JP2005000649A - Hemodialyzer for repeating injection and moisture extracting operation intermittently - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a hemodialysis filtering apparatus for efficiently and easily removing solutes in the area of middle and large molecules at a low cost. <P>SOLUTION: In the hemodialysis filtering process, the dialysis solution inflows from the dialysis solution circuit side to a blood circuit side by using a hemodialyzer storing a hollow fiber membrane and forcibly reversed filtering through the hemodialyzer, and the blood circuit solution outflows to the dialysis solution circuit side with filtering through the hemodialyzer. The inflow operation from the dialysis solution side to the blood circuit side by the reversed filtering and the outflow operation from the blood circuit side to the dialysis solution circuit side by the filtering are intermittently repeated several times in the hemodialyzer. <P>COPYRIGHT: (C)2005,JPO&NCIPI

Description

  The present invention relates to a hemodialysis (filtration) device, and in particular, blood purification that efficiently removes waste and water from a patient's body by periodically and intermittently performing filtration and reverse filtration in a hemodialysis operation. Relates to the device.

  For the treatment of patients with renal failure, various blood purification methods have been proposed in which blood taken from the patient's body is purified and returned to the body. In order to purify blood, a hemodialyzer (dialyzer) containing a semi-permeable membrane (hereinafter also referred to as a dialysis membrane) such as a hollow fiber cellulose membrane, a polyacrylonitrile membrane, or a polysulfone membrane is used in the housing. However, the embodiment of the purification method to be adopted differs depending on the patient's condition and situation.

  For example, in the case of hemodialysis (HD), blood and dialysate are brought into contact with each other through a dialysis membrane of a hemodialyzer, and urea, uric acid, etc. accumulated in the patient's blood are removed by movement of the substance by diffusion. In the case of blood filtration (HF), moisture, waste products, and toxins in the blood can be removed by filtration through a membrane hole opened in the dialysis membrane.

  In the above therapy, HD (hemodialysis) is excellent in the removal characteristics of small molecule wastes and solutes, but has a drawback that the removal performance of medium molecules and large molecules is insufficient. On the other hand, HF (blood filtration) has excellent removal characteristics of medium (large) molecular wastes, but has the disadvantages of low small molecule removal performance and blood protein leakage. Moreover, both HD and HF are greatly influenced by the characteristics of the hollow fiber membrane of the hemodialyzer.

  As a therapy that combines the advantages of both HD and HF, that is, both excellent removal properties, a hemodiafiltration (HDF) method has been proposed, and efficient solute removal has been expected. In the type HDF system, only about 5 to 10 L of liquid replacement could be performed, and the effect did not appear remarkably. For this reason, large-volume liquid replacement HDF using online HDF or Push & Pull HDF attracts attention, and the former online HDF that can construct a system relatively easily is spreading.

As prior art documents, Patent Document 1 and Patent Document 2 shown below are disclosed.
Japanese Patent Laid-Open No. 6-134031 Japanese Patent Laid-Open No. 7-313589

However, in order to implement HDF (including online HDF, Push & Pull HDF), a dedicated blood circuit for injecting a replacement fluid (replacement fluid) is required, and in addition, the bottle-type HDF requires the preparation of a dedicated replacement fluid. Met.
On the other hand, the present invention provides a hemodialysis apparatus that can shift from HD treatment to HDF, or easily transfer from HDF treatment to HD without requiring preparation of a dedicated blood circuit or a dedicated replacement fluid. is there.

In the present invention, the above-described problem has been solved by the following configuration.
That is, in the configuration of the present invention, in hemodialysis (filtration), a hemodialyzer 8 containing a hollow fiber membrane is used, and either the liquid feeding pump P6 or the liquid feeding pump P3 via the hemodialyzer 8 is used. Alternatively, the dialysate is allowed to flow from the dialysate supply circuit 12 side to the second blood circuit 11 side by forced reverse filtration by interlocking control of both pumps, and similarly by filtration through the hemodialyzer 8. 1 is a hemodialysis apparatus 1 for discharging the fluid in the first blood circuit 10 to the dialysate discharge circuit 13 side, and the inflow operation of the fluid from the dialysate supply circuit 12 side to the second blood circuit side by the reverse filtration. (Hereinafter, also referred to as reverse filtration operation), the fluid outflow operation (hereinafter also referred to as filtration operation) from the first blood circuit 10 side to the dialysate discharge circuit 13 side by the filtration is intermittently performed at least a plurality of times. It is a hemodialysis apparatus characterized by repetition.

  In the specification of the present application, the process of intermittently repeating the reverse filtration operation and the filtration operation a plurality of times is abbreviated as a tidal HDF (Tidal: a state in which the inflow and outflow of liquid are repeated following the tides).

  The hemodialysis (filtration) apparatus according to the present invention has the above-described configuration, and the blood flowing into the body by reverse filtration is taken out of the body by filtration, that is, the blood circulation system and the dialysate supply through the dialyzer 8. By connecting the drainage system, there is a time lag before the water in the blood circulation system moves to the dialysate supply / drainage system due to the pressure difference, so the solute is removed (exchanged) after permeating into the patient's cells or stroma. ) As a result, the removal efficiency of solute or the removal effect of medium and large molecules is remarkably improved.

By using the hemodialysis (filtration) apparatus of the present invention, the filtration (filtration) effect is improved, and it becomes possible to remove medium and large molecular weight substances. Further, by increasing the filtration effect, the efficiency depending on the membrane characteristics of the hollow fiber of the hemodialyzer can be improved.
Furthermore, the replacement fluid that has flowed into the blood circuit by reverse filtration penetrates into the patient's cells or stroma, where it is dehydrated after substance exchange (so that fluid replacement or dehydration is performed at the body fluid level). Compared with the current HDF and HF, blood purification efficiency is improved in each stage.

Hereinafter, the present invention will be described in detail based on embodiments shown in the drawings.
FIG. 1 is a block diagram showing a schematic configuration in one embodiment of the hemodialysis apparatus of the present invention. In the figure, reference numeral 1 denotes a hemodialysis apparatus, a dialysis working apparatus 2, a control apparatus 3 for controlling operations and processes for the dialysis apparatus 1, a blood input apparatus 4 for inputting commands, conditions and operations, and an input state. And a display device 5 for displaying the control mechanism and a monitor 6 for displaying the operation state of the control device.

  In addition, the input device 4 and the monitor 6 of the working device are communicated to the control device 3 by the transmission system 7, and the setting condition is changed by the input device 4 while confirming the operation state of the dialysis working device 2 with the monitor 6. However, it is also possible to change the operation of the dialysis active device 2 via the transmission system 7 and the control device 3. In FIG. 1, both the input device 4 and the monitor 6 communicate with the control device 3 by the transmission system 7, but all of the input device 4, the monitor 6, and the control device 3 communicate with the transmission system 7. May be.

  The details of the dialysis working device 2 will be described later with reference to FIG. 4. For example, a dewatering pump, a blood pump, a dialysate supply / discharge device, a dialysate circuit, a blood circuit, and other fluid flow paths, and a flow for opening and closing them. A device that operates when actually performing hemodialysis treatment, such as a path opening / closing device and a hemodialyzer that performs filtration and reverse filtration, is provided.

  The input device 4 for inputting processing conditions and commands is a device for setting or increasing or reducing the total amount of filtration from the patient, the treatment time, the amount of the reverse filtrate flowing into the patient, or water removal and water injection (by reverse filtration). ) Is one cycle, there are devices that set or increase / decrease how much time is required per cycle. Although it is desirable that each condition can be input and changed on one panel, it is not limited to this.

  Further, the display device 5 allows the operator to confirm (understand) the commands / conditions of the input device 4, their input states, and the control mechanism before the dialysis working device 2 operates. 5 may be constituted by a panel integrated with the input device 4. Further, as described above, the monitor 6 for monitoring the operation state of the dialysis working device 2 communicates with the dialysis working device 2, displays the operation state of the dialysis working device 2, and operates according to preset conditions. If not, the dialysis active device 2 can be finely adjusted via the transmission system 7 and the control device 3.

  FIG. 2 shows a procedure for performing hemodialysis with the hemodialysis apparatus of the present invention, that is, (a) condition setting (input) → (b) input confirmation → (c) display of hemodialysis conditions → (d) confirmation / determination. → (e) Execution (hemodialysis treatment) → (f) (Monitoring of the operation state of the dialysis machine → (g) Adjustment / change → (h) Steps of feedback control to the dialysis machine.

  First, the total amount of body fluid removal amount, treatment time, and replacement fluid injection amount (also referred to as the amount of reverse filtrate flowing into the patient's body, the total amount of replacement fluid) is set and input to the input device 4. Also, within the time required for hemodialysis, the number of cycles to be repeated in total is set, with the combination of the replacement fluid injection by back filtration of the hemodialyzer and the dewatering by filtration taken as one cycle. Since the treatment time / cycle is a time required for one cycle, the time may be set. For example, the time for one cycle can be adjusted in the range of 1 min to 60 min.

  Here, in one cycle, the input to the hemodialysis apparatus is such that the relationship between the time of replacement fluid injection by reverse filtration and the time of water removal by filtration is always [substitution fluid injection time] <[water removal time]. If restrictions are set, solute removal or blood purification can be efficiently performed without difficulty in the living body. In addition, if the hemodialysis apparatus is regulated so as to satisfy | replacement fluid injection amount | + | patient water removal amount | = | total filtration amount | By setting the injection amount and the body fluid removal amount, the amount of drainage of the water removal pump is automatically calculated and the water removal pump is controlled, which is convenient.

  Regarding the input operation of the hemodialyzer, as shown in FIG. 2, if the body fluid removal amount and the total amount of the replacement fluid (infusion) are not input, the process cannot proceed to the next step. Even if there is not, since a default value (initial value) has been set in advance, the operation is controlled under the condition of the initial value. A screen for confirming whether the values to be set are entered is displayed. After confirming that it is OK, the replacement fluid injection amount and body fluid removal amount for each cycle as shown in FIG. A drainage pattern is displayed.

  Here, A is the first total filtration amount, A ′ is the first substitution fluid injection amount, A ″ is the first body fluid removal amount, B is the second total filtration amount, and B ′ is the second substitution fluid. If the injection volume, B ″ is the second body fluid removal volume, the total filtration volume, water removal time, and replacement in each cycle are maintained while maintaining the relationship of A = A ′ + A ″, B = B ′ + B ″. Liquid injection amount and replacement liquid injection time can be set and changed.

  The actual change of the water removal-injection pattern is performed in the following procedure. By determining (inputting) the body fluid removal amount, water removal time, total amount of replacement fluid, and the number of cycles, the time per cycle and the water removal time required per cycle are automatically calculated. [Substitution liquid injection time / cycle] = [time of one cycle]-[water removal time / cycle]-[blank time] is set.

  In this screen, while maintaining the above-described relationship (so that the replacement fluid injection amount, body fluid removal amount and drainage pump drainage amount become constant), by increasing / decreasing [substitution fluid injection time / cycle], [Drainage time / cycle of drainage pump], drainage amount of drainage pump, and replacement fluid injection speed are determined. Conversely, [substitution liquid injection time / cycle] and the like may be changed in conjunction with each other by setting an increase / decrease in [drainage time / cycle of water removal pump].

  By changing the time setting per cycle and changing [substitution liquid injection amount / cycle], it is possible to change the substitution liquid injection amount for each cycle. It is also possible to change the time of the entire cycle. The change in the amount of the replacement liquid and the time due to the change as described above is reflected in a cycle that is later in time. By changing the pattern per cycle, the remaining cycle pattern is also changed to the same pattern, but it is also possible to set a pattern for each pattern.

  Furthermore, it is possible to change the body fluid removal amount in each cycle in accordance with a body fluid removal pattern by hematocrit monitor for measuring a hematocrit value or ultrafiltration.

  However, the Tidal HDF therapy of the present invention has a possibility of affecting the blood circulation dynamics of the patient because the replacement fluid injection amount per one time is larger than that of the normal Push & Pull HDF. Therefore, it is desirable to perform monitoring using an automatic sphygmomanometer, hematocrit monitor or the like, or to perform interlocking control with these monitors. As another safety mechanism, the water removal operation or the replacement fluid injection operation may be stopped by detecting abnormalities in the blood circuit internal pressure, dialysate pressure, bubble detector, or the like.

  In the tidal HDF of the present invention, pressure fluctuations in the blood circuit occur depending on the replacement fluid injection timing, so it is desirable to set alarm reference values for venous pressure and dialysis fluid pressure separately.

Next, FIG. 4 shows a schematic diagram of the entire hemodialysis apparatus of the present invention.
The hemodiafiltration device 1 has a hemodialyzer 8 that purifies blood by bringing blood and dialysate into contact with each other through a semipermeable membrane, and a blood pump P1 that guides blood taken from the living body 9 to the dialyzer 8. Dialysate supply circuit having a first blood circuit 10, a second blood circuit 11 having means for guiding blood flowing out from the dialyzer 8 to the living body 9, and a dialysate supply pump P 5 for guiding dialysate to the dialyzer 8. 12 and a dialysate discharge circuit 13 having a dialysate discharge pump P4 for discharging the dialysate flowing out of the dialyzer 8. In order to improve the purification of the dialysate, it is desirable to provide an endotoxin removal filter 16 in the dialysate supply circuit 12 upstream of the hemodialyzer 8.

  In the hemodialysis machine 1, a liquid feed pump P3 different from the pump is installed in one or both of the dialysate supply pump P5 installation section of the dialysate supply circuit 12 and the dialysate discharge pump P4 installation section of the dialysate discharge circuit 13. , P6 are provided, and the liquid pumps P3, P6 provided in the (or these) bypass circuits 14, 15 and the blood pump P1 are both pumps capable of forward and reverse rotation. .

  Here, if the liquid feed pump P3 is rotated in the same direction as the dialysate discharge pump P4, water removal by filtration is performed. Conversely, if the liquid feed pump P3 is rotated in the direction opposite to the dialysate discharge pump P4, The replacement liquid is injected by filtration. Alternatively, if the liquid feed pump P6 is rotated in the same direction as the dialysate supply pump P5, the replacement liquid is injected by reverse filtration. Conversely, if the liquid feed pump P6 is rotated in the opposite direction to the dialysate supply pump P5, Water removal by filtration is performed.

  Blood pump P1 and any one or both of pumps P3 and P6 (provided in the bypass circuit), although not shown, such as a channel opening / closing means for opening and closing the dialysate circuit and the blood circuit The dialysis active device 2 is communicated to the control device 3 by a transmission system 7 (FIG. 1). The control device 3 operates either one of the liquid feeding pumps P3 and P6 so as to perform forced back filtration through the hemodialyzer 8.

  By this reverse filtration operation, the dialysate flows into the blood circuit side, and after a predetermined time has elapsed, this time, the liquid pump P3 or P6 is operated to perform filtration through the hemodialyzer 8. By this filtration operation, the liquid in the blood circuit is drained to the dialysate side. At this time, the liquid discharge amount is set so that the liquid feed pump P3 or P6 discharges an amount obtained by adding the amount of the body fluid removed to the amount of the reverse filtrate (substitution liquid) that has flowed in first.

Embodiments of the present invention will be described below.
As described above, according to the present invention, the operation can be started by inputting the set value with the input device 4 while confirming the set condition with the display device 5. In the dialysate supply / discharge system in which the dialysate supply pump P5 and the dialysate discharge pump P4 are adjusted to have the same amount using the hemodialyzer 8 containing the hollow fiber, the supply pump P3 is discharged from the dialysate. Filtration (water removal) through the hemodialyzer 8 can be performed by driving in the same liquid feeding direction as the pump P4. Further, by driving this liquid feed pump P3 in the direction opposite to the filtration (water removal), reverse filtration through the dialyzer 8 can be performed.
Alternatively, if the liquid feed pump P6 is rotated in the same direction as the dialysate supply pump P5, the replacement liquid is injected by reverse filtration. Conversely, if the liquid feed pump P6 is rotated in the opposite direction to the dialysate supply pump P5, Water removal by filtration is performed. Alternatively, the same operation can be performed by interlocking control of the liquid feed pumps P3 and P6.
In the inflow operation of the liquid from the dialysate side to the blood circuit side by the reverse filtration (hereinafter also referred to as reverse filtration operation), the inflow speed and the inflow amount set in advance are performed, and from the blood circuit side by the filtration The liquid outflow operation to the dialysate circuit side (hereinafter also referred to as filtration operation) is performed at a preset outflow speed and outflow amount. The present invention is a hemodialysis apparatus that repeats such an inflow operation and an outflow operation intermittently and alternately.

The hemodialysis apparatus of the present invention can take various embodiments as shown below while maintaining the characteristics.
That is, the present invention is the hemodialysis apparatus in which the filtration operation and the reverse filtration operation are alternately repeated as described above, thereby enabling efficient solute removal.

  In the hemodialysis apparatus of the present invention, a blank time during which neither the filtration operation nor the reverse filtration operation is performed can be provided between the reverse filtration operation and the filtration operation. The set value is input to the input device 4 while checking the blank time on the display device 5. Thereby, the back-filtered liquid easily penetrates to the stroma or cell level.

    The amount of liquid movement (the amount of filtrate or the amount of reverse filtrate) in each operation is calculated by the product of the liquid movement speed (filtration rate or the reverse filtration rate) of each operation and the time required for each operation. The hemodialysis apparatus. In practicing the present invention, it is necessary to calculate the amount of filtrate or the amount of reverse filtrate to be measured in order to measure the degree of hemodiafiltration treatment using the amount of replacement fluid as a guide. This facilitates setting and control.

  When the combination of the filtration operation and the reverse filtration operation performed thereafter is taken as one unit (cycle), the time for performing the reverse filtration operation in each cycle is the filtration operation within the same cycle. The hemodialysis apparatus is regulated so as to be less than time. The cycle time per time is calculated by the number of cycles during the hemodialysis (filtration) treatment time. In the cycle time of one time, the time of each process is calculated by the ratio of preset filtration time (water removal time), blank time, and reverse filtration time (injection time). As a result, water can be removed from the living body without difficulty and solute removal can be performed efficiently.

  It is the hemodialysis apparatus that can arbitrarily set the number of cycles performed within the treatment time when the total time required during the hemodialysis operation period is the treatment time. It is necessary to set the number of cycles according to the patient's condition and situation because the amount of fluid removed on the treatment day is different each time, and the setting is confirmed by the input device 4 while confirming with the display device 5 of this device. Enter the input value. Thereby, blood purification processing according to the patient's condition and the situation at that time can be performed.

The amount of body fluid removed from the patient by hemodialysis treatment is the body fluid removal amount, the total amount of fluid flowing in by the reverse filtration operation is the total amount of replacement fluid, and the cycle is composed of at least the filtration operation followed by the reverse filtration operation. In the hemodialysis apparatus, the tidal HDF process is operated or controlled by setting the treatment time, body fluid removal amount, replacement fluid total amount, and cycle number. The set value of each item is input to the input device 4 while being confirmed on the display device 5.
Thereby, it is possible to finely set the treatment appropriate for the patient or the treatment that the doctor considers best.

  In the hemodialysis apparatus, the tidal HDF is operated or controlled by inputting the body fluid removal amount and the total replacement fluid amount to the input device 4. Since the above is an important item that differs depending on each patient, the input operation is indispensable.

  When there is no input of the treatment time or the number of cycles, the hemodialyzer is operated or controlled with an initial value set in the input device 4 in advance. The above items do not affect the treatment so much depending on the patient, and can be input only when necessary. Thereby, the input operation can be omitted, and the burden on the staff is reduced.

  The filtering operation and body fluid removal can be performed by interlocking control of the liquid feeding pump P6 and the liquid feeding pump P3. That is, the filtering operation is generated by the reverse rotation of the liquid feeding pump P6 or the forward rotation of the liquid feeding pump P3, and the reverse filtering operation is generated by the forward rotation of the liquid feeding pump P6 or the reverse rotation of the liquid feeding pump P3. In this case, the body fluid removal amount is regulated to be the sum of the injection amount (negative value) by back filtration and the drainage amount by filtration.

  The filtration operation can be achieved by dewatering by reverse rotation of the liquid feed pump P6, and the reverse filtration operation can be achieved by injection by forward rotation of the liquid feed pump P6. Here, if the water removal amount and the injection amount are made equal, the drainage amount of the liquid feeding pump P3 is regulated to become the body fluid removal amount.

  The filtration operation can be achieved by reverse rotation of the liquid feed pump P6, and the reverse filtration operation can be achieved by injection by forward rotation of the liquid feed pump P6. Here, assuming that the reverse rotation speed of the liquid feed pump P6 per cycle is greater than the normal rotation speed and the amount of liquid filtered by the reverse rotation of the liquid feed pump P6 is the total filtration amount (plus value), the total amount of body fluid removed is It is regulated by the sum of the filtration amount and the injection amount (negative value).

  When the filtration operation and the reverse filtration operation are performed by the liquid feed pump P3 provided in the dialysate circuit, the amount of liquid that the liquid feed pump P3 drains out of the circuit from the dialysate discharge circuit 13 is defined as the pump drainage amount. Then, the pump drainage amount is determined by the amount of filtrate (water removal amount) flowing out from the first blood side circuit to the dialysate discharge side circuit 13 by the filtration operation, and the dialysate supply side circuit 12 by the reverse filtration operation. The hemodialysis apparatus is regulated so as to be the sum of the amount of the reverse filtrate flowing into the second blood circuit side (substitution fluid injection amount). Thereby, hemodiafiltration can be performed in a state where the set body fluid removal amount is always secured.

  In the hemodialysis apparatus, the liquid pump P3 drainage amount in each cycle is regulated to be the sum of the filtrate amount and the reverse filtrate amount in each cycle. This adds and monitors the amount of filtrate and the amount of reverse filtrate [minus value] in each cycle by counting the amount of rotation of the liquid feed pump P3. Thereby, in each cycle, hemodiafiltration can be performed in a state where the set amount of patient water removal is secured, and water removal over time can be controlled.

  When the amount of water removed by the ultrafiltration operation in each cycle is defined as the amount of body fluid removed per cycle, the amount of body fluid removed per cycle equals the amount of body fluid removed by the number of cycles. This is a hemodialysis apparatus. Since this operation is a stage in which the time and amount of Push and Pull (c) in FIG. 2 are equally distributed, the body fluid removal amount is also an equal value divided by the number of cycles. Thereby, the input operation can be simplified.

  When the amount of water removed by the filtration operation in each cycle is defined as the amount of water removed per cycle, the amount of water removed per cycle is the product of the reverse filtration rate and the reverse filtration time allocated to each cycle. It is the said hemodialysis apparatus calculated by. When the amount of the replacement liquid per cycle (reverse filtration rate × injection time) is changed, the water removal amount is automatically changed to be equal to the amount of the replacement liquid. When the treatment conditions are changed, the body fluid removal pattern is also automatically changed. By redistributing the body fluid removal amount to each cycle according to the engine ratio of each cycle of the changed body fluid removal pattern, the input operation is facilitated.

The time required for the filtration operation in each cycle is the water removal time per cycle, and the amount of water discharged by the water removal pump by the filtration operation is the pump drainage amount per cycle. When the time required is the replacement liquid injection time per cycle, and the amount of liquid flowing in by reverse filtration operation is the replacement liquid (injection) amount per cycle, the replacement liquid injection time per cycle is increased or decreased. Thus, the hemodialysis apparatus in which the water removal time per cycle, the water removal amount per cycle, and the pump drainage amount per cycle are automatically set.
In reverse filtration operation, there are two parameters, reverse filtration time and reverse filtration amount. If one (time) is changed, the speed (quantity / time) calculated before the change is unchanged, and the other parameter (quantity). For this, the value is changed at any time by automatic calculation. In this way, automatic setting is performed by automatically calculating using the relationship between the two parameters and the calculation result of the parameters. The set parameters are stored in the internal memory of the device. In this case, it is possible to change the automatic setting pattern by setting the parameters to be unchanged.
Thereby, it is possible to take a detailed response according to each patient and the situation at that time. Furthermore, input operations by staff can be reduced.

  By increasing or decreasing the water removal time per cycle, the replacement fluid injection time per cycle, the replacement fluid injection amount per cycle, and the pump drainage amount per cycle are automatically set as described above. The hemodialysis apparatus. Thereby, it is possible to take a detailed response according to each patient and the situation at that time. Furthermore, input operations by staff can be reduced.

  The hemodialysis apparatus can change the amount of the replacement fluid in each cycle or the amount of water removal in each cycle by increasing / decreasing the amount of the replacement fluid injected per cycle or the amount of water removal per cycle as described above. Thereby, it is possible to take a detailed response according to each patient and the situation at that time. Furthermore, input operations by staff can be reduced.

  In each of the cycles, the hemodialysis apparatus can arbitrarily change the time required for one cycle. Detailed response can be taken according to each patient and the situation at that time.

  When the water removal time and water removal amount setting state per cycle, and the setting state of the replacement liquid injection time and the replacement liquid amount in the same cycle are the water removal per one cycle-injection pattern, water removal per cycle- In the hemodialysis apparatus, when the injection pattern is set or changed, the dewatering-injection pattern in each cycle after the set cycle is set or changed to the same pattern. Thereby, the input operation by the staff can be reduced.

  Water removal conditions set by hematocrit value measurement means (quantitative method using an optical sensor using red blood cells, platelets, plasma, etc., each of which is a component of the blood and has specific absorption characteristics) and hematocrit value measurement It is the said hemodialysis apparatus which can change the water removal-injection pattern in each cycle by the blood state display from a means. Thereby, it is possible to take a detailed response according to each patient and the situation at that time.

  In the hemodialysis apparatus, the total filtration-infusion pattern in each cycle can be changed in accordance with the body fluid removal conditions set by the body fluid removal program by ultrafiltration. In other words, the amount of body fluid removed for each hemodialysis (filtration) treatment is divided in time, and the total filtration rate is set for each stage (every elapsed time). This function (program) to be changed is set by the input device 4 while being confirmed by the display device 5 and set in the internal memory. Thereby, it is possible to take a fine response according to the condition of each patient.

  Either the filtration operation or the reverse filtration operation, or both operations are performed a plurality of times in succession, a plurality of times or a single filtration operation, and a plurality of times or a single backfiltration operation. The hemodialysis apparatus repeats a cycle consisting of at least twice. Thereby, it is possible to take an efficient and delicate response by setting more appropriate conditions according to the condition of each patient.

  The amount of liquid movement (the amount of filtrate or reverse filtrate) in each operation is calculated by the product of the liquid movement speed (filtration rate or reverse filtration speed) of each operation and the time required for each operation. The hemodialysis apparatus. Accordingly, the present invention can easily perform input / setting and control.

It is a block diagram which shows the structure in one Example of the hemodialysis apparatus of this invention, and the outline of control. It is a flowchart which shows the outline of the flow of processing operation by the hemodialysis apparatus of an example of this invention. It is a schematic diagram which shows an example of the water removal-injection pattern by the hemodialysis apparatus of this invention. It is a schematic diagram which shows the outline of the whole structure of the hemodialysis apparatus of an example of this invention.

Explanation of symbols

1. Hemodialysis machine 2. Dialysis machine Control device 4. 4. Input device Display device 6. Monitor 7. Transmission system 8. 8. hemodialyzer Living body 10. First blood circuit 11. Second blood circuit 12. Dialysate supply circuit 13. Dialysate drain circuit 14. Bypass circuit 15. Bypass circuit 16. Endotoxin removal filter P1. Blood pump P3. Liquid feed pump P4. Dialysate discharge pump P5. Dialysate supply pump P6. Feed pump

Claims (25)

In hemodialysis (filtration), the dialysate is supplied to the dialysate supply circuit 12 by forced reverse filtration (also referred to as injection) through the hemodialyzer 8 using a hemodialyzer 8 containing a hollow fiber membrane. Hemodialysis which flows into the second blood circuit 11 side from the side and causes the fluid in the first blood circuit 10 to flow out to the dialysate discharge circuit side 13 by filtration (also referred to as water removal) through the hemodialyzer 8. The apparatus 1 includes an operation for inflow of fluid from the dialysate supply circuit 12 side by reverse filtration to the second blood circuit side 11 (hereinafter also referred to as reverse filtration operation), and the first blood circuit 10 side by the filtration. A hemodialysis apparatus characterized in that a fluid outflow operation (hereinafter, also referred to as a filtration operation) from the dialysis fluid discharge circuit side 13 is repeated at least a plurality of times intermittently. The hemodialysis apparatus according to claim 1, wherein the filtration operation and the reverse filtration operation are alternately repeated. The hemodialysis apparatus according to claim 1, wherein a blank time during which neither a filtration operation nor a reverse filtration operation is performed is provided between the reverse filtration operation and the filtration operation. The amount of liquid movement in each operation (forward filtration amount or water removal amount, and reverse reverse filtration amount or injection amount) is the liquid movement speed (filtration rate or water removal rate, or reverse filtration rate and injection amount in each operation). The hemodialysis apparatus according to any one of claims 1 to 3, which is calculated by a product of a speed) and a time required for each operation. When the combination of the filtration operation and the reverse filtration operation performed thereafter is taken as one unit (cycle), the time for performing the reverse filtration operation in each cycle is the filtration operation within the same cycle. The hemodialysis apparatus according to any one of claims 1 to 4, wherein the hemodialysis apparatus is regulated so as to be less than time. The hemodialysis apparatus according to claim 5, wherein the number of cycles performed within the processing time can be arbitrarily set when the total time required for hemodialysis processing is treated time. The treatment consisting of the amount of body fluid removed from the patient by hemodialysis treatment, the amount of body fluid removed, the total amount of fluid flowing in by the reverse filtration operation, the total amount of replacement fluid, and at least the filtration operation followed by the reverse filtration operation The tidal hemodiafiltration (HDF) process is operated or controlled by setting the items of the treatment time, the amount of fluid removed, the total amount of replacement fluid, and the number of cycles when the number of cycles in time is defined as the number of cycles. Item 6. The hemodialysis apparatus according to Item 5. The hemodialysis apparatus according to claim 5, wherein the tidal HDF is operated or controlled by inputting the body fluid removal amount and the total replacement fluid amount. The hemodialysis apparatus according to claim 7 or 8, which is operated or controlled with an initial value set in advance in an input device when there is no input of the treatment time or the number of cycles. The hemodialysis apparatus according to any one of claims 5 to 9, wherein the body fluid removal amount in each cycle is regulated so as to be a sum of an injection amount (minus value) by the liquid feeding pump P6 and a drainage amount by the liquid feeding pump P3. The reverse filtration operation is performed by a liquid feed pump P3 (also referred to as a dewatering pump) provided in the dialysate discharge circuit 13, and the amount of liquid discharged from the dialysate discharge circuit by the liquid feed pump P3 is reduced. Assuming the liquid pump P3 drainage amount, this liquid pump P3 drainage amount flows out by the filtration operation, the total filtration amount (the sum of the water removal amount and the body fluid removal amount), and the reverse filtration operation. The hemodialysis apparatus according to any one of claims 1 to 9, wherein the hemodialysis apparatus is regulated so as to be a sum of a reverse filtration amount (a substitution liquid amount or an injection amount). The hemodialysis according to any one of claims 5 to 9, wherein the absolute value of the injection amount and water removal amount by the liquid feeding pump P6 in the cycle is equal, and the drainage amount of the liquid feeding pump P3 is regulated to be the body fluid removal amount. apparatus. The hemodialysis apparatus according to any one of claims 5 to 9, wherein a body fluid removal amount in the cycle is regulated so as to be a sum of an injection amount (minus value) of the liquid feeding pump P6 and a total filtration amount. The amount of the liquid feed pump P3 drainage in each cycle is regulated to be the sum of the filtrate amount and the reverse filtrate amount (negative value) in each cycle. The hemodialysis apparatus according to any one of the items. The hemodialysis according to any one of claims 5 to 14, wherein in the filtration operation period in each cycle, the amount of body fluid removed per cycle is obtained by equally dividing the amount of body fluid removed by the number of cycles. apparatus. When the amount of water removed by the filtration operation in each cycle is defined as the amount of water removed per cycle, the amount of water removed per cycle is the product of the reverse filtration rate and the reverse filtration time allocated to each cycle. The hemodialysis apparatus according to any one of claims 5 to 11, which is calculated by: The time required for the filtration operation in each cycle is the water removal time per cycle, and the amount of liquid pump P3 drained by the filtration operation is the liquid pump P3 drainage amount per cycle. The injection time per cycle is increased or decreased when the time required for the reverse filtration operation is the injection time per cycle, and the amount of the liquid flowing in by the reverse filtration operation is the replacement liquid amount (injection amount) per cycle. The hemodialysis apparatus according to any one of claims 5 to 13, wherein a water removal time per cycle, a removal amount per cycle, and a pump drainage amount per cycle are automatically set. 18. The injection time per cycle, the injection amount per cycle, and the liquid feed pump P3 drainage amount per cycle are automatically set by increasing or decreasing the water removal time per cycle. The hemodialysis apparatus as described. The water removal amount in each cycle or the injection amount in each cycle can be automatically changed by increasing or decreasing the injection amount per cycle or the water removal amount per cycle. The hemodialysis apparatus according to the section. The hemodialysis apparatus according to any one of claims 5 to 19, wherein in each cycle, the time required for one cycle can be arbitrarily changed. Dewatering-injection pattern per cycle, where the water removal time and water removal amount setting per cycle, and the setting time of the injection time and replacement liquid amount in the same cycle are the water removal-injection pattern per cycle. The blood according to any one of claims 5 to 14 and 16, wherein the water removal / injection pattern in each cycle after the set cycle is set or changed to the same pattern when set or changed. Dialysis machine. The water removal / infusion pattern in each cycle can be changed by the water removal conditions set by the hematocrit value measuring means or the blood state display from the hematocrit value measuring means. A hemodialysis apparatus according to any one of the above items. The hemodialysis apparatus according to any one of claims 5 to 14, 16, 17, and 18, wherein a total filtration-infusion pattern in each cycle can be changed according to a body fluid removal condition set by a body fluid removal program by ultrafiltration. . Either the filtration operation or the reverse filtration operation, or both operations are performed a plurality of times in succession, a plurality of times or a single filtration operation, and a plurality of times or a single backfiltration operation. The hemodialysis apparatus according to claim 1, wherein the cycle consisting of is repeated at least twice. The amount of liquid movement (the amount of filtrate or reverse filtrate) in each operation is calculated by the product of the liquid movement speed (filtration rate or reverse filtration speed) of each operation and the time required for each operation. The hemodialysis apparatus according to claim 24.

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