JP6384667B2 - 患者のドライウェイトを推定する方法 - Google Patents
患者のドライウェイトを推定する方法 Download PDFInfo
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- JP6384667B2 JP6384667B2 JP2014530947A JP2014530947A JP6384667B2 JP 6384667 B2 JP6384667 B2 JP 6384667B2 JP 2014530947 A JP2014530947 A JP 2014530947A JP 2014530947 A JP2014530947 A JP 2014530947A JP 6384667 B2 JP6384667 B2 JP 6384667B2
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- A61M2230/04—Heartbeat characteristics, e.g. ECG, blood pressure modulation
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M2230/00—Measuring parameters of the user
- A61M2230/20—Blood composition characteristics
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M2230/00—Measuring parameters of the user
- A61M2230/65—Impedance, e.g. conductivity, capacity
Description
本願は、2011年9月19日に出願された米国特許仮出願第61/536,488号の権益及び2011年9月19日に出願された国際出願PCT/US2011/052152号の権益を主張する出願であり、これら出願の両方を参照により引用し、これらの記載内容全体を本明細書の一部とする。
ル・メジャーメント(Physiol. Meas.),2011年,第32巻,p.887〜902;チュー・エフ,クールマン・エム・ケー,コタンコ・ピー,セイバート・イー,レオナルド・イー・エフ,レビン・エヌ・ダブリュー(Zhu F., Kuhlmann M.K., Kotanko P., Seibert E., Leonard E.F., Levin N.W.),「ア・メソッド・フォア・ザ・エスティメイション・オブ・ハイドレーション・ステイト・ドゥアリング・ヒモダイアリシス・ユージング・ア・カーフ・バイオインピーダンス・テクニック(A method for the estimation of hydration state during hemodialysis using a calf bioimpedance technique)」,フィジオロジカル・メジャーメント(Physiol. Meas.),2008年,第29巻,p.503〜516;ロポット・エフ,ネイエドリー・ビー,ノヴォトナ・エイチ,マクノヴァ・エム,スルコヴァ・エス(Lopot F., Nejedly B., Novotna H., Mackova M., Sulkova S.),「エイジ‐リレイテッド・エクストラセルラー・トゥ・トータル・ボディ・ウォーター・ボリューム・レイシオ(イーシーヴイ/ティービーダブリュー)‐‐キャン・イット・ビー・ユーズド・フォア“ドライ・ウェイト”ディターミネイション・イン・ダイアリシス・ペイシェンツ? アプリケーション・オブ・マルチフリークエンシー・バイオインピーダンス・メジャーメント(Age-related extracellular to total body water volume ratio (Ecv/TBW)?can it be used for “dry weight” determination in dialysis patients? Application of multifrequency bioimpedance measurement)」,ザ・インターナショナル・ジャーナル・オブ・アーティフィシャル・オーガンズ(Int. J. Atrif. Organs),2002年,第25巻,p.762〜769)、体内総水分量(TBW)と細胞外水分量(ECV)の比、及び一実施形態では血液量モニタ(BVM)による、一実施形態では細胞外コンパートメント中の光学的性質を算定することによる血液量測定法(ロポット・エフ,ニヨンネイサン・ブイ,スバロヴァ,ポラコヴィック・ブイ,スヴァラ・エフ,スルコヴァ・エス(Lopot F., Nyiomnaitham V., Svarova, Polakovic V., Svara F., Sulkova S.),「コンティニュアス・ブラッド・ボリューム・モニタリング・アンド“ドライ・ウェイト”アセスメント(Continuous blood volume monitoring and “dry weight” asessment)」,ジェイ・レン・ケア(J. Ren. Care),2007年,第33号,p.52〜58;ブース・ジェイ,ピニー・ジェイ,ダベンポート・エー(Booth J., Pinney J., Davenport A.),「ドゥ・チェインジズ・イン・レラティブ・ブラッド・ボリューム・モニタリング・コリレイト・トゥ・ヒモダイアリシス‐アソシエイテッド・ハイポテンション?(Do changes in relative blood volume monitoring correlate to hemodialysis-associated hypotension?)」,ネフロン・クリニカル・プラクティス(Nephron. Clin. Pract.),第117号,p.179〜183;シンハ・エー・ディー,ライト・アール・ピー,アグラワル・アール(Sinha A.D., Light R.P., Agarwal R.),「レラティブ・プラズマ・ボリューム・モニタリング・ドゥアリング・ヒモダイアリシス・エイズ・ザ・アセスメント・オブ・ドライ・ウェイト(Relative plasma volume monitoring during hemodialysis AIDS the assessment of dry weight)」,ハイパーテンション(Hypertension),第55巻,p.305〜311)によって算定される。なお、これら非特許文献を参照により引用し、その開示内容全体を本明細書の一部とする。
NFSWwBIS = 透析前重量(体重) - ΔHS [kg] (1)
流体状態又は過剰流体の質量若しくは過剰流体量の絶対差(ΔHS)は、次の通りである。
ΔHS = [ECWWB - HECW_NH_AT X MWB + k X (ICWWB - HICW_NH_AT X MWB)]
/ [HExF - (HECW NH_AT + k X HICW_NH_AT)] [kg] (2)
上式において、次の通りである。
HECW_NH_AT = MECW_NH_AT / MNH_AT (3)
HICW_NH_AT = MICW_NH_AT / MNH_AT (4)
HExF = MExW / MExF (5)
k = (HECW_NH_AT - HECW_NH_LT)/ (HICW_NH_LT - HICW_NH_AT) (6)
上式において、NHは、正常流体状態を示し、ATは、脂肪組織であり、LTは、脂肪の少ない組織である。
ρ = R ・ A/L [Ω・m] (7)
上式において、Aは、例えば2つの周長の平均値によって計算された断面積であり、
A=(C1+C2)2/(16・π) [m2] (8)
上式において、図6に示されているように、Lは、バイオインピーダンス手技で用いられた記録電極相互間の間隔であり(この場合、L=0.1m)、Aは、個々のふくらはぎの代表的な断面積であり、メートルで表されたCは、ふくらはぎに対して実施された1回又は2回以上の周長測定から得られた個人のふくらはぎに関する周長値であり、Rは、バイオインピーダンス手技から得られたふくらはぎに関する抵抗値である。
ρN = ρ/BMI [Ω・m3/kg] (9)
Claims (14)
- 第1の算定ユニットと、第2の算定ユニットを備える、患者のドライウェイトを推定する器械を動作させる方法であって、
前記第1の算定ユニットが第1の期間における治療セッションの相互の間の前記患者の第1の流体状態を算定するステップと、
前記第2の算定ユニットが、前記第1の期間に続く第2の期間における治療セッション中の前記患者の第2の流体状態を算定するステップと、
前記患者のドライウェイトを推定する器械が、前記第2の流体状態に基づいて前記ドライウェイトを推定するステップとを含み、
前記第1の算定ユニットは、前記第1の流体状態を、
a)画像化方法、
b)生化学マーカ、
c)バイオインピーダンス測定法、又は、多周波数バイオインピーダンス測定、及び
d)体内総水分量(TBW)と細胞外水分量(ECV)の比、のうちの少なくとも1つによって算定し、
前記第2の算定ユニットは、前記第2の流体状態を、
a)血液量測定法、及び
b)分節バイオインピーダンス分光法(BIS)、のうち少なくとも一方によって算定する、方法。 - 前記バイオインピーダンス測定法は、単一周波数バイオインピーダンス測定であり、又は、前記多周波数バイオインピーダンス測定はBCMによるものである、請求項1記載の方法。
- 前記器械が、前記第1の流体状態に基づいて正常流体状態を推定するステップを更に含む、請求項1又は2記載の方法。
- 前記器械は、前記正常流体状態及び/又は重量(NFSWwBIS)を、全身モデル又はふくらはぎ標準化抵抗率(CNR)方法によって推定する、請求項3記載の方法。
- 前記第1の期間は1〜2ヶ月間続く、請求項1〜4のうちいずれか一に記載の方法。
- 前記器械は、前記第1の流体状態を定期的に算定する、請求項1〜5のうちいずれか一に記載の方法。
- 前記器械は、前記第1の流体状態及び/又は前記第2の流体状態を、連続的に又は間欠的に算定する、請求項1〜6のうちいずれか一に記載の方法。
- 前記器械は、前記患者の前記ドライウェイトを、前記第2の期間中の前記第2の流体状態の進展によって推定する、請求項1〜7のうちいずれか一に記載の方法。
- 前記器械は、前記患者の前記ドライウェイトを、前記第2の期間における抵抗曲線及び/又は標準化抵抗率を分析することによって推定する、請求項1〜8のうちいずれか一に記載の方法。
- 前記器械は、抵抗を、ふくらはぎバイオインピーダンス分光法によって測定すると共に/或いは前記患者の前記標準化抵抗率は、標準化ふくらはぎ抵抗率である、請求項9記載の方法。
- 前記器械は、前記第1の流体状態、前記第2の流体状態、前記ドライウェイト又は任意の他のデータを、データベースに伝送する、請求項1〜10のうちいずれか一に記載の方法。
- 前記データベースはセントラルサーバのところで操作可能とされている、請求項11記載の方法。
- 前記セントラルサーバは、前記伝送データを、前記患者及び/又は特定の患者群について統計値及び/又は結論を導き出すことができるよう処理する、請求項12記載の方法。
- 前記特定の患者群は、同等な身体パラメータを備えた患者群である、請求項13記載の方法。
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US201161536488P | 2011-09-19 | 2011-09-19 | |
US61/536,488 | 2011-09-19 | ||
USPCT/US2011/052152 | 2011-09-19 | ||
US2011052152 | 2011-09-19 | ||
PCT/US2012/055914 WO2013043598A1 (en) | 2011-09-19 | 2012-09-18 | Estimation of the dry weight of a dialysis patient |
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WO2013043598A1 (en) | 2011-09-19 | 2013-03-28 | Fresenius Medical Care Holdings, Inc. | Estimation of the dry weight of a dialysis patient |
DE102011118998A1 (de) * | 2011-11-14 | 2013-05-16 | Seca Ag | Verfahren und Vorrichtung zur Ermittlung des Körpergewichtes einer Person |
US10314532B2 (en) * | 2013-07-29 | 2019-06-11 | The Regents Of The University Of Michigan | Evaluating cardiovascular health using intravascular volume |
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EP3410932A1 (en) | 2016-02-02 | 2018-12-12 | The Trendlines Group Ltd. | Device for detecting body fluid balance and/or electrolyte balance |
EP3416549A4 (en) * | 2016-02-16 | 2019-09-18 | Impedimed Limited | INDICATOR FOR HEART FAILURE |
CN105962939A (zh) * | 2016-06-16 | 2016-09-28 | 南昌大学第二附属医院 | 尿毒症患者干体重评估仪 |
DE102016115496A1 (de) * | 2016-08-22 | 2018-02-22 | B. Braun Avitum Ag | Verfahren und System zur post-dialytischen Bestimmung des Trockengewichts |
JP6613266B2 (ja) * | 2017-06-01 | 2019-11-27 | 日機装株式会社 | 血液浄化装置 |
WO2019138917A1 (ja) * | 2018-01-10 | 2019-07-18 | ニプロ株式会社 | 細胞外液量算出装置及び細胞外液量算出方法 |
GB2576770B (en) * | 2018-08-31 | 2020-09-23 | Heartfelt Tech Limited | System and method for identifying fluid retention in a body part |
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JP2004049492A (ja) | 2002-07-18 | 2004-02-19 | Jms Co Ltd | 基準体重算出方法および血液透析装置 |
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WO2013043598A1 (en) | 2013-03-28 |
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CN103998072B (zh) | 2018-02-06 |
EP2758092A1 (en) | 2014-07-30 |
US10953147B2 (en) | 2021-03-23 |
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