JP5490438B2 - Blood purification equipment - Google Patents

Description

  The present invention relates to a blood purification apparatus for purifying a patient's blood while circulating it outside the body.

  In general, in blood purification therapy such as dialysis treatment, a blood circuit composed of a flexible tube is used to circulate a patient's blood extracorporeally. This blood circuit is mainly composed of an arterial blood circuit in which an arterial puncture needle for collecting blood from a patient is attached to the tip, and a venous blood circuit in which a venous puncture needle for returning blood to the patient is attached to the tip. Thus, blood purification means called a dialyzer is interposed between the arterial blood circuit and the venous blood circuit to purify blood circulating outside the body.

  In such a dialyzer, a plurality of hollow fibers are arranged inside, and blood passes through the inside of each hollow fiber, and on the outside thereof (between the outer peripheral surface of the hollow fiber and the inner peripheral surface of the housing). It is set as the structure which can flow a dialysate. The hollow fiber has a blood purification membrane with micropores (pores) formed in the wall surface, and waste products of blood passing through the hollow fiber permeate the blood purification membrane and are discharged into the dialysate. At the same time, waste blood is discharged and purified blood returns to the patient's body.

  By the way, in the conventional blood purification apparatus, after the priming process for filling the blood circuit with the priming solution, the dialysate is introduced into the dialyzer with the puncture needles attached to the tip of the arterial blood circuit and the venous blood circuit. A blood removal step of introducing blood from the patient into the blood circuit before being performed, and a blood purification treatment step of circulating the patient's blood extracorporeally in the blood circuit while introducing and discharging dialysate into the dialyzer. (For example, refer patent document 1).

  That is, the blood circuit before the blood purification treatment process is filled with a priming solution (such as physiological saline) in advance, and after the puncture needle is punctured into the patient, the blood pump is driven to remove the blood removal step (the dialysate is In a state where the blood of the patient is not replaced with the priming solution, the blood is introduced into the blood circuit, and when the medical staff determines that the blood removal has been successfully performed, the dialysate is supplied to the dialyzer. The blood purification treatment process (dialysis treatment) is performed by removing water.

JP 2001-61959 A

  However, in the conventional blood purification apparatus, the blood purification treatment process (dialysis treatment) is performed after the medical staff visually confirms that the blood removal process has been performed well. A medical worker must be accompanied until the blood process is completed, and there is a problem that many medical workers are required when a large number of people are treated at once.

  In addition, it is conceivable to automatically shift from the blood removal process to the blood purification treatment process in consideration of the driving state of the blood pump. In this case, for example, the patient's shunt is narrowed or the tip of the puncture needle is Even when blood cannot be sufficiently sucked, such as when it is in contact with a blood vessel wall or a venous valve, there is a risk of shifting from the blood removal process to the blood purification treatment process, which is problematic in terms of safety.

  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 automatically shifting from a blood removal process to a blood purification treatment process more safely.

The invention according to claim 1 is a blood circuit comprising an arterial blood circuit and a venous blood circuit capable of extracorporeally circulating patient blood, a blood pump disposed in the arterial blood circuit, and the arterial blood circuit And a blood purification means that is connected between the blood circuit and the venous blood circuit and that can purify blood flowing through the blood circuit and that can be discharged while the dialysate is supplied, and dehydrating the blood flowing through the blood purification means And a puncture needle at the distal end of the arterial blood circuit and the distal end of the venous blood circuit after the priming process for filling the blood circuit with the priming liquid and filling the blood purification means with the liquid. A blood removal step of introducing blood from the patient into the blood circuit before the dialysate is supplied to the blood purification means in a state where the patient is punctured with the dialysis fluid attached, and the blood purification means In the blood purification apparatus capable of sequentially performing a blood purification treatment step for circulating the patient's blood extracorporeally in the blood circuit while being supplied, the blood removal step and the blood purification treatment step by driving the blood pump or the water removal pump And a control means for sequentially performing the determination, and determining whether the fluid flowing through the arterial blood circuit or the venous blood circuit is blood, which is attached to the distal side of the arterial blood circuit or the distal side of the venous blood circuit. Blood control means, and the control means is attached to at least the distal end side of the arterial blood circuit after the blood pump or dewatering pump is driven to reach a predetermined number of revolutions. In addition, the blood is automatically transferred from the blood removal step to the blood purification treatment step on the condition that the blood discrimination means discriminates that the blood is flowing.

  According to the first aspect of the present invention, the control means can automatically shift from the blood removal process to the blood purification treatment process on the condition that the blood discrimination means discriminates that blood is flowing. Thus, it is possible to avoid the transition to the blood purification treatment process with poor blood removal, and it is possible to automatically shift from the blood removal process to the blood purification treatment process more safely.

Further, the control means removes the blood on the condition that the blood pump or the dewatering pump has been driven to reach a predetermined number of revolutions and that the blood discrimination means has determined that blood is flowing. Since the process is automatically shifted to the blood purification treatment process, it is possible to automatically shift from the blood removal process to the blood purification treatment process while further improving safety.

1 is an overall schematic view showing a blood purification apparatus according to an embodiment of the present invention. Schematic diagram showing the internal configuration of the dialyzer body in the blood purification apparatus The schematic diagram which shows the state at the time of the priming process in the blood purification apparatus The schematic diagram which shows the state at the time of the blood removal process in the blood purification apparatus The schematic diagram which shows the state at the time of the blood purification treatment process in the blood purification apparatus Front view showing blood discrimination means in the blood purification apparatus VII-VII line sectional view of FIG. Flow chart showing control contents in the blood purification apparatus The flowchart which shows the control content in the blood purification apparatus which concerns on a reference example

Hereinafter, embodiments of the present invention will be specifically described with reference to the drawings.
The blood purification apparatus according to the present embodiment is for purifying a patient's blood while circulating it extracorporeally, and is applied to a dialysis apparatus used in dialysis treatment. As shown in FIG. 1, such a dialysis machine is mainly composed of a blood circuit 1 to which a dialyzer 2 as blood purification means is connected, and a dialysis machine main body 5 for removing water while supplying dialysate to the dialyzer 2. . As shown in the figure, the blood circuit 1 is mainly composed of an arterial blood circuit 1a and a venous blood circuit 1b made of a flexible tube. The arterial blood circuit 1a and the venous blood circuit 1b A dialyzer 2 as a blood purification means is connected between them.

  An arterial puncture needle a is connected to the distal end of the arterial blood circuit 1a, and an iron blood pump 3 is disposed in the middle. The arterial blood circuit 1a has a connector 1aa formed at the distal end thereof, and can be connected to a connector a1 formed at the proximal end of the arterial puncture needle a. That is, by connecting the connector 1aa and the connector a1, the arterial puncture needle a can be attached to the distal end of the arterial blood circuit 1a.

  On the other hand, a venous puncture needle b is connected to the distal end of the venous blood circuit 1b, and a venous drip chamber 4 for defoaming is connected midway. Similar to the arterial blood circuit 1a described above, the venous blood circuit 1b has a connector 1ba formed at the tip thereof, and can be connected to the connector b1 formed at the proximal end of the venous puncture needle b. . That is, the arterial puncture needle b can be attached to the distal end of the venous blood circuit 1b by connecting the connector 1ba and the connector b1.

  The blood pump is then inserted with the arterial puncture needle a and the venous side puncture needle b punctured into the patient's shunt C (an access blood vessel in which the artery and vein are short-circuited by surgery or the like, see FIGS. 4 and 5). When 3 is driven, the patient's blood reaches the dialyzer 2 through the arterial blood circuit 1a, and after blood purification is performed by the dialyzer 2, returns to the patient's body through the venous blood circuit 1b. That is, the blood of the patient is purified by the dialyzer 2 while circulating outside the body by the blood circuit 1.

  The dialyzer 2 is formed with a blood introduction port 2a, a blood outlet port 2b, a dialysate inlet port 2c, and a dialysate outlet port 2d in the casing. Among these, the blood inlet port 2a has an arterial blood circuit 1a. The base end of the venous blood circuit 1b is connected to the blood outlet port 2b. The dialysate introduction port 2c and the dialysate lead-out port 2d are connected to a dialysate introduction line L1 and a dialysate discharge line L2 extending from the dialyzer body 6, respectively.

  A plurality of hollow fibers are accommodated in the dialyzer 2, the inside of the hollow fibers is used as a blood flow path, and the flow of dialysate is between the hollow fiber outer peripheral surface and the inner peripheral surface of the housing. It is considered a road. 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.

  On the other hand, as shown in FIG. 2, the dialyzer body 5 bypasses the dual pump 7 formed across the dialysate introduction line L1 and the dialysate discharge line L2, and the dual pump 7 in the dialysate discharge line L2. It is mainly composed of a connected bypass line L3 and a water removal pump 8 connected to the bypass line L3. One end of the dialysate introduction line L1 is connected to the dialyzer 2 (dialyte introduction port 2c), and the other end is connected to the dialysate supply device 13 for preparing a dialysate having a predetermined concentration.

  One end of the dialysate discharge line L2 is connected to the dialyzer 2 (dialysate outlet port 2d), and the other end is connected to a drainage means (not shown). After the liquid reaches the dialyzer 2 through the dialysate introduction line L1, it is sent to the drainage means through the dialysate discharge line L2 and the bypass line L3. In the dialyzer body 5, a heater and a deaeration unit connected to the dialysate introduction line L1 may be provided.

  The dewatering pump 8 is for removing water from the blood of the patient flowing through the dialyzer 2. That is, when the dewatering pump 8 is driven, since the duplex pump 7 is a fixed type, the volume of liquid discharged from the dialysate discharge line L2 is larger than the amount of dialysate introduced from the dialysate introduction line L1. Thus, the water is removed (dehydrated) from the blood by the large volume. In addition, you may make it remove a water | moisture content from a patient's blood by means (for example, what utilizes what is called a balancing chamber etc.) other than this water removal pump 8.

  A blood discriminator 9 as blood discriminating means, a tube detector 11 for detecting whether or not the arterial blood circuit 1a is set, and a flow path are provided at the distal end side (near the connector 1aa) of the arterial blood circuit 1a. An arterial side setting means D1 having an electromagnetic valve V1 that can be closed or released is arranged. Further, a blood discriminator 10 as blood discriminating means, a tube detector 12 for detecting whether or not the venous blood circuit 1b has been set, and a flow at the distal end side (near the connector 1ba) of the venous blood circuit 1b A vein side setting means D2 having an electromagnetic valve V2 capable of closing or releasing the path is disposed.

  More specifically, as shown in FIGS. 6 and 7, the arterial side setting means D1 (same as the vein side setting means D2) includes the blood discriminator 9, the tube detector 11, and the electromagnetic valve V1 in the housing 14. It comprises, and it is comprised so that the artery side blood circuit 1a can be inserted in the groove part 14a formed in the said housing | casing 14, and can be set. Among these, blood discriminator 9 (same as blood discriminator 10) replaces the priming solution and blood filled in blood circuit 1 after the blood purification treatment step (hemodialysis treatment), and thus arterial blood circuit 1a. It is possible to determine whether or not the liquid flowing through (or the venous blood circuit 1b) is blood.

  Specifically, as shown in FIG. 7, the blood discriminator 9 includes a pair of openings 9a and 9b facing the groove portion 14a, and a light emitting element Sa that can transmit and receive light (such as infrared rays) through the openings 9a and 9b. It is mainly composed of a light receiving element Sb. When light is emitted from the light emitting element Sa, light can pass through the arterial blood circuit 1a fitted in the groove 14a and the liquid flowing in the groove and can be received by the light receiving element Sb. It is possible to determine whether the flowing liquid is priming liquid or blood. That is, blood has a lower light transmittance than the priming solution, so that it can be determined that the priming solution has been replaced with blood by detecting a decrease in the amount of light received by the light receiving element Sb.

  Blood discriminators 9 and 10 are electrically connected to control means 6 disposed in dialyzer body 5. The control means 6 is composed of a microcomputer or the like disposed in the dialyzer body 5 and drives the blood pump 3 at an arbitrary timing to sequentially perform a priming step, a blood removal step, and a blood purification treatment step. Is for. The priming step is a step of filling the blood circuit 1 with the priming solution and filling the inside of the dialyzer 2 (specifically, filling the dialysate channel with dialysate and filling the blood channel with the priming solution). As shown in FIG. 3, a closed blood circuit is formed by connecting the connector 1aa at the distal end of the arterial blood circuit 1a and the connector 1ba at the distal end of the venous blood circuit 1b. In such a state, the blood pump 3 is driven while releasing the occlusion by the clamping means K such as forceps and opening the priming solution supply line L4, so that the physiological saline (priming solution) in the saline bag B is fed into the blood circuit 1. Fill.

  As shown in FIG. 4, the blood removal step is performed with the puncture needles (arterial puncture needle a and venous puncture needle b) attached to the distal end of the arterial blood circuit 1a and the distal end of the venous blood circuit 1b. This is a step for puncturing the patient's shunt C and driving the blood pump 3 to introduce blood from the patient into the blood circuit 1 before the dialysate is supplied to the dialysate flow path of the dialyzer 2. That is, the blood removal step refers to a step of introducing the patient's blood into the blood circuit 1 before the blood purification treatment step, and a state in which dialysate is not supplied into the dialyzer 2 (a state where the dual pump 7 is stopped). Say.

  As shown in FIG. 5, the blood purification treatment step drives the blood pump 3 while maintaining the state where the puncture needles (arterial puncture needle a and venous puncture needle b) are punctured into the patient, and the dialyzer 2 This is a step of circulating the patient's blood extracorporeally in the blood circuit 1 while supplying dialysate (with the water removal pump 8 driven). In other words, the blood purification treatment step refers to a step of purifying the patient's blood by the dialyzer 2 while circulating it outside the blood circuit 1 and removing water by the water removal pump 8.

Here, the control means 6 according to the present embodiment has determined that the blood is flowing at least by the blood discriminator 9 after the blood pump 3 has been driven and has reached a predetermined rotational speed. As a condition, the blood removal process is automatically transferred to the blood purification treatment process. That is, as shown in FIG. 8, the blood removal process is started and the blood pump 3 is driven by the control means 6 (S1), and it is determined that the blood pump 3 is driven at a predetermined rotational speed (S2). When it is determined that blood is flowing in the vessel 9 (S3), the blood purification treatment process is started by driving the water removal pump 8 while supplying dialysate to the dialyzer 2 (S4). -ing

According to the present embodiment, the control means 6 has determined that the blood has been flowing at least by the blood discriminator 9 after the blood pump 3 has been driven and has reached a predetermined number of revolutions. As a condition, since the blood removal process is automatically transferred to the blood purification treatment process, it is safer than the case where the blood pump 3 is simply driven at a predetermined number of revolutions and is transferred from the blood removal process to the blood purification treatment process. It is possible to automatically shift from the blood removal process to the blood purification treatment process while improving the performance.

In addition, as a reference example , the control means 6 departs on the condition that the blood pump 3 has been driven for a predetermined time and the blood discriminator 9 (or blood discriminator 10) has determined that blood is flowing. You may comprise so that it may transfer to a blood purification treatment process automatically from a blood process. In this case, as shown in FIG. 9, the blood removal process is started and the blood pump 3 is driven by the control means 6 (S1), and it is determined that the blood pump 3 is driven for a predetermined time (S2 ′). When it is determined that blood is flowing in the discriminator 9 (or blood discriminator 10) (S3), the blood purification treatment process is started by driving the water removal pump 8 while supplying dialysate to the dialyzer 2. (S4).

According to such a reference example , the control means 6 performs the blood removal step on the condition that the blood pump 3 is driven for a predetermined time and the blood discriminators 9 and 10 determine that blood is flowing. Is automatically transferred from the blood removal process to the blood purification treatment process on the condition that the blood pump 3 has been driven for a predetermined time, and thus blood removal is performed while improving safety. It is possible to automatically shift from the process to the blood purification treatment process.

In the reference example , the control means 6 can automatically shift from the blood removal process to the blood purification treatment process on the condition that one of the blood discriminators 9 and 10 has determined that blood is flowing. Alternatively, it may be possible to automatically shift from the blood removal step to the blood purification treatment step on condition that at least the blood discriminator 9 has determined that blood is flowing.

In the present embodiment, in the blood removal step, the blood of the patient is introduced from the arterial puncture needle a of the arterial blood circuit 1a, and the priming is filled from the venous puncture needle b of the venous blood circuit 1b at the time of priming. In the blood removal step, the water removal pump 8 is driven to filter the priming liquid in the blood circuit 1 (forward filtration) and to discharge it to the dialysate drainage means. May be .

According to the present type condition, the control means 6, on condition that it is determined that Te in blood discriminator 9 which blood flows, is automatically transferable from blood removal process blood purification treatment process Therefore, it is possible to avoid the transition to the blood purification treatment process with poor blood removal, and it is possible to automatically shift from the blood removal process to the blood purification treatment process more safely .

  Although the present embodiment has been described above, the present invention is not limited to these embodiments. For example, liquid flowing through the arterial blood circuit 1a or the venous blood circuit 1b as the blood discriminators 9, 10 (blood discriminating means). It is good also as another form which can discriminate | determine whether it is blood. Further, the blood discriminators 9 and 10 according to the present embodiment are not limited to those provided in the arterial side setting means D1 and the venous side setting means D2, but independently the distal end side or vein of the arterial blood circuit 1a. It may be attached to the tip side of the side blood circuit 1b.

  Furthermore, according to this embodiment, the puncture needle is a so-called double needle in which the puncture needle is composed of an arterial puncture needle a and a venous puncture needle b. The present invention may be applied to a so-called single needle connected to the tip and the tip of the venous blood circuit 1b. In this embodiment, the present invention is applied to a dialysis apparatus used at the time of dialysis treatment, but other blood purification apparatuses (for example, blood filtration dialysis method, blood filtration method, AFBF, which can purify the patient's blood while circulating it extracorporeally). And may be applied to blood purification devices, plasma adsorption devices, etc.

Control means for sequentially performing a blood removal step and a blood purification treatment step by driving a blood pump or a dewatering pump, and attached to the tip side of the arterial blood circuit or the tip side of the venous blood circuit. Blood discriminating means capable of discriminating whether or not the liquid flowing through the circuit or the venous blood circuit is blood, and the control means is operated after the blood pump or the dewatering pump is driven to reach a predetermined rotational speed. And blood that is automatically transferred from the blood removal process to the blood purification treatment process on the condition that it is determined that blood is flowing at least by the blood determination means attached to the distal end side of the arterial blood circuit As long as it is a purification device, it can be applied to ones having different external shapes or ones to which other functions are added.

DESCRIPTION OF SYMBOLS 1 Blood circuit 1a Arterial blood circuit 1b Venous blood circuit 2 Dialyzer (blood purification means)
DESCRIPTION OF SYMBOLS 3 Blood pump 4 Vein side drip chamber 5 Dialyzer main body 6 Control means 7 Duplex pump 8 Dewatering pump 9, 10 Blood discriminator (blood discrimination means)
11, 12 Tube detector 13 Dialysate supply device B Saline bag L1 Dialysate introduction line L2 Dialysate discharge line L3 Bypass line L4 Priming solution supply line

Claims (1)

A blood circuit comprising an arterial blood circuit and a venous blood circuit capable of extracorporeally circulating the patient's blood;
A blood pump disposed in the arterial blood circuit;
A blood purification means connected between the arterial blood circuit and the venous blood circuit, capable of purifying blood flowing through the blood circuit, and capable of being discharged while being supplied with dialysate;
A water removal pump for removing water from the blood flowing through the blood purification means;
And puncturing the patient by attaching a puncture needle to the tip of the arterial blood circuit and the tip of the venous blood circuit after the priming process of filling the blood circuit with the priming solution and filling the blood purification means with the solution. A blood removal step of introducing blood from a patient into the blood circuit before the dialysate is supplied to the blood purification means, and a patient in the blood circuit while supplying the dialysate to the blood purification means In a blood purification apparatus capable of sequentially performing a blood purification treatment step of extracorporeally circulating the blood of
Control means for sequentially performing the blood removal step and the blood purification treatment step by driving the blood pump or the water removal pump;
A blood discriminating means attached to the distal end side of the arterial blood circuit or the distal end side of the venous blood circuit and capable of discriminating whether or not the fluid flowing through the arterial blood circuit or the venous blood circuit is blood;
And the control means is connected to the blood discriminating means attached at least on the distal end side of the arterial blood circuit after the blood pump or the dewatering pump is driven to reach a predetermined rotational speed. The blood purification apparatus is characterized in that it automatically shifts from the blood removal step to the blood purification treatment step on the condition that it is determined that blood is flowing.

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