JP6620549B2 - Hemodialysis machine - Google Patents

Description

  The present invention relates to a hemodialysis apparatus, and more particularly, to a hemodialysis apparatus including two dialysis fluid containers having an interior divided into three chambers.

2. Description of the Related Art Conventionally, a hemodialysis apparatus has been known that includes two dialysate containers in which an interior is sequentially partitioned into three chambers, a supply chamber, a variable volume chamber, and a recovery chamber (Patent Document 1).
More specifically, this hemodialysis apparatus includes a first dialysate container in which three chambers of a first supply chamber, a first variable volume chamber, and a first recovery chamber are sequentially formed, and a second supply therein. A second dialysate container in which three chambers, a chamber, a second variable volume chamber, and a second recovery chamber are sequentially formed, and liquid is moved from one variable volume chamber to the other variable volume chamber to Pump means for increasing or decreasing the volume, and while the dialysate is supplied from one supply chamber to one recovery chamber via a dialyzer, the volume in the one variable volume chamber is reduced and the other variable volume chamber is reduced. At the same time, fresh dialysate is supplied to the other supply chamber and the used dialysate in the other recovery chamber is discharged to the outside.
In the hemodialysis device, while supplying dialysate from one supply chamber to one recovery chamber via a dialyzer, the volume in the one variable volume chamber is reduced, and the amount of water removal is set according to the decrease. It is supposed to be.

Japanese Examined Patent Publication No. 3-62107

The pump means is designed to alternately move the same amount of liquid from one variable volume chamber to the other variable volume chamber, but if there is an error in the alternate feed amount, one variable volume chamber Accordingly, the amount of liquid stored in the first and second variable volume chambers gradually differs.
If the amount of liquid stored in one variable volume chamber is different from the amount of liquid stored in the other variable volume chamber, the amount of dialysate that can be stored in the first supply chamber and the second supply chamber will be different. The amount of dialysate that can be supplied from each supply chamber to the dialyzer will be different. If this condition is left unattended and repeated hemodialysis treatment is performed for a long time, the normal amount of water removal cannot be managed. In the case where the inside of the dialysate container is partitioned into three chambers by two diaphragms, there is a risk that the diaphragm will be broken.
In view of such circumstances, the present invention provides a hemodialysis apparatus that can eliminate the imbalance of the amount of liquid stored in two variable volume chambers.

That is, the present invention includes a first dialysate container in which three chambers of a first supply chamber, a first variable volume chamber, and a first recovery chamber are sequentially formed, and a second supply chamber and a second variable volume chamber inside. And a second dialysate container in which three chambers, ie, a second recovery chamber, are sequentially formed, and pump means for moving the liquid from one variable volume chamber to the other variable volume chamber to increase or decrease the volume in each variable volume chamber And reducing the volume in one variable volume chamber and increasing the volume in the other variable volume chamber while supplying dialysate from one supply chamber to one recovery chamber via a dialyzer. At the same time, in a hemodialysis apparatus that supplies fresh dialysate to the other supply chamber and discharges the used dialysate from the other recovery chamber to the outside,
Providing a measuring means for measuring the flow rate of the liquid fed from the first supply chamber to the first recovery chamber and the flow rate of the liquid fed from the second supply chamber to the second recovery chamber, When the flow rate of either one is less than the flow rate of the other, the pump means moves the liquid in the one variable volume chamber to the other variable volume chamber so that the difference between the flow rates is reduced. It is made to let you.

According to the above configuration, when the amount of liquid stored in the two variable volume chambers becomes unbalanced, for example, the liquid amount in the first variable volume chamber is larger than the liquid amount in the second variable volume chamber. In this case, the flow rate of the liquid fed from the first supply chamber to the first recovery chamber is smaller than the flow rate of the liquid fed from the second supply chamber to the second recovery chamber. The difference in the amount of circulation can be detected by the measuring means.
When the flow rate on the first dialysate container side becomes smaller than the flow rate on the second dialysate container side, the pump means moves the liquid in the first variable volume chamber to the second variable volume chamber. The difference between the two circulation amounts can be adjusted to be small.
Therefore, by performing such adjustment, it is possible to always perform normal dialysis treatment even if dialysis treatment is repeatedly performed for a long time.

System diagram showing an embodiment of the present invention Sectional view showing pump means 46 Sectional view along line III-III in FIG. System diagram showing the state during dialysis System diagram showing other conditions during dialysis System diagram showing the state during balance adjustment System diagram showing other states during balance adjustment

The present invention will be described below with reference to the illustrated embodiment. In FIG. 1, a dialyzer 1 for dialysis includes an outer case 1A and a number of hollow fiber membranes 1B housed therein, and blood is an artery of the blood circuit 2. The blood supplied to the inside of the hollow fiber membrane 1B through the side circuit 2A and dialyzed in the dialyzer 1 passes from the inside of the hollow fiber membrane 1B to the human body through the vein side circuit 2B of the blood circuit 2. It is supposed to be returned.
In this embodiment, two first dialysate containers 5 and a second dialysate container 5 ′ are juxtaposed, and the dialysate containers 5 and 5 ′ allow the inside of the outer case 1A of the dialyzer 1 to be Dialysis can be performed by alternately supplying fresh dialysate to the space between the outside of the hollow fiber membrane 1B. At this time, the dialysate is circulated in the direction opposite to the direction of blood flow in the hollow fiber membrane 1B.

The inside of the first dialysate container 5 is divided into three chambers by two diaphragms 6, 7, that is, a first supply chamber 8, a first variable volume chamber 9, and a first recovery chamber 10, sequentially. The fresh dialysate introduced into the first supply chamber 8 formed on one side in the first dialysate container 5 is supplied to the other chamber of the dialyzer 1 through the dialysate supply circuit 13, and the chamber The treated dialysate from can be collected in the first collection chamber 10 formed on the other side of the first dialysate container 5 via the dialysate collection circuit 14.
The dialysate supply circuit 13 connects the first supply chamber 8 to the dialyzer 1 via a first supply path 17, a first supply valve 18, a supply path 19, a filter 20, a supply path 21 and an on-off valve 22. The dialysate recovery circuit 14 communicates the dialyzer 1 with the recovery path 25, the on-off valve 26, the recovery path 27, the liquid feed pump 28, the deaerator 29, the first recovery path 30, and the first recovery valve 31. The first collection chamber 10 is communicated with the first collection chamber 10 via the first collection chamber 10.

Furthermore, fresh dialysate is introduced into the first supply chamber 8 from a fresh dialysate supply source (not shown) through an introduction path 34, an on-off valve 35, a pump 36, a first introduction path 37, and a first introduction valve 38. The disposal of the treated dialysate from the first recovery chamber 10 can be performed via a first disposal valve 40, a first disposal path 41, a disposal path 42, and an on-off valve 43 to a collection tank (not shown). It can be discarded.
The central first variable volume chamber 9 formed in the first dialysate container 5 is sealed with a liquid such as silicone oil, for example, and when one diaphragm 6 moves, the liquid passes through the liquid. The other diaphragm 7 can be displaced following the diaphragm 6.
The configuration relating to the second dialysate container 5 ′ is also the same as the configuration for the first dialysate container 5 described above, and in the same part, the reference numeral used for the first dialysate container 5 is “′”. Is shown.

The first variable volume chamber 9 and the second variable volume chamber 9 ′ of the dialysate containers 5, 5 ′ are communicated with each other via a communication path 45, and a pump means 46 is provided in the communication path 45. The liquid can be alternately moved from one variable volume chamber to the other variable volume chamber.
The pump means 46 includes a cylinder 48 arranged in the horizontal direction as shown in FIGS. 2 and 3, and a piston 49 slidably and rotatably fitted in the cylinder 48. A notch 49 a having a predetermined shape is formed on the outer periphery of the tip of the piston 49, and a pump chamber 50 whose volume is varied by the notch 49 a and the tip of the piston 49 and the inner surface of the cylinder 48 is formed. ing.
The communication passage 45 is opened at a position facing the inner peripheral surface of the cylinder 48 in the reciprocating range of the notch 49 a of the piston 49, and only one of the openings according to the rotational angle position of the piston 49, that is, Only one of the first variable volume chamber 9 and the second variable volume chamber 9 'communicates with the pump chamber 50 through the notch 49a.

  Further, an arm 49 b is attached to the end of the piston 49 projecting outward from the cylinder 48 so as to be orthogonal to the axial direction, and the spherical portion 49 c provided at the tip of the arm 49 b is connected to the inside of the cup-shaped joint 51. It is pivotally connected to a spherical recess 51a formed at a predetermined circumferential position. The joint 51 is connected to the drive shaft 52a of the servomotor 52 with an inclination of a predetermined angle with respect to the axis of the piston 49. The servo motor 52 is controlled by a control device (not shown), and the control device can monitor the rotation amount of the servo motor 52 by, for example, counting pulse signals from the servo motor 52. .

In the pump means 46 having the above-described configuration, when the servo motor 52 is rotated, the piston 49 pivotally connected to the spherical recess 51a of the joint 51 via the arm 49b is rotated in the one direction. Since it is reciprocated within 48, the volume of the pump chamber 50 can be increased or decreased accordingly.
In the state shown in FIGS. 2 and 3, the piston 49 is located at the leftmost end inserted into the cylinder 48 (see FIG. 2), and the communication between the pump chamber 50 and the second variable volume chamber 9 ′ is established. At the same time as being blocked, the first variable volume chamber 9 communicates with the pump chamber 50 via the notch 49a.

From this state, when the piston 49 is rotated rightward while being rotated in one direction and is extracted from the cylinder 48 and the volume in the pump chamber 50 is increased, the liquid in the first variable volume chamber 9 is transferred into the pump chamber 50. Sucked into.
When the piston 49 is extracted to the right end position, the communication between the first variable volume chamber 9 and the pump chamber 50 is blocked by the rotation of the piston 49, and the second variable volume chamber 9 ' When the piston 49 is left-handed from this state and pushed into the cylinder 48 to reduce the volume in the pump chamber 50, the inside of the pump chamber 50 is reduced. The liquid is discharged into the second variable volume chamber 9 ′.
When the piston 49 reaches the left end shown in FIG. 2, the first variable volume chamber 9 communicates with the pump chamber 50 through the notch 49a as described above, and the pump chamber 50 and the second Since the communication of the variable volume chamber 9 ′ is cut off and the above-described operation is repeated by the one-way rotation of the servo motor 52, the liquid in the first variable volume chamber 9 is transferred to the second variable volume chamber 9 ′. It can be made to flow.
On the other hand, by reversing the servo motor 52, an operation opposite to the above-described operation is performed, and the liquid in the second variable volume chamber 9 ′ can flow into the first variable volume chamber 9. The pump means 46 is not limited to that of the above-described embodiment, and may be of any configuration as long as the pump changes the discharge direction by forward and reverse rotation of the motor, such as a roller pump.

The dialysis operation by the hemodialyzer having the above configuration will be described. In the state shown in FIG. 4, the first supply valve 18 and the first recovery valve 31 on the first dialysate container 5 side are closed, and the first introduction valve 38 and The first discard valve 40 is opened.
In contrast, on the second dialysate container 5 ′ side, contrary to the first dialysate container 5 side, the second supply valve 18 ′ and the second recovery valve 31 ′ are opened, and the second introduction valve 38 ′ and The second disposal valve 40 'is closed.
Therefore, in this connected state, the first dialysate container 5 side is disconnected from the dialyzer 1, and fresh dialysate is pumped by the pump 36 into the first supply chamber 8 on the first dialysate container 5 side. Has been introduced. As a result, the diaphragms 6 and 7 are integrally moved to the left so that the treated dialysate recovered in the first recovery chamber 10 is discharged to the outside via the waste passage 42 and the on-off valve 43. Become.

On the other hand, the second dialysate container 5 ′ side is connected to the dialyzer 1, and fresh dialysate in the second supply chamber 8 ′ is supplied to the dialyzer 1 via the dialysate supply circuit 13 and processed. The finished dialysate is recovered from the dialyzer 1 through the dialysate recovery circuit 14 into the second recovery chamber 10 '.
At this time, the servo motor 52 for driving the pump means 46 is rotated in the forward direction, so that the volume in the first variable volume chamber 9 increases and the volume in the second variable volume chamber 9 ′ decreases. . Therefore, a larger amount of treated dialysate than the amount of fresh dialysate supplied from the second supply chamber 8 ′ into the outer case 1A of the dialyzer 1 is gradually recovered in the second recovery chamber 10 ′, and the second The amount of volume reduction in the variable volume chamber 9 ′ is the amount of ultrafiltration in the dialyzer 1.
Then, when the servo motor 52 is rotated forward by a predetermined amount and the volume of the second variable volume chamber 9 ′ is decreased by a predetermined amount, and therefore the volume of the first variable volume chamber 9 is increased by a predetermined amount, the rotation of the servo motor 52 is stopped. Ultrafiltration is stopped.

As shown in FIG. 5, the valves on the second dialysate container 5 ′ side are switched, the second supply valve 18 ′ and the second recovery valve 31 ′ are closed, and the second introduction valve 38 ′ and the second discarding are closed. The valve 40 'is opened. Then, the communication between the second dialysate container 5 ′ and the dialyzer 1 is blocked.
On the other hand, on the first dialysate container 5 side, the first supply valve 18 and the first recovery valve 31 are opened, and the first introduction valve 38 and the first discard valve 40 are closed. As a result, fresh dialysate is supplied to the dialyzer 1 only from the first dialysate container 5 side.
In this connected state, since the volume of the first variable volume chamber 9 is gradually reduced by the reverse rotation of the servo motor 52, the first supply chamber is provided on the first dialysate container 5 side. More processed dialysate than the amount of fresh dialysate supplied from 8 into the outer case 1A of the dialyzer 1 is gradually recovered in the first recovery chamber 10, and thus the first variable volume chamber Ultrafiltration corresponding to the volume reduction in 9 is performed.
On the second dialysate container 5 'side, fresh dialysate is pumped and introduced into the second supply chamber 8' by the pump 36, whereby the diaphragms 6 and 7 are integrally left. And the processed dialysate in 2nd collection | recovery chamber 10 'is discharged | emitted through the waste path 42 outside.

Further, when the servo motor 52 is reversed by a predetermined amount, the rotation of the servo motor 52 is stopped. Thereafter, the valves on the first dialysate container 5 side are switched, the first supply valve 18 and the first recovery valve 31 are closed, and the first introduction valve 38 and the first discard valve 40 are opened. On the second dialysate container 5 ′ side, the second supply valve 18 ′ and the second recovery valve 31 ′ are opened, and the second introduction valve 38 ′ and the second discard valve 40 ′ are closed.
As a result, the communication between the first dialysate container 5 and the dialyzer 1 is cut off, and when the fresh dialysate is supplied to the dialyzer 1 only from the second dialysate container 5 'side, the servo motor 52 Forward rotation is started.
This state is the same as the state described first, and thereafter the same operation is repeated to perform dialysis.

As can be understood from the above description, the liquid in the first variable volume chamber 9 and the liquid in the second variable volume chamber 9 ′ are alternately placed by a predetermined amount of forward rotation and a predetermined amount of reverse rotation of the servo motor 52. Although it is moved by a fixed amount, the amount of liquid moved from the first variable volume chamber 9 to the second variable volume chamber 9 ′ and the first variable volume from the second variable volume chamber 9 ′ due to manufacturing errors of the pump means 46 and the like. The amount of liquid transferred to the chamber 9 does not necessarily match exactly.
As a result, by repeating a predetermined amount of forward rotation and a predetermined amount of reverse rotation of the servo motor 52 for a long period of time, the liquid amount in the first variable volume chamber 9 and the liquid amount in the second variable volume chamber 9 ′ are gradually increased. Will become unbalanced.
For example, when the amount of liquid in the first variable volume chamber 9 is larger than the amount of liquid in the second variable volume chamber 9 ′, the amount of dialysate that can be stored in the first supply chamber 8 is the second supply chamber 8. 'The amount of dialysis fluid that can be stored in the interior is less than the amount of dialysis fluid that can be stored in the interior. This is less than the amount of liquid to be fed.

In order to eliminate such unbalance, for example, when the hemodialysis apparatus is washed, the following balance adjustment operation is performed subsequently. At the time when the hemodialyzer has been washed, RO water has been introduced into each circuit of the hemodialyzer.
First, in FIG. 6, a bypass passage 55 that communicates the primary side of the filter 20 (the front side through which the filter flows) and the recovery passage 27 is provided, and an on-off valve 56 that opens and closes the bypass passage 55 is provided. It has been. The on-off valve 56 is closed during the dialysis operation described above (see FIGS. 4 and 5), but the on-off valve 56 is opened during the balance adjustment operation, and the on-off valve near the entrance / exit of the dialyzer 1 is used. 22 and 26 are closed.
In addition, a measuring means 57 for measuring the flow rate is provided in the supply path 19 before the filter 20. In this embodiment, the measuring means starts the flow sensor 57 that detects the presence or absence of the flow of RO water (fluid) and the supply of RO water from the supply chambers 8 and 8 ′ to the recovery chambers 10 and 10 ′. The flow sensor 57 is composed of a counter (not shown) that counts the time until it is detected that the flow of RO water is lost.
The measuring means is not limited to the one constituted by the flow sensor 57 and the counter, and may have any constitution as long as the circulation amount can be measured.

The state of FIG. 6 is similar to the state of FIG. 4 described above, and the first supply valve 18 and the first recovery valve 31 on the first dialysate container 5 side are closed, and the first introduction valve 38 and the first discard valve are closed. 40 is open. In this connected state, RO water is pumped and introduced into the first supply chamber 8 on the first dialysate container 5 side by the pump 36.
On the other hand, on the second dialysate container 5 ′ side, the second supply valve 18 ′ and the second recovery valve 31 ′ are opened, and the second introduction valve 38 ′ and the second discard valve 40 ′ are closed. At this time, the volume in the second supply chamber 8 ′ of the second dialysate container 5 ′ is maximized, and the volume in the second recovery chamber 10 ′ is minimized.
During the balance adjustment operation, the servo motor 52 of the pump means 46 is not operated, and the communication between the variable volume chambers 9 and 9 'is blocked. Therefore, the volume in the variable volume chambers 9 and 9 'does not fluctuate.

From this state, when the liquid feed pump 28 provided in the recovery path 27 is started at a predetermined liquid flow rate, the RO water in the second supply chamber 8 ′ is supplied from the dialysate supply circuit 13, the flow sensor 57, and the bypass passage 55. Then, the fluid is fed at a constant flow rate into the second recovery chamber 10 ′ through the dialysate recovery circuit 14.
During this time, when the flow sensor 57 detects the RO water flowing through the supply passage 19, a counter (not shown) starts counting, and the flow in the flow rate is that the volume in the second supply chamber 8 'is minimized and the flow rate of the RO water becomes zero. When detected by the sensor 57, the counter records the circulation time counted so far.

When the volume in the second supply chamber 8 ′ is minimized and the volume in the first supply chamber 8 is maximized, the valves on the second dialysate container 5 ′ side are switched as shown in FIG. Thus, the second supply valve 18 ′ and the second recovery valve 31 ′ are closed, and the second introduction valve 38 ′ and the second discard valve 40 ′ are opened. On the other hand, on the first dialysate container 5 side, the first supply valve 18 and the first recovery valve 31 are opened, and the first introduction valve 38 and the first discard valve 40 are closed.
From this state, when the liquid feed pump 28 is started at the same predetermined liquid feed flow rate as that on the second dialysate container 5 ′ side, the RO water in the first supply chamber 8 is supplied to the dialysate supply circuit 13. Then, the fluid is fed into the first recovery chamber 10 through the flow sensor 57, the bypass passage 55, and the dialysate recovery circuit 14 at the same constant flow rate as that on the second dialysate container 5 ′ side.
Then, the flow sensor 57 and the counter record the count time from the start of the supply of the RO water from the inside of the first supply chamber 8 until the flow rate of the RO water becomes zero.

Since the liquid feed pump 28 is feeding at a constant flow rate, the flow time of the RO water fed from the first supply chamber 8 to the first recovery chamber 10 and the second feed chamber 8 ′ to the second If there is a difference between the circulation time of the RO water fed to the recovery chamber 10 ′, it is the amount of the liquid fed from the first supply chamber 8 to the first recovery chamber 10 and the second supply chamber 8 ′. Therefore, there is a difference in the flow rate of the liquid fed to the second recovery chamber 10 ′. Thereby, it is detected that there is a difference in the volumes of the variable volume chambers 9, 9 ′.
The volume difference due to the time difference can be calculated. On the other hand, the feed amount (volume fluctuation amount in the pump chamber 50) when the piston 49 is rotated once by the servo motor 52 of the pump means 46 is measured in advance. Therefore, based on the time difference, the rotation direction and the number of rotations of the piston 49 for reducing the difference can be calculated.
Therefore, when there is a difference between one of the flow rates and the other flow rate, the control device (not shown) moves the liquid in one variable volume chamber to the other variable volume chamber by the pump means 46. It is possible to adjust so that the difference in circulation amount is reduced.
When the balance adjustment is performed by the pump means 46, the open / close valves may be controlled to be open / closed so that the volume fluctuations of the variable volume chambers 9, 9 ′ can be allowed. In principle, if the supply chambers 8, 8 ′ of the dialysate containers 5, 5 ′ are in communication with each other and the recovery chambers 10, 10 ′ are in communication with each other, both variable volume chambers 9, 9 ′ The volume of can be adjusted.

In addition, although the said balance adjustment operation | work can be performed when washing | cleaning of a hemodialysis apparatus is complete | finished as mentioned above, it is not necessarily limited to this, Before starting washing | cleaning or in the middle of a dialysis process In this case, the dialysis solution is fed.
Further, the cumulative rotational speed of the piston 49 is recorded, and the cumulative rotational speed N until the balance adjustment work, and the rotational direction and rotational speed of the piston 49 required for correcting the error at that time are stored. After the first balance adjustment, when the rotational speed of the piston 49 reaches the cumulative rotational speed N again, the rotational direction and rotational speed of the piston 49 required for correcting the error are not measured without measuring the flow rate described above. It is only necessary to execute the correction. In this case, after performing the correction work that does not measure the flow rate several times, the balance adjustment work that measures the flow rate may be performed again, and the number of times of the balance adjustment work that actually measures the flow rate is reduced. can do.
Furthermore, it is desirable that the volume difference between the two variable volume chambers 9 and 9 'becomes zero after the balance adjustment operation. However, it is not always necessary to adjust until the volume difference becomes zero. It does not matter.

DESCRIPTION OF SYMBOLS 1 Dialyzer 5, 5 'Dialysate container 8, 8' Supply chamber 9, 9 'Variable volume chamber 10, 10' Recovery chamber 13 Dialysate supply circuit 14 Dialysate recovery circuit 18, 18 'Supply valve 31, 31' Recovery Valve 38, 38 'Introducing valve 40, 40' Discarding valve 45 Communication path 46 Pump means 48 Cylinder 49 Piston 52 Servo motor 57 Flow sensor (measuring means)

Claims (2)

A first dialysate container in which three chambers of a first supply chamber, a first variable volume chamber, and a first recovery chamber are sequentially formed, and a second supply chamber, a second variable volume chamber, and a second recovery chamber are formed therein. A second dialysate container in which three chambers are sequentially formed, and pump means for moving the liquid from one variable volume chamber to the other variable volume chamber to increase or decrease the volume in each variable volume chamber, While the dialysate is supplied from the supply chamber to the one recovery chamber via the dialyzer, the volume in the one variable volume chamber is decreased and the volume in the other variable volume chamber is increased. In a hemodialysis apparatus that supplies fresh dialysate to the chamber and discharges the used dialysate from the other recovery chamber to the outside,
Providing a measuring means for measuring the flow rate of the liquid fed from the first supply chamber to the first recovery chamber and the flow rate of the liquid fed from the second supply chamber to the second recovery chamber, When the flow rate of either one is less than the flow rate of the other, the pump means moves the liquid in the one variable volume chamber to the other variable volume chamber so that the difference between the flow rates is reduced. A hemodialysis apparatus characterized by being made to have.   The measuring means includes a flow sensor that is provided in a dialysate circuit communicating the supply chamber and the recovery chamber to detect the presence or absence of a liquid flow, and starts feeding the liquid from the supply chamber to the recovery chamber. The hemodialyzer according to claim 1, further comprising: a counter that counts a time from when the flow sensor detects that the flow of liquid has ceased.

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