JPH0423558Y2 - - Google Patents
Info
- Publication number
- JPH0423558Y2 JPH0423558Y2 JP19223287U JP19223287U JPH0423558Y2 JP H0423558 Y2 JPH0423558 Y2 JP H0423558Y2 JP 19223287 U JP19223287 U JP 19223287U JP 19223287 U JP19223287 U JP 19223287U JP H0423558 Y2 JPH0423558 Y2 JP H0423558Y2
- Authority
- JP
- Japan
- Prior art keywords
- perfusate
- carbon dioxide
- blood
- gas
- dialysate
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired
Links
- CURLTUGMZLYLDI-UHFFFAOYSA-N Carbon dioxide Chemical compound O=C=O CURLTUGMZLYLDI-UHFFFAOYSA-N 0.000 claims description 50
- 229910002092 carbon dioxide Inorganic materials 0.000 claims description 25
- 210000004369 blood Anatomy 0.000 claims description 24
- 239000008280 blood Substances 0.000 claims description 24
- 239000001569 carbon dioxide Substances 0.000 claims description 24
- 230000004087 circulation Effects 0.000 claims description 12
- 238000009792 diffusion process Methods 0.000 claims description 12
- 239000007789 gas Substances 0.000 claims description 11
- 239000007788 liquid Substances 0.000 claims description 11
- 210000004072 lung Anatomy 0.000 claims description 10
- 239000011261 inert gas Substances 0.000 claims description 5
- 102000003846 Carbonic anhydrases Human genes 0.000 claims description 4
- 108090000209 Carbonic anhydrases Proteins 0.000 claims description 4
- 230000005855 radiation Effects 0.000 claims description 4
- 239000012528 membrane Substances 0.000 claims description 2
- 238000000502 dialysis Methods 0.000 description 9
- BVKZGUZCCUSVTD-UHFFFAOYSA-M Bicarbonate Chemical compound OC([O-])=O BVKZGUZCCUSVTD-UHFFFAOYSA-M 0.000 description 7
- 230000007423 decrease Effects 0.000 description 5
- 230000010412 perfusion Effects 0.000 description 5
- 238000011282 treatment Methods 0.000 description 5
- 238000010586 diagram Methods 0.000 description 4
- 238000001914 filtration Methods 0.000 description 4
- 239000012530 fluid Substances 0.000 description 4
- 238000010979 pH adjustment Methods 0.000 description 4
- 239000006185 dispersion Substances 0.000 description 3
- 238000003973 irrigation Methods 0.000 description 3
- 230000002262 irrigation Effects 0.000 description 3
- XLYOFNOQVPJJNP-UHFFFAOYSA-N water Substances O XLYOFNOQVPJJNP-UHFFFAOYSA-N 0.000 description 3
- MYMOFIZGZYHOMD-UHFFFAOYSA-N Dioxygen Chemical compound O=O MYMOFIZGZYHOMD-UHFFFAOYSA-N 0.000 description 2
- 208000004756 Respiratory Insufficiency Diseases 0.000 description 2
- 230000017531 blood circulation Effects 0.000 description 2
- 229910001882 dioxygen Inorganic materials 0.000 description 2
- 239000001257 hydrogen Substances 0.000 description 2
- 229910052739 hydrogen Inorganic materials 0.000 description 2
- -1 hydrogen ions Chemical class 0.000 description 2
- 201000004193 respiratory failure Diseases 0.000 description 2
- OKTJSMMVPCPJKN-UHFFFAOYSA-N Carbon Chemical compound [C] OKTJSMMVPCPJKN-UHFFFAOYSA-N 0.000 description 1
- 206010030113 Oedema Diseases 0.000 description 1
- 210000000601 blood cell Anatomy 0.000 description 1
- 229910052799 carbon Inorganic materials 0.000 description 1
- 230000003197 catalytic effect Effects 0.000 description 1
- 239000012141 concentrate Substances 0.000 description 1
- 239000003792 electrolyte Substances 0.000 description 1
- 238000005534 hematocrit Methods 0.000 description 1
- 230000003834 intracellular effect Effects 0.000 description 1
- 210000003734 kidney Anatomy 0.000 description 1
- 230000004199 lung function Effects 0.000 description 1
- 238000002360 preparation method Methods 0.000 description 1
- 230000002685 pulmonary effect Effects 0.000 description 1
- 238000000108 ultra-filtration Methods 0.000 description 1
Description
【考案の詳細な説明】
「産業上の利用分野」
この考案は呼吸不全患者の肺機能を補助するた
めに使用される体外循環型肺補助装置に関するも
のである。[Detailed description of the invention] "Industrial Application Field" This invention relates to an extracorporeal circulation type lung assist device used to assist the lung function of patients with respiratory failure.
「従来の技術」
呼吸不全患者に対して、その血液を体外循環さ
せ、その間に血液中の二酸化炭素成分を除くため
に、血液の損傷が少く、かつ効率のよい装置とし
て、人工腎臓用の血液透析器を用いた体外循環型
肺補助装置が提案されている。第２図はそのブロ
ツク系統図である。図において、患者の血液は血
液ポンプにより血液ラインを通つて透析器２へ送
られ、透析器２内で膜を介して、血液中の重炭酸
イオン（HCO3 -）び溶存二酸化炭素（CO2）が
灌流液中に移動し、二酸化炭素成分が減少した血
液はドリツプチヤンバ３、血液用流量計６、静脈
圧調整器４を順次経由して患者の体内に戻され
る。``Prior art'' A blood pump for artificial kidneys has been developed as a highly efficient device that causes less damage to the blood in order to extracorporeally circulate the blood of patients with respiratory failure and remove carbon dioxide components from the blood during the extracorporeal circulation. An extracorporeal circulation type lung support device using a dialyzer has been proposed. FIG. 2 is a block system diagram. In the figure, a patient's blood is sent to a dialyzer 2 through a blood line by a blood pump, and inside the dialyzer 2, bicarbonate ions (HCO 3 - ) and dissolved carbon dioxide (CO 2 ) in the blood are removed through a membrane. ) moves into the perfusate, and the blood with reduced carbon dioxide components is returned to the patient's body via the drip chamber 3, the blood flow meter 6, and the venous pressure regulator 4 in this order.
灌流液供給部１０より放散筒１１へ供給された
灌流液は放散筒１１の出口よりPH電極１２、温度
計１３、ポンプ１４、流量計１５を順次経由して
透析器２へ流入され、透析器２より流出される灌
流液は液圧計１６、液切れ検出器１７、ヒータ１
８を順次経由して放散筒１１へ戻される。 The perfusate supplied from the perfusate supply unit 10 to the diffusion tube 11 flows from the outlet of the diffusion tube 11 into the dialyzer 2 via the PH electrode 12, thermometer 13, pump 14, and flowmeter 15 in order, and then flows into the dialyzer 2. The perfusate flowing out from 2 is connected to a hydraulic pressure gauge 16, a liquid shortage detector 17, and a heater 1.
8 and then returned to the diffusion tube 11.
ガス供給部２０より供給される不活性ガスは圧
力調整器２１、止め弁２２、ガス流量弁２３、ガ
ス流量計２４、逆止弁２５を順次経由して放散筒
１１へ与えられる。 The inert gas supplied from the gas supply section 20 is supplied to the dispersion tube 11 via a pressure regulator 21, a stop valve 22, a gas flow valve 23, a gas flow meter 24, and a check valve 25 in this order.
放散筒１１においては、灌流液中の水素イオン
（H+）が重炭酸イオン（HCO3 -）と結合し、重
炭酸水素（H2CO3）が生成され、この重炭酸水
素が灌流液中に含まれる炭酸脱水素酵素C.A.（カ
ーボニツク・アンヒドラーゼ）の触媒作用によつ
て二酸化炭素に酸化される。即ち
HCO3 -＋H+H2CO3H2Ｏ＋CO2 (1)
C.A.
となる。灌流液は放散筒１１で不活性ガスと気液
接触され、この新たに添加された二酸化炭素と既
に透析器において灌流液内に取込んだ二酸化炭素
とは共に炭酸ガスとして放散される。 In the diffusion tube 11, hydrogen ions (H + ) in the perfusate combine with bicarbonate ions (HCO 3 - ) to generate bicarbonate (H 2 CO 3 ), and this bicarbonate is added to the perfusate. is oxidized to carbon dioxide by the catalytic action of carbonic anhydrase CA (carbonic anhydrase) contained in That is, HCO 3 - +H + H 2 CO 3 H 2 O + CO 2 (1) CA. The perfusate is brought into gas-liquid contact with an inert gas in the diffusion tube 11, and this newly added carbon dioxide and the carbon dioxide already taken into the perfusate in the dialyzer are both diffused as carbon dioxide gas.
PH調整液供給部３０よりPH調整液がピンチバル
ブ３１を介して放散筒１１へ供給され、水素イオ
ン（H+）が充填される。灌流液中の重炭酸イオ
ン及び二酸化炭素の濃度をそれぞれ〔HCO3 -〕、
〔CO2〕で表せば、灌流液のPHは所謂ヘンダーソ
ン−ハツセルバツハ（Henderson−Hasselbach）
の方程式で与えられる。即ち
PH＝pKA＋log〔HCO3 -〕／〔CO2〕 (2)
ここでpKAは定数で6.1である。重炭酸イオン
（HCO3 -）が増えればPHは大きくなり、またPH調
整液を与えて(1)式の反応を促進させれば、重炭酸
イオン（HCO3 -）は減少し、二酸化炭素（CO2）
が増加するのでPHは減少する。 A PH adjusting liquid is supplied from the PH adjusting liquid supply section 30 to the diffusion tube 11 via the pinch valve 31, and hydrogen ions (H + ) are filled therein. The concentrations of bicarbonate ion and carbon dioxide in the perfusate are [HCO 3 - ] and
Expressed in [CO 2 ], the pH of the perfusate is the so-called Henderson-Hasselbach
is given by the equation. That is, PH=pK A +log [HCO 3 - ]/[CO 2 ] (2) Here, pK A is a constant and is 6.1. If the bicarbonate ion (HCO 3 - ) increases, the pH will increase, and if a pH adjustment solution is given to promote the reaction of equation (1), the bicarbonate ion (HCO 3 - ) will decrease and the carbon dioxide ( CO2 )
increases, so PH decreases.
透析器２においては、二酸化炭素成分が血液よ
り灌流液へ移行すると同時に水分も同様に移動す
る。即ち血液と灌流液との圧力の差、所謂透析器
の濾過圧が正のときは血液から水分が除去され、
逆に負のときは血液中に水分が入り込む。また濾
過圧が零であれば水分の移動はない。従つて必要
に応じ濾過圧を制御する必要がある。このため制
御部４０は液圧計１６のデータと静脈圧計５のデ
ータの差つまり濾過圧を算出し、必要に応じ静脈
圧調整器４を制御する。 In the dialyzer 2, at the same time that the carbon dioxide component is transferred from the blood to the perfusate, water is also transferred. In other words, when the pressure difference between the blood and the perfusate, the so-called filtration pressure of the dialyzer, is positive, water is removed from the blood.
Conversely, when it is negative, water enters the blood. Furthermore, if the filtration pressure is zero, there is no movement of moisture. Therefore, it is necessary to control the filtration pressure as necessary. Therefore, the control unit 40 calculates the difference between the data of the hydraulic pressure gauge 16 and the data of the venous pressure gauge 5, that is, the filtration pressure, and controls the venous pressure regulator 4 as necessary.
制御部４０は、放散筒１１の放散路に設けた
CO2温度計１９のデータｘと灌流液の流入通路の
流量計１５のデータｙとにより炭酸ガス除去流量
ｚ＝xyを計算し、この値が設定値と等しくなる
ように、ガス流量弁２３を制御して不活性ガスの
流量を調節すると共に灌流液の流入通路のポンプ
１４を制御して循環する灌流液の流量を調整す
る。この炭酸ガス除去流量ｚを設定値へ調整する
制御は肺補助装置を稼働させた直後に行われる。
また制御部４０は灌流液の温度、液圧、PH、流
量、液切れ、血液の流量、静脈圧、不活性ガス流
量、炭酸ガス濃度等の各データを表示器４１へ表
示する。 The control unit 40 is provided in the radiation path of the radiation cylinder 11.
The carbon dioxide removal flow rate z=xy is calculated from the data x of the CO 2 thermometer 19 and the data y of the flow meter 15 of the irrigation fluid inflow passage, and the gas flow valve 23 is adjusted so that this value is equal to the set value. The flow rate of the inert gas is controlled and the pump 14 of the irrigation fluid inflow passage is controlled to adjust the flow rate of the circulating irrigation fluid. Control to adjust the carbon dioxide removal flow rate z to the set value is performed immediately after the lung assist device is activated.
The control unit 40 also displays various data on the display 41, such as the temperature, fluid pressure, PH, flow rate, liquid shortage, blood flow rate, venous pressure, inert gas flow rate, and carbon dioxide concentration of the perfusate.
炭酸ガス除去流量、灌流液のPH及び温度等の各
設定値は操作部４２より制御部４０の記憶回路に
記憶される。 Setting values such as the carbon dioxide removal flow rate, PH and temperature of the perfusate are stored in the storage circuit of the control unit 40 from the operation unit 42.
「考案が解決しようとする問題点」
いま患者の体外循環直前の血中炭酸ガス分圧
を、PbCO2（Ｏ）（mmHg）、体外循環型肺補助装置
がスタートしてからｔ分後の炭酸ガス分圧を
PbCO2（ｔ）（mmHg）、灌流液中の炭酸ガス分圧を
PaCO2（mmHg）とすれば、これらの間には、
PbCO2（ｔ）＝PaCO2＋｛PbCO2（Ｏ）−
PaCO2｝e-t/〓 (3)
τ＝VB／AKX（τ：時定数、VB：血液の総量
、KX：炭酸ガスの移動係数cm／min、Ａ：透
析器の膜面積m2）なる関係が存在することを物質
移動論より導くことができる。通常は患者の血中
炭酸ガス分圧は時間経過と共に減少し、長時間で
はその減少の割合は低下するので３〜５時間をめ
どに治療が行われるケースが多い。しかしながら
患者の症例によつては血中電界質バランスが崩れ
ることもあり、この場合には炭酸ガス除去の後、
透析を行う場合もあり、また最初から透析のみを
行う場合もある。``Problem that the invention aims to solve'' Now, let us calculate the partial pressure of carbon dioxide in the patient's blood just before extracorporeal circulation, PbCO 2 (O) (mmHg), and the carbon dioxide after t minutes after the extracorporeal circulation pulmonary support device starts. gas partial pressure
PbCO 2 (t) (mmHg), the partial pressure of carbon dioxide in the perfusate
If PaCO 2 (mmHg), between these, PbCO 2 (t) = PaCO 2 + {PbCO 2 (O) −
PaCO 2 }e -t/ 〓 (3) τ=V B /AK X (τ: time constant, V B : total blood volume, K m 2 ) can be derived from mass transfer theory. Normally, the partial pressure of carbon dioxide in a patient's blood decreases over time, and the rate of decrease decreases over a long period of time, so treatment is often performed over a period of 3 to 5 hours. However, depending on the patient's case, the electrolyte balance in the blood may be disrupted, and in this case, after removing carbon dioxide,
In some cases, dialysis is performed, and in others, only dialysis is performed from the beginning.
また体外循環により患者のヘマトクリツト（血
液全体に占める血球成分比）が低下し、患者によ
つては細胞内浮腫が発生する場合があるので、限
外濾過により血液を濃縮する必要もある。しかし
ながら従来の体外循環型肺補助装置においてはこ
の機能がなく、透析を行う場合には別に透析装置
を用意しなければならず、特に狭い治療室にて治
療が行われる場合には装置の入れ替え等の準備が
煩雑で、医師や看護婦などの労力は大変なもので
あつた。 In addition, extracorporeal circulation lowers the patient's hematocrit (ratio of blood cell components to the total blood), and intracellular edema may occur in some patients, so it is necessary to concentrate the blood by ultrafiltration. However, conventional extracorporeal circulation type lung support devices do not have this function, and when performing dialysis, a separate dialysis machine must be prepared, and especially when treatment is performed in a small treatment room, it is necessary to replace the device. The preparations were complicated and required a lot of effort on the part of doctors and nurses.
「問題点を解決するための手段」
この考案においては、従来の体外循環型肺補助
装置には組み込まれていなかつた透析との切換を
可能にするもので、放散筒にオーバーフローライ
ンと、放散筒に対し灌流液供給部からの接続ライ
ン及び透析液供給ラインを切り換える３方弁とを
設け、灌流液を循環するモードと、透析液を供給
しながら放散筒内で透析液をオーバーフローさせ
て循環透析するモードとを切り換えて使用可能と
する。``Means for solving the problem'' This invention enables switching between dialysis and dialysis, which was not incorporated in conventional extracorporeal circulation type lung support devices, and includes an overflow line and an overflow line in the emission tube. A three-way valve is installed to switch between the connection line from the perfusate supply unit and the dialysate supply line, allowing two modes: one mode in which the perfusate is circulated, and one mode in which the dialysate overflows in the dispersion tube while being supplied with the dialysate. Switch between modes to enable use.
「実施例」
第１図はこの考案の実施例のブロツク系統図で
ある。第２図の従来例と同一の個所には同一の符
号を付して重複した説明は省略する。灌流液供給
部１０からの放散筒１１へのラインには３方弁
７′が配置され、同弁のもう１方の入口は透析液
入口３５となつている。また放散筒１１にはオー
バーフローライン４７が設けられ、そのオーバー
フローラインにはストツプバルブ４８が設けられ
ている。Embodiment FIG. 1 is a block system diagram of an embodiment of this invention. The same parts as in the conventional example shown in FIG. 2 are denoted by the same reference numerals, and redundant explanation will be omitted. A three-way valve 7' is disposed in the line from the perfusate supply section 10 to the diffusion tube 11, and the other inlet of the valve is a dialysate inlet 35. Further, the diffusion tube 11 is provided with an overflow line 47, and a stop valve 48 is provided on the overflow line.
次にこれらの部分の動作をモード別に説明す
る。先ず灌流モードにおいては、３方弁７′は灌
流液供給部１０から放散筒１１への灌流液供給ラ
インをアクテイブにする。 Next, the operations of these parts will be explained for each mode. First, in the perfusion mode, the three-way valve 7' activates the perfusion liquid supply line from the perfusion liquid supply section 10 to the dispersion tube 11.
またオーバーフローライン４７に設けられたス
トプバルブ４８は閉となる。またピンチバルブ３
１を開にし、PH調整液供給部３０からの供給が行
われるようにしてライン４３を有効とし、更に止
め弁２２を開とし、ガス供給部２０からの酸素ガ
スの供給が行われるようにしてライン４４を有効
にする。つぎに透析モードにおいては、３方弁
７′は透析液入口３５と放散筒１１とのラインを
アクテイブとする様に切り替えられる。オーバー
フローライン４７のストツプバルブ４８は開とな
り、循環透析液の一部は放散筒１１内でオーバー
フローし、廃棄される。止め弁２２を閉としてガ
ス供給部３０からの酸素ガスの供給が行われない
ようにしてライン４４を無効とし、ピンチバルブ
３１を閉じてPH調整液供給部３０からのPH調整液
の供給ライン４３はストツプされる。 Also, the stop valve 48 provided in the overflow line 47 is closed. Also pinch valve 3
1 is opened so that supply from the PH adjustment liquid supply section 30 is performed to enable the line 43, and further the stop valve 22 is opened so that oxygen gas is supplied from the gas supply section 20. Enable line 44. Next, in the dialysis mode, the three-way valve 7' is switched to activate the line between the dialysate inlet 35 and the diffusion tube 11. The stop valve 48 of the overflow line 47 is opened, and a portion of the circulating dialysate overflows within the diffusion cylinder 11 and is discarded. The stop valve 22 is closed to prevent the supply of oxygen gas from the gas supply section 30 to disable the line 44, and the pinch valve 31 is closed to supply the PH adjustment liquid from the PH adjustment liquid supply section 30 to the line 43. is stopped.
「考案の効果」
この考案によれば患者の血中炭素ガス成分の除
去を行う灌流モードだけではなく、同一の装置で
透析も行うことができ、患者に対して幅の広い治
療が可能となる。また灌流モードと透析モードと
の切換が簡便にかつ誤操作なく安全に行えるので
治療スタツフの手間を大幅に削減することができ
る。このようにこの考案は体外循環型肺補助装置
の適用範囲、操作性を著しく向上することができ
る。``Effects of the invention'' According to this invention, not only can the perfusion mode be used to remove carbon gas components from the patient's blood, but also dialysis can be performed using the same device, making it possible to provide a wide range of treatments for patients. . Furthermore, switching between the perfusion mode and the dialysis mode can be performed easily and safely without any erroneous operation, which can significantly reduce the effort of the treatment staff. In this manner, this invention can significantly improve the applicability and operability of the extracorporeal circulation type lung assist device.
第１図はこの考案の体外循環型肺補助装置の実
施例を示しブロツク系統図、第２図は従来の体外
循環型肺補助装置を示すブロツク系統図である。
FIG. 1 is a block system diagram showing an embodiment of the extracorporeal circulation type lung auxiliary device of this invention, and FIG. 2 is a block system diagram showing a conventional extracorporeal circulation type lung auxiliary device.
Claims (1)
と灌流液とを透析器内で膜を介して接触させ、血
液中の二酸化炭素成分を灌流液中へ移動させて放
散筒へ導き、炭酸脱水素酵素の存在下に不活性ガ
スと気液接触させて上記二酸化炭素成分を炭酸ガ
スとして放散させ、この炭酸ガスを除去した灌流
液を上記放散筒と上記透析器との間で循環させて
使用する肺補助装置において、 上記放散筒に連結されたオーバーフローライン
と、 上記放散筒に対し、灌流液供給部からの接続ラ
インと透析液供給ラインとを切り換える３方弁と
を設け、 灌流液を循環するモードと、透析液を供給しな
がら上記放散筒内で透析液をオーバーフローさせ
て循環透析するモードとを切り換えて使用可能と
した体外循環型肺補助装置。[Claim for Utility Model Registration] Extracorporeally circulating blood from a patient whose blood has been removed by a blood pump is brought into contact with perfusate through a membrane in a dialyzer, and carbon dioxide components in the blood are moved into the perfusate and released. The carbon dioxide component is introduced into the cylinder and brought into gas-liquid contact with an inert gas in the presence of carbonic anhydrase to diffuse the carbon dioxide component as carbon dioxide gas, and the perfusate from which carbon dioxide gas has been removed is transferred between the diffusion cylinder and the dialyzer. In the lung auxiliary device, the overflow line is connected to the above-mentioned radiation tube, and the three-way valve is configured to switch between the connection line from the perfusate supply section and the dialysate supply line to the above-mentioned radiation tube. An extracorporeal circulation type lung assist device which can be used by switching between a mode in which a perfusate is circulated and a mode in which the dialysate is overflowed in the diffusion cylinder while supplying the dialysate.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| JP19223287U JPH0423558Y2 (en) | 1987-12-18 | 1987-12-18 |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| JP19223287U JPH0423558Y2 (en) | 1987-12-18 | 1987-12-18 |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| JPH0195945U JPH0195945U (en) | 1989-06-26 |
| JPH0423558Y2 true JPH0423558Y2 (en) | 1992-06-02 |
Family
ID=31483099
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| JP19223287U Expired JPH0423558Y2 (en) | 1987-12-18 | 1987-12-18 |
Country Status (1)
| Country | Link |
|---|---|
| JP (1) | JPH0423558Y2 (en) |
-
1987
- 1987-12-18 JP JP19223287U patent/JPH0423558Y2/ja not_active Expired
Also Published As
| Publication number | Publication date |
|---|---|
| JPH0195945U (en) | 1989-06-26 |
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