JP2006218131A - Peritoneal dialyzer, dialysate set and peritoneal dialyzer control method - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a peritoneal dialyzer which can prevent small bubbles from being delivered to the peritonea, a dialysate set and a peritoneal dialyzer control method. <P>SOLUTION: The peritoneal dialyzer is used in a connected condition where it forms a channel communicating with a patient's peritoneal cavity (4) by connecting a plurality of dialysis bags (5a to 5f) storing a dialysate, a spare bag (7), and a waste dialysate bag (6), and has a channel changeover means to switch a channel to a first liquid feed condition where a used dialysate stored in the patient's peritoneal cavity for a prescribed period is fed to the waste bag by a liquid feed means, a second liquid feed condition where a dialysate stored in one of the dialysis bags is fed to the spare bag by the liquid feed means, heated by heating means (60, 91, 92 and 93) and stored in the spare bag, a third liquid feed condition where a dialysate from the spare bag is fed to the patient's peritoneal cavity by the delivery means and stored in the patient's peritoneal cavity for a prescribed period, and a control means connected to the liquid feed means, the heating means and the channel switching means. <P>COPYRIGHT: (C)2006,JPO&NCIPI

Description

  The present invention relates to a peritoneal dialysis device, a dialysate set, and a control method for the peritoneal dialysis device, and more particularly to a technique using a cassette body in which a pump unit and a heating unit are integrally formed.

  In recent years, continuous ambulatory peritoneal dialysis (CAPD) has attracted attention because of its low cost of treatment and prevention of peritoneal adhesion compared to dialysis using an artificial kidney. Yes.

  The peritoneal dialysis apparatus used in the dialysis method by peritoneal dialysis is generally discharged from a patient with an infusion bag connected to a dialysate bag containing dialysate to be injected into the peritoneum (intraperitoneal) of the patient. A reservoir bag connected to a drainage bag for collecting dialysate is placed in a pressure chamber and used. That is, a pressure chamber for accommodating an injection bag and a reservoir bag is formed in the dialysis device main body of the peritoneal dialysis device, and the injection bag or the reservoir bag is pumped by pressurizing and depressurizing the inside of the chamber. The heater for heating the dialysate in the injection bag to a predetermined temperature range is provided in the dialyzer body.

  However, since the peritoneal dialysis apparatus itself is large and heavy, the peritoneal dialysis apparatus requires a large installation space for the peritoneal dialysis apparatus, particularly in home medical care, which is a medical site. Handling of the dialysis machine becomes troublesome, and there is a risk of hindering smooth medical practice.

  On the other hand, Japanese Patent No. 313887 proposes a peritoneal dialysis apparatus in which a valve actuator is opened and closed to switch the flow path of the disposable cassette body at the time of selection. Japanese Patent Application Laid-Open No. 11-347115 proposes a disposable cassette body in which a pump section and a heating section for feeding peritoneal dialysate are integrally formed. The cassette body is heated from both sides, and the heated peritoneal dialysis fluid is delivered into the abdominal cavity of the patient by two pump units.

  However, according to the former, since the valve actuator is operated intermittently, there is a problem that the operation sound of the valve is generated during dialysis during sleep at night, which is harsh.

  Moreover, according to the latter, there existed a problem that heating capability was not enough with respect to the liquid feeding capability of a pump.

  Therefore, the present applicant has put to practical use a peritoneal dialysis device based on the configuration disclosed in Japanese Patent Laid-Open No. 2003-000704. According to this peritoneal dialysis device, a resin bag that slowly permeates only air is filled with the dialysate, and after warming, the solution is sent to the abdominal cavity. During this warming, air dissolved in the dialysate based on Henry's law precipitates to form bubbles.

  That is, in the chart showing the correlation between the amount of bubbles and the temperature in FIG. 9, when the volume of the dialysis bag is 3500 ml, for example, the temperature in the bag is 5 ° C. of the room temperature in winter, It is known that air bubbles of 32 ml are generated when heated to a temperature close to 37 ° C. by means. The bubbles generated in this manner are present in the sterilized dialysis bag and are accumulated in the heating part of the cassette body heated by the surface heater. It detected with the bubble sensor, the liquid transfer of the transfer was stopped, and the bubble was sent and collected toward the waste bag.

On the other hand, since fine bubbles of small particles cannot be detected by the bubble sensor, they may be sent as they are into the abdominal cavity.
Japanese Patent No. 3113887 JP 11-347115 A Japanese Patent Laid-Open No. 2003-000704

  However, although it is reported that small bubbles do not cause any problems in the human body, they have been reported to cause diffuse pain that becomes a stiff shoulder after dialysis treatment for a long time.

  Therefore, the present invention has been made in view of the above-mentioned problems, and it is possible to prevent small bubbles from being sent to the abdominal cavity, which is a cause of dissipative pain that causes stiff shoulders after long-term dialysis treatment. An object is to provide a peritoneal dialysis device, a dialysate set, and a control method for the peritoneal dialysis device.

In order to solve the above-described problems and achieve the object, according to the present invention, a plurality of dialysis bags storing dialysis fluid, suspended spare bags, and drainage bags are connected to each other. A peritoneal dialysis device used in a connected state to form a flow path communicating with the abdominal cavity,
A first liquid-feeding state in which a spent dialysate stored in the abdominal cavity of a patient for a predetermined time is sent to the drainage bag by a liquid-feeding means; and the dialysate stored in one of the dialysis bags, The liquid is fed to the spare bag by the liquid feeding means, heated by the warming means and accumulated in the spare bag, and the bubbles generated by the warming are accumulated in the space above the liquid level of the spare bag. The flow into the second liquid feeding state and the third liquid feeding state in which the dialysate is fed from the spare bag to the patient's abdominal cavity by the liquid feeding means and stored in the patient's abdominal cavity for a predetermined time. It is connected to the flow path switching means for switching the path, the liquid feeding means, the heating means, and the flow path switching means, and for changing from the first state to the third state. And a control means for controlling the control. There.

  In addition, the flow path switching unit supplies the spent dialysate to the dialysis bag which has been emptied in the second liquid supply state by the liquid supply unit after the third liquid supply state. 4 is switched to the liquid feeding state.

  The dialysis bag, the spare bag, and the drainage bag include one of plugs, a part of the flow path, an actuated portion of the liquid feeding means, and a heated portion of the warming means. And a cassette body integrally provided with the switched portion of the flow path switching means, and comprises a cassette loading means for making the cassette body detachable, the dialysis bag with respect to the cassette body, The spare bag and the drainage bag are connected to each other through the other side of the plug to be brought into the connected state.

  The actuated portion includes a diaphragm that is brought into a positive pressure state and a negative pressure state by the actuating portion of the liquid feeding means after the cassette body is loaded in the cassette loading means, and the heated portion is The meandering flow path is heated from above and below by the surface heater of the heating means, and is heated after the cassette body is loaded in the cassette loading means.

  Further, in the dialysate set used in the peritoneal dialysis device, the plurality of dialysis bags, the spare bag, the drainage bag, and the flow path are in a closed and sterile state before the connection state. It is characterized by.

  In addition, a plurality of dialysis bags storing dialysate, a suspended spare bag, and a drain bag are connected to form a flow path that communicates with the patient's abdominal cavity. A method for controlling a peritoneal dialysis apparatus for performing peritoneal dialysis treatment by feeding into the abdominal cavity and draining from the abdominal cavity after a lapse of a predetermined time, wherein the used dialysis solution stored in the abdominal cavity of a patient for a predetermined time A step of bringing the liquid into a first liquid-feeding state by means of means, and the dialysis fluid in one dialysis bag is fed to the spare bag by the liquid-feeding means, and the heating means And a second liquid feeding state in which air bubbles generated by the heating are accumulated in a space above the liquid level of the spare bag; and Patient's abdominal cavity by liquid delivery means It is characterized by comprising a step of the third liquid feed state allowed to stored a predetermined time into the peritoneal cavity of the patient while feeding the dialysis fluid.

  In addition, after the third liquid feeding state, the liquid feeding unit makes a fourth liquid feeding state in which the used dialysate is fed to the dialysis bag that has been emptied in the second liquid feeding state. The method further includes a process.

  Also, a cassette is provided in which a part of the flow path, the actuated part of the liquid feeding means, the heated part of the warming means, and the switched part of the flow path switching means are integrally disposed. A step of loading a cassette body that is detachable from the loading means into the cassette loading means, and the dialysis bag, the spare bag, and the drainage bag are connected to the cassette body via a plug. And a step of forming the flow path.

  Further, after the cassette body is loaded on the cassette loading means, the diaphragm which is the actuated part is brought into a positive pressure state and a negative pressure state by the actuating part of the liquid feeding means, and the heated part The meandering flow path heated from the upper and lower surfaces by the surface heater of the heating means includes a step of heating the cassette body after the cassette body is loaded in the cassette loading means.

  In particular, a peritoneal dialysis device, a dialysate set, and a control method for the peritoneal dialysis device that can prevent small air bubbles that are caused to cause diffuse pain including stiff shoulders after long-term dialysis treatment are sent to the abdominal cavity. Provided.

  Below, the peritoneal dialysis apparatus of this invention is demonstrated in detail based on suitable embodiment shown to an accompanying drawing. It should be noted that the configuration of each embodiment described below is merely an example, and it goes without saying that the technical scope of the present invention is not limitedly interpreted.

  First, FIG. 1 shows a tube 9 in which a peritoneal dialysis apparatus 1 according to an embodiment of the present invention, a cassette body 2, a plurality of dialysis bags 5 in which dialysate is stored, a spare bag 7, and a drainage bag 6 are connected. The external perspective view which showed the connection state which forms the flow path connected to a patient's abdominal cavity by connecting with the plugs 8a-8j provided in, and sends dialysate into the abdominal cavity 4 (broken line illustration) of a patient. is there.

  In this figure, the peritoneal dialysis device 1 is provided with a cassette body 2 for the peritoneal dialysis device that is detachably attached to the dialysis device 1. The peritoneal dialysis device 1 includes an opening 300 for mounting the cassette body 2 from the front, a lid member 301 that is fixed so as to cover the opening 300 by being rotated, a display unit 23, and the start of treatment. It has a start switch 24a for performing an operation and a stop switch 24b for performing a treatment stop operation.

  The shape and color of the operation unit 24a and the operation unit 24b are different from each other so that they can be easily distinguished from each other. One projection is formed on the operation unit 24a and two projections are formed on the operation unit 24b. Has been. Further, in order to prevent erroneous operation, the operation unit 24a and the operation unit 24b are spaced apart as illustrated with the display unit 23 interposed therebetween.

  The display unit 23 is composed of, for example, a touch panel provided with a liquid crystal display panel or the like, and displays various information necessary for dialysis by a pressing operation of the touch panel, and performs an operation instruction of the apparatus together with a voice guide, Ensures operability and convenience.

  The peritoneal dialysis device 1 has a main base and a sub-base as attachment bases, and each of the illustrated resin covers is provided, and the main base and the sub-base are made of an aluminum metal plate having a thickness of 1 to 2 mm. Furthermore, weight reduction is achieved by drilling large holes everywhere. A lightweight resin cover is fixed to each of these bases. Further, for example, a memory card having a storage capacity of 100 megabytes or more is provided so as to be able to be loaded into the card reader shown by the broken line from the back of the device. It is configured to make changes quickly.

  Further, a shield plate (not shown) is movably provided on the front side of the right side surface of the peritoneal dialysis device 1 so that the cassette body 2 is moved to the arrow direction by preventing mechanical interference with the tube 9 of the cassette body 2. It can be set in the loading position by moving in the direction.

  On the other hand, the cassette body 2 includes a cassette body main body 81 that is detachable from the cassette body mounting portion, a lower main body frame 811 that is continuously formed from the main body 81 of the cassette body 2, and a gap 86 from the lower main body frame 811. And an upper main body frame 812 provided so as to face each other.

  Further, the main body 81 of the cassette body 2 is integrally formed with diaphragms 20 and 21, which are actuated parts of the liquid feeding means, a heating part 60 and a flow path switching part as shown in the figure.

  On the other hand, six dialysis bags 5 having a volume of around 3500 ml are connected to the tube 9 via plugs 8a to 8f, and a pair of holes are formed with respect to a pair of hooks 3f provided on the stand 3 as shown in the figure. It is set in a suspended state by inserting the part 5k. As a result, the dialysate is supplied through the tube 9 connected to the bottom surface of the volume portion of each dialysis bag 5, and the used dialysate can be collected as will be described later.

  The stand 3 is provided between a base member 3c, left and right support members 3a and 3a which are provided upright from the back side of the base member 3c and bent toward the front side, and the support members 3a and 3a. The horizontal bar member 3b is fixed, and a pair of hooks 3f fixed below the horizontal bar member 3b. Further, as shown in the figure, the stand 3 has a height of the hook 3f for suspending the dialysis bag 5 and the spare bag 7, and adds the length of the tube and the plug to the vertical dimension of each bag. The tube and the plug are configured to be vertical as shown in the figure.

  Further, the base member 3c of the stand 3 has a sufficiently large area so that the drainage bag 6 can be placed on the side, and a fixing portion having sufficient mechanical strength for fixing the supporting members 3a and 3a vertically. Forming.

  Next, FIG. 2 forms a flow path that communicates with the abdominal cavity of a patient by connecting a plurality of dialysis bags storing a dialysate, a spare bag, and a drainage bag to the peritoneal dialysis apparatus 1 of FIG. It is the schematic diagram made into the connection state to do.

  If similar components that have already been described in the figure are given the same reference numerals and omitted, the drainage bag 6 is connected to the tube 9h using the plug 8h. Here, for the plugs 8h to 8j, the state after the connection is illustrated, and in the state before the connection, one of the plugs and the other of the plugs are in separate states and are illustrated by being connected. It becomes a state. Further, one end of a clamp 10h constituting the flow path switching means is connected to the tube 9h, and a tube 9k serving as a common flow path is connected to the other end of the clamp 10h.

  Moreover, the dialysis bag 5a set to the state suspended as shown in FIG. 1 is connected to the tube 9a using the plug 8a. One of the clamps 10a constituting the flow path switching means is connected to the tube 9a, and the tube 9k serving as a common flow path is connected to the other of the clamps 10a.

  Similarly, dialysis bags 5b-5f are connected to tubes 9b-9f using plugs 8b-8f. One of the clamps 10b to 10f constituting the channel switching means is connected to these tubes 9b to 9f, and the tube 9k serving as a common channel is connected to the other of these clamps 10b to 10f.

  Further, the spare bag 7 set in a suspended state as shown in FIG. 1 is connected to the tube 9g using a plug 8g. One of the clamps 10g constituting the flow path switching means is connected to the tube 9g, and the tube 9k serving as a common flow path is connected to the other of the clamps 10g.

  Each of these clamps 10h to 10g and clamps 10k, 10m, 10n, 10p, 10q, and 10j described later are built in a cassette body 2 shown by a one-dot chain line in the drawing, and the peritoneal dialysis device 1 is loaded with the cassette body 2 The tube 9 is closed by a cam mechanism which will be described later in a state of being loaded in the position, and each clamp functions so as to be opened by returning to the original state by an elastic force.

  As described above, the tube 9k to which the drainage bag, the spare bag, and the dialysis bag are connected via the plug and the clamp is joined to the tube 19 by the T-shaped tube. In addition, a bubble sensor 14a is provided so as to surround the tube 19, and when bubbles larger than a predetermined (threshold) value flowing into the tube 19 are detected, if bubbles are mixed, that is indicated. By stopping the operation, air bubbles are prevented from entering the abdominal cavity.

  From the middle of the tube 19, a tube 29 connected to the clamp 10k is branched through a T-shaped tube. A diaphragm 20 is connected to the tube 29, and a clamp 10 m is connected to the diaphragm 20. A meandering flow path serving as the heating unit 60 is connected from the clamp 10m, and the heating unit 60 is sandwiched from above and below by the surface heaters 91, 92, and 93 so that the temperature rises in a short time. It is configured. The temperature of each surface heater 91, 92, 93 is monitored by the temperature sensor 13, and the temperature is controlled so that each heater has an appropriate temperature.

  Temperature sensors 12A and 12B are provided upstream and downstream of the heating unit 60, detect the temperature of the dialysate whose temperature has been increased by the heating unit 60, and control the temperature together with the temperature sensor 13 described above. A feedback system is configured to maintain the dialysate at a temperature close to body temperature.

  A clamp 10n is connected to the outlet of the heating unit 60, and a tube 59 is connected to the clamp 10n. The tube 39 and the tube 49 are branched from the middle of the tube 59, the clamp 10 p is connected to the tube 39, and the tube 39 is connected so as to return to the tube 29. A clamp 10q is connected to the tube 49 branched from the middle of the tube 59, and is connected so as to return to the tube 19 through the diaphragm 21.

  A clamp 10j is connected to the tube 59, and a tube 9m is connected to the clamp 10j. The clamp 9j is connected to the abdominal cavity 4 of the patient via a plug 8j connected to the tube 9m. A flow meter 16a and a bubble sensor 14b for detecting bubbles are provided in the middle of the tube 9m. In addition, the apparatus 1 is provided with an outside air temperature sensor 16b that detects the outside air temperature. Furthermore, a clamp (not shown) for opening and closing each tube is provided everywhere to prevent liquid leakage during setting.

  Here, as a constituent material of each bag, tube and heating unit, and diaphragm, a soft resin material is used. Examples of the soft resin material include polyolefins such as polyethylene, polypropylene, ethylene-propylene copolymer, and ethylene-vinyl acetate copolymer (EVA), polystyrene, polyamide, polyimide, and poly- (4-methylpentene-1). Polyesters such as ionomers, acrylic resins, polyethylene terephthalate (PET), polybutylene terephthalate (PBT), styrene-based, polyolefin-based, polyurethane-based, polyester-based, polyamide-based thermoplastic elastomers, silicone resins, polyurethanes, etc. Alternatively, copolymers, blends, polymer alloys and the like mainly composed of these may be used, and one or more of these may be used in combination (for example, as a laminate of two or more layers).

  Next, FIG. 3 is a block diagram of the peritoneal dialysis apparatus 1. The control system 15 which is a control means in this figure includes a CPU 150 and a storage unit 152. The CPU 150 includes a clamp control unit 153 for controlling opening and closing of the plurality of clamps 10a to 10q, and a plurality of surfaces. A heater control unit 154 for controlling the temperatures of the heaters 91, 92, and 93 and a pumping operation control unit 155 for controlling the pumping operation unit 10 that is a liquid feeding unit are electrically connected. The CPU 150 is connected to the temperature sensors 12A and 12B, the temperature sensor 13 for each heater, the display unit 23, and the operation units 24a and 24b. The bubble sensors 14 a and 14 b are connected to the CPU 150 via the bubble sensor unit 14.

  The CPU 150 is electrically connected to a power supply circuit 156, a battery circuit 157, a sound generation circuit 400, and a cassette body loading control unit 301 for controlling the cassette body loading means 300. The display unit 23 is electrically connected to a card reader 203 that can be loaded with the memory card.

  Further, the electromagnetic flow meter 16 a and the outside air temperature sensor 16 b are connected to the CPU 150 via various sensor units 16.

  According to the control system 15, when the temperature measured by the temperature sensor 12A is equal to or higher than a predetermined temperature of 39 ° C., the clamp control unit 153 controls the clamp to perform the clamp state and the unclamp state. In addition, the heater control unit 154 controls the energization of the surface heaters 91, 92, and 93.

  Moreover, the output value of each surface heater 91, 92, 93 is selected based on the temperature of the dialysate. That is, the control system 15 controls the temperature of the dialysate to be injected within a predetermined temperature range based on the temperature measured by the temperature sensor 12A and the temperature measured by the temperature sensor 12B. The energization control to each surface heater 91, 92, 93 is performed.

  Then, the clamp control unit 153 which is a flow path switching unit switches each clamp to a clamped state and an unclamped state as described later, thereby allowing the used dialysate stored in the abdominal cavity of the patient for a predetermined time to be fed. To send to each bag.

  Specifically, a first liquid-feeding state in which a used dialysate stored in the abdominal cavity of a patient for a predetermined time is sent to the drainage bag 6 and a dialysate stored in one of the dialysis bags are supplied. The liquid is fed to the spare bag 7 by the means, the second liquid feed state is heated by the warming means and accumulated in the spare bag 7, and the dialysate is sent from the spare bag 7 to the abdominal cavity 4 of the patient by the liquid feed means. For example, after the third liquid feeding state for storing the liquid in the abdominal cavity of the patient for a predetermined time and after the third liquid feeding state, the liquid feeding unit emptied the second liquid feeding state. The flow path is switched to the fourth liquid supply state in which the used dialysate is supplied to the dialysis bag 5a.

  FIG. 4A is a piping diagram for explaining the first liquid feeding state in a connected state forming a flow path communicating with the abdominal cavity, and FIG. 4B is a piping diagram for explaining the second liquid feeding state. is there.

  In this figure, components that have already been described are denoted by the same reference numerals and description thereof is omitted. First, in FIG. 4 (a), a connection state is formed to form a flow path communicating with the abdominal cavity, and preparation for dialysis is performed. When the device is ready and the device 1 is activated, the patient lies on the bed. Thereafter, the used dialysate (hatched in the figure) stored in the abdominal cavity 4 for a predetermined time during the day is brought into a first liquid feeding state for feeding into the drainage bag 6 by the liquid feeding means.

  Specifically, in FIG. 4A, the clamps of the dialysis bags 5a to 5f leading to the tube 9k are all closed, the clamp of the spare bag 7 is also closed, and the clamp 10h of the drainage bag 6 is opened. In addition, the clamps 10n and 10m of the tube 59 and the clamp 10q of the tube 49 are closed, while the clamp 10j of the tube 9m, the clamp 10p of the tube 39, and the clamp 10k of the tube 29 are opened. In this state, the diaphragm 20 is operated by the liquid feeding means, thereby forming a flow path that communicates the abdominal cavity 4, the tube 9m, the tube 59, the tube 39, the tube 29, the tube 19, and the tube 9h. Is done. Through this flow path, liquid feeding is performed in the direction of the arrow in the figure, and about 3500 ml of liquid is fed to the drainage bag 6. As a result, the abdominal cavity 4 becomes empty.

  Next, in FIG. 4B, the dialysate stored in one of the dialysis bags is sent to the spare bag 7 by the liquid feeding means, and heated by the warming means to be stored in the spare bag. It shifts to 2 liquid feeding state.

  Specifically, in FIG. 4B, the clamp 10h of the drainage bag 6 is closed. Further, only the clamp 10a of the dialysis bag 5a among the dialysis bags 5a to 5f leading to the tube 9k is opened. Also, the clamps 10k, 10m, and 10n of the tube 29 and the clamp 10q of the tube 49 are opened, while the clamp 10j of the tube 9m and the clamp 10p of the tube 39 are closed. Further, the clamp 10q of the tube 49 is opened.

  In this state, the diaphragm 20 is first operated by the liquid feeding means, and before and after this, the surface heaters 91, 92, 93 are energized to increase the temperature of the dialysate to near body temperature. Liquid feeding in the direction of the solid arrow in the figure is performed through the flow path. That is, the heated dialysate flows through the tube 49 serving as a bypass flow path, and the diaphragm 21 starts liquid feeding in the direction indicated by the broken line in the figure. Before and after this, the empty clamp 10a of the dialysis bag 5a is closed and the clamp 10g of the spare bag 7 is opened.

  Then, as described in FIG. 9 above, for example, the dialysate heated from 5 ° C. at room temperature to 37 ° C. near the body temperature flows into the spare bag 7 set in the suspended state as described above. However, at this time, about 3500 ml of liquid is fed while growing small bubbles that have been deposited with the temperature change by the heating means in the space 7a on the surface of the dialysate after heating.

  Next, FIG. 5A is a piping diagram illustrating a third liquid feeding state in a connected state that forms a flow path communicating with the abdominal cavity, and FIG. 5B illustrates a fourth liquid feeding state. It is a piping diagram.

  In this figure, components that have already been described are denoted by the same reference numerals and will not be described. First, in FIG. 5A, the dialysate is sent from the spare bag 7 to the abdominal cavity 4 of the patient by the solution feeding means. The state of the 3rd liquid feeding state for making it hold | maintain and storing in the abdominal cavity 4 of a patient for a predetermined time is shown.

  Specifically, in FIG. 5 (a), only the clamp 10g of the spare bag 7 leading to the tube 9k is opened. At this time, the dialysis bag 10a is empty.

  Moreover, while the clamps 10k, 10m, and 10n of the tube 29 are opened, the clamp 10j of the tube 9m is also opened. The clamp 10p of the tube 39 and the clamp 10q of the tube 49 are closed.

  In this state, the diaphragm 20 is operated by the liquid feeding means, and the dialysate that has already been heated is fed through the flow path in the direction of the solid arrow in the figure. At this time, the temperature of the dialysate after warming is again detected by the temperature sensor and adjusted to an appropriate temperature, and then fed into the abdominal cavity 4 through the tube 9m. After this, the first dialysis treatment performed by the difference in osmotic pressure between the blood in the blood vessels around the abdominal cavity and the dialysate is completed by waiting for a predetermined time of about 1.5 to 2 hours. .

  At this time, since the small bubbles generated in the preliminary bag 7 are grown in the space portion 7a on the liquid surface of the dialysate and the liquid is fed from the bottom surface, the bubbles do not flow out at all. Next, in FIG. 5 (b), after the third liquid feeding state described in FIG. 5 (a), the used dialysate is applied to the dialysis bag 10a which is emptied in the third liquid feeding state by the liquid feeding means. The state of the 4th liquid feeding state which liquid-feeds is shown.

  Specifically, in FIG. 5B, the clamp 10g of the spare bag 7 leading to the tube 9k is closed. At this time, since the spare bag 7 is empty, it can be used as a spare bag 7 for dialysis treatment using the next dialysis bag 5b. On the other hand, since the dialysis bag 10a is empty, liquid feeding to the dialysis bag 10a is performed. For this reason, the clamps 10k, 10m and 10n of the tube 29 are closed, while the clamp 10j of the tube 9m, the clamp 10q of the tube 49 and the clamp 10a of the dialysis bag 5a are opened.

  In this state, the diaphragm 21 is operated by the liquid feeding means, and the used dialysate is fed to the dialysis bag 5a through the tube 49 serving as a bypass channel.

  This transition, by repeating the above-mentioned second liquid supply state to the fourth liquid supply state, the bedtime of the patient by storing the used dialysate in all of the dialysis bags 5b, 5c, 5d, 5e, and 5f Peritoneal dialysis over 8 hours, which is the time, is completed.

  The spent dialysate collected in each dialysis bag in this way can be transported individually by removing each plug after each dialysis bag is closed using a clamp. Can be disposed of. In addition, the used dialysis bag is incinerated.

  FIG. 6 is a flowchart illustrating the operation of the apparatus 1 indicating that the first to fourth liquid feeding states are set. In this figure, when preparation for liquid delivery is completed in step S1, the power source of the apparatus 1 is turned on, the process proceeds to step S2, a self-check program is started, and the presence or absence of an abnormal state in the apparatus is inspected. Thereafter, the process proceeds to step S3, where a priming operation is performed to expel air in the flow path of the dialysate after the dialysis bag and other connections, and the inside of the tube is filled with the dialysate.

  As described above, when the patient is ready for dialysis treatment at bedtime and the treatment is started by turning on the switch in step S4, the process proceeds to step S5 and the first liquid supply state as the initial drainage is set. Thus, the dialysis fluid is collected in the waste solution bag 6 during the daytime activity of the patient. Before and after this, the dialysate is heated, and the preliminarily heated dialysate is stored in the reserve bag 7 to the second liquid feeding state.

  Following this, the process proceeds to step S6 and the above-described third liquid feeding state is set. That is, a treatment for injecting dialysate into the tumor cavity 4 of the patient is performed. Thereafter, in step S7, the dialysate is stored in the abdominal cavity 4 of the patient, and the dialysis treatment by osmotic pressure is performed, so that the used dialysate, which is a waste liquid containing the waste that is deposited on the dialysate, Temporarily collect in the abdominal cavity 4. Following this, the process proceeds to step S8, the liquid is supplied to the dialysis bag 5a which has been emptied by setting the above-mentioned fourth liquid supply state, and the treatment with the first dialysis bag is completed.

  In step S9, it is determined whether or not the treatment for the predetermined number of cycles for the remaining dialysis bags has been completed, and the dialysis solution for the dialysis bags 5a to 5e (see FIG. 2) is repeatedly performed. When the process is completed, the process proceeds to step S10 and the drainage is performed again. That is, the used dialysate that has not been collected from the abdominal cavity 4 of the patient is drained while changing the direction of the body.

  When the drainage is completed in this manner, the final injection is performed in step S11. When living with the dialysate being placed in the abdominal cavity 4 during daytime activities, the dialysate stored in the dialysis bag 5f is finally used. Inject the solution. All of the liquid feeding is completed as described above, and the infusion set is removed from the device 1 in step S12, and the power of the device 1 is turned off in step S12.

  Next, FIG. 7A is a plan view of the cassette body 2, and FIG. 7B is a cross-sectional view taken along line XX in FIG. 7A. The structure of the cassette body 2 can be substantially the same as that disclosed in the above-mentioned Japanese Patent Application Laid-Open No. 2003-000704. The difference is that the clamp is a switched portion of the flow path switching means. As for dialysis bag 5a-5f provided with 10a-10f, the point located in the near side like illustration is mentioned. Further, the clamp 10h of the drainage bag 6 and the clamp 10g of the spare bag 7 are located on the right side. In addition, two diaphragms 20 and 21 are provided side by side as shown.

  Further, in FIG. 7B, the cam mechanism 100 is arranged to be driven by the motor 101 in order to drive the fingers up and down in order to control each clamp and switch between the clamped state and the unclamped state. However, since the configuration of this cam mechanism is also described in detail in Japanese Patent Laid-Open No. 2003-000704, description thereof is omitted. Here, a worm gear mechanism can be used instead of the cam mechanism.

  FIG. 8 is a schematic diagram showing a state in which the flow path switching means for closing the clamp is configured by a worm gear mechanism. In this figure, the cassette body 2 is set in the apparatus 1, and the claw body 600 for closing the tube 9 built in the cassette body 2 with the clamps 10a to 10q is moved up and down at the positions indicated by the solid line and the broken line in the figure. By being driven, it is brought into a clamped state and an unclamped state. The nail | claw body 600 is being fixed to the cylinder 610 guided to an up-down direction by the guide member not shown.

  A pair of groove portions 601 are formed on the side surface of the cylindrical body 610 at symmetrical positions. A moving member 602 is built in the cylindrical body 610, and a pair of pins 619 that are inserted into the groove portion 601 are fixed to the outer peripheral surface of the moving member 602. While being prevented from rotating inside the body 610, the moving member 602 is configured to stop at an upper position and a lower position. Further, a compression spring 666 built in the space of the cylindrical body 610 is provided above the moving member 602 so that the compression spring 666 is appropriately deformed so that the tube 9 is not excessively pressed by the claw body 600. To prevent damage. An internal thread member 622 having an internal thread portion is fixed inside the moving member 602, and an external thread portion 620 is engaged with the internal thread portion. A worm wheel 630 is fixed to the other end of the male screw portion 620 and is pivotally supported by a bearing (not shown).

  On the other hand, the worm gear 640 is driven by the motor 650, and the electromagnetic solenoid 631 moves up and down so that the worm wheel 630 is engaged with the worm gear 640 (broken line) and disengaged (solid line). It is configured to be driven.

  According to the above configuration, when the electromagnetic solenoid 631 is individually energized and the worm wheel 630 is moved to the position indicated by the broken line, the rotational force of the worm gear 640 is transmitted to the male screw portion 620 and meshed therewith. When the female screw member 622 is moved upward, the moving force is transmitted to the cylindrical body 610 via the compression spring 666, and the claw body 600 is moved to the broken line position, whereby the tube 9 is brought into a clamped state indicated by the broken line. be able to.

  Moreover, although each said diaphragm 20 and 21 can perform liquid feeding with the air circuit described in detail in Unexamined-Japanese-Patent No. 2003-000704, a liquid feeding means is not limited to this diaphragm type, for example, a tube It may be a peristaltic type or a roller pump type that performs a peristaltic motion by acting on the outer peripheral surface, and any kind of pump can be used.

A plug 8a in which a tube 9 is provided with a peritoneal dialysis device 1, which is an embodiment of the present invention, a cassette body 2, a plurality of dialysis bags 5 storing dialysate, a spare bag 7, and a drainage bag 6. It is the external appearance perspective view which showed the connection state which forms the flow path connected to a patient's abdominal cavity by connecting by -8j, and sends a dialysate into the abdominal cavity 4 (broken line illustration) of a patient. 1 is a schematic view showing a connection state in which a plurality of dialysis bags storing a dialysate, a spare bag, and a drainage bag are connected to each other using a plug to form a channel communicating with the abdominal cavity of a patient. It is. 1 is a block diagram of a peritoneal dialysis device 1. FIG. (A) is a piping diagram explaining the 1st liquid feeding state made into the connection state which forms the flow path connected to abdominal cavity, (b) is a piping diagram explaining the 2nd liquid feeding state. (A) is a piping diagram explaining the 3rd liquid feeding state made into the connection state which forms the flow path connected to an abdominal cavity, (b) is a piping diagram explaining the 4th liquid feeding state. 6 is a flowchart for explaining the operation of the apparatus 1 indicating that the first to fourth liquid feeding states are set. (A) is a top view of the cassette body 2, and (b) is an XX arrow directional cross-sectional view of (a). It is a schematic diagram which shows a mode that the flow-path switching means which obstruct | occludes a clamp was comprised with the worm gear mechanism. It is a graph which shows the correlation of bubble amount and temperature.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Peritoneal dialysis apparatus 2 Cassette body 3 Stand 4 Abdominal cavity 5a-5f Dialysis bag 6 Drainage bag 7 Spare bag 8a-8j Plug 9 Tube 10a-10q Clamp 19, 29, 39, 49, 59 Tube 20, 21 Diaphragm 60 Warming Part

Claims (9)

A peritoneal dialysis machine used in a connected state that forms a flow path communicating with the abdominal cavity of a patient by connecting a plurality of dialysis bags storing dialysate, a suspended spare bag, and a drainage bag There,
A first liquid-feeding state in which a spent dialysate stored in the abdominal cavity of a patient for a predetermined time is sent to the drainage bag by a liquid-feeding means; and the dialysate stored in one of the dialysis bags, The liquid is fed to the spare bag by the liquid feeding means, heated by the warming means and accumulated in the spare bag, and the bubbles generated by the warming are accumulated in the space above the liquid level of the spare bag. The flow into the second liquid feeding state and the third liquid feeding state in which the dialysate is fed from the spare bag to the patient's abdominal cavity by the liquid feeding means and stored in the patient's abdominal cavity for a predetermined time. Flow path switching means for switching the path;
And a control means connected to the liquid feeding means, the heating means, and the flow path switching means, and for controlling to change from the first state to the third state. A peritoneal dialysis device.   The flow path switching means supplies the spent dialysate to the dialysis bag that has been emptied in the second liquid supply state by the liquid supply means after the third liquid supply state. 2. The peritoneal dialysis device according to claim 1, wherein the peritoneal dialysis device is switched to a liquid feeding state. The dialysis bag, the spare bag, and the drainage bag include one of plugs, a part of the flow path, an actuated part of the liquid feeding means, a heated part of the warming means, A cassette body integrally provided with the switched portion of the flow path switching means, and a cassette loading means for making the cassette body detachable,
The said dialysis bag, the said reserve bag, and the said drainage bag are connected with the said cassette body through the other of a plug, It is set as the said connection state. Peritoneal dialysis machine. The actuated portion includes a diaphragm that is brought into a positive pressure state and a negative pressure state by the actuating portion of the liquid feeding means after the cassette body is loaded in the cassette loading means,
The heated portion includes a meandering channel heated from above and below by a surface heater of the heating means, and heats after the cassette body is loaded in the cassette loading means. Item 3. The peritoneal dialysis device according to Item 2. A dialysate set used in the peritoneal dialysis device according to any one of claims 1 to 4,
The dialysate set, wherein the plurality of dialysis bags, the spare bag, the drainage bag, and the flow path are in a closed aseptic state before the connection state. A plurality of dialysis bags storing dialysate, a suspended spare bag, and a drainage bag are connected to form a flow path that communicates with the patient's abdominal cavity. A method for controlling a peritoneal dialysis device for performing peritoneal dialysis treatment by draining from the abdominal cavity after a predetermined time,
A step of bringing the used dialysate stored in the abdominal cavity of the patient for a predetermined time into a first liquid-feeding state in which the liquid-feeding means feeds the drainage bag;
The dialysis solution in one dialysis bag is fed to the spare bag by the fluid feeding means, heated by the warming means and stored in the spare bag, and bubbles generated by the heating are A step of bringing the second liquid feeding state to be accumulated in the space above the liquid level of the spare bag;
A step of feeding the dialysate from the spare bag to the abdominal cavity of the patient by the liquid feeding means, and a third liquid feeding state for storing the dialysate in the abdominal cavity of the patient for a predetermined time. Control method of dialysis machine.   After the third liquid feeding state, a step of setting the fourth liquid feeding state in which the used dialysate is fed to the dialysis bag emptied in the second liquid feeding state by the liquid feeding means. The method for controlling a peritoneal dialysis device according to claim 6, further comprising: A part of the flow path, the actuated part of the liquid feeding means, the heated part of the warming means, and the switched part of the flow path switching means are integrally disposed and a cassette loading means Loading the cassette body detachable into the cassette loading means;
The dialysis bag, the spare bag, and the drainage bag are connected to the cassette body via a plug to form the flow path, further comprising the step of: 8. A method for controlling a peritoneal dialysis device according to item 7. The diaphragm, which is the actuated part, is brought into a positive pressure state and a negative pressure state by the actuating part of the liquid feeding means after the cassette body is loaded in the cassette loading means;
A step of heating the meandering channel which is the heated portion and is heated from the upper and lower surfaces by the surface heater of the heating means after the cassette body is loaded in the cassette loading means. The method for controlling a peritoneal dialysis device according to any one of claims 6 to 8.

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