JP3261511B2 - Diafiltration equipment - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a diafiltration apparatus capable of simultaneously performing dialysis and filtration, and more particularly, to drawing a body fluid from a blood circuit side to a dialysate side through a semipermeable membrane in an artificial dialyzer. By repeatedly pushing the dialysate from the dialysate side to the blood circuit side, H (hemodialysis) and H (hemofiltration) are combined.
The present invention relates to a diafiltration device that performs a DF operation.

[0002]

2. Description of the Related Art In recent years, in the treatment of patients with renal insufficiency, a device that artificially performs a function of excreting waste products or pathogenic substances in body fluids such as blood as urine out of the body, so-called artificial kidney, has been widely used. Have been.

[0003] Such a device is provided with a dialyzer (dialyzer) in which a semipermeable membrane made of a thin tubular hollow fiber is accommodated in a container. For example, in a hollow fiber type dialyzer which is frequently used at present, a hollow dial is used. A large number of ultrafine tubules made of fibers are bundled and accommodated in a container, blood is circulated in the tubules, and dialysate is fed out of the tubules to perform permeation and diffusion on the wall surrounding the tubules, that is, the semipermeable membrane. It is like that.

[0004] By bringing the blood and the dialysate into contact with each other through the semipermeable membrane as described above, the HD operation utilizes the osmotic pressure difference due to the concentration difference between the blood and the dialysate through the semipermeable membrane. At this time, CL, Na, K, Ca, etc. accumulated in the patient's body fluid are removed, and the blood is returned to the patient's body again as a blood having a solution concentration close to normal. In the HF operation, a semipermeable membrane is used. By utilizing the filtration effect of the above, water is extracted from the blood side by a pressure difference, while a solution containing necessary substances is replenished to the blood and returned to the body.

[0005]

SUMMARY OF THE INVENTION The present invention relates to the above H
D, a simple configuration of a high-efficiency HDF-type device capable of performing HF operations simultaneously, and in view of the fact that the replacement liquid conventionally used for replenishing the solution is expensive, the replacement liquid is used. It is an object of the present invention to provide a diafiltration apparatus which replenishes a dialysate having the same component as the replacement liquid without using the same.

[0006] The present invention also provides a method for removing water from the blood circuit side by the action of removing water from the blood circuit side and injecting dialysate into the blood circuit side in the dialyzer.
When the blood cell component in the blood circuit increases and the dialysate is injected into the blood circuit side, the blood cell concentration on the blood circuit side decreases, so it is necessary to suppress the effect of the blood return flow to the patient, It is an object of the present invention to provide a diafiltration apparatus having such a suppression function.

Further, according to the present invention, in the above-mentioned dialysis treatment, before starting the dialysis treatment, it is necessary to clean the blood circuit and fill the circuit solution when using the dialyzer. It is an object of the present invention to provide a diafiltration apparatus capable of preventing air bubbles from entering into a dialyzer or easily removing air bubbles from entering into a dialyzer.

[0008]

In order to solve the above problems, a diafiltration apparatus according to the present invention provides a diafiltration apparatus by contacting blood to be circulated with a dialysate through a semipermeable membrane contained in a container. A dialyzer configured to purify blood, an arterial circuit for guiding blood taken out of the body to the dialyzer, and a venous circuit for guiding blood flowing out of the dialyzer into the body; A blood pump connected to the blood circuit for flowing blood in the blood circuit; a liquid supply circuit configured to supply the dialysate to the dialyzer at a constant flow rate; and a drainage for discharging the dialysate flowing out of the dialyzer. In the apparatus provided with a circuit, the liquid supply circuit is provided with a flow meter for measuring the amount of dialysate supplied, and the drain circuit is a flow meter and a negative pressure pump for measuring the amount of dialysate discharged. An automatic valve is provided in the front and rear flow paths of the negative pressure pump. By connecting the installed bypass circuit and measuring the supply amount and the drainage amount to the dialyzer with the two flow meters, the water removal amount and the injection amount in the dialyzer are measured, and the measurement result is obtained. By automatically adjusting the opening and closing of the auto valve to control the suction amount of the negative pressure pump, a predetermined negative pressure and a positive pressure are repeatedly generated with respect to the blood pressure of the dialyzer. It is a feature.

Further, each of the two flow meters comprises a measuring chamber provided with a three-way valve and flow rate change detecting means,
Each measuring chamber includes a right chamber and a left chamber partitioned by a diaphragm, and the flow rate change detecting means detects that one of the right chamber and the left chamber is full by the flow rate change detecting means. The configuration may be such that the three-way valve is switched and the flow rate in each flow meter is calculated based on the switching time of the three-way valve. Further, the flow rate of the blood pump is increased or decreased according to the measurement result of the control device, and when the dialysate is press-fitted into the blood circuit side in the dialyzer, the flow rate of the blood pump is reduced, and the dialysate is reduced. When blood is drawn from the blood circuit side, the flow rate of the blood pump may be increased.

[0010] Further, the dialyser is pressed into the blood circuit side by a pressurizing action on the dialyzer and then stopped, thereby washing the dialyzer and filling the dialysate. It may be.

[0011]

In the diafiltration apparatus of the present invention described above, the dialysate flows into one of the right chamber and the left chamber of the supply-side measuring chamber and the drain-side measuring chamber having the same measuring volume and is full. When it becomes, the dialysate flows into the other empty chamber, and the respective three-way valves are switched.The switching time difference between the respective three-way valves at this time is detected by the respective flow rate change detecting means, and the detection result is obtained. The control unit measures the water removal amount and the injection amount in the dialyzer, and calculates the measurement result as [water removal amount-injection amount = body water extraction amount] in the dialyzer.

In this apparatus, the opening and closing of the auto valve is automatically adjusted so as to obtain the above-mentioned predetermined water removal amount and injection amount, and the suction amount of the negative pressure pump is controlled. By generating a predetermined negative pressure and positive pressure with respect to the pressure, between the blood circuit side of the dialyzer and the dialysate circulation circuit side through the semipermeable membrane, the dialysate is injected and water is extracted from the body. Can be discharged.

Here, the negative pressure relative to the blood pressure of the dialyzer is generated when the negative pressure pump reaches the maximum suction amount by closing the auto valve, and at this time, water is transferred from the blood circuit side to the dialysate side. A retraction is performed, and at the same time a transfer of waste products in the blood.

The positive pressure with respect to the blood pressure of the dialyzer is
When the negative pressure pump stops suction by releasing the auto valve, the dialysate is generated by the supply water pressure of the dialysate, and at this time, the dialysate is injected into the blood side to compensate for the shortage of the water extracted above. The difference between the amount of water removed from the dialysate and the amount injected is the amount of water drawn out of the body. Thus, the same HF operation and HD operation can be performed by the same device.

Further, as described above, when water is drawn from the blood circuit side in the dialyzer due to a change in the dialysate pressure in the dialyzer, the blood cell concentration in the blood circuit increases, so that the flow rate of the blood pump increases. When the dialysate is injected into the blood circuit side, the blood cell concentration in the blood circuit decreases, and thus the flow rate of the blood pump is reduced, thereby suppressing a change in the flow rate of blood returned to the patient. it can.

Further, in the artificial treatment as described above,
When using a dialyzer, it is necessary to fill the circuit solution without introducing air bubbles into the dialyzer and completely remove the air bubbles generated in the dialyzer. In order to clean the blood circuit and fill the solution in the circuit, a certain amount of the dialysate is injected into the blood circuit through the pores of the semi-permeable membrane to form an end of the arterial circuit and the venous circuit. By flushing the dialyser, the inside of the dialyzer can be easily washed and the air bubbles in the dialyzer can be easily pushed out, and then the dialyser is filled with the dialysate by stopping the injection of the dialysate. it can.

[0017]

Embodiments of the present invention will be described below with reference to the drawings. FIG. 1 is a circuit diagram of a diafiltration apparatus according to an embodiment of the present invention.

In the figure, reference numeral 2 denotes a blood circuit for circulating blood extracted from the body, and an arterial circuit 3 for guiding the blood extracted from the body to the dialyzer 5 through the blood outlet 7.
And a venous circuit 4 for guiding the blood flowing out of the dialyzer 5 into the body via the blood introducing unit 8. The arterial circuit 3 is provided with a blood pump 6. In the blood circuit 2, blood flowing from the blood outlet 7 flows through the blood circuit 2 by the operation of the blood pump 6 and is returned to the body from the blood inlet 8.

The dialyzer 5 has a container in which a semipermeable membrane made of a thin tubular hollow fiber is housed, and the blood in the blood circuit 2 flows through the thin tube forming the semipermeable membrane, and the blood flows out of the thin tube. The dialysate supplied between the liquid supply circuit 9 and the drainage circuit 10, which will be described later, contacts the semi-permeable membrane to purify blood by the osmotic pressure of the semi-permeable membrane.

The dialyzer 5 has a liquid supply circuit 9 for guiding the dialysate into the dialyzer 5 and a dialysate introduced into the dialyzer 5 via a semipermeable membrane in the dialyzer 5. A drainage circuit 10 that contacts the blood and then drains from the dialyzer 5 is connected. The liquid supply circuit 9 supplies dialysate toward the drainage circuit 10 by a supply pressure of a pump or the like (not shown), and a constant flow valve 13 is provided in the middle of the liquid supply circuit 9. As a result, the dialysate passing through the liquid supply circuit 9 is supplied to the dialyzer 5 while being maintained at a constant flow rate. As a result, the dialysate in the outer region of the tubular semipermeable membrane of the dialyzer 5 becomes blood within the semipermeable membrane. A positive pressure is applied to the circuit side to flow through the drainage circuit 10.

Further, in the present apparatus, the liquid supply circuit 9 is provided with a liquid supply side measuring chamber 11 provided with a three-way valve 14 on the inlet side of the dialyzer 5, and on the inflow side of the liquid supply side measuring chamber 11. Flow rate change detecting means 17 is provided.

The liquid supply side measuring chamber 11 has a right chamber 11a and a left chamber 11b separated by a diaphragm 11c.

The flow rate change detecting means 17 is known (Japanese Patent Application No. Sho 63).
No.-64811), which is composed of a flow rate detector or a pressure detector, and a right chamber 11a and a left chamber 11b of the measuring chamber 11.
When the dialysate fed to any one of the above flows into and becomes full, it is detected by the flow rate change detecting means 17 as the presence or absence of a flow rate change or a change in the flow pressure, and as a result, the three-way valve 14 is switched. The dialysate flows into the other empty chamber.

Further, the drain circuit 10 is provided with a drain side measuring chamber 12 provided with a three-way valve 14 at the outlet side of the dialyzer 5, and the drain side measuring chamber 12 is provided with the above-mentioned liquid feeding side measuring chamber. 11 includes a right chamber 12a and a left chamber 12b partitioned by a diaphragm 12c, and the liquid supply-side measuring chamber 11 and the drain-side measuring chamber 12 perform the same operation, and perform the same operation. Has a metering volume. The discharge side of the drain side measuring chamber 12 is connected to a flow rate change detecting means 18 having the same structure as described above, and further provided with a negative pressure pump 20 via an orifice 19. A bypass circuit 21 is formed before and after the flow path of the negative pressure pump 20, and an automatic valve 22 controlled by a motor is provided in the bypass circuit 21.

In the above configuration, when the automatic valve 22 is completely closed, the negative pressure pump 20 sucks the gas to the maximum and creates a negative pressure for the dialysate in the dialyzer 5. When completely released, the suction flow rate by the negative pressure pump 20 circulates through the bypass circuit and the suction action of the negative pressure pump 20 does not work. At this time, the inside of the dialyzer 5 is supplied via the liquid supply circuit 9 as described above. A positive pressure is generated by the dialysate, and the suction amount of the negative pressure pump 20 is adjusted according to the degree of opening and closing of the auto valve 22, and a positive pressure and a negative pressure for the blood pressure are alternately provided in the dialyzer 5. Can occur.

That is, by opening and closing the auto valve 22, the suction operation of the negative pressure pump 20 is adjusted and the dialyzer 5 is operated.
When the dialysate pressure in the inside is changed and a negative pressure acts on the dialyzer 5 due to the closing of the auto valve 22, water is drawn (removed) from the blood circuit 2 side, and conversely, by opening the auto valve 22. When a positive pressure acts on the dialyzer 5, the dialysate is pushed (injected) into the blood circuit side.

Further, in the present apparatus, the flow rate change detecting means 17 on the liquid supply side measuring chamber 11 side and the flow rate change detecting means 18 on the drain side measuring chamber 12 side are connected to the control device 23, and The switching time difference between the three-way valves 14 of the liquid supply-side measurement chamber 11 and the drainage-side measurement chamber 12 associated with water removal and injection is determined by flow rate change detection means 17 and 18.
And the detection result is measured by the control device 23, and the measurement result is calculated as [water removal amount−injection amount = body water extraction amount] in the dialyzer 5, and the predetermined Automatic valve 2 to obtain the water removal amount and injection amount
2 is automatically adjusted to control the suction amount of the negative pressure pump 20. As a result, by repeatedly generating a predetermined negative pressure and positive pressure with respect to the blood pressure in the dialyzer 5, the dialysate between the blood circuit side and the dialysate flow circuit side of the dialyzer 5 via the semipermeable membrane is formed. Press-fit and withdraw moisture from the body, thus using the same device for conventional HF operation and HD
The operation can be performed together.

Further, in the present apparatus, the operation of the blood pump 6 is controlled based on the measurement result of the control device 23, and water is drawn from the blood circuit 2 side by the change of the dialysate pressure in the dialyzer 5. Occasionally, the flow rate of the blood pump 6 is increased to suppress an increase in the concentration of blood cell components in the blood circuit 2.
When it is press-fitted to the side, the flow rate of the blood pump 6 is reduced so that the concentration of blood cell components in the blood circuit 2 is prevented from decreasing, whereby the flow rate of blood returned to the patient can be adjusted. It is.

Further, in the above artificial dialysis,
In using the dialyzer, it is necessary to fill the solution in the circuit without introducing air bubbles into the dialyzer, and to completely remove the air bubbles generated in the dialyzer.

In the present invention, in order to clean the blood circuit and fill the circuit in the circuit before the start of the dialysis treatment, a certain amount of the dialysate is injected into the blood circuit 2 by the press-in action of the dialysate. By circulating in the inside 5 and flushing out from the ends of the blood outlet 7 and the blood inlet 8 of the arterial circuit 3 and the venous circuit 4, the inside of the dialyzer 5 is washed and bubbles in the dialyzer are pushed out. By stopping the press-fitting of the dialysate, the dialyser 5 is brought into a standby state in which the dialysate is filled.

As a result, conventionally, in preparation for treatment using a dialysis device, the arterial circuit 3 and the venous circuit 4 of the dialyzer 5 are conventionally used.
The solution is fed from one end of the dialysis device and allowed to pass through the capillary group of the dialyzer 5, but air bubbles adhering to the pores of the fibers on the inner wall of the capillary cannot be smoothly degassed. Although a time-consuming and troublesome manual operation of giving a blow from the surface has been required, the above operation can automatically perform cleaning and filling of the solution in the thin tube forming the semipermeable membrane.

[0032]

As described above, according to the diafiltration apparatus of the present invention, the water content is determined by the switching time difference between the three-way valve for each of the right chamber and the left chamber of the supply-side measuring chamber and the drain-side measuring chamber. The amount of water removed and the amount of dialysate injected are measured, and based on the measurement results, the negative pressure and positive pressure on the dialyzer are determined by opening and closing the auto valve in the bypass circuit of the negative pressure pump provided in the drainage circuit and operating time. And the pressure are automatically and alternately generated, and by automatically controlling the water removal amount and the injection amount, the difference between the water removal amount and the injection amount is discharged as the amount of water to be drawn out of the body. With the same device that removes waste products from blood and thus has a simple configuration, it is possible to perform conventional HF operation and HD operation together simply by using dialysate without using expensive replacement fluid. .

Further, the present apparatus can be configured so that the flow rate of the blood pump in the blood circuit can be easily increased or decreased based on the measurement results of the above-mentioned water removal amount and injection amount. It is possible to suppress the change in the flow rate with a simple configuration.

Further, in the present apparatus, the removal of air bubbles in the dialyzer and the filling of the solution in the circuit before the use of the dialyzer can be performed by a simple operation by utilizing the action of injecting the dialysate into the dialyzer. It is possible to greatly reduce the labor of the worker.

[Brief description of the drawings]

FIG. 1 is a circuit diagram of a diafiltration apparatus according to an embodiment of the present invention.

[Description of sign]

2 ... blood circuit, 3 ... arterial circuit, 4 ... venous circuit, 5 ... dialyzer, 6 ... blood pump, 7 ... blood derivation unit, 8 ... blood introduction unit, 9 ... liquid supply circuit, 10 ... drainage circuit, 11 ... Measurement chamber on the liquid supply side, 12 ... Measurement chamber on the drain side, 13 ... Constant flow valve, 14, 15 ... Three-way valve, 17, 18 ... Flow rate change detecting means, 19 ... Orifice, 20 ... Negative pressure pump, 21 ... Bypass Circuit, 22 ... Auto valve, 23 ... Control device.

Claims (4)

(57) [Claims] 1. A dialyzer configured to purify blood by contacting the circulated blood with a dialysate via a semi-permeable membrane contained in a container, and a dialyzer that removes blood taken out of the body. A blood circuit having an arterial circuit leading to the blood vessel and a venous circuit leading blood flowing out of the dialyzer into the body, a blood pump connected to the arterial circuit and flowing the blood in the blood circuit, and the dialyzer. In a device including a liquid supply circuit configured to supply a dialysate at a constant flow rate and a drainage circuit configured to discharge the dialysate flowing out of the dialyzer, the liquid supply circuit includes a dialysate supply amount. Is provided in the drainage circuit, a flowmeter for measuring the amount of dialysate drainage is provided, and a negative pressure pump is provided. The circuit is connected and the dialyser is connected to the dialyzer by the two flow meters. The amount of water removed and the amount of injection in the dialyzer are measured by measuring the amount of liquid and the amount of drainage, and the opening / closing of the auto valve is automatically adjusted based on the measurement result to control the suction amount of the negative pressure pump. Thus, a predetermined negative pressure and a positive pressure are repeatedly generated with respect to the blood pressure of the dialyzer. 2. The two flowmeters each comprise a measuring chamber provided with a three-way valve and a flow rate change detecting means. Each measuring chamber has a right chamber and a left chamber partitioned by a diaphragm. The three-way valve is switched by detecting that one of the right chamber and the left chamber is full by the flow rate change detecting means, and the flow rate in each flow meter is determined based on the switching time of the three-way valve. 2. The diafiltration apparatus according to claim 1, wherein is calculated. 3. The flow rate of the blood pump is increased or decreased according to the measurement result of the control device, and when the dialysate is pressed into the blood circuit side in the dialyzer, the flow rate of the blood pump is reduced. The diafiltration apparatus according to claim 1, wherein the flow rate of the blood pump is increased when the dialysate is withdrawn from the blood circuit side. 4. The method according to claim 1, wherein the dialysate is pressed into the blood circuit side by a pressurizing action on the dialyzer and then stopped, thereby washing the dialyzer and filling the dialysate. The diafiltration device according to claim 1, wherein: