JPH0512944B2 - - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION (Technical Field) The present invention relates to a blood purification device, which effectively prevents hypotension attacks and shock symptoms during blood purification, and improves its safety and operability. The present invention relates to a blood purification device that can be effectively implemented.

(Prior art and its problems) In recent years, the blood of a living body once taken out of the body,
The blood is allowed to flow through a box housing a semipermeable membrane, and the blood is subjected to a predetermined purification effect and its quantity is controlled by the dialysis and filtration effects through the semipermeable membrane. Blood purification therapy using so-called artificial organs, in which kidney and liver functions are artificially restored by returning the blood to the body, has been commonly adopted, and its remarkable effects have been It recognized. For example, hemodialysis or filtration therapy using a so-called artificial kidney, which is applied to patients with renal failure, is a typical example.

By the way, such hemodialysis (including filtration).
(The same applies hereafter) In patients undergoing treatment, during hemodialysis, the blood level may drop abnormally, and this rapid blood drop may cause symptoms such as vomiting and convulsions. Furthermore, it can cause the patient to lose consciousness, and in severe cases,
causing the patient to face death. This is called a dialysis shot, and in general, 10 to 10 of all dialysis patients undergo two to three dialysis shots during one dialysis treatment.
It is recognized that as much as 20% of

Therefore, in order to predict the occurrence of dialysis shock symptoms during dialysis operation and to catch them as soon as possible, the blood pressure of the dialysis patient is frequently measured during hemodialysis operation, and the dialysis patient's blood pressure is measured frequently during hemodialysis operation. It is necessary to decide whether or not it is possible, or to take measures such as controlling the water removal operation and supplying replacement fluid to the blood.

However, conventional dialysis machines do not have appropriate means for blood measurement, and therefore nurses and others must measure blood pressure at predetermined time intervals using normal auscultation. The operation was extremely troublesome for both the patient and the measurer.

Furthermore, since the symptoms of sudden drop in blood pressure, which are the direct cause of such dialysis shocks, occur in just 1 to 2 minutes, blood pressure measurements performed at predetermined time intervals as described above can be used to detect the occurrence of such symptoms. It is extremely difficult not only to predict the occurrence of the disease, but also to immediately grasp its occurrence, which is why countermeasures against dialysis shocks have been a late move and have been successful.

(Solution Means) Here, the present invention has been made against the background of the above-mentioned circumstances, and its feature is that blood is allowed to flow inside a box housing a semipermeable membrane, and dialysis operation is performed. In a blood purification device that removes a predetermined amount of water from the blood by filtration through the semipermeable membrane while performing dialysis or without performing dialysis, has a measurement hole into which the measurement hole is inserted, and is located on one opening side of the measurement hole together with a compression means for compressing the body part inserted into the measurement hole, and is inserted into the measurement hole. a tip pressure means that covers substantially the entire surface of the tip portion of the body part that protrudes from the measurement hole and applies a predetermined pressure to the tip portion;
A blood pressure measuring device configured to apply external pressure through compression by the compression means and extract a predetermined blood pressure signal;
(b) When the blood pressure value obtained based on the blood pressure signal taken out by the blood pressure measuring device deviates from a predetermined blood pressure value set in advance, stopping the water removal operation from the blood in the case; /or Water removal to increase the amount of fluid supplied to the blood/
The reason is that a replacement fluid control device is provided.

(Effects of the Invention) The blood purification device having the structure according to the present invention includes a predetermined blood pressure measuring device, and measures the blood pressure based on the blood pressure signal taken out by the blood pressure measuring device. The water removal operation from the blood and the supply of replacement fluid to the blood are automatically controlled.

As this blood pressure measuring device, a blood pressure measuring device using a volume compensation method and equipped with a tip pressurizing means for the distal tip portion of the blood pressure measurement site will be adopted. Congestion in the distal end portion of the subject to be examined, which occurs due to compression by the compression means, can be effectively relieved by the action of the distal end pressurizing means without releasing the external pressure caused by the compression means. Therefore, it is possible to continuously measure blood pressure.

Therefore, in the blood purification device structured according to the present invention, the patient's blood pressure fluctuations can be automatically and continuously monitored, and measures corresponding to the fluctuations can be taken immediately. Therefore, the occurrence of dialysis shock, etc. can be effectively prevented, and recovery measures can be taken quickly, and safety and operability can be extremely effectively improved.

(Example) In order to clarify the present invention more specifically, an example having a structure according to the present invention will be described in detail below with reference to the drawings.

First, in FIG. 1, reference numeral 10 denotes a dialyzer as a blood purifier, which is composed of a box housing a semipermeable membrane in the form of a film, a tube, or a hollow fiber. and,
A blood supply channel 12 for guiding blood from the patient's body is connected to the dialyzer 10, and a blood pump 14 disposed on the blood supply channel 12 supplies a certain amount of blood. is guided to the dialyzer 10. Further, the blood increased in this dialyzer 10 is returned to the patient's body through a blood delivery channel 16. Note that air chambers 18 are disposed above the blood flow paths 12 and 16 before and after the dialyzer 10 to prevent air from entering the patient's body.

Further, a dialysate supply channel 20 for guiding the dialysate into the dialyzer 10 is connected to the dialyzer 10, and furthermore, the dialysate is brought into contact with blood through a semipermeable membrane in the dialyzer 10. A dialysate discharge channel 22 is connected thereto for discharging unnecessary substances or harmful substances taken out from the blood by the dialysis and/or filtration action of the semipermeable membrane.

Furthermore, a known dialysate supply/water removal control device 24 is provided on the dialysate supply flow path 20 and dialysate discharge flow path 22 to adjust the dialysate supply amount and dialysate pressure. The device 24 adjusts the transmembrane pressure between the blood side and the dialysate side via the semipermeable membrane in the dialyzer 10, and removes water from the body according to the transmembrane pressure. It is beginning to be practiced.

On the other hand, on the blood delivery channel 16 to which such a dialyzer 10 is connected, a fluid supply channel 28 of a replacement fluid tank 26 containing an electrolyte solution (replacement fluid) such as physiological saline is connected. By the operation of the liquid feeding pump 30 disposed on the liquid feeding channel 28, the electrolyte solution is replenished and supplied to the concentrated blood after filtration, and the blood whose component composition has been adjusted becomes blood. It is configured to be returned to the patient's body through the delivery channel 16.

In this embodiment, as shown in FIG. 1, a dialysate supply/water removal adjustment device 24 that adjusts the amount of water removed by the dialyzer 10 and a fluid feeder that adjusts the amount of replacement fluid supplied are used. The operation of the pump 30 is controlled by a water removal/fluid replacement control device 32. That is, this water removal/replacement control device 32 is connected to a blood pressure measuring device 34, and compares the patient's blood pressure value inputted from the blood pressure measuring device 34 with a reference value set in the setting device 36, Based on the comparison value, the dialysate supply and
It is designed to control the operation of the water removal adjustment device 24 and the liquid feeding pump 30.

More specifically, a specific example of the blood pressure measuring device 34 suitably employed in this embodiment is shown in FIG. 2. In this figure, reference numeral 38 denotes a main body of a detection section of a known blood pressure measuring device that performs non-invasive continuous measurement of intravascular pressure based on volume compensation, and is made of rubber or polyurethane in a substantially cylindrical chamber forming body 40. A compression cuff 42 formed of an elastic thin film such as
By fixing them, a ring-shaped sealed space is formed between them. By inserting the finger 46 of the subject (dialysis patient) into the measurement hole 44 penetrating the central portion, the detection unit main body 38 is attached to the middle phalanx of the patient's finger. It's summery.

In addition, in the sealed space of this compression cuff 42,
A compression cuff 42 is filled with a predetermined fluid or gas, and is activated by a pressurizer 48 connected to it.
By changing the internal volume of the sealed space, the external pressure applied to the finger 46 inserted into the measurement hole 44 can be controlled to be increased or decreased.

On the other hand, in the chamber forming body 40, a light source 50 made of a light emitting diode is disposed facing the side surface of the finger 46, while an inner periphery of the compression cuff 42 facing the light source 50 with the finger 46 in between is disposed. On the surface is a photoelectric detector 5 consisting of a phototransistor.
These light sources 50 and photoelectric detectors 52 constitute, as is well known, a mechanism for detecting changes in blood vessel volume using the light absorption characteristics of blood at the relevant part of the finger 46.

Then, the detection unit main body 3 having such a structure
8, as is well known, although not shown, the output signal from the photoelectric detector 52 is introduced into a control system composed of a servo system,
Based on the output signal, the operation of the pressurizer 48 is controlled so that the intravascular volume is always maintained at the intravascular volume when the blood vessel wall is in an unloaded state. The pressure applied to the outer surface of the middle segment of the finger 46 is controlled to compensate for the intravascular volume.

Therefore, the change in external pressure (internal pressure of the compression cuff 42) required to always clamp the intravascular volume to a constant target value through such volume control always matches the change in intravascular pressure, and therefore By measuring the external pressure with the pressure sensor 54, the intravascular pressure (arterial blood pressure) is measured.

Furthermore, in the case of such a blood pressure measuring device 34,
A finger tip pressurizing body 56 is attached to the distal end portion of the patient's finger 46 inserted into the measurement hole 44 of the detection unit main body 38 having the above-described structure, protruding from the measurement hole 44. ing.

This finger tip pressurizing body 56 has a cylindrical bag-shaped pressurizing cuff 60 made of an elastic material such as rubber, which is formed of an elastic material such as rubber, on a cylindrical body 58 having a substantially bottomed cylindrical shape. It has a structure in which it is fixed to the opening peripheral portion of the body 58, and a sealed space is provided between the pressurizing cuff 60 and the inner wall surface of the cylindrical body 58. Further, this pressurizing cuff 60 is connected to the measurement hole 4 of the detection section main body 38.
When the distal phalanx of the subject's finger 46 protruded from 4 is inserted, the inner diameter is deep enough to cover substantially the entire surface of the distal phalanx, and at the same time does not press the outer surface of the distal phalanx. It is formed by

A predetermined fluid or gas is sealed in this sealed space, and the space is connected via a valve means 64 to a pressurizer 62 that can output a constant pressure. Such valve means 64
The sealed space formed by the pressurization cuff 60,
It has a function of selectively switching between a state of communication with the pressurizer 62 and a state of being open to the atmosphere, and its operation is controlled by a control device 66. This control device 66 is configured to include a setting device that can arbitrarily set the time interval at which the valve means 64 is switched. Thus, the inside of the sealed space of the pressurizing cuff 60 is pressurized to a predetermined pressure value set in the pressurizer 62.

Therefore, in the blood pressure measuring device 34 having such a structure, when the inside of the pressurizing cuff 60 is controlled to be in communication with the pressurizer 62 by the valve means 64, the finger tip pressurizing body 56 A predetermined pressure is applied to the distal segment protruding from the measurement hole 44 of the subject's finger 46, thereby increasing the internal pressure of the venous blood vessel and causing the blood present in the distal segment to increase. It will be forcibly pushed out toward the proximal phalanx of the finger. Therefore, when continuously measuring blood pressure by applying external pressure to the middle part of the finger 46 using the detection unit main body 38, the finger tip pressurizing body 56 is applied in parallel with the blood pressure measurement. By applying a predetermined pressure to the distal joint of the finger 46 at predetermined time intervals, the congestion in the distal joint caused by the external pressure from the detection unit main body 38 can be effectively relieved. Therefore, continuous blood pressure measurement over a long period of time becomes possible extremely easily without causing pain to the subject and without releasing the external pressure applied to the fingers by the detection unit main body 38.

The operation of the finger tip pressurizing body 56 is controlled intermittently, for example, at intervals of 1 minute and continuously for 30 seconds, but the specific time may vary. The interval should be determined appropriately depending on the patient. Further, the finger tip pressurizing body 5
The pressure applied to the finger 46 at step 6 is a pressure value that can push the blood congested in the distal phalanx into the venous blood vessel toward the proximal phalanx by obtaining the middle phalanx where external pressure is applied by the detection unit main body 38. Although it is acceptable if there is a value, it is preferably set to a value other than the systolic blood pressure at the blood pressure measurement site.

In the blood pressure measurement device 34 having such a structure, the pressure sensor 54 of the detection unit main body 38
The blood pressure value detected by is guided to the water removal/replacement control device 32, and by comparing this blood pressure value with a reference value preset by the setting base 36, The patient's condition during dialysis can be continuously monitored, and furthermore, treatment according to the patient's condition can be automatically and promptly performed.

That is, the setting device 36 presets the lower limit of blood pressure (for example, 70% of the initial blood pressure value) and the maximum permissible rate of decrease in blood pressure (for example, 30 mmHg/min), and then controls water removal/replacement. In the device 32, the blood pressure values input from the blood pressure measuring device 34 are compared with these set values, and if the blood pressure values are outside the acceptable range, the dialysate supply and
The operation of the water removal adjustment device 24 is controlled to reduce the amount of water removed to substantially zero, and the fluid pump 30 pumps a predetermined amount of fluid into the bloodstream at a constant rate (for example, 100 ml).
(with a speed of about 200ml/min)
The water removal/replenishment control device 32
An operating signal is sent to the dialysate supply/removal control device 24 and the liquid pump 30 from the dialysate.

In addition, in the case of the blood pressure measuring device 34 in this embodiment, it is difficult to accurately detect the blood pressure under a condition where a predetermined pressure is applied to the distal part of the finger 46 by the finger tip pressurizing body 56. However, in this embodiment, the operating state of the fingertip pressurizing body 56 is input from the control device 66 to the water removal/replenishment control device 32, and the measured blood pressure value under the operating state is canceled. Because of its structure, there are no problems with its operation.

Therefore, in the blood purification device of this embodiment having the above-described structure, since the blood pressure of the patient undergoing dialysis is continuously measured, there are no prodromal symptoms and no comparison is possible. The sudden occurrence of hypotensive attacks can be effectively prevented, and even if they do occur, recovery measures can be taken extremely quickly, thus preventing symptoms from worsening. can be prevented or recovered automatically, and safety during dialysis can be extremely effectively improved.

In addition, since the blood pressure measuring device 34 employed in such a blood purification device is always worn by the patient during dialysis, it is difficult to use a cuff by a nurse or the like as in conventional blood pressure measurement. This eliminates the need for mounting and removing operations, and the burden on the patient and the person being measured can be effectively reduced.

Although one embodiment of the blood purification device having the structure according to the present invention has been described in detail above, this is a literal illustration, and the present invention should not be construed as being limited to such specific details. do not have.

For example, in the blood purification device in the embodiment described above, the lower limit value and the allowable maximum rate of decrease in blood pressure were set by the setting device 36, but only the lower limit value is set. You can do it like this.

Further, in the blood purification device in the above embodiment, when the blood pressure measurement value deviates from a predetermined blood pressure value set in advance, the operation of the dialysate supply/water removal adjustment device 24 is controlled. As a result, the amount of water removed is substantially reduced to zero, and the supply of replacement fluid by the liquid feed pump 30 is increased. Preventing hypotensive attacks and recovering from them can be effectively achieved even by performing only one of them, and furthermore, their operation should be controlled in stages according to the measured blood pressure value. is also possible.

Furthermore, there is no problem in providing a liquid feeding channel for supplying the replacement fluid into the blood channel on the blood supply channel 12 side.

Furthermore, in the case of such a blood purification device, a recording device such as a printer that records blood pressure measurement values, and furthermore, when the blood pressure measurement value deviates from a predetermined blood pressure value set in advance, an alarm sound or light is provided. An alarm device or the like that emits an alarm is preferably installed, thereby further improving safety during dialysis.

In addition, although a dialysis device is mentioned in the above example as a blood purification device to which the present invention is applied, blood purification and water removal are performed simply by the filtration action of a semipermeable membrane without using a dialysate. The present invention can be advantageously applied to such a filtration device, and furthermore, it can be applied to a well-known dialysis device that purifies blood through dialysis and filtration.
The present invention can also be applied to filtration devices.

Further, even if the blood pressure measuring device 34 is applied to a blood purification device having a structure according to the present invention, it is not limited to the structure as in the above embodiment, and for example, as a blood vessel volume change detection method, In addition to the transmission type photoplethysmography method as described above, blood pressure measuring devices using reflection type photoplethysmography, ultrasonic waves, or bioelectrical impedance can of course be adopted, and other structures may be used. The present invention can be effectively applied to a blood pressure measuring device using a volume compensation method, or even a blood pressure measuring device whose measurement site is other sites such as the wrist or the proximal phalanges of the fingers.

Furthermore, the finger tip pressurizing body 56 used in such a blood pressure measuring device can also be configured integrally with the detection unit main body 38, or can be configured entirely of an elastic body. Furthermore, it is also possible to seal the finger 46 insertion opening of the cylindrical body 58 so that fluid pressure or air pressure can be applied directly to the relevant part.

In addition, although not listed in detail, the present invention can be implemented in various modifications, modifications, improvements, etc. based on the knowledge of those skilled in the art, and such embodiments may be implemented in accordance with the present invention. It goes without saying that any of these are included within the scope of the present invention as long as they do not depart from the spirit of the invention.

[Brief explanation of the drawing]

FIG. 1 is a schematic diagram showing a model of an embodiment of a blood purification device structured according to the present invention, and FIG. 2 is a diagram showing a blood measuring device used in the blood purification device shown in FIG. It is a schematic diagram shown as a model. 10: Dialyzer, 12: Blood supply channel, 14: Blood pump, 16: Blood delivery channel, 20: Dialysate supply channel, 22: Dialysate discharge channel, 24: Dialysate supply/water removal adjustment device , 26: fluid replacement tank, 30: fluid pump, 32: water removal/fluid replacement control device, 34: blood pressure measurement device, 36: setting device, 38: detection unit main body,
42: Compression cuff, 46: Finger, 54: Pressure sensor, 56: Finger tip pressurizing body, 60: Pressure cuff.

Claims (1)

[Scope of Claims] 1 Blood is made to flow through a box housing a semipermeable membrane, and a predetermined amount of water is removed from the blood through the semipermeable membrane during dialysis or by filtration alone. This blood purification device has a measurement hole into which a body part such as a finger is inserted, and a pressure means for compressing the body part inserted into the measurement hole, and a pressure means for compressing the body part inserted into the measurement hole. Tip pressure that is located on the opening side and applies a predetermined pressure to the tip portion, covering substantially the entire surface of the tip portion of the body part inserted into the measurement hole that protrudes from the measurement hole. a blood pressure measuring device comprising means for applying external pressure through compression by the compression means and extracting a predetermined blood pressure signal; and a blood pressure value determined in advance based on the blood pressure signal taken out by the blood pressure measuring device. water removal for stopping the water removal operation from the blood in the case and/or increasing the amount of replacement fluid supplied to the blood when the blood pressure value deviates from a predetermined blood pressure value;
A blood purification device comprising: a fluid replacement control device.