 is improved. By lowering it, it can effectively contribute to prevention or stabilization of blood pressure drop of the patient and further to blood pressure recovery.

Further, when the blood pressure recovers or rises due to the blood purifying operation mainly having the blood filtering action as described above, the operation of the driving device 16 is controlled by the control device 30 to control the double plunger. By increasing the difference between the amount of dialysate supplied from the pump 14 to the dialysate supply channel 10 and the amount of discharge of the replacement liquid pump 24, the ratio (ratio of hemodialysis to hemofiltration in the dialyzer 2) )
Can be increased.

In the control of the driving device 16 of the double plunger pump 14 by the control device 30, which can advantageously realize the blood operation according to the patient's blood pressure as described above, generally, a doctor, a nurse, etc. Is executed manually or based on a signal from a suitable detecting means (not shown) such as a blood pressure detecting mechanism.
The blood pressure of the patient during past dialysis, which is automatically performed based on information on the patient's blood pressure and / or symptoms obtained by being detected by such detection means or accumulated so far. It is desirable to perform the operation in a time-series or time-based manner and / or automatically based on information on symptoms. This makes it possible to implement a blood purification operation that precisely corresponds to each patient.

Further, in addition to the hemodiafiltration apparatus having the structure shown in FIG. 1, the present invention has a structure having a mechanism for adjusting the inflow and outflow of dialysate as shown in FIG. It is also possible to employ a hemodiafiltration device.

That is, in the example shown in FIG. 2, the inflow / outflow converters 32a and 32b are disposed on the dialysate supply flow path 10 and the dialysate discharge flow path 12, respectively. The insides of the converters 32a and 32b are partitioned into two chambers on the left and right sides by diaphragms 34a and 34b, respectively, and a supply branch flow path 36 and a discharge branch flow path that bypass the inflow / outflow converters 32a and 32b, respectively. The branch flow path 38 includes three-way valves 40a,
0b; provided to the dialysate supply channel 10 and the dialysate discharge channel 12 via 40c and 40d, respectively. Then, the dialysate supply flow path 10 and the supply branch flow path 36 are connected to one chamber (left chamber in the figure) partitioned by the diaphragms 34a, 34b of the inflow / outflow converters 32a, 32b, respectively. And the dialysate discharge flow path 12 and the discharge branch flow path 38
Diaphragm 34 of inflow / outflow converter 32a, 32b
a and 34b are connected to the other chamber (right chamber in the figure).

Further, on the dialysate supply flow path 10, liquid feed pumps 42a and 42b are provided so as to be located on the upstream side of the three-way valve 40a and on the downstream side of the three-way valve 40b, respectively. , The dialysate sent from the pump 42a is supplied to the inflow / outflow converters 32a, 32b.
While the three-way valve 40b is switched, the dialysate in one such chamber is dialyzed by the suction / discharge action of the liquid sending pump 42b. The dialysis solution is supplied to the dialysate supply flow path 10 on the side of the vessel 2. The three-way valve 40
By the switching operation of c and 40d, the inflow / outflow converter 32
The other chamber of a, 32b is alternately filled with dialysate to be drained from dialyzer 2, where:
The inflow and inflow of the dialysate by one of the liquid feed pumps 42a and 42b into and out of the other chamber are performed in the opposite direction to the suction and suction.
The dialysate to be discharged can flow out of the system through the three-way valve 40d.

In short, in such a mechanism, the dialysate is guided to one of the dialysate supply flow path 10 and the supply branch flow path 36 by the operation of the three-way valve 40a, Inflow / outflow converter 32a or 32
b, while the dialysate contained in one chamber of the other inflow / outflow converter 32b or 32a is supplied to the dialysate 2 on the dialyzer 2 side by the operation of the three-way valve 40b. In this case, the three-way valve 40
By the switching operation of c and 40d, the dialysate to be discharged from the other chamber of the inflow / outflow converter 32a or 32b in which the dialysate is introduced into one chamber is pressed by the diaphragm 34a or 34b. The inflow / outflow converter 32b or 3 in which the dialysate is guided from one chamber to the dialyzer 2 side while being discharged at
In 2a, such a dialysate is accommodated in the other chamber of the inflow / outflow converter 32b or 32a by the suction effect of the movement of the diaphragm 34b or 34a, whereby the supply of the dialysate is performed. The supply amount of the dialysate in the flow path 10 and the discharge flow rate of the dialysate in the dialysate discharge flow path 12 are equalized.

The operation of the two pumps 42a and 42b provided on the dialysate supply flow path 10 can be controlled by the control device 30. Therefore, blood purification is performed. In a patient receiving the operation, when the blood pressure drop is predicted or when the blood pressure drop actually occurs, the control device 30 controls the operation of the two liquid feeding pumps 42a and 42b, respectively. , The discharge amount of these liquid feed pumps 42a and 42b is reduced so that the discharge amount (liquid feed amount) of the liquid feed pumps 42a and 42b approaches the discharge amount of the replacement liquid pump 24. The effect is reduced so that a blood purification operation mainly including hemofiltration is performed. Note that the discharge amount of the replacement liquid pump 24 is changed in accordance with the degree of progress of the deterioration (clogging) of the semipermeable membrane in the dialyzer 2, and accordingly, the discharge amounts of the two liquid supply pumps 42a and 42b are changed. It is desirable to control the amount in response to such a change in the discharge amount of the replacement liquid pump 24.

Accordingly, here, the two inflow / outflow converters 32a and 32b, the four three-way valves 40a to 40d, the supply branch flow path 36, and the discharge branch flow path 38 are used to form the dialysate supply flow path 10. A flow rate equalizing mechanism for making the flow rate of the dialysate the same as the flow rate of the dialysate in the dialysate discharge channel 12 is configured.
At 2b, dialysate feed pump means for sending dialysate to the dialysate supply flow path 10 is configured, and further includes a flow rate equalizing mechanism and dialysate feed pump means. At 20, a mechanism for adjusting the inflow and outflow of dialysate is configured.

Further, in the present invention, an apparatus (system) having an arrangement as shown in FIG. 3 is advantageously employed so that individual hemodiafiltration operations of a plurality of patients can be simultaneously performed. Will be done.

Incidentally, in FIG. 3, a plurality of dialysers 2 are shown.
In contrast, a plurality of replacement liquid supply channels (22) connecting the respective blood return flow paths 6 and the dialysate supply flow paths 10 are connected to one replacement liquid filter 26, and the one replacement liquid filter At 26, the purified dialysate is supplied to each blood return flow path 6 as a replacement liquid. Specifically, each of the replacement liquid supply flow paths (22) is composed of an upstream replacement liquid supply flow path 22a and a downstream replacement liquid supply flow path 22b, and is dialyzed through the upstream replacement liquid supply flow path 22a. The dialysate introduced from the liquid supply flow path 10 is guided to one substitution liquid filter 26 and purified, and then supplied as a substitution liquid to the blood return flow path 6 through the downstream substitution liquid supply flow path 22b. The dialysate (replacement liquid) flow rate in these two flow paths is the same across the upstream-side replacement liquid supply flow path 22a and the downstream-side replacement liquid supply flow path 22b. In this way, the flow rate equalizing / liquid sending pump 46 for sending the liquid is
Each is provided as a replacement liquid sending means (24).

A known dialysate inflow and outflow control mechanism 44 for controlling the supply and discharge of the dialysate is provided on the dialysate supply flow path 10 and the dialysate discharge flow path 12. The adjusting mechanism 44 adjusts the dialysate discharge flow rate from the dialyzer 2 through the adjusting mechanism 44 and the dialysate supply flow rate to the dialyzer 2, and the difference between the dialysate flow rate from the body and It is set to be the amount of water removal. Such a dialysate inflow / outflow mechanism 44 is conventionally well known as a device attached to a diafiltration device. For example, a commercially available ultrafiltration controller (Toray: UFCII) Or a so-called UFR controller can be used.

The operation of the dialysate inflow and outflow amount adjusting mechanism 44 and the replacement liquid supply flow paths (22a, 22a) are performed.
b) The operation of the flow rate equalizing / liquid sending pump 46 provided above is
The difference between the amount of dialysate supplied to the dialysate supply flow path 10 by the dialysate inflow and outflow amount adjustment mechanism 44 and the discharge amount of the flow rate equalization / liquid sending pump 46 is controlled by the control device 30. Can be adjusted to approach zero, so that each dialyzer 2
By reducing the hemodialysis effect in the blood flow, so that the blood purification operation mainly by hemofiltration is allowed to proceed, thereby preventing or stabilizing the decrease in the blood pressure of the patient,
In addition, blood pressure can be recovered.

As described above, the dialysate guided through each of the replacement liquid supply flow paths (22) is purified by one replacement liquid filter 26, and can be supplied into the blood return flow path 6 as a replacement liquid. By doing so, it is possible to significantly reduce the number of replacement liquid filters 26 to be used, so that the overall cost can be advantageously reduced in the diafiltration operation for a plurality of patients. It becomes.

In the example shown in FIG. 3, a system using one replacement liquid filter 26 in the individual hemodiafiltration operation of two patients is disclosed. It goes without saying that the above individual hemodiafiltration operation of the patient can be performed using one substitution liquid filter 26, and in such a case, each The liquid supply passage (22) is provided with one replacement liquid filter 26.
, Respectively, in the same manner as in the example of FIG.

Although the typical specific examples of the hemodiafiltration apparatus according to the present invention have been described above in detail, the present invention has been described in terms of such specific examples.
It goes without saying that it is not subject to any restrictions. In addition, in addition to the specific examples described above, various changes, modifications, improvements, and the like based on the knowledge of those skilled in the art can be made to the present invention without departing from the spirit of the present invention. It should be understood.

For example, in the illustrated specific examples, the replacement fluid supply channel 22 for diverting the dialysate flowing through the dialysate supply channel 10 and supplying it as a replacement fluid is provided in the blood channel. A so-called post-dilution method, which is connected to the blood return flow path 6, is used. By connecting such a replacement liquid supply flow path 22 to the blood supply flow path 4, It is also possible to adopt a so-called pre-dilution method in which a dialysate as a replacement liquid is mixed into blood before being supplied to the dialyzer 2, and furthermore, the pre-dilution method and the previous It is also possible to adopt a method combining the post-dilution method.

Further, even in the arrangement relationship between the replacement liquid pump 24 and the replacement liquid filter 26 on the replacement liquid supply flow path 22, the replacement liquid filter 26 is disposed downstream of the replacement liquid pump 24 in the illustrated specific example. On the contrary, even if the replacement liquid filter 26 is arranged on the upstream side of the replacement liquid pump 24, there is no problem. However, the present invention is not limited to the method using a purification method by passing through a semipermeable membrane, and it is possible to use other appropriate sterilization purification means.

Further, as a mechanism for adjusting the inflow and outflow of dialysate, or as a constituent mechanism thereof, a flow rate equalizing mechanism as described above, a dialysate feeding pump means or a flow rate equalizing / feeding pump mechanism is also exemplified. However, the present invention is not limited to only those, and any mechanism or structure or device that can be easily used or conceived by those skilled in the art can be adopted. Pump 20
, While the double plunger pump 14 and the liquid feed pumps 42a and 42b in the dialysate inflow and outflow amount adjustment mechanisms can be operated and controlled so that the suction / discharge amounts are variable. The configuration is recommended on the basis of the operation control by the control device 30, and the replacement liquid is controlled by the control device 30 using the replacement liquid pump 24 as a variable discharge pump. While increasing the discharge amount of the pump 24, the amount of dialysate supplied to the dialysate supply flow path 10 by the mechanism for adjusting the inflow and outflow of dialysate such as the double plunger pump 14 and the liquid feed pumps 42a and 42b is reduced. It is also possible to

[0046]

As is clear from the above description, in the hemodiafiltration apparatus according to the present invention, a decrease in blood pressure of a patient during a hemodiafiltration operation is predicted or a blood pressure decrease actually occurs. The control device controls the operation of the dialysate inflow and outflow amount adjustment mechanism with respect to the replacement liquid sending means, and determines the difference between the inlet flow rate of the dialysate into the dialysate supply flow path and the discharge amount in the replacement liquid sending means. By reducing the size, the hemodialysis effect in the blood purifier is reduced, and in such a blood purifier, since the blood filtration operation can be advanced mainly, the reduction of the blood pressure of the patient is effective. The blood purification operation can be stopped or stabilized, and the blood purification operation can be continued. Therefore, when the blood purification operation is reduced or stopped due to the conventional decrease in blood pressure. It became a possible entirely capable allowed solve the various problems in the.

[Brief description of the drawings]

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

FIG. 2 is a system diagram showing another example of the hemodiafiltration apparatus according to the present invention.

FIG. 3 is a system diagram showing an example of a hemodiafiltration apparatus according to the present invention, which is applied to a plurality of patients.

[Explanation of symbols]

2 dialyzer 4 blood supply flow path 6 blood return flow path 8 blood pump 10 dialysate supply flow path 12 dialysate discharge flow path 14 double plunger pump 16 drive device 18 branch flow path 20 dewatering pump 22 replacement liquid supply flow path 24 Replacement liquid pump 26 Replacement liquid filter 30 Control device 32a, b Inflow / outflow converter 34a, b Diaphragm 36 Supply branch flow path 38 Discharge branch flow path 40a-d Three-way valve 42a, b Liquid transfer pump 44 Dialysate inflow and Outflow control mechanism 46

Claims (5)

[Claims] 1. A blood purifier containing a semipermeable membrane in a box, dialyzing blood by contacting the blood with a dialysate via the semipermeable membrane, and filtering and filtering the blood. A blood flow path for flowing blood through the blood purifier, a dialysate supply flow path for supplying dialysate to the blood purifier, and a dialysate discharge flow path for discharging dialysate from the blood purifier And a replacement fluid supply channel connecting the dialysate supply channel and the blood channel, and a replacement solution purification unit and a replacement solution delivery unit provided on the replacement solution supply channel. A replacement fluid supply mechanism for purifying a predetermined amount of dialysate guided from the flow path and supplying the purified fluid as a replacement fluid to the blood flow channel; and a replacement fluid supply mechanism provided on the supply flow channel and the discharge flow channel of the dialysate. The inlet flow rate in the supply flow path and the outlet flow rate in the discharge flow path are simultaneously adjusted, and A hemodiafiltration apparatus including a dialysate inflow and outflow control mechanism for equalizing the amount of water removed from the inside, wherein the dialysate inlet flow into the dialysate supply flow path in the dialysate inflow and outflow control mechanism And a control device for adjusting a difference between a discharge amount of a dialysate as a replacement liquid in the replacement liquid supply means provided on the replacement liquid supply flow path, and a blood controller in the blood purifier by the control device. A hemodiafiltration apparatus characterized in that the ratio between the dialysis action and the hemofiltration action can be changed. 2. The hemodiafiltration apparatus according to claim 1, wherein the controller controls the difference between the inlet flow rate and the discharge rate to be reduced to 0 to 200 mL / min. 3. The control device controls the difference between the inlet flow rate of dialysate into the dialysate supply flow path and the discharge rate of dialysate as a replacement fluid into the blood flow path, by controlling the patient's blood pressure and blood pressure. /
The hemodiafiltration apparatus according to claim 1 or 2, further comprising a mechanism for automatically performing the operation based on information on symptoms. 4. The method according to claim 1, wherein the controller controls the difference between the dialysate inlet flow rate into the dialysate supply flow path and the discharge rate of dialysate as a replacement fluid into the blood flow path. 3. The hemodiafiltration apparatus according to claim 1, further comprising a mechanism for automatically performing a time series and automatically based on information on blood pressure and / or symptoms during past dialysis. 4. 5. A plurality of said blood purifiers are arranged for individual hemodiafiltration operations of a plurality of patients, and said blood flow path and said dialysate supply flow for said plurality of blood purifiers. And a dialysate discharge flow path are respectively provided, and a replacement liquid supply flow path connecting the blood flow path and the dialysate supply flow path in each blood purifier is provided for each blood purifier, and The plurality of replacement liquid supply flow paths are connected to one replacement liquid purification means, and each of the replacement liquid supply means provided on each replacement liquid supply flow path,
5. The method according to claim 1, wherein a dialysate as a replacement liquid guided to each blood flow path through each of the replacement liquid supply flow paths is purified by the one replacement liquid purification means. The hemodiafiltration device according to claim.