JP2512628B2 - Peritoneal filtration device - Google Patents
Peritoneal filtration deviceInfo
- Publication number
- JP2512628B2 JP2512628B2 JP2316652A JP31665290A JP2512628B2 JP 2512628 B2 JP2512628 B2 JP 2512628B2 JP 2316652 A JP2316652 A JP 2316652A JP 31665290 A JP31665290 A JP 31665290A JP 2512628 B2 JP2512628 B2 JP 2512628B2
- Authority
- JP
- Japan
- Prior art keywords
- chamber
- peritoneal
- dialysate
- filter
- conduit
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired - Fee Related
Links
- 238000001914 filtration Methods 0.000 title claims description 64
- 239000012528 membrane Substances 0.000 claims description 48
- 239000000706 filtrate Substances 0.000 claims description 37
- 210000000683 abdominal cavity Anatomy 0.000 claims description 21
- 239000011148 porous material Substances 0.000 claims description 15
- 239000012982 microporous membrane Substances 0.000 claims description 3
- 238000000502 dialysis Methods 0.000 description 43
- 210000004379 membrane Anatomy 0.000 description 32
- 238000007912 intraperitoneal administration Methods 0.000 description 15
- 210000003734 kidney Anatomy 0.000 description 13
- 239000008280 blood Substances 0.000 description 12
- 210000004369 blood Anatomy 0.000 description 12
- 238000001631 haemodialysis Methods 0.000 description 10
- 230000000322 hemodialysis Effects 0.000 description 10
- 239000002207 metabolite Substances 0.000 description 8
- 238000011282 treatment Methods 0.000 description 8
- 239000007788 liquid Substances 0.000 description 6
- 239000000126 substance Substances 0.000 description 6
- WQZGKKKJIJFFOK-GASJEMHNSA-N Glucose Chemical compound OC[C@H]1OC(O)[C@H](O)[C@@H](O)[C@@H]1O WQZGKKKJIJFFOK-GASJEMHNSA-N 0.000 description 5
- XSQUKJJJFZCRTK-UHFFFAOYSA-N Urea Chemical compound NC(N)=O XSQUKJJJFZCRTK-UHFFFAOYSA-N 0.000 description 5
- 239000004202 carbamide Substances 0.000 description 5
- 210000004303 peritoneum Anatomy 0.000 description 5
- 239000000243 solution Substances 0.000 description 5
- XLYOFNOQVPJJNP-UHFFFAOYSA-N water Substances O XLYOFNOQVPJJNP-UHFFFAOYSA-N 0.000 description 5
- 210000003200 peritoneal cavity Anatomy 0.000 description 4
- 230000001186 cumulative effect Effects 0.000 description 3
- 238000010586 diagram Methods 0.000 description 3
- 238000007599 discharging Methods 0.000 description 3
- 230000000694 effects Effects 0.000 description 3
- 239000008103 glucose Substances 0.000 description 3
- BPYKTIZUTYGOLE-IFADSCNNSA-N Bilirubin Chemical compound N1C(=O)C(C)=C(C=C)\C1=C\C1=C(C)C(CCC(O)=O)=C(CC2=C(C(C)=C(\C=C/3C(=C(C=C)C(=O)N\3)C)N2)CCC(O)=O)N1 BPYKTIZUTYGOLE-IFADSCNNSA-N 0.000 description 2
- OKTJSMMVPCPJKN-UHFFFAOYSA-N Carbon Chemical compound [C] OKTJSMMVPCPJKN-UHFFFAOYSA-N 0.000 description 2
- PNNCWTXUWKENPE-UHFFFAOYSA-N [N].NC(N)=O Chemical compound [N].NC(N)=O PNNCWTXUWKENPE-UHFFFAOYSA-N 0.000 description 2
- 206010012601 diabetes mellitus Diseases 0.000 description 2
- 230000005059 dormancy Effects 0.000 description 2
- 239000003814 drug Substances 0.000 description 2
- 229940079593 drug Drugs 0.000 description 2
- NOESYZHRGYRDHS-UHFFFAOYSA-N insulin Chemical compound N1C(=O)C(NC(=O)C(CCC(N)=O)NC(=O)C(CCC(O)=O)NC(=O)C(C(C)C)NC(=O)C(NC(=O)CN)C(C)CC)CSSCC(C(NC(CO)C(=O)NC(CC(C)C)C(=O)NC(CC=2C=CC(O)=CC=2)C(=O)NC(CCC(N)=O)C(=O)NC(CC(C)C)C(=O)NC(CCC(O)=O)C(=O)NC(CC(N)=O)C(=O)NC(CC=2C=CC(O)=CC=2)C(=O)NC(CSSCC(NC(=O)C(C(C)C)NC(=O)C(CC(C)C)NC(=O)C(CC=2C=CC(O)=CC=2)NC(=O)C(CC(C)C)NC(=O)C(C)NC(=O)C(CCC(O)=O)NC(=O)C(C(C)C)NC(=O)C(CC(C)C)NC(=O)C(CC=2NC=NC=2)NC(=O)C(CO)NC(=O)CNC2=O)C(=O)NCC(=O)NC(CCC(O)=O)C(=O)NC(CCCNC(N)=N)C(=O)NCC(=O)NC(CC=3C=CC=CC=3)C(=O)NC(CC=3C=CC=CC=3)C(=O)NC(CC=3C=CC(O)=CC=3)C(=O)NC(C(C)O)C(=O)N3C(CCC3)C(=O)NC(CCCCN)C(=O)NC(C)C(O)=O)C(=O)NC(CC(N)=O)C(O)=O)=O)NC(=O)C(C(C)CC)NC(=O)C(CO)NC(=O)C(C(C)O)NC(=O)C1CSSCC2NC(=O)C(CC(C)C)NC(=O)C(NC(=O)C(CCC(N)=O)NC(=O)C(CC(N)=O)NC(=O)C(NC(=O)C(N)CC=1C=CC=CC=1)C(C)C)CC1=CN=CN1 NOESYZHRGYRDHS-UHFFFAOYSA-N 0.000 description 2
- 230000002503 metabolic effect Effects 0.000 description 2
- 239000011259 mixed solution Substances 0.000 description 2
- 239000012466 permeate Substances 0.000 description 2
- 239000000047 product Substances 0.000 description 2
- 230000036962 time dependent Effects 0.000 description 2
- 210000002700 urine Anatomy 0.000 description 2
- HSINOMROUCMIEA-FGVHQWLLSA-N (2s,4r)-4-[(3r,5s,6r,7r,8s,9s,10s,13r,14s,17r)-6-ethyl-3,7-dihydroxy-10,13-dimethyl-2,3,4,5,6,7,8,9,11,12,14,15,16,17-tetradecahydro-1h-cyclopenta[a]phenanthren-17-yl]-2-methylpentanoic acid Chemical compound C([C@@]12C)C[C@@H](O)C[C@H]1[C@@H](CC)[C@@H](O)[C@@H]1[C@@H]2CC[C@]2(C)[C@@H]([C@H](C)C[C@H](C)C(O)=O)CC[C@H]21 HSINOMROUCMIEA-FGVHQWLLSA-N 0.000 description 1
- 102000009027 Albumins Human genes 0.000 description 1
- 108010088751 Albumins Proteins 0.000 description 1
- 241000894006 Bacteria Species 0.000 description 1
- 208000034767 Hypoproteinaemia Diseases 0.000 description 1
- 102000004877 Insulin Human genes 0.000 description 1
- 108090001061 Insulin Proteins 0.000 description 1
- 210000001015 abdomen Anatomy 0.000 description 1
- 238000013459 approach Methods 0.000 description 1
- 239000003613 bile acid Substances 0.000 description 1
- 230000017531 blood circulation Effects 0.000 description 1
- 230000000052 comparative effect Effects 0.000 description 1
- 239000003792 electrolyte Substances 0.000 description 1
- 239000012530 fluid Substances 0.000 description 1
- 238000002615 hemofiltration Methods 0.000 description 1
- 239000012510 hollow fiber Substances 0.000 description 1
- 229940125396 insulin Drugs 0.000 description 1
- 230000007794 irritation Effects 0.000 description 1
- 210000004185 liver Anatomy 0.000 description 1
- 239000002357 osmotic agent Substances 0.000 description 1
- 210000000496 pancreas Anatomy 0.000 description 1
- 239000003330 peritoneal dialysis fluid Substances 0.000 description 1
- 230000003134 recirculating effect Effects 0.000 description 1
- 230000000284 resting effect Effects 0.000 description 1
- 238000000926 separation method Methods 0.000 description 1
- 238000001179 sorption measurement Methods 0.000 description 1
- 230000003068 static effect Effects 0.000 description 1
- 230000007704 transition Effects 0.000 description 1
- 210000000689 upper leg Anatomy 0.000 description 1
Landscapes
- External Artificial Organs (AREA)
- Separation Using Semi-Permeable Membranes (AREA)
Description
本発明は腹膜濾過装置に関し、さらに詳しくは腹腔透
析液を膜孔径の異なる少なくとも２個の濾過器に供給し
て濾過された濾液を腹腔に返還する小型で携帯可能な連
続再循環式腹膜濾過装置に関する。The present invention relates to a peritoneal filtration device, and more specifically, a small and portable continuous recirculation type peritoneal filtration device that supplies peritoneal dialysate to at least two filters having different membrane pore sizes and returns the filtered filtrate to the abdominal cavity. Regarding
連続的人工腎の治療として、連続的腹膜透析（CAPD）
や急性腎不全患者等を対象にした連続的血液濾過（CH
F）等が知られている。それらの１日の低分子量物質、
たとえば尿素のクリアランスはCAPDの場合、１日に2lの
透析液を４回交換し、除水量を薬液2lとしても最大10l/
日である。 また置換液を使用したCHFでは尿素の血中濃度を100mg
/dl以下に維持するに必要な置換液量は最低10l/日必要
である。 更に、間歇的治療である血液透析（HD）においては、
血液尿素窒素（BUN）のクリアランスを150ml/分とし、
週３回、１日４時間透析するとして、１日当たりのクリ
アランスを算出すると15.4l/日に相当するようになる。 すなわち現行の人工腎の性能はせいぜい10〜15l/日で
生体腎の尿素の１日当たりのクリアランスといわれてい
る薬液170l/日に遠く及ばない。そして、これは片腎廃
絶、残り片腎の4/5以上が機能停止した状態に相当し、
生体腎の性能に少しでも近づく人工腎の開発が要望され
てきた。 一方、血液透析（HD）においては第５図の１週間３
回、１日４時間透析した時の人体の血液尿素窒素（BU
N）の変化を示した図にみられるように、BUN値は大きく
変動しており、この変動が全ての合併症を引き起こす原
因になっている。Continuous peritoneal dialysis (CAPD) as a treatment for continuous artificial kidney
Hemofiltration (CH
F) etc. are known. Those daily low molecular weight substances,
For example, in the case of CAPD, the clearance for urea is 10 l / max even if 2 l of dialysate is changed 4 times a day and the amount of water removed is 2 l.
Is the day. In the case of CHF using a replacement solution, the blood concentration of urea was 100 mg.
A minimum of 10 l / day of replacement fluid is required to maintain below / dl. Furthermore, in hemodialysis (HD), which is an intermittent treatment,
The blood urea nitrogen (BUN) clearance is 150 ml / min,
Assuming that the patient is dialyzed three times a week for four hours a day, the daily clearance will be equivalent to 15.4 l / day. That is, the current performance of the artificial kidney is at most 10 to 15 l / day, which is far short of 170 l / day of the drug solution, which is said to be the daily clearance of urea in the living kidney. And, this is equivalent to the state of one kidney abolition, 4/5 or more of the remaining one kidney stopped functioning,
There has been a demand for the development of an artificial kidney that approaches the performance of the living kidney as much as possible. On the other hand, in hemodialysis (HD), 3
Blood urea nitrogen (BU)
As can be seen in the figure showing changes in N), BUN values fluctuate widely, and this fluctuation causes all complications.
かかる現行の人工腎の課題を解決するためには連続的
治療による人工腎システムの開発が不可欠である。その
ためには昼間患者が活動しながら人工腎の治療ができる
ことが必須の要件であり、小型で人体に携帯可能な人工
腎の開発が要望されてきた。 本発明者等はかかる課題を解決するために鋭意研究し
た結果、連続再循環腹膜透析と濾過器とを組み合わすこ
とによって小型の腹膜濾過装置が得られることを見出し
本発明に到達した。 腹膜透析と透析器とを組み合わした腹膜透析装置とし
て特開昭60-150758号が知られている。しかしながら、
この装置は透析器に透析液制御装置が連結するために装
置が大型になり、昼間活動しながら連続的に透析を行う
ことができない欠点を有していた。 本発明の目的は昼間活動しながら人工腎治療を行うこ
とができる小型で携帯可能な腹膜濾過装置を提供するこ
とである。 更に本発明の他の目的は夜間休眠しながらでも連続再
循環腹膜透析を行うことができる腹膜透析とサイクラー
による透析とを組み合わした装置に簡単に断続的な変更
可能な腹膜濾過装置を提供することである。In order to solve the problems of the current artificial kidney, it is essential to develop an artificial kidney system by continuous treatment. For that purpose, it is an essential requirement that the artificial kidney can be treated while the patient is active during the daytime, and there has been a demand for the development of a compact artificial kidney that can be carried by the human body. The inventors of the present invention have conducted extensive studies to solve such problems, and have found that a small-sized peritoneal filtration device can be obtained by combining continuous recirculation peritoneal dialysis and a filter, and arrived at the present invention. JP-A-60-150758 is known as a peritoneal dialysis device in which a peritoneal dialysis and a dialyzer are combined. However,
This device has a drawback that it cannot be continuously dialyzed while it is active during the daytime because the device becomes large because the dialysate control device is connected to the dialyzer. An object of the present invention is to provide a small and portable peritoneal filtration device capable of performing artificial kidney treatment while active in the daytime. Still another object of the present invention is to provide a peritoneal dialysis device that can be easily intermittently changed to a device that combines peritoneal dialysis and cycler dialysis that can perform continuous recirculating peritoneal dialysis while resting at night. Is.
すなわち、本発明は腹腔と、少なくとも２個の濾過器
およびそれらを結合する導管とからなる腹膜濾過装置に
おいて、透析液を収容する腹腔と、内部が微細孔膜から
なる第１濾過膜によって区分された第１濾過器の第１室
と、該第１濾過膜より小さい孔径を有する微細孔膜から
なる第２濾過膜によって内部が区分された第２濾過器の
第４室およびそれらを結合する導管とによって形成され
る閉回路と、前記第１濾過器第１室の透析液が第１濾過
膜を濾過して得られる第１濾過液が収容される第２室
と、前記第１濾過液が移行する第２濾過器の第３室とを
結合する導管と、前記第１濾過液の一部が第２濾過器の
第３室から排出されるための導管とによって形成される
腹膜濾過装置である。 また本発明は前記腹膜濾過装置において、第１濾過膜
の孔径が20〜1000Åであり、第２濾過膜の孔径が10〜30
0Åである腹膜濾過装置である。That is, the present invention is a peritoneal filtration device comprising an abdominal cavity, at least two filters and a conduit connecting them, and is divided into an abdominal cavity containing a dialysate and a first filtration membrane having a microporous membrane inside. A first chamber of the first filter, a fourth chamber of the second filter whose interior is divided by a second filtration membrane consisting of a microporous membrane having a smaller pore size than the first filtration membrane, and a conduit connecting them. A closed circuit formed by a first chamber, a second chamber containing a first filtrate obtained by filtering the first filter membrane with the dialysate in the first chamber of the first filter, and the first filtrate. A peritoneal filtration device formed by a conduit connecting the migrating third chamber of the second filter and a conduit for discharging a portion of the first filtrate from the third chamber of the second filter. is there. Further, in the peritoneal filtration device of the present invention, the pore size of the first filtration membrane is 20 to 1000Å and the pore size of the second filtration membrane is 10 to 30.
It is a peritoneal filtration device that is 0Å.
本発明は腹腔内に供給された新鮮透析液が腹膜を介し
て血液と接触し、腹膜が透過膜の作用をして血液中の代
謝生成物が腹腔内に透過されて、腹腔内透析液となる。 腹腔内透析液は第１濾過器の第１室に供給されて第１
濾過膜で濾過されて第２室で第１濾過液となる。第１室
を通過した腹腔内透析液は第２濾過器の濾過液側である
第４室に移行し、前記第１濾過液が第２濾過膜を濾過し
て得られる第２濾過液と混合して腹腔に戻される。 一方、第１濾過器の第２室から第２濾過器の第３室に
移行した第１濾過液は第２濾過器の第３室で、腹膜を透
過した代謝生成物、例えば尿分に相当する容量またはそ
れ以上の容量を排出する。第１濾過液の一部を排出する
ことによって、閉回路を循環する腹腔内透析液の容量は
ほぼ一定に保持されて腹膜透析することができる。In the present invention, the fresh dialysate supplied into the peritoneal cavity comes into contact with blood through the peritoneum, the peritoneal membrane acts as a permeable membrane, and metabolites in the blood are permeated into the peritoneal cavity. Become. The peritoneal dialysate is supplied to the first chamber of the first filter to
It is filtered by the filter membrane and becomes the first filtrate in the second chamber. The intraperitoneal dialysate that has passed through the first chamber moves to the fourth chamber, which is the filtrate side of the second filter, and the first filtrate is mixed with the second filtrate obtained by filtering the second filtration membrane. Then it is returned to the abdominal cavity. On the other hand, the first filtrate that has moved from the second chamber of the first filter to the third chamber of the second filter is equivalent to the metabolite that has permeated the peritoneum in the third chamber of the second filter, for example, urine. Eject or exceed the capacity to be used. By discharging a part of the first filtrate, the volume of the intraperitoneal dialysate circulating in the closed circuit can be kept substantially constant and peritoneal dialysis can be performed.
以下本発明の一例を実施例で説明する。 第１図は本発明腹膜濾過装置の一例を示す説明図であ
り、第２図は本発明腹膜濾過装置を人体に携帯した状態
を示す図であり、第３図および第４図は昼間に本発明腹
膜濾過装置を使用した時、夜間に使用する腹膜濾過装置
の一例を示す説明図であり、第５図は間歇的血液透析を
一週間行った時のBUNの経時変化を示すグラフである。 図中１は腹腔、２は第１濾過器、３は第２濾過器、４
は第１濾過膜、５は第２濾過膜、６は第１室、７は第２
室、８は第３室、９は第４室、10は第１導管、11は第２
導管、12は第３導管、13は第４導管、14は第１濾過液排
出導管、15は新鮮透析液供給導管、16、17、18および19
はポンプ、20は排出液収容バッグを示す。 第１図において、所定量の滅菌された新鮮透析液が導
管15から腹腔１に供給される。腹腔１内で透析液は腹膜
を介して血液と接触し、血液中の代謝生成物が腹腔内に
透過されて腹腔内透析液となる。腹腔内が負圧にならな
いように浸透活性物質たとえばグルコースを透析液に予
め所定量添加してもよいが、本発明腹膜濾過装置ではグ
ルコースを添加しなくても腹膜透析を行うことができ
る。それによって腹膜への刺激も少なく、糖尿病の原因
も除去できる。 第１図では腹腔１へは新鮮透析液供給導管15、腹腔透
析液が流出される第１導管10および第２透析器３から戻
ってきた返還透析液が流入される第３導管12の３本の導
管が夫々接続されたように図示されているが、腹腔への
導管の接続は外部細菌が腹腔内へ侵入するのを防止する
ために１本の導管で接続するのが好ましい。すなわち透
析液流入口および流出口は腹腔から離れたダブル ルー
メン カテーテル等からなり、新鮮透析液供給導管15は
第４導管12の途中からたとえば三方弁または２つの弁を
開閉して腹腔１へ新鮮透析液を供給することができる。 腹腔内透析液はポンプ16によって第１導管を経て第１
透析器２の第１室６に供給される。本発明腹膜濾過装置
で使用されるポンプはミニポンプまたはローラクランプ
である。 第１濾過器２は第１濾過膜４によって第１室と第２室
に区分されており、第１室は腹腔内透析液が供給される
第１導管10と、該透析液が通過して供出される第２導管
11と結合されている。一方第２室は腹腔内透析液が第１
濾過膜４を濾過した第１濾過液が収容される室であり、
該第１濾過液が移行する第２濾過器３の第３室８と第４
導管13によって連結している。 第１濾過膜４および第２濾過膜５は平膜状フイルタ
ー、プレート状、コイル状または中空糸状の膜が使用さ
れる。第１濾過膜４の孔径は20〜1000Å、好ましくは10
0〜200Åである。孔径が20Å未満であると、濾過効率が
低下する傾向があり、1000Åを超えると、アルブミンが
抜けて低蛋白血症になる傾向がある。 第１濾過器２の第１室６で第１濾過膜４を濾過した代
謝生成物質を含む濾液を除いた腹腔内透析液は第２導管
11を経て第２濾過器３の第４室９に移行される。 一方、第１濾過器２の第２室７の第１濾過液はポンプ
18によって第４導管13を経て第２濾過器３の第３室８へ
供給される。第１濾過液は第２濾過膜５で濾過されて第
２濾過液となる。 第２濾過器３は第２濾過膜５によって第３室と第４室
に区分されている。第３室８は第１濾過器第２室７から
の第１濾過液が流入する第４導管13と、流入した第１濾
過液の一部を排出する第１濾過液排出導管14と接続して
いる。第１濾過液が排出される容量は腹腔１内で腹膜を
介して透過した血液中の代謝生成物質、たとえば尿分に
相当する容量またはそれ以上の容量である。第１濾過液
の一部を排出することによって循環する腹腔内透析液の
容量はほぼ一定に維持され、腹腔内で腹膜を介して血液
と透析し、血液中の代謝生成物質を腹腔内の透析液に透
過することができる。 第１濾過液の一部はポンプ19によって排出導管14から
排出されるが、必要により排出液は第２図に示すような
排出液収容バッグ20に収容してもよい。 第４室９は第１濾過器２の第１室６からの腹腔内透析
液が流入する第２導管11と、第３室８内の第１濾過液が
第２濾過膜５によって濾過されて得られた第２濾過液と
第４室９に流入した前記腹腔内透析液との混合液が流出
する第３導管12とが接続されている。 第２濾過膜５の孔径は10〜300Å、好ましくは30〜100
Åである。孔径が10Å未満であると、濾過効率が低下す
る傾向があり、300Åを超えるとβ2-ミクログロブリン
大中分子量物質が透過する傾向がある。 第２濾過器３の第４室９から流出した腹腔透析液と第
２濾過液との混合液はポンプ17によって第３導管12を経
て腹腔１に戻される。 本発明腹膜濾過装置は循環する透析液への薬液の注入
が容易であるので種々の医療への応用が考えられる。た
とえば循環透析液のグルコース濃度を測定してインスリ
ンを循環透析液の導管の途中から注入して糖尿病患者の
治療に供し、人工膵臓の役割をしたり、活性炭等を含有
した吸着筒を第１濾過器２と第２濾過器３の間の第２導
管11に設けて循環透析中のビリルビンや胆汁酸等を吸着
し、肝補助の役割をすることができる。そしてこれらへ
の応用は血液中へ直接注入したり、注出したりするので
はなく、透析液中へ薬液の注入、注出をするので、事故
といってもせいぜい膜の目詰まりやリーク程度でモジュ
ール交換で安全に迅速に対応できる。 本発明腹膜濾過装置を人体に携帯したのが第２図であ
って、下腹部に取りつけたバンド等で本発明腹膜濾過装
置本体を携帯し、排出液収容バッグは大腿部へ取りつけ
ることによって昼間患者は自由に活動しながら腹膜透析
を行うことができる。そして本体に取りつけられた記録
計によって累積除水量は簡単に見ることができ患者は経
験と勘で排水量を調整することができる。 本実施例では、本発明腹膜濾過装置を腹膜透析と２個
の濾過器とを組み合わせて説明したが、３個以上の濾過
器を使用することによって、循環する腹腔内透析液中に
含有されている代謝生成物の分離を更に厳密にすること
ができる。 本発明腹膜濾過装置は一般に昼間活動しながら透析す
る際に使用されるが、夜間の休眠中または在宅透析にも
使用することができる。 夜間の休眠中または在宅透析の際には、第１図の腹膜
濾過装置で使用した第１濾過器２および第２濾過器３の
濾液側にサイクラーからの透析液を連続供給して透析器
として使用することができる。 第３図はかかる静止中での透析の一例を示した説明図
である。図中21は第１透析器であって第１図の第１濾過
器２を透析器としてそのまま使用することができる。22
は第２透析器であって第１図の第２濾過器３をそのまま
透析器として使用することができる。そしてこれらの濾
過器に所定の導管を嵌合または螺合することによって簡
単に循環腹膜透析装置を形成することができる。 腹腔50に収容されている腹腔内透析液はポンプ36によ
って導管29を経て第１透析器21の第１室25に供給され
る。該腹腔内透析液中に含有されている代謝生成物のあ
る種の物質は第１透析器21の第１濾過膜23を透過して第
２室26へ移行する。第２室には新鮮透析液貯蔵器60から
ポンプ39によって導管32を経て新鮮透析液が供給され、
第１透析膜23を介して腹腔内透析液と透析が行われる。
透析処理が終了した処理済透析液は導管33から排出され
る。第１透析膜23および第２透析膜24は中空糸状、平膜
状、コイル状の形態をしている。第１透析膜23の孔径は
20〜1000Å、好ましくは100〜200Åである。 第１透析器21の第１室25を通過した腹腔内透析液はポ
ンプ37によって導管30を経て第２透析器22の第３室27に
供給される。第２透析器22は第２透析膜24によって第３
室27と第４室28とに区分されており、第４室28には新鮮
透析液貯蔵器60からポンプ40によって導管34を経て新鮮
透析液が供給され、第２透析膜24を介して第３室27の腹
腔内透析液中の代謝生成物を透過させる。透析が終了し
た第４室28の処理済透析液は導管35から排出される。第
２透析膜24の孔径は10〜300Å、好ましくは30〜100Åで
ある。 第２透析器22の第３室27を通過した腹腔内透析液はポ
ンプ38によって導管31を経て腹腔50に戻される。すなわ
ち第３図の腹膜透析装置は腹腔と２個の透析器およびそ
れらを連結する導管とからなる閉回路と、前記２個の透
析器の濾液側に新鮮透析液を連続供給して透析を行う装
置を設けたものである。 第４図は第３図の透析器の濾液側に設けた新鮮透析液
供給装置をサイクラーによる透析に変更した腹膜透析装
置である。すなわち、第１透析器21の濾液側である第２
室26に第１透析液貯蔵容器41から透析液が流入し、透析
が終了した処理済透析液は導管43から透析液貯蔵容器41
へ戻され、処理済透析液が第２室26と透析液貯蔵容器41
とを循環する閉回路を形成する。第２透析器22の濾液側
の第４室28に流入する透析液についても同様であって、
透析液貯蔵容器42と第４室28とを連結する導管とによっ
て処理済透析液が循環する閉回路を形成する。 本発明腹膜濾過装置を昼間の活動時に、第３図または
第４図の腹膜透析装置の夜間の静止時に連続的に使用す
ることによって昼夜連続的に透析を実施することができ
る。濾過器の交換は定期的に実施し、たとえば夜間から
昼間に移行する時に毎日行うのが好ましい。 昼間に使用する本発明腹膜濾過装置はβ2-ミクログロ
ブリンのような中・高分子量物質を除去し夜間の透析装
置では尿素のような低分子量物質の除去が可能であり、
電解質の調整が容易である。 実施例１ 第１図の腹膜濾過装置において、腹腔に2lの新鮮透析
液を注入した。第１濾過器の第１濾過膜の孔径は14mμ
で膜面積は0.2m2である。第２濾過器の第２濾過膜の孔
径は3.5mμで膜面積は0.2m2である。循環する透析液流
量は80ml/分で、第１濾過器の濾液流量は40ml/分、第２
濾過器の濾液流量は38ml/分、除水流量は2ml/分で、１
日に16時間濾過した。次いで夜間には第４図の腹膜透析
装置を使用した。第１透析器および第２透析器は昼間使
用した第１濾過器および第２濾過器を使用した。その時
の循環透析液流量は100ml/分サイクラーの新鮮透析液流
量は100ml/分で８時間透析した。得られた尿素およびβ
2-ミクログロブリン（以下BMGで示す）のクリアランス
を第１表に示す。 比較例として現行の血液透析を血液流量150ml/分、週
３回、１回４時間した時の１週間の累積クリアランスか
ら１日たりのクリアランスを換算して前記代謝生成物質
のクリアランスを算出した。 BMGは殆ど昼間の活動時に腹膜透析する本発明腹膜濾
過装置で除去されるので、夜間の第４図の腹膜透析装置
での透析時間を無視しても、本発明の実施例の腹膜濾過
装置は現行の血液透析（HD）と比較して約８倍の性能を
有している。Hereinafter, an example of the present invention will be described with reference to an example. FIG. 1 is an explanatory view showing an example of the peritoneal filtration device of the present invention, FIG. 2 is a diagram showing a state in which the peritoneal filtration device of the present invention is carried by a human body, and FIGS. It is explanatory drawing which shows an example of the peritoneal filtration apparatus used at night when the invention peritoneal filtration apparatus is used, and FIG. 5 is a graph which shows the time-dependent change of BUN when performing intermittent hemodialysis for one week. In the figure, 1 is an abdominal cavity, 2 is a first filter, 3 is a second filter, 4
Is a first filtration membrane, 5 is a second filtration membrane, 6 is a first chamber, 7 is a second
Chamber, 8 is third chamber, 9 is fourth chamber, 10 is first conduit, 11 is second
Conduit, 12 is a third conduit, 13 is a fourth conduit, 14 is a first filtrate discharge conduit, 15 is a fresh dialysate supply conduit, 16, 17, 18 and 19
Is a pump, and 20 is a drainage containing bag. In FIG. 1, a predetermined amount of sterilized fresh dialysate is supplied to the abdominal cavity 1 through a conduit 15. The dialysate in the abdominal cavity 1 comes into contact with blood through the peritoneum, and metabolites in the blood are permeated into the peritoneal cavity to become an intraperitoneal dialysate. Although a predetermined amount of osmotically active substance such as glucose may be added to the dialysate in advance so that the intraperitoneal pressure does not become negative, the peritoneal dialysis device of the present invention can perform peritoneal dialysis without adding glucose. This reduces irritation to the peritoneum and eliminates the cause of diabetes. In FIG. 1, the fresh dialysate supply conduit 15 into the abdominal cavity 1, the first conduit 10 through which the peritoneal dialysate flows out, and the third conduit 12 through which the return dialysate returned from the second dialyzer 3 flows. Although each of the conduits is shown as connected, it is preferable to connect the conduits to the abdominal cavity with a single conduit to prevent external bacteria from entering the abdominal cavity. That is, the dialysate inlet and outlet consist of a double lumen catheter or the like separated from the abdominal cavity, and the fresh dialysate supply conduit 15 is opened and closed from the middle of the fourth conduit 12 by opening or closing, for example, a three-way valve or two valves to the abdominal cavity 1. A liquid can be supplied. The intraperitoneal dialysate is first pumped through the first conduit by the pump 16.
It is supplied to the first chamber 6 of the dialyzer 2. The pump used in the peritoneal filtration device of the present invention is a mini pump or a roller clamp. The first filter 2 is divided into a first chamber and a second chamber by a first filtration membrane 4, and the first chamber has a first conduit 10 to which an intraperitoneal dialysate is supplied and a dialysate through which the dialysate passes. Second conduit to be delivered
Combined with 11. On the other hand, in the second chamber, the peritoneal dialysate is the first
A chamber for containing a first filtrate obtained by filtering the filtration membrane 4,
The third chamber 8 and the fourth chamber of the second filter 3 to which the first filtrate moves
It is connected by a conduit 13. As the first filtration membrane 4 and the second filtration membrane 5, flat membrane filters, plate-shaped, coil-shaped or hollow fiber-shaped membranes are used. The pore size of the first filtration membrane 4 is 20 to 1000Å, preferably 10
0-200〜. If the pore size is less than 20Å, the filtration efficiency tends to decrease, and if it exceeds 1000Å, albumin tends to escape and hypoproteinemia occurs. The peritoneal dialysate excluding the filtrate containing the metabolites obtained by filtering the first filtration membrane 4 in the first chamber 6 of the first filter 2 is the second conduit.
After passing through 11, it is transferred to the fourth chamber 9 of the second filter 3. On the other hand, the first filtrate in the second chamber 7 of the first filter 2 is pumped.
It is supplied by 18 via the fourth conduit 13 to the third chamber 8 of the second filter 3. The first filtrate is filtered by the second filtration membrane 5 to become the second filtrate. The second filter 3 is divided into a third chamber and a fourth chamber by the second filtration membrane 5. The third chamber 8 is connected to a fourth conduit 13 into which the first filtrate from the first filter second chamber 7 flows, and a first filtrate discharge conduit 14 to discharge a part of the first filtrate that has flowed in. ing. The volume of the first filtrate to be discharged is a volume corresponding to or higher than the metabolic product in blood, such as urine, which has permeated through the peritoneum in the abdominal cavity 1. The volume of the peritoneal dialysate circulated by discharging a part of the first filtrate is maintained at a substantially constant level, and the peritoneal membrane is dialyzed against the blood in the peritoneal cavity, and the metabolic products in the blood are dialyzed intraperitoneally. It can penetrate liquid. A part of the first filtrate is discharged from the discharge conduit 14 by the pump 19, but the discharged liquid may be stored in the discharged liquid storage bag 20 as shown in FIG. 2 if necessary. The fourth chamber 9 has a second conduit 11 into which the intraperitoneal dialysate from the first chamber 6 of the first filter 2 flows, and the first filtrate in the third chamber 8 is filtered by the second filtration membrane 5. The third conduit 12 through which the mixed solution of the obtained second filtrate and the intraperitoneal dialysate that has flowed into the fourth chamber 9 flows out is connected. The pore size of the second filtration membrane 5 is 10 to 300Å, preferably 30 to 100
It is Å. If the pore size is less than 10Å, the filtration efficiency tends to decrease, and if it exceeds 300Å, the β 2 -microglobulin large and medium molecular weight substance tends to permeate. The mixed solution of the peritoneal dialysate and the second filtrate, which has flowed out from the fourth chamber 9 of the second filter 3, is returned to the abdominal cavity 1 by the pump 17 through the third conduit 12. Since the peritoneal filtration device of the present invention can easily inject a drug solution into a circulating dialysate, it can be applied to various medical treatments. For example, the glucose concentration of the circulating dialysate is measured, and insulin is injected from the middle of the conduit of the circulating dialysate to be used for treatment of diabetic patients, acting as an artificial pancreas, and the adsorption cylinder containing activated carbon etc. is first filtered. It is provided in the second conduit 11 between the device 2 and the second filter 3 to adsorb bilirubin, bile acid, etc. in the circulating dialysis, and can serve as a liver aid. The application to these is not to inject or pour directly into the blood, but to inject or pour out the medicinal solution into the dialysate, so at best, even if an accident is caused, the membrane will not be clogged or leaked. You can safely and quickly respond by replacing the module. FIG. 2 shows that the peritoneal filtration device of the present invention is carried by a human body, and the peritoneal filtration device body of the present invention is carried by a band or the like attached to the lower abdomen, and the drainage storage bag is attached to the thigh during the daytime. Patients are free to perform peritoneal dialysis. The cumulative amount of water removed can be easily viewed by the recorder attached to the main unit, and the patient can adjust the amount of water discharged through experience and intuition. In the present embodiment, the peritoneal dialysis device of the present invention has been described by combining the peritoneal dialysis and two filters, but by using three or more filters, the peritoneal dialysis fluid can be contained in the circulating intraperitoneal dialysate. The separation of existing metabolites can be more stringent. The peritoneal filtration device of the present invention is generally used for dialysis during daytime activities, but can also be used for nighttime dormancy or home dialysis. During nighttime dormancy or home dialysis, the dialysate from the cycler is continuously supplied to the filtrate side of the first filter 2 and the second filter 3 used in the peritoneal filtration device of FIG. Can be used. FIG. 3 is an explanatory diagram showing an example of such dialysis during rest. Reference numeral 21 in the figure is a first dialyzer, and the first filter 2 of FIG. 1 can be used as it is as a dialyzer. twenty two
Is a second dialyzer, and the second filter 3 of FIG. 1 can be used as it is as a dialyzer. Then, a circulating peritoneal dialysis device can be easily formed by fitting or screwing a predetermined conduit to these filters. The intraperitoneal dialysate contained in the abdominal cavity 50 is supplied to the first chamber 25 of the first dialyzer 21 via the conduit 29 by the pump 36. Certain substances of metabolites contained in the intraperitoneal dialysate pass through the first filtration membrane 23 of the first dialyzer 21 and move to the second chamber 26. Fresh dialysate is supplied to the second chamber from a fresh dialysate reservoir 60 by a pump 39 via a conduit 32,
Dialysis is performed with the intraperitoneal dialysate through the first dialysis membrane 23.
The treated dialysate for which the dialysis treatment has been completed is discharged from the conduit 33. The first dialysis membrane 23 and the second dialysis membrane 24 have a hollow fiber shape, a flat membrane shape, or a coil shape. The pore size of the first dialysis membrane 23 is
20-1000Å, preferably 100-200Å. The intraperitoneal dialysate that has passed through the first chamber 25 of the first dialyzer 21 is supplied to the third chamber 27 of the second dialyzer 22 via the conduit 30 by the pump 37. The second dialyzer 22 is connected to the third dialyzer 24 by the second dialysis membrane 24.
The chamber is divided into a chamber 27 and a fourth chamber 28, and fresh dialysate is supplied to the fourth chamber 28 from a fresh dialysate reservoir 60 by a pump 40 via a conduit 34 and a second dialysate membrane 24. Permeate the metabolites in the intraperitoneal dialysate in chamber 27. The treated dialysate in the fourth chamber 28 after the dialysis is discharged from the conduit 35. The pore size of the second dialysis membrane 24 is 10 to 300Å, preferably 30 to 100Å. The intraperitoneal dialysate that has passed through the third chamber 27 of the second dialyzer 22 is returned to the abdominal cavity 50 by the pump 38 via the conduit 31. That is, the peritoneal dialysis device shown in FIG. 3 performs dialysis by continuously supplying a fresh dialysate to the filtrate side of the two dialyzers and a closed circuit composed of an abdominal cavity, two dialyzers and a conduit connecting them. A device is provided. FIG. 4 shows a peritoneal dialysis device in which the fresh dialysate supply device provided on the filtrate side of the dialyzer of FIG. 3 is changed to dialysis by a cycler. That is, the second dialyzer 21, which is the filtrate side of the first dialyzer 21,
The dialysate flows from the first dialysate storage container 41 into the chamber 26, and the treated dialysate for which dialysis has been completed is supplied from the conduit 43 to the dialysate storage container 41.
The processed dialysate is returned to the second chamber 26 and the dialysate storage container 41.
Form a closed circuit that circulates and. The same applies to the dialysate flowing into the fourth chamber 28 on the filtrate side of the second dialyzer 22,
A conduit connecting the dialysate storage container 42 and the fourth chamber 28 forms a closed circuit through which the treated dialysate circulates. The peritoneal filtration apparatus of the present invention can be used for continuous dialysis during the daytime by continuously using the peritoneal dialysis apparatus of FIG. 3 or 4 at rest during nighttime. Replacement of the filter is preferably carried out on a regular basis, for example daily during the transition from night to daytime. The peritoneal filtration device of the present invention used in the daytime can remove medium and high molecular weight substances such as β 2 -microglobulin and can remove low molecular weight substances such as urea in the nighttime dialysis device,
Adjustment of the electrolyte is easy. Example 1 In the peritoneal filtration apparatus shown in FIG. 1, 2 liters of fresh dialysate was injected into the abdominal cavity. The pore size of the first filter membrane of the first filter is 14mμ
The membrane area is 0.2 m 2 . The second filter of the second filter has a pore size of 3.5 mμ and a membrane area of 0.2 m 2 . Circulating dialysate flow rate is 80ml / min, filtrate flow rate of the first filter is 40ml / min, second is
The filtrate flow rate of the filter is 38 ml / min and the dewatering flow rate is 2 ml / min.
Filtered for 16 hours a day. Next, at night, the peritoneal dialysis device shown in FIG. 4 was used. As the first dialyzer and the second dialyzer, the first filter and the second filter which were used during the day were used. The circulating dialysate flow rate was 100 ml / min, and the fresh dialysate flow rate of the cycler was 100 ml / min for 8 hours. The obtained urea and β
Table 1 shows the clearance of 2- microglobulin (hereinafter referred to as BMG). As a comparative example, the clearance of the above metabolites was calculated by converting the clearance for one day from the cumulative clearance for one week when the current hemodialysis was performed at a blood flow rate of 150 ml / min three times a week for four hours once. Since BMG is removed by the peritoneal filtration apparatus of the present invention that performs peritoneal dialysis during most daytime activities, even if the dialysis time of the peritoneal dialysis apparatus of Fig. 4 at night is ignored, the peritoneal filtration apparatus of the embodiment of the present invention It has about eight times the performance of the current hemodialysis (HD).
本発明腹膜濾過装置は小型で携帯可能であるので、昼
間において活動しながら腹膜透析を行うことができる。
そして夜間に使用する静止しながら腹膜透析する装置と
併用することによって、人工腎の連続的治療が可能にな
った。その結果、現行の間歇的血液透析が原因となって
いる合併症を防止することができる。 本発明腹膜濾過装置は透析液の補充する必要はなく、
また患者の血液が置換液となるので置換液が不要であ
る。かかる薬液が必要ないので設備も簡略化され、患者
は累積除水量を見ながら患者の経験と勘で除水量を調整
することができる。Since the peritoneal filtration device of the present invention is small and portable, it is possible to perform peritoneal dialysis while active during the daytime.
By using this together with a static peritoneal dialysis device used at night, continuous treatment of artificial kidneys became possible. As a result, complications caused by the current intermittent hemodialysis can be prevented. The peritoneal filtration device of the present invention does not require replenishment of dialysate,
Moreover, since the patient's blood becomes the replacement liquid, the replacement liquid is unnecessary. Since such a chemical solution is not required, the equipment is simplified, and the patient can adjust the water removal amount based on the experience and intuition of the patient while observing the cumulative water removal amount.
第１図は本発明腹膜濾過装置の一例を示す説明図であ
り、第２図は本発明腹膜濾過装置を人体に携帯した状態
を示す図であり、第３図および第４図は昼間に本発明腹
膜濾過装置を使用した時、夜間に使用する腹膜濾過装置
の一例を示す説明図であり、第５図は間歇的血液透析を
一週間行った時のBUNの経時変化を示すグラフである。 図中１は腹腔、２は第１濾過器、３は第２濾過器、４は
第１濾過膜、５は第２濾過膜、６は第１室、７は第２
室、８は第３室、９は第４室、10は第１導管、11は第２
導管、12は第３導管、13は第４導管、14は第１濾過液排
出導管、15は新鮮透析液供給導管、16、17、18および19
はポンプ、20は排出液収容バッグを示す。FIG. 1 is an explanatory view showing an example of the peritoneal filtration device of the present invention, FIG. 2 is a diagram showing a state in which the peritoneal filtration device of the present invention is carried by a human body, and FIGS. It is explanatory drawing which shows an example of the peritoneal filtration apparatus used at night when the invention peritoneal filtration apparatus is used, and FIG. 5 is a graph which shows the time-dependent change of BUN when performing intermittent hemodialysis for one week. In the figure, 1 is an abdominal cavity, 2 is a first filter, 3 is a second filter, 4 is a first filtration membrane, 5 is a second filtration membrane, 6 is a first chamber, and 7 is a second.
Chamber, 8 is third chamber, 9 is fourth chamber, 10 is first conduit, 11 is second
Conduit, 12 is a third conduit, 13 is a fourth conduit, 14 is a first filtrate discharge conduit, 15 is a fresh dialysate supply conduit, 16, 17, 18 and 19
Is a pump, and 20 is a drainage containing bag.
Claims (2)
れらを結合する導管とからなる腹膜濾過装置において、 透析液を収容する腹腔と、内部が微細孔膜からなる第１
濾過膜によって区分された第１濾過器の第１室と、該第
１濾過膜より小さい孔系を有する微細孔膜からなる第２
濾過膜によって内部が区分された第２濾過器の第４室お
よびそれらを結合する導管とによって形成される閉回路
と、 前記第１濾過器第１室の透析液が第１濾過膜を濾過して
得られる第１濾過液が収容される第２室と、前記第１濾
過液が移行する第２濾過器の第３室とを結合する導管
と、 前記第１濾過液の一部が第２濾過器の第３室から排出さ
れるための導管とによって形成される腹膜濾過装置。1. A peritoneal filtration device comprising an abdominal cavity, at least two filters and a conduit connecting them, a first abdominal cavity containing a dialysate and a microporous membrane inside.
A first chamber of a first filter divided by a filtration membrane and a second chamber comprising a micropore membrane having a pore system smaller than that of the first filtration membrane
A closed circuit formed by a fourth chamber of the second filter and a conduit connecting them, the interior of which is divided by a filter membrane, and the dialysate of the first chamber of the first filter filters the first filter membrane. A conduit connecting the second chamber containing the first filtrate obtained as described above and the third chamber of the second filter to which the first filtrate moves, and a part of the first filtrate is the second chamber. A peritoneal filtration device formed by a conduit for draining from the third chamber of the filter.
２濾過膜の孔径が10〜300Åである請求項１記載の腹膜
濾過装置。2. The peritoneal filtration apparatus according to claim 1, wherein the pore size of the first filtration membrane is 20 to 1000Å and the pore size of the second filtration membrane is 10 to 300Å.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| JP2316652A JP2512628B2 (en) | 1990-11-21 | 1990-11-21 | Peritoneal filtration device |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| JP2316652A JP2512628B2 (en) | 1990-11-21 | 1990-11-21 | Peritoneal filtration device |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| JPH04187158A JPH04187158A (en) | 1992-07-03 |
| JP2512628B2 true JP2512628B2 (en) | 1996-07-03 |
Family
ID=18079406
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| JP2316652A Expired - Fee Related JP2512628B2 (en) | 1990-11-21 | 1990-11-21 | Peritoneal filtration device |
Country Status (1)
| Country | Link |
|---|---|
| JP (1) | JP2512628B2 (en) |
Families Citing this family (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| EP2070535B1 (en) | 1998-08-24 | 2015-07-08 | Kurokawa, Kiyoshi | Drugs for relieving carbonyl stress and peritoneal dialysates |
-
1990
- 1990-11-21 JP JP2316652A patent/JP2512628B2/en not_active Expired - Fee Related
Also Published As
| Publication number | Publication date |
|---|---|
| JPH04187158A (en) | 1992-07-03 |
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