JP2016214367A - Blood purification device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a blood purification device capable of notifying of an abnormality of a patient with a high degree of precision by effectively using parameters related to blood pressure.SOLUTION: A blood purification device equipped with treatment means 1 capable of purifying a patient's blood that extracorporeally circulates and performing blood purification treatment, and blood pressure detection means 2 for detecting blood pressure and a pulse of the patient undergoing blood purification treatment includes: calculation means 4 for obtaining at least pulse pressure, average blood pressure, and minimal blood pressure based on the value of detection by the blood pressure detection means 2; determination means 5 for determining whether or not the pulse pressure, average blood pressure, and minimal blood pressure obtained by the calculation means 4 have exceeded predetermined threshold values respectively; and display means 7 for performing predetermined notification according to the pulse pressure, minimal blood pressure, or average blood pressure on condition that it is determined by the determination means 5 that the pulse pressure, minimal blood pressure or average blood pressure has exceeded the predetermined threshold value.SELECTED DRAWING: Figure 1

Description

  The present invention relates to blood comprising therapeutic means capable of purifying blood of a patient circulating extracorporeally to perform blood purification treatment, and blood pressure detection means capable of detecting the maximum blood pressure, minimum blood pressure and pulse of the patient undergoing blood purification treatment. The present invention relates to a purification device.

  In general, in dialysis treatment, a blood circuit for circulating a patient's blood extracorporeally, a dialyzer connected in the middle of the blood circuit, an iron-type blood pump, and a dialyzer are introduced or led out. A dialysis treatment apparatus having a dialysis apparatus main body that can be dehydrated while performing hemodialysis treatment is used. Since the dialysis treatment performed by such a dialysis treatment apparatus is usually performed for about 4 hours every other day, the hemodynamics of the patient under treatment changes greatly, and in particular, removal of excess water ( It is an important issue to effectively and surely prevent blood pressure reduction by water removal).

  In order to cope with such a problem, conventionally, a dialysis treatment apparatus including a sphygmomanometer (blood pressure detection means) for measuring the blood pressure of a patient during blood purification treatment has been proposed. According to such a conventional dialysis treatment apparatus, the blood pressure of the patient during blood purification treatment (especially the patient's maximum blood pressure) can be monitored with a sphygmomanometer, and a medical staff such as a doctor can grasp the decrease in blood pressure. (For example, refer to Patent Documents 1 to 3).

JP 2010-104750 A Japanese Patent Laid-Open No. 5-115546 JP-T-2004-527296

  However, in the above-described conventional technology, although the maximum blood pressure can be monitored and the decrease in blood pressure can be notified, there is a problem that other parameters relating to the blood pressure such as the minimum blood pressure and the average blood pressure cannot be effectively used. The applicant has eagerly studied the effective use of parameters related to blood pressure other than the systolic blood pressure, and in particular, monitoring the pulse pressure, the diastolic blood pressure and the average blood pressure calculated from the difference between the systolic blood pressure and the diastolic blood pressure. did. That is, the pulse pressure can be used as an index of central arteriosclerosis, and the minimum blood pressure and the average blood pressure can be used as an index of coronary blood flow and an index of blood flow state of an important organ, respectively.

  The present invention has been made in view of such circumstances, and it is an object of the present invention to provide a blood purification apparatus capable of accurately reporting a patient's abnormality by effectively utilizing parameters related to blood pressure.

  The invention according to claim 1 is a blood comprising treatment means capable of purifying blood of a patient circulating extracorporeally and performing blood purification treatment, and blood pressure detection means capable of detecting blood pressure and pulse of the patient undergoing blood purification treatment. In the purification device, based on the detection value by the blood pressure detection means, calculation means for obtaining at least pulse pressure, average blood pressure, and minimum blood pressure, and the pulse pressure, average blood pressure, and minimum blood pressure determined by the calculation means are respectively predetermined threshold values. Depending on the pulse pressure, minimum blood pressure, or average blood pressure, provided that the determination means determines that the pulse pressure, minimum blood pressure, or average blood pressure has exceeded a predetermined threshold. And a notification means for performing predetermined notification.

  The invention according to claim 2 is the blood purification apparatus according to claim 1, wherein the pulse pressure exceeds a predetermined threshold, and the minimum blood pressure and the average blood pressure do not exceed the predetermined threshold, and the pulse pressure Is different from the second state in which at least one of the minimum blood pressure and the average blood pressure exceeds the predetermined threshold, and the notification state regarding the degree of danger by the notification means is different in the second state. It is characterized by notifying that the degree of danger is higher than the state of 1.

  According to a third aspect of the present invention, in the blood purification apparatus according to the first or second aspect, the calculation means is based on a detection value by the blood pressure detection means in addition to the pulse pressure, the average blood pressure, and the minimum blood pressure. The maximum blood pressure and the maximum blood pressure decrease degree from the start of blood purification treatment are determined, and the determination means determines whether the maximum blood pressure and the maximum blood pressure decrease degree exceed a predetermined threshold, and the notification means On the condition that it is determined that the systolic blood pressure or the systolic blood pressure lowering level exceeds a predetermined threshold value, predetermined notification according to the systolic blood pressure or the systolic blood pressure lowering level is performed.

  Invention of Claim 4 is the blood purification apparatus as described in any one of Claims 1-3. WHEREIN: In addition to the said pulse pressure, average blood pressure, and the minimum blood pressure, the said calculation means is the detection value by the said blood pressure detection means. The pulse rate and the PRP obtained by multiplying the pulse rate by the maximum blood pressure are determined, and the determination means determines whether the pulse rate and the PRP exceed a predetermined threshold, and the notification On the condition that the pulse rate or PRP is determined to have exceeded a predetermined threshold by the means, predetermined notification according to the pulse rate or PRP is performed.

  According to a fifth aspect of the present invention, in the blood purification apparatus according to any one of the first to fourth aspects, the notification means includes display means capable of displaying information related to blood purification treatment in real time. By the means, the calculated value obtained by the calculating means and the rate of change of the circulating blood volume during the blood purification treatment are displayed together.

  According to a sixth aspect of the present invention, in the blood purification apparatus according to any one of the first to fifth aspects, an electrocardiogram measuring unit capable of measuring an electrocardiogram of a patient undergoing blood purification treatment, and the electrocardiogram measuring unit And an electrocardiogram acquisition means for obtaining an electrocardiogram based on the measurement signal, and the determination means determines whether or not the electrocardiogram acquired by the electrocardiogram acquisition means is abnormal, and the electrocardiogram is abnormal On the condition that it is determined that the notification means performs a predetermined notification according to the abnormality of the electrocardiogram.

  The invention according to claim 7 is the blood purification apparatus according to claim 6, further comprising an analysis unit capable of performing an analysis of heart rate variability based on the electrocardiogram acquired by the electrocardiogram acquisition unit and evaluating an autonomic nerve function, The determination by the determination unit is performed according to the result of the heart rate variability analysis by the analysis unit.

  The invention according to claim 8 is the blood purification apparatus according to claim 7, wherein the electrocardiogram acquisition means and the analysis means are used for a bedside terminal device disposed in the vicinity of a patient undergoing blood purification treatment, or for blood purification treatment. It is arranged in a central monitoring device capable of transmitting the relevant conditions or information.

  The invention according to claim 9 is the blood purification apparatus according to any one of claims 1 to 8, wherein the notifying means indicates the state of the patient estimated based on the calculated value calculated by the calculating means. It can be displayed.

  According to the first aspect of the present invention, the calculation means for obtaining at least the pulse pressure, the average blood pressure and the minimum blood pressure based on the detection value by the blood pressure detection means, and the pulse pressure, the average blood pressure and the minimum blood pressure obtained by the calculation means are respectively According to the determination means for determining whether or not the predetermined threshold is exceeded, and on the condition that the determination means determines that the pulse pressure, the minimum blood pressure or the average blood pressure has exceeded the predetermined threshold, according to the pulse pressure, the minimum blood pressure or the average blood pressure In addition, since the notification means for performing the predetermined notification is provided, it is possible to effectively notify the patient abnormality by effectively utilizing the parameters relating to the blood pressure.

  According to the invention of claim 2, the first state in which the pulse pressure exceeds the predetermined threshold and the minimum blood pressure and the average blood pressure do not exceed the predetermined threshold, the pulse pressure exceeds the predetermined threshold, and the minimum blood pressure and The notification form regarding the degree of risk by the notification means is different between the second state in which at least one of the average blood pressures exceeds a predetermined threshold, and a notification that the degree of risk is higher in the second state than in the first state. Since this is performed, it is possible to perform notification by weighting the risk level (weighting the risk level).

  According to the invention of claim 3, the calculating means obtains the maximum blood pressure and the maximum blood pressure lowering level from the start of blood purification treatment based on the detected value by the blood pressure detecting means in addition to the pulse pressure, the average blood pressure and the minimum blood pressure. The determination means determines whether or not the maximum blood pressure and the maximum blood pressure decrease level exceed a predetermined threshold, and the notification means determines that the maximum blood pressure or the maximum blood pressure decrease level exceeds the predetermined threshold. Since the predetermined notification according to the maximum blood pressure or the maximum blood pressure lowering level is performed, the abnormalities of the patient can be accurately notified by effectively utilizing the maximum blood pressure and the maximum blood pressure decreasing level.

  According to the invention of claim 4, the calculating means is a PRP obtained by multiplying the pulse rate and the pulse rate by the maximum blood pressure based on the detected value by the blood pressure detecting means in addition to the pulse pressure, the average blood pressure and the minimum blood pressure. If the determination means determines whether the pulse rate and PRP have exceeded a predetermined threshold, and the notification means determines that the pulse rate or PRP has exceeded the predetermined threshold, the pulse Since the predetermined notification according to the number or PRP is performed, the patient's abnormality can be accurately notified by effectively utilizing the pulse rate and PRP.

  According to the invention of claim 5, the notifying means comprises display means capable of displaying information related to blood purification treatment in real time, and the calculated value obtained by the calculating means and the circulation during blood purification treatment by the display means. Since the change rate of the blood volume is displayed together, it is possible to monitor the change rate of the circulating blood volume and the calculated value obtained by the calculation means in association with each other.

  According to the invention of claim 6, there is provided an electrocardiogram measuring means capable of measuring an electrocardiogram of a patient undergoing blood purification treatment, and an electrocardiogram acquiring means obtaining an electrocardiogram based on a measurement signal from the electrocardiogram measuring means. The determination means determines whether or not the electrocardiogram acquired by the electrocardiogram acquisition means is abnormal, and the notification means responds to the abnormality of the electrocardiogram on the condition that the electrocardiogram is determined to be abnormal Since the predetermined notification is performed, it is possible to notify the patient's abnormality more accurately by utilizing the electrocardiogram acquired by the electrocardiogram acquisition means in addition to the blood pressure parameter.

  According to the seventh aspect of the present invention, the analysis means capable of performing the heart rate variability analysis based on the electrocardiogram acquired by the electrocardiogram acquisition means and evaluating the autonomic nerve function, and according to the result of the heart rate variability analysis by the analysis means. Since the determination by the determination means is performed, it is possible to make a determination in consideration of the autonomic nerve function.

  According to the invention of claim 8, the electrocardiogram acquisition means and the analysis means are a bedside terminal device disposed in the vicinity of a patient undergoing blood purification treatment, or central monitoring capable of transmitting conditions or information relating to blood purification treatment. Since it is disposed in the device, the bedside terminal device or the central monitoring device provided in the conventional blood purification device can be used.

  According to the ninth aspect of the present invention, the notifying means can display the patient state estimated based on the calculated value calculated by the calculating means, so that the calculated value calculated by the calculating means is simply displayed. In comparison, a medical staff such as a doctor can more easily grasp the patient's condition.

The schematic diagram which shows the blood purification apparatus which concerns on the 1st Embodiment of this invention. Schematic diagram showing treatment means in the blood purification apparatus The schematic diagram which shows the internal structure of the treatment means (dialyzer main body) in the blood purification apparatus The perspective view which shows the external appearance of the dialyzer main body in the blood purification apparatus Flow chart showing control contents in the blood purification apparatus The schematic diagram which shows the blood purification apparatus which concerns on the 2nd Embodiment of this invention. Flow chart showing control contents in the blood purification apparatus

Hereinafter, embodiments of the present invention will be specifically described with reference to the drawings.
As shown in FIG. 1, the blood purification apparatus according to the first embodiment includes a treatment means 1, a blood pressure detection means 2, an input means 3, a calculation means 4, a determination means 5, a control means 6, It mainly comprises display means 7 (corresponding to “notification means” of the present invention). In the present embodiment, the dialyzer main body H is provided with an input unit 3, a calculation unit 4, a determination unit 5, a control unit 6, and a display unit 7.

  The treatment means 1 according to this embodiment is for performing blood purification treatment by performing hemodialysis and water removal while circulating the patient's blood extracorporeally. As shown in FIGS. A blood circuit 8 for circulating the blood outside the body, a dialyzer 9 connected to the blood circuit 8 for blood dialysis, and a water purifier connected to the dialyzer 9 and supplying dialysate The dialysis machine main body H is mainly composed.

  The blood circuit 8 is made of a flexible tube through which a fluid such as blood can flow, and has an arterial blood circuit 8a and a venous blood circuit 8b. An arterial puncture needle a can be connected to the tip of the arterial blood circuit 8a, and an iron-type blood pump 10 and a hematocrit sensor 12 are disposed in the middle. On the other hand, a venous puncture needle b is connected to the distal end of the venous blood circuit 8b, and an air trap chamber 11 for defoaming is connected midway.

  The hematocrit sensor 12 includes a light-emitting element such as an LED and a light-receiving element such as a photodiode. The hematocrit sensor 12 irradiates blood with a predetermined wavelength from the light-emitting element, and receives the transmitted or reflected light by the light-receiving element. Thus, the hematocrit value indicating the concentration of the blood of the patient flowing in the blood circuit 8 is measured. The hematocrit value is an index indicating the blood concentration, and is specifically expressed by the volume ratio of red blood cells in whole blood.

  In the present embodiment, the change rate (ΔBV) of the circulating blood volume can be obtained based on the hematocrit value detected by the hematocrit sensor 12. Specifically, if the hematocrit value obtained by the hematocrit sensor 12 is Ht, the change rate ΔBV of the circulating blood volume is (Ht at the start of dialysis−Ht at the time of measurement) / Ht × 100 at the time of measurement. It can be obtained from the formula. Thereby, the change rate (ΔBV) of the circulating blood volume of the patient can be sequentially detected as the dialysis treatment time elapses.

  Thus, when the blood pump 10 is driven with the patient punctured with the arterial puncture needle a and the vein puncture needle b, the blood of the patient reaches the dialyzer 9 through the arterial blood circuit 8a. The blood is purified by the air trap 9 and defoamed in the air trap chamber 11 and returns to the patient's body through the venous blood circuit 8b. Thus, the blood of the patient can be purified by the dialyzer 9 while circulating outside the body by the blood circuit 8.

  The dialyzer 9 is formed with a blood introduction port 9a, a blood outlet port 9b, a dialysate inlet port 9c, and a dialysate outlet port 9d in the casing. Among these, the blood inlet port 9a has an arterial blood circuit 8a. The base end of the venous blood circuit 8b is connected to the blood outlet port 9b. The dialysate introduction port 9c and the dialysate lead-out port 9d are connected to a dialysate introduction line L1 and a dialysate discharge line L2 extending from the dialyzer body H, respectively.

  A plurality of hollow fibers are accommodated in the casing portion of the dialyzer 9, and the inside of the hollow fibers is used as a blood flow path, and the space between the outer peripheral surface of the hollow fibers and the inner peripheral surface of the casing portion is dialyzed. It is a liquid flow path. A hollow fiber membrane is formed in the hollow fiber by forming a large number of minute holes (pores) penetrating the outer circumferential surface and the inner circumferential surface, and impurities in the blood are passed through the membrane in the dialysate. It is comprised so that it can permeate | transmit.

  As shown in FIG. 3, the dialysis machine main body H is connected to the dual pump P formed across the dialysate introduction line L1 and the dialysate discharge line L2, bypassing the dual pump P in the dialysate discharge line L2. And the dewatering pump 13 connected to the bypass line L3. One end of the dialysate introduction line L1 is connected to the dialyzer 9 (dialyte introduction port 9c), and the other end is connected to a dialysate supply device (not shown) for preparing a dialysate having a predetermined concentration. In addition, one end of the dialysate discharge line L2 is connected to the dialyzer 9 (dialysate outlet port 9d), and the other end is connected to a drainage means (not shown) and supplied from the dialysate supply device. After the dialysate reaches the dialyzer 9 through the dialysate introduction line L1, the dialysate is sent to the drainage means through the dialysate discharge line L2 and the bypass line L3.

  The dewatering pump 13 is for removing water from the blood of the patient flowing through the dialyzer 9. That is, when the dewatering pump 13 is driven, the volume of the liquid discharged from the dialysate discharge line L2 becomes larger than the amount of dialysate introduced from the dialysate introduction line L1, and moisture from the blood is increased by the larger volume. Is removed. In addition, you may make it remove a water | moisture content from a patient's blood by means other than the water removal pump 13 (for example, what utilizes what is called a balancing chamber etc.).

  A drainage concentration sensor may be provided in the dialysate discharge line L2 in the dialyzer body H. This drainage concentration sensor is a concentration of a liquid that flows along with blood purification (in this embodiment, drainage discharged from a dialyzer 9 as a blood purifier) (for example, urea, uric acid, etc. contained in the drainage). (Substance concentration) can be detected. According to such a drainage concentration sensor, the standardized dialysis amount (Kt / V) can be obtained based on the detected concentration change of the drainage, and the standardized dialysis amount (Kt / V) is sequentially obtained as the dialysis treatment time elapses. Can be detected.

  As shown in FIG. 4, the dialysis machine main body H includes display means 7 that can display information related to blood purification treatment in real time. The display means 7 can display various information on, for example, a touch panel type liquid crystal screen, and the display content is controlled by the control means 6 (see FIG. 1). For example, on the liquid crystal screen of the display means 7, a graph of ΔBV sequentially calculated during treatment can be displayed in time series, and the current ΔBV, ΔBV change rate, etc. can be displayed as numerical values.

  Here, the blood purification apparatus according to the present embodiment is connected to blood pressure detection means 2 that can detect the blood pressure and pulse of the patient undergoing blood purification treatment. The blood pressure detection means 2 is composed of a sphygmomanometer that can measure a blood pressure (parameters related to blood pressure such as maximum blood pressure and minimum blood pressure) and a pulse of the patient by wrapping a cuff around the arm of the patient, and is disposed in the dialyzer main body H. The input means 3 is electrically connected. By the way, the heartbeat refers to the pulsation of the heart, and the pulsation refers to the pulsation of the arteries that occurs when the heart sends blood to the whole body. May not match.

  The blood pressure detection means 2 according to the present embodiment is composed of a cuff or the like that can be wound around the patient's arm and can detect the blood pressure and the pulse, and the detection result is transmitted to the calculation means 4 via the input means 3 for calculation. The means 4 obtains blood pressure and pulse intermittently during the blood purification treatment, but instead of this, the blood pressure detection means 2 may incorporate the calculation means 4. Further, the blood pressure detection means 2 may be capable of measuring blood pressure and pulse continuously and in real time, for example, by measuring blood pressure and pulse continuously and in real time using an externally connected biological information monitoring device or the like. Therefore, it is possible to determine the abnormality of the patient with higher accuracy.

  The input unit 3 receives a detection value from the blood pressure detection unit 2 and is electrically connected to the calculation unit 4. The detection unit 2 receives the detection value from the blood pressure detection unit 2 via the input unit 3. It can be sent. The calculation means 4 obtains at least the pulse pressure, the average blood pressure, and the minimum blood pressure based on the detection value by the blood pressure detection means 2, and in this embodiment, in addition to the pulse pressure, the average blood pressure, and the minimum blood pressure, the maximum blood pressure is calculated. The maximum blood pressure lowering degree, the pulse rate, and the PRP are calculated.

  The systolic blood pressure of the heart and the diastolic blood pressure of the heart are diastolic blood pressure of the heart, and indicate the maximum and minimum values of the blood pressure measured by the blood pressure detecting means 2, respectively. Among these, the minimum blood pressure is relatively maintained because the blood vessels contract as the sympathetic nerves advance, and the blood flows into the coronary arteries during the diastole of the heart. The systolic blood pressure lowering degree indicates the degree to which the systolic blood pressure has decreased from the start of blood purification treatment to the time of measurement, and can be obtained by an arithmetic expression “maximum blood pressure at the start of blood purification treatment—current systolic blood pressure”.

  The average blood pressure can be obtained by an arithmetic expression of minimum blood pressure + (pulse pressure / 3) (the pulse pressure is obtained by an arithmetic expression “maximum blood pressure−minimum blood pressure” as described below). It can be used as an indicator. This average blood pressure indicates the force of flowing blood into the blood vessel, and can be an indicator of the blood flow state of important organs. The pulse pressure can be obtained by an arithmetic expression (maximum blood pressure−minimum blood pressure) of maximum blood pressure−minimum blood pressure, and can be used as an index of central arteriosclerosis. This pulse pressure reflects the circulated blood volume and heart rate more sensitively than the maximum blood pressure, and can be an index suitable for circulatory management.

  The PRP can be obtained by an arithmetic expression (maximum blood pressure × pulse rate) (product of the maximum blood pressure and the heart rate), and an index of myocardial oxygen consumption can be obtained non-invasively. It is used in exercise electrocardiogram examinations, etc., and is known as a parameter for measuring the intensity of work of the heart. In dialysis treatment (blood purification treatment), the circulatory dynamics are greatly changed and the burden on the heart is increased, which is one of useful parameters.

  As described above, calculating not only the maximum blood pressure and the minimum blood pressure but also the average blood pressure, the pulse pressure, and the PRP and using them for monitoring during blood purification treatment is effective for predicting a decrease in blood pressure. In addition, since the pulse rate can be detected and calculated at the same time, the monitoring accuracy can be further improved. A shock index obtained by dividing the systolic blood pressure by the pulse rate (maximum blood pressure / pulse rate) may be used. This shock index can be used to determine the severity of circulating blood volume reducing shock.

  The determination means 5 is electrically connected to the calculation means 4, and the pulse pressure, average blood pressure and minimum blood pressure obtained by the calculation means 4 (in this embodiment, in addition to the pulse pressure, average blood pressure and minimum blood pressure, It is determined whether or not the pulse rate, PRP, systolic blood pressure, and systolic blood pressure lowering level) exceed predetermined threshold values. The predetermined threshold is predetermined according to the blood pressure parameter to be determined, and is a boundary value between the abnormal value and the normal value.

  The control means 6 is for controlling the display content of the display means 7 and is electrically connected to the treatment means 1, the determination means 5 and the display means 7, and the operating state, setting state, and determination of the treatment means 1. The result of determination by the means 5 can be displayed on the screen of the display means 7. The display means 7 constitutes the notification means of the present invention. The determination means 5 uses the pulse pressure, the minimum blood pressure, the average blood pressure or the like (in this embodiment, in addition to the pulse pressure, the average blood pressure, and the minimum blood pressure, Number, PRP, systolic blood pressure, and systolic blood pressure lowering level) are determined to have exceeded a predetermined threshold value, and a predetermined notification (notification by display) is performed according to the pulse pressure, the minimum blood pressure, or the average blood pressure. Is.

  Furthermore, in the present embodiment, the first state in which the pulse pressure exceeds the predetermined threshold value, and the minimum blood pressure and the average blood pressure do not exceed the predetermined threshold value, and the pulse pressure exceeds the predetermined threshold value, and the minimum blood pressure and the average blood pressure The notification mode regarding the degree of danger by the display means 7 (notification means) is different from that in the second state in which at least one of the blood pressures exceeds a predetermined threshold, and the degree of danger in the second state is higher than that in the first state. A notification to that effect is made.

  Furthermore, the notifying unit according to the present embodiment includes a display unit 7 that can display information related to blood purification treatment in real time, and the display unit 7 calculates the calculated value obtained by the calculation unit 4 and the blood purification treatment in progress. The rate of change in the circulating blood volume (ΔBV) is also displayed. That is, the display means 7 includes the blood pressure change rate (ΔBV) during blood purification treatment, the patient's pulse pressure, mean blood pressure, and lowest blood pressure, as well as the highest blood pressure, the highest blood pressure drop, the pulse rate and Various parameters relating to blood pressure such as PRP can be displayed.

Next, the determination method of the determination means 5 in the blood purification apparatus according to the present embodiment will be described based on the flowchart of FIG.
First, it is determined whether or not the pulse rate calculated by the calculation means 4 based on the detection value of the blood pressure detection means 2 exceeds a predetermined threshold (for example, 100 (bpm)) (S1), and it is determined that the predetermined threshold is exceeded. Then, the display means 7 displays and notifies that the patient is in a tachycardia state (S2). Thereafter, it is determined whether or not the PRP calculated by the calculation means 4 exceeds a predetermined threshold (for example, 12000) (S3), and if it is determined that the predetermined threshold is exceeded, the patient may have a myocardial ischemia state. A message to that effect is displayed on the display means 7 (S4). If PRP does not exceed the predetermined threshold, S4 is skipped and the process proceeds to S5.

  On the other hand, if it is determined in S1 that the pulse rate does not exceed the predetermined threshold value, the process proceeds to S17, and the pulse rate is a predetermined threshold value (a value lower than the predetermined threshold value determined in S1, for example, 50 (bpm)). (S17). If the predetermined threshold is not exceeded, the display means 7 displays and notifies that the patient is in a bradycardia state in S18, and then the series of controls is terminated. If it is determined in S17 that the pulse rate has exceeded the predetermined threshold value, the process proceeds to S5.

  In S5, it is determined whether or not the maximum blood pressure calculated by the calculation unit 4 exceeds a predetermined threshold (for example, 90 (mmHg)) based on the detection value of the blood pressure detection unit 2, and exceeds the predetermined threshold (in this case) If it is determined that the patient's systolic blood pressure has fallen, the display means 7 displays and notifies the display means 7 (S6), and the predetermined value is not exceeded (in this case, the predetermined value is not exceeded). If it is determined that the threshold value has been exceeded, the process skips S6 and proceeds to S7.

  In S7, it is determined whether or not the maximum blood pressure reduction degree calculated by the calculation means 4 based on the detection value of the blood pressure detection means 2 exceeds a predetermined threshold (for example, 30 (mmHg)), and it is determined that the predetermined threshold is exceeded. Then, the patient's systolic blood pressure lowering degree is displayed and notified on the display means 7 (S8), and if it is determined that the predetermined value is not exceeded, S8 is skipped and the process proceeds to S9.

  In S9, it is determined whether or not the pulse pressure (circulation dynamic index) calculated by the calculation unit 4 exceeds a predetermined threshold (for example, 30 (mmHg)) based on the detection value of the blood pressure detection unit 2. (In this case, it is below a predetermined threshold value), the display means 7 displays and notifies that the patient is in a reduced pulse pressure state (S10), and does not exceed the predetermined value ( In this case, if it is determined that the value exceeds a predetermined threshold value, S10 is skipped and the process proceeds to S11 and S13. Here, in the present embodiment, in S10, it is configured to notify that the degree of risk during the treatment of the patient is medium.

  In S11, it is determined whether or not the average blood pressure (index of blood flow of an important organ) calculated by the calculation unit 4 exceeds a predetermined threshold (for example, 60 (mmHg)) based on the detection value of the blood pressure detection unit 2. If it is determined that the predetermined threshold value is exceeded (in this case, the predetermined threshold value is exceeded), the display means 7 displays and notifies that the patient is in an average blood pressure lowering state (S12), and the predetermined value is set. If it is determined that it does not exceed (in this case, a predetermined threshold value is exceeded), S12 is skipped and the process proceeds to S15.

  In S13, it is determined whether or not the minimum blood pressure (coronary blood flow index) calculated by the calculation unit 4 exceeds a predetermined threshold (for example, 40 (mmHg)) based on the detection value of the blood pressure detection unit 2, If it is determined that the threshold value has been exceeded (in this case, the value has fallen below the predetermined threshold value), the display means 7 displays and notifies that the patient is in the lowest blood pressure lowering state (S14) and does not exceed the predetermined value. If it is determined (in this case, the value exceeds the predetermined threshold), S14 is skipped and the process proceeds to S15.

  In S15, it is determined whether notification by S10 has been performed, whether notification by S12 or notification by S14 has been performed, notification by S10 has been performed, and notification by S12 or notification by S14 has been performed. If determined, in S16, the patient is informed that the degree of risk during treatment is high, the notification in S10 is performed, and if the notification in S12 and the notification in S14 are not performed, S16 is skipped. A series of controls are configured to end. That is, the first state in which the pulse pressure exceeds a predetermined threshold and the minimum blood pressure and the average blood pressure do not exceed the predetermined threshold, and at least one of the minimum blood pressure and the average blood pressure is predetermined. The notification form regarding the degree of risk by the display means 7 (notification means) is different from that in the second state exceeding the threshold value, and the second state is notified that the degree of risk is higher than the first state. It is like that.

  According to the above embodiment, the calculation means 4 for obtaining at least the pulse pressure, the average blood pressure and the minimum blood pressure based on the detection value by the blood pressure detection means 2, and the pulse pressure, the average blood pressure and the minimum blood pressure obtained by the calculation means 4 are Each of the determination means 5 for determining whether or not the predetermined threshold value is exceeded, and on the condition that the determination means 5 determines that the pulse pressure, minimum blood pressure or average blood pressure exceeds the predetermined threshold value, the pulse pressure, minimum blood pressure or average Since the display means 7 (notification means) for performing a predetermined notification according to the blood pressure is provided, it is possible to effectively notify the abnormality of the patient by effectively using the parameters relating to the blood pressure.

  In addition, a first state in which the pulse pressure exceeds a predetermined threshold value and the minimum blood pressure and the average blood pressure do not exceed the predetermined threshold value, and the pulse pressure exceeds the predetermined threshold value, and at least one of the minimum blood pressure and the average blood pressure is predetermined Since the notification mode regarding the degree of risk by the notification means is different between the second state exceeding the threshold and the second state is informed that the degree of risk is higher than the first state, It is possible to notify by performing weighting (weighting of the risk level).

  Further, the calculation means 4 according to the present embodiment obtains the maximum blood pressure and the maximum blood pressure decrease level from the start of blood purification treatment based on the detection value by the blood pressure detection means 2 in addition to the pulse pressure, the average blood pressure and the minimum blood pressure. The determination means 5 determines whether or not the maximum blood pressure and the maximum blood pressure decrease level exceed a predetermined threshold value, and the display means 7 (notification means) determines that the maximum blood pressure or the maximum blood pressure decrease level exceeds a predetermined threshold value. On the condition that this is done, the predetermined notification according to the maximum blood pressure or the maximum blood pressure decrease level is performed, so that the abnormalities of the patient can be accurately notified by effectively utilizing the maximum blood pressure and the maximum blood pressure decrease level.

  Furthermore, the calculation means 4 according to the present embodiment is obtained by multiplying the pulse rate and the pulse rate by the maximum blood pressure based on the detected value by the blood pressure detection means 2 in addition to the pulse pressure, the average blood pressure, and the minimum blood pressure. The PRP is determined, and it is determined whether or not the pulse rate and PRP have exceeded a predetermined threshold value by the determination unit 5, and it is determined by the display unit 7 (notification unit) that the pulse rate or PRP has exceeded the predetermined threshold value. Since the predetermined notification according to the pulse rate or PRP is performed on the condition, the patient's abnormality can be notified with high accuracy by effectively using the pulse rate and PRP.

  In particular, the notifying unit according to the present embodiment includes a display unit 7 that can display information related to blood purification treatment in real time, and the display unit 7 calculates the calculated value obtained by the calculation unit 4 and the blood purification treatment in progress. Since the change rate of the circulating blood volume is displayed together, it is possible to monitor the change rate of the circulating blood volume in association with the calculated value obtained by the calculating means. In the present embodiment, the notification means is constituted by the display means 7, but other means (speaker, monitor provided separately, etc.) may be used.

Next, a second embodiment according to the present invention will be described.
As shown in FIG. 6, the blood purification apparatus according to the present embodiment includes a treatment unit 1, a blood pressure detection unit 2, an input unit 3, a calculation unit 4, a determination unit 5, a control unit 6, and a display unit. 7 (corresponding to “notification means” of the present invention), and also includes an electrocardiogram measurement means 14, an input means 15, an electrocardiogram acquisition means 16, an analysis means 17, and an output means 18. It is configured. In the present embodiment, the input unit 15, the electrocardiogram acquisition unit 16, the analysis unit 17, and the output unit 18 are disposed in an external information processing apparatus L that is separate from the dialysis machine main body H. Moreover, the same code | symbol is attached | subjected to the component similar to 1st Embodiment, and those detailed description is abbreviate | omitted.

  The electrocardiogram measuring means 14 is attached in close contact with the patient's skin and can measure the electrocardiogram (biological information) of the patient, and is composed of at least a pair of electrodes that are attached in close contact with a position sandwiching the heart. And electrically connected to the input means 15. The input unit 15 is electrically connected to the electrocardiogram acquisition unit 16, and can transmit a measurement signal from the electrocardiogram measurement unit 14 to the electrocardiogram acquisition unit 16. The electrocardiogram acquisition unit 16 is configured to obtain an electrocardiogram of a patient undergoing blood purification treatment in real time based on a measurement signal from the electrocardiogram measurement unit 14.

  The analysis means 17 can evaluate the autonomic nervous function by performing heart rate variability analysis based on the electrocardiogram acquired by the electrocardiogram acquisition means 16 and, as will be described later, according to the result of the heart rate variability analysis by the analysis means 17. The determination by the determination means 5 is performed. The output means 18 is electrically connected to the input means 3 and outputs the external information such as the electrocardiogram acquired by the electrocardiogram measurement means 14 and the result of the heart rate variability analysis by the analysis means 17 to output the external information. Information is input by the input means 3. In addition, the input means 3 and the output means 18 may be connected by radio | wireless etc. other than what is connected by wiring.

  Here, in the blood purification apparatus according to the present embodiment, the determination unit 5 determines whether or not the electrocardiogram acquired by the electrocardiogram acquisition unit 16 is abnormal and determines that the electrocardiogram is abnormal. As a condition, the display means 7 (notification means) is configured to perform predetermined notification according to the abnormality of the electrocardiogram. In the present embodiment, the analysis means 17 that can evaluate the autonomic nerve function by performing heart rate variability analysis based on the electrocardiogram acquired by the electrocardiogram acquisition means 16 is provided. The determination by the determination means 5 is performed according to the result.

Next, the determination method of the determination means 5 in the blood purification apparatus according to the present embodiment will be described based on the flowchart of FIG.
First, it is determined whether or not the ST measurement value based on the electrocardiogram obtained by the electrocardiogram measurement means 14 is normal (S1). If it is determined that the ST value is abnormal, the patient is subjected to myocardial ischemia. The display means 7 informs that there is a possibility of a state (S2), and if it is determined to be normal, skips S2 and proceeds to S3. In addition, it will be determined by the alerting | reporting of S2 whether it is a cardiogenic shock by abnormality of an electrocardiogram.

  In S3, the occurrence frequency of the arrhythmia is determined based on the electrocardiogram obtained by the electrocardiogram measurement means 14, and if it is determined that the occurrence frequency is high, the display means 7 displays that the patient is in an arrhythmia frequent state. (S4) and if it is determined that the frequency of occurrence is low, the process proceeds to S9, and as a result of the heart rate variability analysis by the analysis means 17, the sympathetic nerve is enhanced or the parasympathetic nerve is enhanced. Judgment is made. If it is determined in S19 that the sympathetic nerve is increased, the process proceeds to S20, and if it is determined that the parasympathetic nerve is increased, the process proceeds to S22.

  In S20, the display means 7 indicates that the heart rate has exceeded a predetermined threshold (for example, 100 (bpm)) and if it is determined that the heart rate has exceeded the predetermined threshold, the display means 7 indicates that the patient is in a tachycardia state. When the information is displayed and notified (S21) and it is determined that the predetermined threshold is not exceeded, S21 is skipped and the process proceeds to S5. In S22, it is determined whether or not the heart rate has exceeded a predetermined threshold (a value lower than the predetermined threshold determined in S20, for example, 50 (bpm)). After the display means 7 displays and informs that the patient is in a bradycardia state, a series of controls are terminated. If it is determined in S22 that the heart rate has exceeded the predetermined threshold value, the process proceeds to S7.

  On the other hand, it is determined whether or not the PRP calculated by the calculation means 4 exceeds a predetermined threshold (for example, 12000) (S5). If it is determined that the PRP exceeds the predetermined threshold, the patient may have a myocardial ischemia state. A message to that effect is displayed on the display means 7 (S6). If PRP does not exceed the predetermined threshold, S6 is skipped and the process proceeds to S7.

  In S7, it is determined whether or not the maximum blood pressure calculated by the calculation unit 4 based on the detection value of the blood pressure detection unit 2 exceeds a predetermined threshold (for example, 90 (mmHg)), and exceeds the predetermined threshold (in this case) If it is determined that the patient's systolic blood pressure has fallen, the display means 7 displays and notifies the display means 7 (S8), and the predetermined value is not exceeded (in this case, the predetermined value is not exceeded). If it is determined that the threshold value has been exceeded, the process skips S8 and proceeds to S9.

  In S9, it is determined whether or not the maximum blood pressure reduction degree calculated by the calculation unit 4 based on the detection value of the blood pressure detection unit 2 exceeds a predetermined threshold (for example, 30 (mmHg)), and it is determined that the predetermined threshold is exceeded. Then, the patient's maximum blood pressure lowering degree is displayed and notified on the display means 7 (S10), and if it is determined that the predetermined value is not exceeded, S10 is skipped and the process proceeds to S11.

  In S11, it is determined whether or not the pulse pressure (circulation dynamic index) calculated by the calculation unit 4 exceeds a predetermined threshold (for example, 30 (mmHg)) based on the detection value of the blood pressure detection unit 2. (In this case, if it is determined that the value has fallen below the predetermined threshold value), the display means 7 displays and notifies that the patient is in a reduced pulse pressure state (S12), and does not exceed the predetermined value ( In this case, if it is determined that the predetermined threshold is exceeded, S12 is skipped and the process proceeds to S13 and S15. Here, in the present embodiment, in S12, it is configured to notify that the degree of risk during the treatment of the patient is medium.

  In S13, it is determined whether or not the average blood pressure (index of blood flow of important organs) calculated by the calculation unit 4 exceeds a predetermined threshold (for example, 60 (mmHg)) based on the detection value of the blood pressure detection unit 2. When it is determined that the predetermined threshold value is exceeded (in this case, the predetermined threshold value is exceeded), the display means 7 displays and notifies that the patient is in an average blood pressure lowering state (S14), and the predetermined value is If it is determined that it does not exceed (in this case, a predetermined threshold value is exceeded), S14 is skipped and the process proceeds to S17.

  In S15, it is determined based on the detection value of the blood pressure detection means 2 whether or not the minimum blood pressure (coronary artery blood flow index) calculated by the calculation means 4 exceeds a predetermined threshold (for example, 40 (mmHg)). If it is determined that the threshold value has been exceeded (in this case, it has fallen below the predetermined threshold value), the display means 7 displays and notifies that the patient is in the state of lowering the minimum blood pressure (S16), and the predetermined value is not exceeded. If it is determined (in this case, the value exceeds the predetermined threshold), S16 is skipped and the process proceeds to S17.

  In S17, it is determined whether the notification by S12 has been performed, whether the notification by S14 or the notification by S16 has been performed, the notification by S12 has been performed, and the notification by S14 or the notification by S16 has been performed. If determined, in S18, the patient is informed as having a high degree of risk during treatment, and if S12 is notified, and if S14 and S16 are not performed, S18 is skipped. A series of controls are configured to end. That is, the first state in which the pulse pressure exceeds a predetermined threshold and the minimum blood pressure and the average blood pressure do not exceed the predetermined threshold, and at least one of the minimum blood pressure and the average blood pressure is predetermined. The notification form regarding the degree of risk by the display means 7 (notification means) is different from that in the second state exceeding the threshold value, and the second state is notified that the degree of risk is higher than the first state. It is like that.

  According to the above embodiment, in addition to the effects of the first embodiment, the electrocardiogram measuring means 14 capable of measuring the electrocardiogram of the patient undergoing blood purification treatment, and the electrocardiogram based on the measurement signal from the electrocardiogram measuring means 14 And an electrocardiogram acquisition means 16 for obtaining the condition, and the determination means 5 determines whether or not the electrocardiogram acquired by the electrocardiogram acquisition means 16 is abnormal and determines that the electrocardiogram is abnormal. Since the display means 7 (notification means) performs predetermined notification according to the abnormality of the electrocardiogram, in addition to the parameters relating to blood pressure, the electrocardiogram acquired by the electrocardiogram acquisition means 16 is utilized to further prevent the abnormality of the patient. Information can be accurately reported.

  Further, according to the present embodiment, the analysis unit 17 that can evaluate the autonomic nerve function by performing the heart rate variability analysis based on the electrocardiogram acquired by the electrocardiogram acquisition unit 16 is provided. Since the determination by the determination means 5 is performed according to the result, it is possible to make a determination in consideration of the autonomic nerve function. Instead of performing the analysis by the analysis unit 17, the electrocardiogram information acquired exclusively by the electrocardiogram acquisition unit 16 may be transmitted to the calculation unit 4, the determination unit 5, etc. via the output unit 18 and the input unit 3.

  Furthermore, the external information processing device L is a central monitoring device that can transmit conditions or information related to blood purification treatment to the blood purification device, or a bedside terminal device (for example, Or a bedside monitor). When the external information processing device L is a central monitoring device or a bedside terminal device, the bedside terminal device or the central monitoring device provided in the conventional blood purification device can be used.

  Although the present embodiment has been described above, the present invention is not limited to this. For example, the blood pressure parameters calculated by the calculation unit 4 and determined by the determination unit 5 are at least pulse pressure, average blood pressure, and minimum blood pressure. Any other parameters are sufficient, and any other parameters can be used. In particular, the input unit 15, the electrocardiogram acquisition unit 16, the analysis unit 17, and the output unit 18 in the second embodiment may be provided in the dialyzer main body H and may not pass through the external information processing apparatus L.

  Further, the notification means (display means 7 in the present embodiment) may display the patient state estimated based on the calculated value calculated by the calculating means 4, for example, the pulse pressure has a predetermined threshold value. If it exceeds, the indication “decrease in circulating blood volume or cardiac output”, if the average blood pressure exceeds a certain threshold, if “average blood flow drops to important organ”, if the minimum blood pressure exceeds a certain threshold In addition, a display such as “decrease in coronary blood flow” or “probable blood pressure cannot be maintained” may be performed. In this way, when the patient state estimated based on the calculated value calculated by the calculating means 4 is displayed on the display means 7 (notifying means), the calculated value calculated by the calculating means 4 is simply used. Compared with what is displayed, it is possible to make it easier for medical personnel such as doctors to grasp the patient's condition.

  Furthermore, in addition to the notification by the notification unit, the predetermined operation by the treatment unit 1 may be stopped (for example, when the pulse pressure exceeds a predetermined threshold value, the water removal pump 13 is stopped). The blood purification apparatus according to this embodiment is applied to a hemodialysis apparatus for performing hemodialysis treatment, but may be a blood purification apparatus for performing other forms of blood purification treatment.

  Based on detection values by the blood pressure detection means, calculation means for obtaining at least pulse pressure, average blood pressure, and minimum blood pressure, and whether or not the pulse pressure, average blood pressure, and minimum blood pressure determined by the calculation means have exceeded predetermined threshold values, respectively And a predetermined notification according to the pulse pressure, the minimum blood pressure, or the average blood pressure, provided that the determination means determines that the pulse pressure, the minimum blood pressure, or the average blood pressure exceeds a predetermined threshold. If it is a blood purification apparatus provided with an alerting | reporting means, it can apply also to the thing from which an external shape differs, or the thing to which the other function was added.

DESCRIPTION OF SYMBOLS 1 Treatment means 2 Blood pressure detection means 3 Input means 4 Calculation means 5 Judgment means 6 Control means 7 Display means 8 Blood circuit 9 Dialyzer (blood purification means)
DESCRIPTION OF SYMBOLS 10 Blood pump 11 Air trap chamber 12 Hematocrit sensor 13 Water removal pump 14 Electrocardiogram measurement means 15 Input means 16 Electrocardiogram acquisition means 17 Analysis means 18 Output means

Claims (9)

A therapeutic means capable of purifying the blood of a patient circulating outside the body and performing blood purification treatment;
Blood pressure detection means capable of detecting the blood pressure and pulse of a patient undergoing blood purification treatment;
In the blood purification apparatus comprising
Calculation means for obtaining at least a pulse pressure, an average blood pressure and a minimum blood pressure based on a detection value by the blood pressure detection means;
Determining means for determining whether or not the pulse pressure, mean blood pressure and minimum blood pressure determined by the calculating means each exceed a predetermined threshold;
Notification means for performing predetermined notification according to the pulse pressure, minimum blood pressure, or average blood pressure on condition that the determination means determines that the pulse pressure, minimum blood pressure, or average blood pressure exceeds a predetermined threshold;
A blood purification apparatus comprising:   A first state in which the pulse pressure exceeds a predetermined threshold and the minimum blood pressure and the average blood pressure do not exceed the predetermined threshold; and the pulse pressure exceeds a predetermined threshold and at least one of the minimum blood pressure and the average blood pressure is predetermined The notification form regarding the degree of risk by the notification means is different from that in the second state exceeding the threshold, and notification that the degree of risk is higher in the second state than in the first state is provided. The blood purification apparatus according to claim 1.   The calculating means obtains the maximum blood pressure and the maximum blood pressure decrease degree from the start of blood purification treatment based on the detected value by the blood pressure detecting means in addition to the pulse pressure, the average blood pressure and the minimum blood pressure, and the determining means And whether or not the systolic blood pressure and the systolic blood pressure lowering degree exceed a predetermined threshold, and on the condition that the notifying means determines that the systolic blood pressure or the systolic blood pressure lowering degree exceeds a predetermined threshold, The blood purification apparatus according to claim 1 or 2, wherein a predetermined notification according to the maximum blood pressure or the maximum blood pressure lowering level is performed.   The calculation means obtains a pulse rate and a PRP obtained by multiplying the pulse rate by the maximum blood pressure based on a detection value by the blood pressure detection means in addition to the pulse pressure, the average blood pressure, and the minimum blood pressure, The determination means determines whether the pulse rate and PRP have exceeded a predetermined threshold, and the pulse rate or PRP is determined on the condition that the notification means determines that the pulse rate or PRP has exceeded a predetermined threshold. The blood purification apparatus according to any one of claims 1 to 3, wherein a predetermined notification according to PRP is performed.   The notification means includes display means capable of displaying information related to blood purification treatment in real time, and the display means provides a calculated value obtained by the calculation means and a rate of change in circulating blood volume during blood purification treatment. The blood purification apparatus according to any one of claims 1 to 4, wherein the blood purification apparatus is displayed together. An electrocardiogram measuring means capable of measuring an electrocardiogram of a patient undergoing blood purification treatment;
An electrocardiogram acquisition means for obtaining an electrocardiogram based on a measurement signal from the electrocardiogram measurement means;
And determining whether or not there is an abnormality in the electrocardiogram acquired by the electrocardiogram acquisition means and determining that the electrocardiogram is abnormal in the determination means. The blood purification apparatus according to any one of claims 1 to 5, wherein predetermined notification according to abnormality of the electrocardiogram is performed.   Analyzing means capable of performing heart rate variability analysis based on the electrocardiogram acquired by the electrocardiogram acquiring means and evaluating the autonomic nervous function, and determining by the determining means according to a result of the heart rate variability analysis by the analyzing means. The blood purification apparatus according to claim 6, wherein   The electrocardiogram acquisition means and the analysis means are disposed in a bedside terminal device disposed in the vicinity of a patient undergoing blood purification treatment, or a central monitoring device capable of transmitting conditions or information relating to blood purification treatment. 8. The blood purification apparatus according to claim 7, wherein   The blood purification apparatus according to any one of claims 1 to 8, wherein the notifying means can display a state of a patient estimated based on the calculated value calculated by the calculating means.

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