JP5548917B2 - Method of operating toxin removal amount measuring device and sampling device - Google Patents

Description

The present invention relates to a method for operating a toxin removal amount measuring device for measuring a toxin removal amount in hemodialysis and a sampling device for sampling a waste solution of dialysate in hemodialysis.

Conventionally, in order to grasp the state of a dialysis patient, a biochemical index obtained mainly from blood is used, and a simple method is obtained in which a result is obtained by one blood collection for one dialysis. Such indicators include the following.
(1) URR (Urea Reduction Rate)
here,
URR = (Upre−Upost) / Upre × 100
Upre: urea nitrogen level before dialysis, Upost: urea nitrogen level after dialysis (2) BUN (Blood Urea Nitrogen)
(3) Serum creatinine concentration is an index of renal dysfunction.
(4) Creanitine production rate (% CrG)
(5) Kt / V; an index of standardized dialysis appropriate dialysis.
here,
Kt / V = -ln (1-URR)
K: dialyzer clearance of urea (provided by the manufacturer)
t: dialysis time
V: patient's total body water

"Urea kinetic modeling in hemodialysis" Clinical Dialysis Vol.17 no.4 2001 35 ・ 433

"What is dialysis that can be eaten for overcoming nutritional disorders and high QOL?" Clinical Engineering vol.17 No.2 2006

  It has been reported that when dialysis is continued without changing any dialysis prescription such as a dialysis membrane to be used, the clinical effect on the patient decreases with time (Non-patent Document 1). The reason is that, while the model in which toxin is removed from the patient body changes with time, conventional biochemical indicators cannot detect the effect of the model change.

  There are 1 pool model and 2 pool model as toxin removal models.

  The one pool model is a model that removes toxins equally from both blood and somatic cells. The one pool model applies at the start of dialysis under certain dialysis prescription conditions, and the toxin concentration in the blood well reflects the total amount of toxin in the body or the amount of toxin removed from the body.

  The two-pool model is a model in which toxins are removed from blood, while the amount of toxins removed from somatic cells decreases, and this is applied after a change over time when dialysis is continued under certain dialysis prescription conditions. In this model, the amount of toxin in the body is higher than the amount estimated from the measured amount of endotoxin in the blood because the toxin is not removed from somatic cells even if the amount of toxin in the blood is reduced. . If it moves to this 2 pool model, since a toxin does not escape from a body, a condition will deteriorate. In this case, it is possible to complete the condition by changing the dialysis prescription.

  Although there are the following methods for grasping that the clinical effect has decreased over time, it has not become widespread for reasons such as requiring complicated work.

(1) Sampling of dialysate An index called Urea CS (clear space), which is the total amount of toxin that is calculated based on the urea concentration and volume of waste liquid of dialysate (about 120 liters) used for one dialysis. Is an excellent indicator of dialysis status. However, due to the problem of the weight and space of the tank for storing the waste liquid and the complexity of measurement, general hospitals do not introduce this as a dialysis index.

(2) Other methods using blood For example, an index called Kc is one of the methods by which a patient's state can be grasped only by sampling blood. However, since blood collection for measurement is performed at a total of 7 points until 45 minutes after dialysis, including before dialysis, the burden is not widespread on both the hospital side and the patient side.

An object of the present invention is to provide an operation method of a toxin removal amount measuring apparatus and a sampling device capable of easily and accurately grasping the toxin removal amount in hemodialysis.

The operation method of the toxin removal amount measuring device of the present invention is an operation method of the toxin removal amount measuring device for measuring the toxin removal amount in hemodialysis,
The toxin removal amount measuring device includes the steps of sampled multiple times the waste of dialysate during dialysis, and estimating the total removal of toxins in dialysis based upon said waste liquid sampled, further the toxin In the step of sampling the waste liquid , the removal amount measuring device determines the sampling interval and the sampling amount so that the sampling amount per unit time during dialysis is substantially constant, and changes in the concentration of toxin in the waste liquid It is characterized in that the sampling interval is shortened in a period during which becomes large.
According to the operation method of this toxin removal amount measuring device, the waste solution of dialysate is sampled a plurality of times during dialysis, and the total removal amount of toxin during dialysis is estimated based on the sampled waste solution. The removal amount can be grasped easily and accurately.
Further, in the step of sampling the waste liquid, a sampling interval and a sampling amount are set so that a sampling amount per unit time during dialysis is substantially constant, and a period in which a change in the concentration of toxin in the waste liquid is large Since the sampling interval is shortened, an accurate toxin removal amount can be calculated with a smaller number of samplings.

  In the step of estimating the total removal amount of the toxin, the total removal amount of the toxin may be estimated by measuring the toxin amount of the sampled waste liquid.

  In the step of estimating the total removal amount of the toxin, the total removal amount of the toxin may be estimated based on the result of measuring the concentration of each toxin in the sampled waste liquid.

  A step of measuring a flow rate of dialysate during dialysis, and a step of calculating a total amount of waste liquid by integrating the flow rate obtained by the step of measuring the flow rate, and a step of estimating a total removal amount of the toxin Then, the total removal amount of the toxin may be estimated using the calculated total amount of waste liquid.

The sampling device of the present invention is a sampling device for sampling the dialysate waste fluid in hemodialysis, a timer for giving a timing for sampling the dialysate waste fluid a plurality of times during dialysis, and the dialysate waste fluid according to the instructions of the timer Sampling means for sampling ,
In the step of sampling the waste liquid, the first period timer and the sampling means determine the sampling interval and the sampling amount so that the sampling amount per unit time during dialysis is substantially constant, and the concentration of the toxin in the waste liquid It is characterized in that the sampling interval is shortened in the period when the change is large .
According to this sampling device, the dialysate waste solution can be sampled a plurality of times during dialysis, and the total removal amount of toxin during dialysis can be estimated based on the sampled waste solution. Can grasp.
Further, in the step of sampling the waste liquid, a sampling interval and a sampling amount are set so that a sampling amount per unit time during dialysis is substantially constant, and a period in which a change in the concentration of toxin in the waste liquid is large Since the sampling interval is shortened, an accurate toxin removal amount can be calculated with a smaller number of samplings.

According to the operating method of the toxin removal amount measuring apparatus of the present invention, the toxin removal amount measuring apparatus, the waste of dialysate was sampled a plurality of times during the dialysis, the total removal of toxins in dialysis based on the sampled effluent Since the amount is estimated, the amount of toxin removed in hemodialysis can be grasped easily and accurately.
In the step of sampling the waste liquid , the toxin removal amount measuring device determines a sampling interval and a sampling amount so that a sampling amount per unit time during dialysis is substantially constant, and in the waste liquid Since the sampling interval is shortened in the period when the concentration change of the toxin becomes large, it is possible to calculate the accurate toxin removal amount with a smaller number of samplings.

According to the sampling apparatus of the present invention, the dialysate waste liquid is sampled a plurality of times during dialysis, and the total removal amount of toxin during dialysis can be estimated based on the sampled waste liquid, so that the toxin removal amount in hemodialysis can be simplified. And it can be grasped accurately.
Further, in the step of sampling the waste liquid, a sampling interval and a sampling amount are set so that a sampling amount per unit time during dialysis is substantially constant, and a period in which a change in the concentration of toxin in the waste liquid is large Since the sampling interval is shortened, an accurate toxin removal amount can be calculated with a smaller number of samplings.

The block diagram which shows the structure of the sampling device for enforcing the operating method of the toxin removal amount measuring device . The block diagram which shows the structure of the control system of a sampling device. The block diagram which shows the structural example of the sampling apparatus which measures a toxin concentration on-line. The block diagram which shows the structural example of the sampling apparatus which samples the blood under dialysis.

Hereinafter, an embodiment of a method for operating the toxin removal amount measuring apparatus according to the present invention will be described.

FIG. 1 is a block diagram showing the configuration of a sampling device for carrying out the method of operating the toxin removal amount measuring device of this embodiment, and FIG. 2 is a block diagram showing the configuration of the control system of the sampling device.

  As shown in FIGS. 1 and 2, the sampling device includes an electromagnetic valve 21, a timer 22, a flow meter 25, a flow meter 26, and a control calculation unit 31, and the operation of the sampling device is controlled by the control calculation unit 31. .

  As shown in FIG. 1, the dialyzer 1 includes a dialysis membrane 11 that partitions a blood region and a dialysis solution region, and blood and dialysate containing waste products are introduced into each region. Waste in the blood moves to the dialysate side through the dialysis membrane 11, and the blood purified by the dialyzer 1 is returned to the patient. Moreover, the dialysate containing a waste product is discharged | emitted as a waste liquid.

  As shown in FIG. 1, a part of the dialysate waste liquid is sampled through a solenoid valve 21. The timing of sampling by the electromagnetic valve 21 is instructed by the timer 22. The timer 22 starts time counting at the start of dialysis based on a signal from the dialysis controller 23 that executes control necessary for dialysis by the dialyzer 1.

  The dialysate waste liquid sampled during dialysis is stored in the container 24. Further, the sampling amount for each time is controlled based on the measurement value of the flow meter 25.

  Further, the flow rate during dialysis obtained by the flow meter 26 is integrated over time in the control calculation unit 31, whereby the total amount of dialysate waste liquid is calculated.

  For example, sampling of the dialysate waste liquid can be performed at a constant cycle with the same sampling amount. For example, if the sampling is performed once every 20 minutes and the sampling amount per time is 10 cc, the total amount accumulated in the container 24 during a 4-hour dialysis session is 120 cc. For this reason, the capacity | capacitance of the container 24 may be very small.

  After completion of dialysis, the waste liquid accumulated in the container 24 is sufficiently stirred, and the toxin concentration is measured. Then, the total amount of toxin removed during dialysis is estimated by multiplying the measured toxin concentration by the total amount of waste liquid calculated by time integration.

As described above, according to the method for operating the toxin removal amount measuring apparatus of the present embodiment, the amount of sample for measuring the amount of toxin can be small, so that it is easy to handle at the time of measurement and it is necessary to prepare a large tank. Absent.

  The sampling amount for each time can be arbitrarily set. For example, it may be 5 cc or 50 cc. The sampling frequency can also be set arbitrarily. For example, sampling may be performed once every 10 minutes or once every 40 minutes.

  Further, the sampling interval may be changed during dialysis. In this case, sampling is performed so that the sampling amount per unit time is substantially constant so that the concentration of the mixed solution of waste liquid sampled multiple times becomes a value that reflects the amount of total toxin removed during dialysis. Adjust the amount. In this case, in the middle stage of dialysis where the concentration change of the toxin is large, it is possible to calculate the exact amount of toxin removal with a smaller number of samplings by shortening the sampling interval compared to the early stage or the latter stage of dialysis where the concentration change is small. It becomes. When the sampling interval is changed, the container may be changed and weighted integration may be performed as another concentration.

  FIG. 3 is a block diagram showing a configuration example of a sampling device that measures the toxin concentration in the dialysate waste liquid online during dialysis. The same components as those in FIG. 1 are denoted by the same reference numerals.

In the example of FIG. 3, the concentration measuring device 27 measures the toxin concentration of the sampled waste liquid on-line. The measured value is given to the control calculation unit 31 . Thereby, the time-dependent change of the toxin concentration in the waste liquid removed during dialysis can be captured. Further, the removed elementary amount can be calculated by multiplying the toxin concentration by the amount of waste liquid per unit time measured by the flow meter 26. This makes it possible to grasp the timing for switching the dialysis prescription during dialysis.

  FIG. 4 is a block diagram illustrating a configuration example of a sampling device that samples blood during dialysis. The same components as those in FIG. 1 are denoted by the same reference numerals.

  In the example of FIG. 4, an electromagnetic valve 41 for sampling blood is provided, and the timer 22 instructs the timing of sampling of blood and dialysate waste fluid. The timing of blood sampling may be simultaneous with or different from the sampling of the dialysate waste liquid.

  According to the configuration of FIG. 4, it is possible to grasp changes in blood Kc and Urea CS during dialysis, and these changes can be used as an index of timing for switching the dialysis prescription.

The scope of application of the present invention is not limited to the above embodiment. INDUSTRIAL APPLICABILITY The present invention can be widely applied to a method for operating a toxin removal amount measuring device that measures a toxin removal amount in hemodialysis and a sampling device that samples a dialysate waste solution in hemodialysis.

1 Dialyzer 11 Dialysis membrane 21, 41 Solenoid valve (sampling means)
22 Timer 23 Dialysis Controller 24 Container 25, 26 Flowmeter 27 Concentration Measuring Device 31 Control Calculation Unit

Claims (5)

In the operation method of the toxin removal amount measuring device for measuring the toxin removal amount in hemodialysis,
The toxin removal amount measuring device includes a step of sampling a waste solution of dialysate a plurality of times during dialysis, and a step of estimating a total removal amount of toxin during dialysis based on the sampled waste solution,
Furthermore, in the step of sampling the waste liquid , the toxin removal amount measuring device determines a sampling interval and a sampling amount so that a sampling amount per unit time during dialysis is substantially constant, and a toxin in the waste liquid. A method for operating a toxin removal amount measuring apparatus, characterized in that a sampling interval is shortened during a period when the concentration change of the toxin increases. The said toxin removal amount measuring apparatus estimates the total removal amount of the toxin by measuring the toxin amount of the sampled waste liquid in the step of estimating the total removal amount of the toxin. 2. An operation method of the toxin removal amount measuring apparatus according to 1. In the step of estimating the total removal amount of the toxin , the toxin removal amount measuring device estimates the total removal amount of the toxin based on the result of measuring the concentration of each toxin in the sampled waste liquid. The operation method of the toxin removal amount measuring apparatus according to claim 1. The toxin removal amount measuring device includes a step of measuring a flow rate of dialysate during dialysis, and a step of calculating a total waste liquid amount by integrating the flow rate obtained by the step of measuring the flow rate,
Further, in the step of estimating the total removal amount of the toxin , the toxin removal amount measuring apparatus estimates the total removal amount of the toxin using the calculated total waste liquid amount. The operation | movement method of the toxin removal amount measuring apparatus of any one of these. In a sampling device that samples the dialysate waste fluid in hemodialysis,
A timer for giving a timing for sampling the dialysate waste liquid a plurality of times during dialysis, and a sampling means for sampling the dialysate waste liquid according to the instructions of the timer;
In the step of sampling the waste liquid, the first period timer and the sampling means determine the sampling interval and the sampling amount so that the sampling amount per unit time during dialysis is substantially constant, and the concentration of the toxin in the waste liquid A sampling apparatus characterized in that a sampling interval is shortened during a period in which a change becomes large.

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