JP2007190235A - Hemodialyzer - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a hemodialyzer quickly changing the electrolyte concentration in the blood by supplying dialysis fluid to the blood by inverse filtering, exerting a similar effect to that of the conventional one in a less consumption of the electrolyte solution, and interlockingly controlling a blood pump, a dialysis fluid sending means and an infusion pump. <P>SOLUTION: This hemodialyzer is so formed that an artery side of the dialyzer is connected with an artery side blood circuit having a blood pump and the vein side is connected with a vein side blood circuit, and the side of the dialyzer is connected with a dialysis fluid supply line having a first fluid sending means and a dialysis fluid discharge line having a second fluid sending means; is provided with electrolyte concentration measuring detectors in the dialysis fluid supply line or in the both of the dialysis fluid supply/discharge lines, a bypass line connecting an upstream side to a downstream side at least in one of the dialysis fluid supply/discharge lines, and a third fluid sending means adjusting the amount of the dialysis fluid in the bypass line; and adjusts the electrolyte concentration in the blood circuit side by carrying out the inverse filtering using the third fluid sending means. <P>COPYRIGHT: (C)2007,JPO&INPIT

Description

  The present invention relates to a hemodialysis apparatus for purifying blood by applying extracorporeal circulation as a treatment to replace the kidney function of patients with chronic renal failure in the medical field, and is particularly important in hemodialysis and hemofiltration dialysis treatment. The present invention relates to a hemodialysis apparatus that can adjust the concentration of various electrolytes.

  For the treatment of patients with renal failure, various blood purification methods have been proposed as methods for purifying blood taken from the patient's body and returning it to the body again. For example, blood purification methods using extracorporeal circulation The types are classified into a hemofiltration (HF) apparatus for removing and replacing body fluid by ultrafiltration, and a hemodiafiltration (HDF) apparatus that combines this HF and hemodialysis (HD) by diffusion.

In long-term dialysis patients, elderly patients, diabetic nephropathy patients, etc. treated with such devices, cardiac function and blood pressure may decrease during treatment, and in such cases, dialysate supplied to the dialyzer High sodium dialysis treatment may be performed to increase the sodium (Na) concentration of the dialysate by injecting sodium chloride (NaCl) solution (saline) into the dialysis solution. In this high sodium dialysis, the normal sodium concentration is about 140 mEq / L (almost the same as the body fluid concentration of the human body), but by injecting a solution containing sodium into the dialysate, the concentration is approximately 145 to 150 mEq / L. The goal is to keep it on.
By such high sodium dialysis treatment, the sodium concentration of the dialysate in the supplied dialysate supply line is increased, sodium ions are transferred from the dialysate to the blood by diffusion within the dialyzer, and the sodium concentration in the blood is reduced. By increasing the osmotic pressure by increasing the osmotic pressure, dialysis is performed by smoothly drawing out water and solutes in the cells and removing the water. By smoothly transferring water from the cells to the blood vessels, the load on the heart is reduced as much as possible to prevent a decrease in blood pressure.
Moreover, it is known that not only Na but also electrolytes such as potassium (K), magnesium (Mg), and calcium (Ca), the excess or deficiency has a significant effect on the heart function of the patient. There is a need to keep these concentrations appropriate. The present invention is directed to a hemodialysis apparatus that can control the concentration of electrolytes such as Na, K, Mg, and Ca.

In the past, for example, saline has been supplied to the dialysate line or blood line in response to a decrease in the blood pressure of the patient, and this is a highly uncertain and difficult person to deal with in an emergency. Instead of a simple administration means, in response to an instruction signal sent by the patient or other personnel, a predetermined amount of sodium is automatically added to the dialysate, ensuring reliable sodium administration and inefficient human A means for avoiding the work is proposed in Patent Document 1.
In addition to improving symptoms such as lowering blood pressure, in order to suppress the appearance of symptoms such as dry mouth and weight gain, which are side effects of high sodium dialysis, a hypertonic solution mainly composed of sodium is used in the blood circuit during hemodialysis. Patent Document 2 proposes a device that intermittently injects a predetermined amount at predetermined intervals via an injection control means in the middle of at least one of the dialysate circuits.
JP 2004-358269 A JP 2003-260129 A

In the conventional dialysis apparatus including the above Patent Document 1 and Patent Document 2, anyway, high sodium dialysis is carried out by utilizing the diffusion phenomenon in the dialyzer by injecting a NaCl solution into the dialysate. Further, as a supply means, an NaCl solution was injected using an injection pump. In the concentration adjustment by diffusion and the supply method by the pump means, the actual sodium concentration in the blood increases after the injection operation, and there is a certain time difference until the movement of water due to the sodium osmotic pressure difference from the cells. For example, when an instruction to change the injection amount of NaCl solution into the dialysate is given, it has been confirmed that it takes a considerable time (two minutes or more) until the actually changed dialysate is supplied to the dialyzer. For this reason, when it is necessary to urgently change the sodium concentration, it may be impossible to cope with it.
Although the above problem has been described in the case of high sodium dialysis, the same problem can occur with other electrolytes (K, Mg, Ca, etc.) listed above.
In order to solve such problems of the conventional example, the present invention injects a solution containing an electrolyte into the dialysate with a pump means for injecting electrolyte such as Na, or reversely without using the pump means. Provided is a hemodialysis apparatus that can rapidly change the electrolyte concentration in the blood by replacing the dialysate with blood by filtration, and can achieve the same effect as the conventional one with less solution consumption It is. In addition, the present invention provides a hemodialysis apparatus capable of adjusting an electrolyte concentration efficiently by interlockingly controlling at least two of a blood pump, a reverse filtration pump, and an electrolyte injection pump. For other purposes.

In order to achieve the above object, the present invention is summarized as follows.
(1) An arterial blood circuit having a blood pump is connected to the arterial side of the dialyzer, a venous blood circuit is connected to the venous side of the dialyzer, and a dialysate supply line having a first liquid feeding means on the side surface of the dialyzer And the dialysate discharge line having the second liquid feeding means, and the electrolyte concentration is measured in the dialysate supply line or both in the dialysate supply line and the discharge line. And a bypass line that communicates the upstream side and the downstream side of the first liquid feeding means or the second liquid feeding means on at least one of the dialysate supply line and the dialysate discharge line. The bypass line is provided with a third liquid feeding means capable of feeding the dialysate in both forward and reverse directions, and reverse filtration is performed using the third liquid feeding means. Hemodialysis apparatus characterized by being configured to adjust the electrolyte concentration in the blood circuit side by the.
(2) A venous pressure gauge for measuring venous pressure is provided in the venous blood circuit, and a control means for interlocking control of the blood pump and the third liquid feeding means is provided. The hemodialysis apparatus according to (1), wherein fluctuations in venous pressure are suppressed by controlling at least one of the flow rates of the blood pump and the third liquid feeding means based on the venous pressure.
(3) An electrolyte solution storage tank is connected to the dialysate supply line via an electrolyte injection pump, and the electrolyte concentration on the blood circuit side is adjusted by moving the electrolyte by diffusion and injecting electrolyte by reverse filtration in a dialyzer. The hemodialysis apparatus according to (1), which is configured as described above.
(4) The electrolyte concentration in the dialysate supply / discharge line is measured by each detector, and the electrolytic mass that enters the body is predicted based on the obtained electrolyte concentration. If this predicted amount is less than the set value, electrolyte injection The hemodialysis apparatus according to (3), wherein a pump is operated to inject an electrolyte solution.
(5) The electrolyte concentration in the dialysate supply / discharge line is measured by each detector, and the electrolytic mass that has entered the body is predicted by the obtained electrolyte concentration. The hemodialysis according to (1), wherein the electrolyte solution is injected by reverse filtration by the liquid feeding means, and at least one of the flow rates of the blood pump and the third liquid feeding means is controlled to suppress fluctuations in venous pressure. apparatus.

According to the hemodialysis apparatus of the present invention, in addition to the movement of electrolyte ions due to diffusion, the electrolyte concentration in blood can be increased by forcibly injecting electrolyte ions with a reverse filtration replenisher compared to the case of only diffusion. . In other words, the same effect can be obtained with less electrolyte solution consumption. Moreover, compared with the case of only diffusion, the blood electrolyte concentration can be changed immediately, and the situation where a rapid change in electrolyte concentration is required can be easily dealt with. Accordingly, it is possible to immediately cope with a decrease in blood pressure or a heart related disorder in a dialysis patient.
In addition, it is possible to arbitrarily control the electrolyte concentration in the blood by controlling the reverse filtration speed and the speed of the blood pump in conjunction with each other, and associatively controlling by adding an electrolyte infusion pump as necessary.
Furthermore, according to the present invention, the concentration of the dialysate can be kept constant, the blood electrolyte concentration can be changed only by reverse filtration, and its applicability is very wide. In addition, the pump can be miniaturized and its practicality is high.

Hereinafter, embodiments of the present invention will be described in detail. In the illustrated embodiment, the concentration adjustment of sodium as an electrolyte will be described as an example. Of course, the present invention is not limited to this, and the same applies to the concentration adjustment of electrolytes other than sodium (potassium, magnesium, calcium, etc.). It can be applied to.
FIG. 1 shows an example of a hemodialysis apparatus suitable for applying the present invention. An arterial blood circuit 2 is connected to an artery side of a dialyzer 1 for purifying blood by extracorporeal circulation of blood, and a venous side is connected to a venous side. A blood circuit 3 is connected, and a dialysate supply line 4 and a dialysate discharge line 5 are connected to the side surfaces of the dialyzer 1, respectively. The arterial blood circuit 2 includes an arterial chamber having a function of removing blood bubbles mixed in the circuit and a blood pump 7 capable of rotating in the forward and reverse directions to remove blood from the arterial connection portion 6a of the patient and lead it to the dialyzer 1. 8 is provided. The venous blood circuit 3 for returning blood to the venous side connection 6b of the patient is provided with a venous chamber 10 having a function of discharging bubbles mixed in the circuit and excess dialysate to the overflow line 9. It has been.

  The dialysate supply line 4 and the dialysate discharge line 5 are provided with a first liquid feeding means 11 (dialysate supply side) and a second liquid feed means 12 (dialysate drain side), respectively, and a dialysate discharge line. 5, a bypass line 13 that connects the upstream side and the downstream side of the second liquid feeding means 12 is provided, and the amount of dialysate for water removal / replacement (reverse filtration) can be adjusted in the bypass line 13. A third liquid feeding means 14 capable of feeding liquid in both reverse directions is provided. In the example shown in the figure, the bypass line capable of feeding in both forward and reverse directions is provided only in the dialysate discharge line 5, but the present invention is not limited to this, and only the dialysate supply line 4 or It can also be provided in both the dialysate supply line 4 and the dialysate discharge line 5. As each liquid feeding means described above, known means such as a reciprocating pump or a rotary pump may be employed.

  When actual hemodialysis is performed in the dialysis apparatus having the above-described configuration, a priming process for cleaning the blood circuit and dialyzer before starting treatment, a blood removal process after puncture for drawing blood from the patient's body, and extracorporeal circulation are performed. A dialysis process by diffusion and filtration in a dialyzer for performing, and a blood return process for returning blood in the blood circuit after dialysis is returned to the patient. The present invention is basically applied to hemodialysis (HD) by diffusion or hemodiafiltration (HDF) with ultrafiltration added thereto.

  In the present invention, first, the case where high sodium dialysis is performed while the concentration and composition of the dialysate are kept constant will be described. Usually, the sodium concentration of dialysate is set to be slightly higher than that of human body fluid (for example, body fluid Na concentration 135 mEq / L, dialysate Na concentration 140 mEq / L). High sodium dialysis is performed by changing the blood sodium concentration by applying reverse filtration from the line 5. That is, in the hemodialysis apparatus as shown in FIG. 1, the third liquid feeding means 14 (for example, constituted of a water flow pump) disposed in the bypass line 13 provided in the dialysate discharge line 5 is connected to the dialysate discharge line. 5 is operated in the direction opposite to the second liquid feeding means 12, reverse filtration (BF) is performed in the dialyzer 1, and the dialysate is fed to the blood side. As a result, the sodium on the blood side is increased by this reverse filtration, and the sodium concentration on the blood side is increased. The operation of increasing the amount of sodium by reverse filtration can be repeated intermittently as necessary.

Thus, when the sodium concentration on the blood side is adjusted by reverse filtration, it is accompanied by a forced dialysis fluid injection operation, so that the speed of concentration adjustment is markedly faster than diffusion. For this reason, when a situation such as a decrease in blood pressure of a patient occurs and a rapid change in sodium concentration is required, it is possible to respond quickly by adjusting the concentration by reverse filtration. Of course, it is also possible to combine the adjustment of the sodium concentration by conventional diffusion and the adjustment of the sodium concentration by reverse filtration.
As shown in FIG. 1, detectors 15 and 16 for measuring the sodium concentration in each line are installed in advance in the dialysate supply line and dialysate discharge line, and measurement is performed by each detector. It is preferable to control to a desired concentration based on the measured sodium concentration. For example, it may be determined whether the density difference between the two detection values is within an appropriate range, and feedback control may be performed based on this. Moreover, the movement of the electrolyte into the body can be estimated by the concentration difference, and further, the accuracy of estimating the electrolytic mass introduced into the body is improved.
Further, the concentration detector can also be provided by providing it in either one of the dialysate supply line and the dialysate discharge line. When the concentration detector is provided only in the dialysate supply line, only the dialyzer solution needs to be checked (confirmation of the electrolyte concentration of the dialyzer solution).
As specific concentration control means, the concentration can be adjusted by adjusting the speed, flow rate, number of times, time, etc. of back filtration (BF) through the third liquid feeding means (pump) 14. At this time, the control device 17 is provided, the proper (set) concentration is calculated based on the signal from the concentration detector, and the control signal is output to the pump, whereby the concentration control can be performed.

When the third liquid feeding means (back filtration pump) 14 is operated to perform the reverse filtration for adjusting the sodium concentration, the venous pressure of the blood circuit, particularly the venous blood circuit 3, varies depending on the pump flow rate (flow rate). If this fluctuation range is large, the patient himself is adversely affected. For this reason, it is necessary to constantly monitor the venous pressure and control the blood pump and the reverse filtration pump in conjunction when the fluctuation range exceeds the allowable range. Specifically, the measured value by the venous pressure gauge 18 provided in the venous blood circuit 3 is input to the control device 17, and when the value exceeds the allowable range, the blood pump 7 and / or reverse filtration is automatically performed. A command is issued to the pump 14, and at least one of the pump flow rates (flow rates) is adjusted to return the venous pressure to an appropriate range. For example, when the venous pressure exceeds an allowable value, a command for lowering the flow rate of the back filtration pump 14, a command for lowering the flow rate of the blood pump 7, or a flow rate balance between both pumps may be adjusted. (Claim 2)
In actual operation, the reverse filtration pump is controlled via the dialyzer, and therefore it is desirable to preferentially use the blood pump 7 that can directly adjust the flow rate of the blood circuit. Of course, the reverse filtration pump 14 can be used when adjustment by the blood pump is difficult for some reason, but both pumps can be used together depending on the case.

  In the control system for suppressing the venous pressure fluctuation, the concentration control can be accurately performed based on the concentration detection values by the sodium concentration detectors 15 and 16 provided in the dialysate line. That is, the amount of sodium entering the body is predicted from the data of the two concentration detectors, and when the amount entering the body is less than the set value, a command is given to the reverse filtration pump 14 to increase the sodium solution flow rate, Conversely, when the amount entering the body is greater than the set value, the sodium solution flow rate may be reduced. By carrying out such control, it becomes possible to control the sodium concentration with high accuracy while monitoring the venous pressure. (Claim 5)

Next, in the present invention, high sodium dialysis can be performed using a dialysis apparatus provided with a sodium storage tank (a tank for storing a NaCl solution), as in the conventional equipment. That is, as shown in FIG. 2, a sodium storage tank 19 is connected to the inlet side of the first liquid delivery means 11 of the dialysate supply line 4 via the injection pump 20, and to the outlet side of the first liquid delivery means 11. A detector 15 for measuring the sodium concentration of the dialysate is installed, and a similar concentration detector 16 is installed in the dialysate discharge line 5. In such a device, a solution in which the sodium concentration is adjusted by the infusion pump 18 is sent to the dialysate supply line 4, and the sodium concentration of the dialysate supplied by the detectors 15 and 16 is detected and fed back. The dialysate maintained at a desired concentration is sent to the dialyzer 1 using the first liquid feeding means 11 and the dialysate is forcibly dialed by reverse filtration (BF) by the third liquid feeding means 14 at an appropriate timing. 1 can be supplied. Thereby, the sodium concentration on the blood side is quickly changed and adjusted (increased).
As a specific control operation in FIG. 2, the amount of sodium entering the body is predicted and calculated by the control device 17 based on the concentration measurement values by the two concentration detectors 15 and 16, and the amount entering the body is determined from the set value. If the amount is too small, a command is given to the sodium infusion pump 20 to increase the sodium solution flow rate from the sodium storage tank 19, and conversely if the amount entering the body is greater than the set value, the sodium solution flow rate may be decreased. (Claim 1)

FIG. 3 shows another embodiment of the present invention. This apparatus includes a third liquid supply means 14 and a fourth liquid supply means 21 provided in a bypass manner in each of the dialysate supply / discharge lines, and a line having a plurality of electrolyte storage tanks such as sodium and potassium. The attached form is adopted, and the concentration is controlled by appropriately combining these liquid feeding means and tanks.
Further, in this dialysis facility, as shown in FIG. 3, a first solution (for example, two kinds of electrolyte solutions) is stored on the inlet side of the fourth liquid feeding means 21 in the bypass line 22 provided in the dialysate supply line 4. , A sodium) storage tank 23 and a second solution (for example, potassium) storage tank 24, and an infusion pump 25 and a solution supply line 27 provided with a switching valve 26 for switching between the tanks 23, 24. Yes. In addition, detectors 15 and 16 for detecting the electrolyte concentration in the dialysate in the dialysate supply and discharge lines 4 and 5 are installed. The solution supply line 27 having the storage tanks 23 and 24, the injection pump 25, and the switching valve 26 can be connected to the outlet side of the fourth liquid feeding means 21 instead of the inlet side of the fourth liquid feeding means 21. (This form is shown in the broken line portion of FIG. 3).

  In the form shown in FIG. 3, several control patterns can be implemented using each liquid feeding means and pump. For example, the storage tanks 23, 24 using a pattern using one or both of the third liquid feeding means 14 and the fourth liquid feeding means 21, the third liquid feeding means 14, the fourth liquid feeding means 21, and the injection pump 25. There are patterns that control multiple electrolyte concentrations. In the case of using the third liquid feeding means 14, the fourth liquid feeding means 21 and the injection pump 25, in addition to the pattern using all, the pattern using the third liquid feeding means 14 and the injection pump 25, the fourth liquid feeding means 21 and A pattern using the infusion pump 25 can be considered. In this way, any back filtration pump and, if necessary, an electrolyte injection pump may be used to control the concentration.

1 is an overall schematic diagram illustrating an example of an embodiment of a dialysis apparatus according to the present invention. It is a whole schematic diagram which shows the other example of embodiment of the dialysis apparatus which concerns on this invention. It is a whole schematic diagram which shows the further another example of embodiment of the dialysis apparatus which concerns on this invention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Dializer 2 Arterial side blood circuit 3 Vein side blood circuit 4 Dialysate supply line 5 Dialysate discharge line 6a Arterial side connection part 6b Venous side connection part 7 Blood pump 8 Arterial side chamber 9 Overflow line 10 Vein side chamber 11 1st sending Liquid means 12 Second liquid feeding means 13 Bypass line 14 Third liquid feeding means 15, 16 Concentration detector 17 Controller 18 Venous pressure gauge 19 Sodium storage tank 20 Sodium injection pump 21 Fourth liquid feeding means 22 Bypass line 23 First solution Storage tank 24 Second solution storage tank 25 Electrolyte injection pump 26 switching valve 27 Solution supply line BF Reverse filtration

Claims (5)

An arterial blood circuit having a blood pump is connected to the arterial side of the dialyzer, a venous blood circuit is connected to the venous side of the dialyzer, and a dialysate supply line having a first liquid feeding means on the side of the dialyzer and a second In a dialysis machine configured by connecting dialysate discharge lines each having a liquid feeding means,
In the dialysate supply line or in both the dialysate supply line and the discharge line, a concentration detector for measuring the electrolyte concentration is provided, and in at least one of the dialysate supply line and the dialysate discharge line, A bypass line that connects the upstream side and the downstream side of the first liquid feeding means or the second liquid feeding means is provided, and a third feed that can be fed in both forward and reverse directions so that the amount of dialysate can be adjusted in the bypass line. A hemodialysis apparatus comprising a liquid means and configured to adjust the electrolyte concentration on the blood circuit side by performing reverse filtration using the third liquid feeding means.   A venous pressure gauge for measuring venous pressure is provided in the venous blood circuit, and a control means for interlocking control of the blood pump and the third liquid feeding means is provided, and the venous pressure from the venous pressure gauge is adjusted by the control means. The hemodialysis apparatus according to claim 1, wherein at least one of a flow rate (or flow rate) of the blood pump and the third liquid feeding unit is controlled based on the fluctuation of the venous pressure.   An electrolyte solution storage tank is connected to the dialysate supply line via an electrolyte injection pump, and the electrolyte concentration on the blood circuit side is adjusted by moving the electrolyte by diffusion and injecting electrolyte by reverse filtration in a dialyzer. The hemodialysis apparatus according to claim 1, wherein   Measure the electrolyte concentration in the dialysate supply / discharge line with each detector, predict the amount of electrolyte entering the body based on the obtained electrolyte concentration, and operate the electrolyte infusion pump when the predicted amount is less than the set value 4. The hemodialysis apparatus according to claim 3, wherein an electrolyte solution is injected.   The electrolyte concentration in the dialysate supply / discharge line is measured by each detector, and the electrolytic mass entering the body is predicted by the obtained electrolyte concentration. If this predicted amount is less than the set value, the third liquid delivery means 2. The hemodialysis according to claim 1, wherein the electrolyte solution is injected by reverse filtration according to, and at least one of a flow rate (flow rate) of the blood pump and the third liquid feeding means is controlled to suppress fluctuations in venous pressure. apparatus.

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