JP4557484B2 - 腹膜透析治療をモニタリングおよび制御するための方法および装置 - Google Patents
腹膜透析治療をモニタリングおよび制御するための方法および装置 Download PDFInfo
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- A61M1/154—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis with a cassette forming partially or totally the flow circuit for the treating fluid, e.g. the dialysate fluid circuit or the treating gas circuit with sensing means or components thereof
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- A61M1/159—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis with a cassette forming partially or totally the flow circuit for the treating fluid, e.g. the dialysate fluid circuit or the treating gas circuit specially adapted for peritoneal dialysis
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- A61M1/14—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis
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- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
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Description
(発明の背景)
本発明は、一般に、末期腎臓疾患の処置に関する。より具体的に、本発明は、腹膜透析の性能をモニタリングするための方法および装置に関する。
【0002】
腎臓がもはや十分に機能しないところまで、腎機能が低下した患者を支持するために透析を使用することは、公知である。2つの主要な透析方法が使用される:血液透析;および腹膜透析。
【0003】
血液透析において、患者の血液は、人工腎臓透析機器を通過される。この機器の膜は、血液を浄化するための人工腎臓として機能する。それは、特別な機器を必要とする体外処置であるので、特定の固有の欠点が、血液透析には存在する。
【0004】
血液透析に関連する欠点を克服するために、腹膜透析が開発された。腹膜透析は、患者自身の腹膜を半透膜として利用する。この腹膜は、身体の腹腔の膜状層である。良好な灌流に起因して、この腹膜は、天然の半透膜として機能し得る。
【0005】
腹膜透析は、腹腔に滅菌水溶液を、周期的に、注入する。この溶液は、腹膜透析溶液または透析液と呼ばれる。拡散および浸透圧交換は、天然の身体膜を横切って、溶液と血流の間で起こる。これらの交換は、腎臓が通常排出する老廃生成物を除去する。この老廃生成物は、代表的に、尿素およびクレアチニンのような溶質からなる。腎臓はまた、透析によって調節される必要のあるナトリウムおよび水のような他の物質のレベルを維持する。透析の間に腹膜を横切る水および溶質の拡散は、限外濾過と呼ばれる。
【0006】
移動性の連続した腹膜透析において、透析溶液は、カテーテルを使用して腹腔に導入される。透析液と血液との間の溶質の交換は、拡散によって達成される。さらなる除去は、血液から透析液への適切な浸透圧勾配を提供して、水が血液から流出することを可能にすることによって達成される。このことは、適切な酸−塩基バランス、電解質バランスおよび流体バランスが、身体内で達成されることを可能にする。この透析溶液は、単に、カテーテルを通して体腔から排液される。
【0007】
腹膜透析は、以下を含む、多くの懸念を生じる:腹膜炎の危険;より低い効率、従って血液透析に比較しての透析時間の持続時間の増加;および自動装置が使用された場合の費用の増加。
【0008】
腹膜透析に対する多くの改変が調べられている。1つのこのような改変は、自動腹膜透析(「APD」)である。APDは、機器(サイクラーと呼ばれる)を使用して、患者の腹腔におよび腹腔から、腹膜透析溶液を、自動注入、休止、および排液する。APDは、特に、腹膜透析患者に対して魅力的である。なぜなら、これは、患者が寝ている間の夜に実施され得るからである。このことは、患者を、彼/彼女の起きている時間および仕事の時間の間の移動性の連続的な腹膜透析の日々の要求から自由にする。
【0009】
APD手順は、代表的に、数時間にわたる。これはしばしば、使用済み透析液を腹腔から空にするための初期排液サイクルで始まる。次いで、このAPD手順は、順番に続く充填、休止および排液の段階の連続を通して進行する。各充填/休止/排液手順は、サイクルと呼ばれる。APDは、多くの異なる方法で実施され得、そして実施される。
【0010】
現在のAPDシステムは、治療期間の間に、患者の腹腔内圧をモニタしない。現在のシステムは、単に、患者カテーテルに取り付けられたラインまたは管腔にポンプが適用し得る外圧(または吸引)を制限するのみである。患者がシステム(しばしば、サイクラーと呼ばれる)の下に置かれる場合、重力頭が、サイクラーが患者カテーテルに適用し得る正の充填圧を加える。逆に、この患者がサイクラーの上に位置する場合、重力頭は、サイクラーが患者カテーテルに適用し得る正の充填圧から減少する。
【0011】
腹腔内圧のモニタリングは、有用である。なぜなら、サイクラーは、しばしば、サイクルの間に患者を完全には引かないからである。具体的に、現在利用可能なサイクラーは、患者がいくらかの流体を吸収したか否かまたはいくらかの流体が、単に、患者またはカテーテルの位置のために、排液され得ないか否かを決定することができない。
【0012】
その結果、いくつかの現在利用可能なシステムは、次ぎの充填の間に患者に送達されるべきである流体の量を決定するために、最小排液閾値を利用する。例えば、サイクラーが患者が「空」であると決定したときに、充填容量の85%が排液されていた場合、次の充填容量は100%となる。80%のみが排液される場合、次の充填容量は95%に制限される。
【0013】
患者が充填容量の所定割合よりも保持された場合、負の限外濾過(uF)警報が鳴る。この所定の割合は、代表的に、充填容量の50%または100%のいずれかであり得る。しかし、患者は、彼/彼女が満たされ過ぎたように感じない場合、この警報を無効にすることができる。1回の治療の間に患者がuF警報を無効にし得る回数は、サイクラーのソフトウェアによって制限され得る。しかし、このuF警報は、代表的に、透析液と共に腹腔にまた蓄積され得る実際の限外濾過液を考慮はしない。
【0014】
現在利用可能なサイクラーは、各サイクル間に、特定の、予めプログラムされた容量にまで患者を満たす。医師は、この充填容量を、患者の大きさ、体重および他の因子に基づいて処方する。しかし、現在利用可能なサイクラーは、腹腔内圧をモニターできないので、医師は、処方を実施する場合、この因子を考慮することができない。腹腔内圧(IPP)は、限外濾過(UF)に対する効果を有することがまた知れらている。
【0015】
図1〜3は、現在のAPDサイクラーの概略的な例示を提供する。それらのいずれも、腹腔内圧をモニターすることを試みない。
【0016】
図1を参照して、サイクラー10aは、透析液容器11を備えるように図示され、患者12および排液容器13が概略的に図示される。容器11から患者12への透析液の注入は、14によって示される重力頭によって引き起こされるが、一方で、患者12から排液容器13への使用された透析液の排液が、15によって示される排液頭によって引き起こされる。このサイクラー10aは、患者12の腹膜の内部の圧力をモニターするためのセンサを含まない。単一管腔16は、透析液容器11と排液容器13の両方を患者12に接続する。サイクラー10aによって作動される弁17、18は、容器11から患者12への透析液の流れまたは患者12から排液容器13への廃棄物質の流れのいずれかを制御する。
【0017】
図2を参照して、サイクラー10bにおいて、排液容器13および透析液容器11は、加圧チャンバ19内に収容される。このチャンバ19は、患者を充填または排液するために加圧または排液され得る。再び、弁17、18のこの選択的作動は、透析液が、患者12に移動されているかまたは患者12から移動されているかを制御する。再び、患者12の腹腔内圧を検出またはモニタするためのセンサは提供されない。
【0018】
図3を参照して、システム10cにおいて、透析液容器11は、ポンプ21に接続され、順に、透析液容器11を共通管腔またはカテーテル16(これらは、患者に接続される)に接続する。流体フロー制御弁が23に提供され、そしてサイクラー10cによって制御される。排液容器13がまた、ポンプ24に接続され、このポンプ24は、次いで、排液容器13を管腔16に接続する。制御弁がまた25に提供される。
【0019】
図1〜3に示されるサイクラー10a〜10cの排液速度および充填速度は、患者ライン16に適用される重力頭(図1を参照のこと)あるいは吸引または圧力(図2および3を参照のこと)によって決定される。代表的に、これらのサイクラー10a〜10cは、充填速度または排液速度のいずれをも最適化することができない。なぜなら、圧力は、重力頭あるいは図2のチャンバ10bによって適用される圧力または吸引(これらは、患者ライン16の対向端部で起こる)のいずれかによって固定されるからである。従って、腹腔内圧を測定することなくまたは腹腔内圧を評価する方法を有することなく、排液速度または充填速度のいずれかを最適化することは困難である。図3のサイクラー10cの場合において、排液速度または充填速度を最適化することは、いかなる圧力の読み取りをも全く欠くので推定である。
【0020】
従って、治療期間の間(排液および充填の間、ならびに休止の間の両方を含む)に、患者の腹腔内圧を測定する改善されたサイクラーに対する必要性が存在する。さらに、腹腔内圧を測定し、そしてサイクルの間に患者をより完全に排液するためのそのデータを使用する改善されたサイクラーに対する必要性が存在する。さらに、患者を過剰充填することを回避するために腹腔内圧を正確に測定する改善されたサイクラーに対する必要性が存在する。最後に、充填サイクルおよび排液サイクルの両方の間に、腹腔内圧をモニタして、患者が充填および排液される速度を最適化し、従って、治療期間の休止部分を増加させる改善されたサイクラーに対する必要性が存在する。
【0021】
(発明の要旨)
本発明は、透析液容器および排液容器を備える、患者に対する腹膜透析を提供するためのシステムを提供することによって上記の必要性を満たし、この透析液容器は、その間にインラインで接続される第一の圧力センサと共に患者に接続され、そしてこの排液容器は、その間にインラインで接続される第二の圧力センサと共に患者に接続される。
【0022】
1つの実施形態において、このシステムは、さらに、透析液容器と第一の圧力センサとの間にインラインで配置される第一のポンプを備える。
【0023】
1つの実施形態において、透析液は、静水圧頭(hydrostatic head)下で、透析液容器から患者に流れる。
【0024】
1つの実施形態において、第二のポンプは、排液容器と第二の圧力センサとの間にインラインで配置される。
【0025】
1つの実施形態において、透析液は、静水圧頭下で、患者から排液容器に流れる。
【0026】
1つの実施形態において、第二の圧力センサは、患者の腹腔内圧を測定するが、一方で、透析液は、透析液容器から患者に流れる。
【0027】
1つの実施形態において、第一の圧力センサが患者の腹腔内圧を測定し、一方で、透析液は、患者から排液容器に流れる。
【0028】
1つの実施形態において、このシステムは、さらに、透析液容器を第一のセンサに接続しそしてこの第一のセンサをカテーテルに接続する第一の管腔および排液容器を第二のセンサに接続し、そしてこの第二のセンサをカテーテルに接続する第二の管腔を備え、このカテーテルは、患者に接続され、患者から排液容器への透析液の流れが、第一の管腔から透析液を排液し、そして透析液を第一の管腔から、第二の管腔を通って排液容器に流させる。
【0029】
1つの実施形態において、このカテーテルは、二重管腔カテーテルである。
【0030】
1つの実施形態において、第一および第二のセンサは、二重インライン圧力/真空センサである。
【0031】
1つの実施形態において、本発明は、患者を透析するための方法を提供し、この方法は、以下の工程を包含する:患者の腹膜にカテーテルを配置する工程:少なくとも1つの透析液容器を提供する工程;この透析液容器を、第一の管腔を用いてカテーテルに接続する工程であって、この第一の管腔は、インラインでカテーテルと透析容器との間に配置される第一の圧力センサを備える、工程;少なくとも1つの排液容器を提供する工程;この排液容器を第二の管腔を用いてカテーテルに接続する工程であって、この第二の管腔は、インラインでカテーテルと排液容器との間に配置される第二の圧力センサを備える工程;透析液容器から患者の腹膜へと透析液を移動させ、そして第二の圧力センサを用いて患者の腹腔内圧をモニタする工程;ならびに患者の腹膜から排液容器に透析液を移動させ、患者の第一の腹腔内圧を第一の圧力センサを用いてモニタする工程。
【0032】
1つの実施形態において、透析液容器から患者の腹膜へと透析液を移動させる工程は、さらに、透析液容器と第一の圧力センサとの間にインラインで配置された第一のポンプを用いて透析液容器から患者に透析液をポンピングする工程を包含する。
【0033】
1つの実施形態において、患者の腹膜から排液容器に透析液を移動させる工程は、さらに、排液容器と第二の圧力センサとの間にインラインで配置された第二のポンプを用いて、患者の腹膜から排液容器に透析液をポンピングする工程を包含する。
【0034】
1つの実施形態において、透析液容器は、患者の腹膜の真上に配置され、そして透析液容器から患者の腹膜に透析液を移動させる工程が、さらに、静水圧頭下で、透析液容器から患者に透析液を流す工程を包含する。
【0035】
1つの実施形態において、排液容器は患者の腹膜の真下に配置され、そして患者の腹膜から排液容器に透析液を移動させる工程が、さらに、静水圧頭下で患者の腹膜から排液容器へと透析液を流す工程を包含する。
【0036】
本発明の他の目的および利点は、以下の詳細な説明および添付の特許請求の範囲を読み、そして添付の図面を参照して明らかとなる。
【0037】
これらの図面は、同一縮尺である必要がなく、そしてこれらの実施形態は、しばしば、図形、想像線、線図および断片図によって示されることが理解されるべきである。特定の例において、本発明の理解のために必要でないかまたは他の詳細を認知することを困難にする詳細は、省略され得る。もちろん、本発明は、本明細書中に例示される特定の実施形態に必ずしも制限されないことが理解されるべきである。
【0038】
(現在好ましい実施形態の詳細な説明)
図4を参照して、サイクラー30は、ポンプ31に接続された透析液容器11を備える。このポンプ31は、圧力センサ32に接続される。このポンプ31および圧力センサ32は、透析液容器11をカテーテル34に接続する管腔33にインラインで配置される。制御弁が35、36に提供される。排液容器13はまた、センサ37に接続されるポンプ36に接続される。ポンプ36およびセンサ37はまた、排液容器13をカテーテル34に接続する管腔38にインラインで接続される。制御弁が、再び、41、42に提供される。充填の間、ポンプ31は、容器11から管腔31およびカテーテル34を介して、患者12の腹膜(示されず)に透析液をポンピングする。この時間の間、センサ37は、腹腔内圧をモニタしそして測定する。信号が、43で概略的に示されるサイクラー30の制御器に送られる。制御パネルは、一般に44で示される。
【0039】
排液の間、センサ31は、患者12の腹腔内圧を正確にモニタおよび測定し得る。図4に示される実施形態において、センサ32と患者12との間には、ポンプまたは制御弁は配置されない。
【0040】
図5を参照して、各々、可逆ポンピングチャンバ51、52と患者12との間に配置されるセンサ53、54を有する可逆ポンピングチャンバ51、52を備えるサイクラー50が示される。制御弁55および56は、可逆ポンピングチャンバ51とセンサ53の別の側面に配置され、そして制御弁57、58が、可逆ポンピングチャンバ52とセンサ54のいずれかの側面に提供される。これらのセンサ53、54は、可逆ポンピングチャンバ51、52の隔膜に対する圧力を実質的に測定する。
【0041】
図6を参照すると、サイクラー60が図示されており、このサイクラーは、排液容器13を収容するチャンバ61および透析液容器11を収容するチャンバ62を備える。各チャンバ61、62は、63、64で示される、一体化された弁アセンブリおよび圧力センサを備える。図6に示される実施形態60において、チャンバ61は、排液され得なければならない。透析液は、重力または圧力充填によって、透析液容器11から流れ得る。再度、弁アセンブリ/センサの組み合わせ63、64が、上で議論されたように、患者12の腹腔内圧をモニタリングする。
【0042】
図7に示される実施形態70において、透析液容器11および排液容器13の両方が、一体化された制御弁および圧力センサ71、72に接続される。一体化された制御弁および圧力センサ71、72の各々が、それぞれ管腔73、74に接続され、これらの管腔は、Y型接続によってカテーテル75aに接続される。Y型接続およびクランプの全ての詳細は示されないが、当業者に公知である。透析液容器11から患者への流れは、75に示される重力頭のもとで行われ、一方で患者から排液容器13への流れは、76に示される重力頭のもとで行われる。
【0043】
図8は、本発明とともに使用するために適切な、1つのインライン圧力センサ80を示す。二重充填セル81、82が、ライン84、85によって接続される減圧によって、可撓性圧力感知膜83に接続される。サイクラーを患者に接続する管腔が、86で示される。
【0044】
図9は、二重ポンピングチャンバカセット87を示し、この二重ポンピングチャンバカセットは、カセット87を患者に接続する出力ライン88および患者をカセット87に接続する入力ライン89を備える。ライン90は、カセット87を透析液容器(図示せず)に接続する。各ポンピングチャンバ91、92は、3つ全てのライン88、89および90と連絡する。従って、全てのラインが、ポンピングチャンバ91、92のいずれかと接続され得る。ポンピングチャンバ91、92は、93に示される共通の隔膜によって、片側が接続される。流れは、94、95、96および97に示される隔膜弁の使用によって、制御される。圧力センサは、120、121、122、123、124、125に示される。しかし、圧力センサ123および120は、本発明によって腹腔内圧を測定するために使用されるセンサである。残りのセンサ121、122、124、125は、ポンプ126、127の作動をモニタリングするために使用される。
【0045】
左の隔膜ポンプ126が透析液を患者に押している場合に、センサ123は、ライン89を介して腹腔内圧を測定し得る。左の隔膜ポンプ126がライン89を通して患者から流体を排液している場合には、センサ120は、ライン88を介して腹腔内圧を測定し得、一方で右のポンプ27は、128で概略的に示される排液ラインを通して、排液容器(図示せず)に流体をポンピングする。右の隔膜ポンプ127が、患者から流体を排液するために使用されている場合には、センサ120が腹腔内圧を測定し得、一方で左の隔膜ポンプ126は、129で概略的に示される排液ラインを通して排液容器(図示せず)に流体をポンピングする。
【0046】
図10および11は、別個の通路101、102を備える二重管腔カテーテル100を示す。二重管腔カテーテル100の使用は、二重管腔患者ラインと比較して、圧力が測定される点を、別個の流路101、102を通る連絡によって、腹膜自体の内部に移動させ得る。二重管腔カテーテル100は、単一管腔カテーテルと同様に取り付けられるが、フロースルーカテーテルまたは標準的なカテーテルのいずれかとして機能する。両方の流路101、102は、排液および充填の間に、流体を引き抜きそして送達するために使用される。一方の流路が流体を送達する間に、他方の流路は排液する。一般的に103で示される端部セクションは、穿孔されている。
【0047】
先行技術のAPDサイクラーのためのAPD治療と、本発明に従って作製されたものとの比較は、以下のように要約される:
【0048】
【表1】
【0049】
【表2】
表1の調査は、サイクラー1が、充填5の開始時に、負のuF警報で午前4:30頃に患者を目覚めさせたことを示す。患者は、この警報を無視した。なぜならこの患者は、満たされ過ぎたことを感じず、そしてすぐに眠りに戻ったからである。この患者は、呼吸が困難であり過剰に満たされ過ぎたことを感じたときである、約15分後に目覚めた。この患者は、手動で約1500mlを排液したが、眠りに戻り得なかった。この患者は、製造業者に、形式的な製品の苦情を提出した。
【0050】
表1のデータは、サイクラー2が、完全に正常な治療を実施したが、全治療クリアランス(夜間の患者の容量の合計に基づいて計算した)が、本発明の方法を用いるサイクラーを使用してサイクラー3によって得られるクリアランスの84.5%のみであったことを示す。
【0051】
表1のデータは、サイクラー3が、完全に正常な治療を実施し、そして充填容量が、患者の腹腔内圧による4つの場合ではなく、最大の充填容量による1つの場合に、制限されたことを示す。この患者は、いかなる不快をも決して感じず、そして夜の間に警報を出されなかった。IPPの制限は、完了していない連続的な排液を有する場合でさえも、この患者の満たされ過ぎを防止する。この患者の腹膜内の流体の容量は、決して3リットルを超えない。
【0052】
サイクラー1を装着した患者は、休止3および4の間に、14mmHgを越える腹腔内圧を有した。この患者の呼吸は損なわれ得、そしてこの患者の心臓はより激しく働かなければならないが、この不快は、休止5の間に4,099mlのピークとなるまで、この患者を熟睡から目覚めさせるには十分ではなかった。
【0053】
まとめると、本発明の方法は、最適な充填、および従ってより大きなクリアランスを提供し、一方で不快および生体身体器官の機能の抑制をもたらす満たされ過ぎを防止する。負のuF警報は、めったに起こらない。なぜなら、必要な大きさの満たされ過ぎが、IPPセンサによって防止されるからである。
【0054】
(腹腔内圧(IPP)の計算)
IPPを計算するために、最初に、患者の頭の高さの補正を、エネルギーの保存を使用して計算し得る:
Δ(1/2ρV2+P−ρagh)+摩擦損失=0
患者ラインを通る流体の速度Vは、その流体密度と同様に、このラインの両端において同じであるので、この式は、以下のように書かれ得る:
(P2−P1)−ρag(h2−h1)+摩擦損失=0
これは、以下のように並べ替えられ得る:
【0055】
【数1】
(実施例1)
P1=1.25psig=85060(グラム/cm)/(cm2・秒2)
P2=0.9psig=61240(グラム/cm)/(cm2・秒2)
摩擦損失=39130(グラム/cm)/(cm2・秒2)
(約172cm/秒の流速の、内径4mmのライン中197cmn/分の流れの場合)
ここで、
ag=981cm/秒2
ρ=1グラム/cm3
【0056】
【数2】
Δh=−15.6cm(患者は、膜の15.6cm下にいる)。
【0057】
(実施例2)
P1=1.25psig=85060(グラム/cm)/(cm2・秒2)
P2=0.45psig=306240(グラム/cm)/(cm2・秒2)
摩擦損失=39130(グラム/cm)/(cm2・秒2)
(約172cm/秒の流速の、内径4mmのライン中197cmn/分の流れの場合)
ここで、
ag=981cm/秒2
ρ=1グラム/cm3
【0058】
【数3】
Δh=+15.6cm(患者は、膜の15.6cm上にいる)。
患者の頭の高さは、各充填の開始時に確立され得る。充填の間に起こる頭の高さの任意の変化は、患者の睡眠時からの腹腔内圧(IPP)の増加に起因し得る。
【0059】
図12を参照すると、患者の血液中の尿素濃度110と、代表的なAPDサイクラーのための透析液中の尿素濃度111との間の濃度勾配が、グラフで示されている。図13および14に示す結果を比較すると、本発明のセンサを備えるAPDサイクラーの方が優れた結果を与えることが明らかである。具体的には、図13にグラフで示されるデータは、先行技術のAPDサイクラーを使用して得られた。図14に得られるデータは、腹腔内圧をモニタリングするために2つのセンサを利用するAPDサイクラーを使用して得られた。血流中の尿素濃度110は、図13より図14においての方が低いことに注目のこと。透析液容量または充填容量は、図13に示す治療より図14に示す治療に対して、より低いことにさらに注目のこと。従って、本発明は、より低い充填容量での改善された尿素クリアランスを提供する。
【0060】
本明細書中に記載された現在好ましい実施形態に対して、種々の変化および改変が、当業者に明らかであることが、理解されるべきである。このような変化および改変は、本発明の意図および範囲から逸脱することなく、そしてその付随する利点を減少させることなく、なされ得る。従って、このような変化および改変が、添付の特許請求の範囲に包含されることが、意図される。
【図面の簡単な説明】
【図1】図1は、先行技術の自動化腹膜透析システムを概略的に示す。
【図2】図2は、先行技術の自動化腹膜透析システムを概略的に示す。
【図3】図3は、先行技術の自動化腹膜透析システムを概略的に示す。
【図4】図4は、本発明に従って作製された自動化腹膜透析システムを概略的に示す。
【図5】図5は、本発明に従って作製された自動化腹膜透析システムの第二の実施形態を概略的に示す。
【図6】図6は、本発明に従って作製された自動化腹膜透析システムの第三の実施形態を概略的に示す。
【図7】図7は、本発明に従って作製された自動化腹膜透析システムの第四の実施形態を概略的に示す。
【図8】図8は、本発明に従って作製された圧力センサを示す。
【図9】図9は、本発明に従って作製された二重ポンピングチャンバおよび圧力センサを組込んだ第五の実施形態を示す。
【図10】図10は、本発明で使用され得る二重管腔カテーテルを概略的に示す。
【図11】図11は、図10の線11−11に実質的に沿って取られた断面図である。
【図12】図12は、多重休止透析期間の間の血液中の尿素濃度および透析液中の尿素濃度をグラフ的に示す。
【図13】図13は、先行技術に従って実施される自動化腹膜透析溶液についての、患者の血流中での尿素の濃度 対 透析液溶液中の尿素の濃度をグラフ的に示す。
【図14】図14は、本発明に従って実施される自動化腹膜透析治療期間での、患者の血流中の尿素の濃度 対 透析液中での尿素の濃度をグラフ的に示す。
Claims (16)
- 患者に腹膜透析を提供するためのシステムであって、該システムは、以下:
間に第一の圧力センサをインラインで接続して、患者に接続される透析液容器であって、該第一の圧力センサは、透析液が該患者から排液容器へと流れる間に、該該患者の腹腔内圧を測定する、透析容器;および
間に第二の圧力センサをインラインで接続して、該患者に接続される排液容器であって、該第二の圧力センサは、透析液が該透析液容器から該患者へと流れる間に、該患者の腹腔内圧を測定する、排液容器、
を備える、システム。 - 前記透析液容器と前記第一の圧力センサとの間にインラインで配置される第一のポンプをさらに備える、請求項1に記載のシステム。
- 静水圧頭のもとで、透析液が前記透析液容器から前記患者へと流れる、請求項1に記載のシステム。
- 前記排液容器と前記第二の圧力センサとの間にインラインで配置される第二のポンプをさらに備える、請求項1に記載のシステム。
- 透析液が、静水圧頭のもとで前記患者から前記排液容器へと流れる、請求項1に記載のシステム。
- 透析液が前記透析液容器から前記患者へと流れる間に、前記第二の圧力センサが、該患者の腹腔内圧を測定する、請求項1に記載のシステム。
- 透析液が前記患者から前記排液容器へと流れる間に、前記第一の圧力センサが該患者の腹腔内圧を測定する、請求項1に記載のシステム。
- 前記透析液容器を前記第一のセンサへ、そして該第一のセンサをカテーテルへと接続する、第一の管腔、および
前記排液容器を前記第二のセンサへ、そして該第二のセンサを該カテーテルへと接続する、第二の管腔、
をさらに備え、
該カテーテルが、前記患者に接続され、
該患者から該排液容器への透析液の流れが、透析液を該第一の管腔から排出し、そして該第一の管腔からの該透析液を、該第二の管腔を通して該排液容器へと流す、請求項1に記載のシステム。 - 前記カテーテルが二重管腔カテーテルである、請求項8に記載のシステム。
- 前記第一および第二のセンサが、二重インライン圧力/減圧センサである、請求項1に記載のシステム。
- 患者に腹膜透析を提供するためのシステムであって、該システムが、以下:
間に第一のポンプおよび第一の圧力センサをインラインで接続して、該患者に接続される透析液容器であって、該第一のセンサが、該第一のポンプと該患者との間に配置され、該第一の圧力センサは、透析液が第二のポンプによって該患者から該液容器へとポンピングされる間に、該患者の腹腔内圧を測定する、透析液容器、および
間に第二のポンプおよび第二の圧力センサをインラインで接続して、該患者に接続される排液容器であって、該第二のセンサが、該第二のポンプと該患者との間に配置され、該第二の圧力センサは、透析液が該第一のポンプによって該透析液容器から該患者へとポンピングされる間に、該患者の腹腔内圧を測定する、排液容器、
を備える、システム。 - 透析液が前記第一のポンプによって前記透析液容器から前記患者へとポンピングされる間に、前記第二の圧力センサが、該患者の腹腔内圧を測定する、請求項11に記載のシステム。
- 透析液が前記第二のポンプによって前記患者から前記排液容器へとポンピングされる間に、前記第一の圧力センサが、該患者の腹腔内圧を測定する、請求項11に記載のシステム。
- 前記透析液容器を前記第一のポンプへ、そして該第一のポンプを前記第一のセンサへ、そして該第一のセンサをカテーテルへと接続する、第一の管腔、および
前記排液容器を前記第二のポンプへ、そして該第二のポンプを前記第二のセンサへ、そして該第二のセンサを該カテーテルへと接続する、第二の管腔、
をさらに備え、
該カテーテルが、該患者に接続されており、
該第二のポンプの作動が、透析液を該第一の管腔から排出し、そして該透析液を該第一の管腔から該排液容器へとポンピングする、請求項11に記載のシステム。 - 前記カテーテルが二重管腔カテーテルである、請求項14に記載のシステム。
- 前記第一および第二のセンサが二重インライン圧力/減圧センサである、請求項11に記載のシステム。
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US09/501,778 US6497676B1 (en) | 2000-02-10 | 2000-02-10 | Method and apparatus for monitoring and controlling peritoneal dialysis therapy |
US09/501,778 | 2000-02-10 | ||
PCT/US2001/004083 WO2001058509A1 (en) | 2000-02-10 | 2001-02-08 | Method and apparatus for monitoring and controlling peritoneal dialysis therapy |
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JP2003533243A JP2003533243A (ja) | 2003-11-11 |
JP2003533243A5 JP2003533243A5 (ja) | 2007-11-22 |
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AT (1) | ATE330647T1 (ja) |
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2000
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JP2003533243A (ja) | 2003-11-11 |
CO5280187A1 (es) | 2003-05-30 |
US7507220B2 (en) | 2009-03-24 |
US20020120227A1 (en) | 2002-08-29 |
WO2001058509A1 (en) | 2001-08-16 |
US8323231B2 (en) | 2012-12-04 |
US20110028892A1 (en) | 2011-02-03 |
US20170014566A1 (en) | 2017-01-19 |
US20030204162A1 (en) | 2003-10-30 |
EP1253954A1 (en) | 2002-11-06 |
EP1253954B1 (en) | 2006-06-21 |
US20070135758A1 (en) | 2007-06-14 |
ATE330647T1 (de) | 2006-07-15 |
DE60120922D1 (de) | 2006-08-03 |
US8206339B2 (en) | 2012-06-26 |
US20130150780A1 (en) | 2013-06-13 |
US6497676B1 (en) | 2002-12-24 |
AR032148A1 (es) | 2003-10-29 |
US9474842B2 (en) | 2016-10-25 |
DE60120922T2 (de) | 2007-02-01 |
US10322224B2 (en) | 2019-06-18 |
US6592542B2 (en) | 2003-07-15 |
AU2001234940A1 (en) | 2001-08-20 |
MXPA02007765A (es) | 2002-10-11 |
US8172789B2 (en) | 2012-05-08 |
US20090198174A1 (en) | 2009-08-06 |
TW503097B (en) | 2002-09-21 |
DK1253954T3 (da) | 2006-10-23 |
ES2266160T3 (es) | 2007-03-01 |
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