JPH0630200Y2 - Hemodialysis machine - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION "Industrial field of application" The present invention relates to a hemodialysis device using a hemodialysis technique such as a so-called artificial kidney.

"Prior Art" A conventional hemodialysis apparatus will be described with reference to FIG. Blood is given to the arterial blood tube 1 from the patient's artery, is carried out by the blood pump 2, and is supplied to the dialyzer 4 via the arterial drip chamber 3. This blood comes into contact with the dialysate through the dialysis membrane in the dialyzer 4, and surplus ions in the blood,
Waste and water move to the dialysate side. Blood exiting the dialyzer 4 is returned to the patient's vein from the venous blood tube 6 through the venous drip chamber 5, but the line after the venous drip chamber 5 is usually a branch for connecting a replacement fluid line. A stopper 7 is set, and a replacement fluid set including a replacement fluid bottle 8, a replacement fluid drip chamber 9, and a drip adjusting roller 10 is connected to the same line.

On the other hand, the dialysate supplied from the dialysate supply unit 11 is sequentially supplied to the dialyzer 4 from the inlet line 15 through the constant flow valve 12, the inlet valve 13, and the heating tank 14. The dialysate 4, which has taken in surplus ions, waste products and water from the blood in the dialyzer 4, passes through the outlet line 16 and is discharged through the outlet valve 17 and the dialysate pump 18. The upstream side of the inlet valve 13 and the downstream side of the outlet valve 17 are bypassed by a flow path including the bypass valve 19. The bypass valve 19 is normally closed, but when the dialysate is excessively elevated during dialysis, the bypass valve 19 is opened, the inlet valve 13 and the outlet valve 17 are closed, and the dialyser 4 is not supplied with the dialysate.

"Problems to be solved by the device" In hemodialysis, depending on the patient's condition before the start of dialysis,
Doctors and nurses set the dialysis machine to remove water, and change settings and operate fluid replacement while monitoring the patient's condition during dialysis. At this time, the blood pressure of the patient is measured at regular intervals and used as an index of circulatory dynamics. For example, in the case of excessive removal of water, the patient's blood pressure decreases and a shock occurs. Therefore, it is necessary to immediately perform fluid replacement to restore the blood pressure.

However, the number of dialysis workers (doctors, nurses, dialysis technicians, etc.) is absolutely small compared to the recent increase in dialysis patients, so one nurse or dialysis technician is responsible for dialysis with 10 beds or more depending on the facility. Not a few. For this reason, in reality, there is a delay in blood pressure measurement time, and there is also a delay in measures for lowering blood pressure. However, in the conventional device, the function of taking in the blood pressure data and the function of issuing an alarm for urging replacement fluid due to a decrease in blood pressure have not been considered.

Regarding the recording of the patient's blood pressure data (blood pressure, pulse) and body temperature data, the nurse measured it, for example, every hour and entered it on a recording sheet, and saved it in a file for each patient after the completion of dialysis. . For this reason, even if it is said to be every hour, there is actually a measurement deviation of several minutes to ten and several minutes, and accurate blood data and body temperature data are not time-series managed even in one dialysis. Furthermore, in order to grasp the tendency of patient data in multiple dialysis, it is inevitable that the data management is incomplete. This is the same from the standpoint of the labor required by a small number of staff.

The purpose of this invention is to solve the above-mentioned problems of the prior art, and in the case where the blood pressure of the patient is lowered by automatically capturing, storing and processing the biometric data of the patient side in addition to the existing dialysis data. A safe and high-quality dialysis is performed by issuing an alarm and performing replacement fluid treatment, and also by storing the dialysis data over multiple dialysis times to assist in grasping the dialysis data of the patient in time series. In addition to performing the above, it is to provide a hemodialysis device that significantly reduces the burden on dialysis workers.

[Means for Solving the Problems] According to the present invention, a means for capturing blood pressure data of a dialysis patient by a sphygmomanometer connected to the outside and a means for measuring body temperature data of the dialysis patient by a temperature sensor attached to the dialysis patient are provided. , A means for outputting the amount of ultrafiltration, a means for monitoring the dropping of the replacement fluid, an alarm is issued when the blood pressure data is lowered, and the restart of the replacement fluid is urged when the replacement fluid is stopped as a treatment, When the replacement fluid is continuing, a means for promoting an increase in the replacement fluid rate, the blood pressure data in multiple dialysis,
Means for storing dialysis data including body temperature data and ultrafiltration volume data, and means for transferring the dialysis data including the blood pressure data, body temperature data and ultrafiltration volume data to a central monitoring device, etc. Provided in the device.

"Embodiment" An embodiment of the present invention is shown in FIG. The same parts as those in FIG. 8 are designated by the same reference numerals, and duplicate description will be omitted. In FIG. 1, the control unit 20 is the central portion of this device including a microcomputer. The cuff 22 is wrapped around the patient during blood pressure measurement, and the blood pressure is measured by the sphygmomanometer 21. This blood pressure monitor 2
1 is selected to have the function of outputting the measurement data (maximum / minimum blood pressure and pulse) to the outside, but regarding the external output interface, including the serial interface such as the international standard EIA-RS-232C, An 8-bit parallel interface or the like is used. The measurement data from the sphygmomanometer 21 is the sphygmomanometer I / F 23 in this device.
Although it is taken into the control unit 20 via the
As for 3, the same external output I / F of the blood pressure monitor 21 is selected.

Further, the patient is equipped with the thermometer sensor 25, but in this embodiment, a method of detecting with a skin temperature thermistor is adopted. The measurement data of the thermometer sensor 25 is obtained by the thermometer circuit 2
After being processed into data that can be post-processed in 4, the control unit 20
Is taken into.

On the other hand, regarding the replacement fluid line, the replacement fluid drip chamber 9
The drop number sensor 26 is set to. In the present embodiment, this is realized by the combination of the light projecting element and the light receiving element. The drive of the light projecting element and the processing of the signal from the light receiving element are performed by the drop number counter 27.

FIG. 2 is a block system diagram showing an essential part of the embodiment of FIG. 1, in which a microcomputer is used for the control unit 20,
The central processing unit (CPU) 40 is a read-only memory (RO
M) The programs stored in 41 are sequentially decoded and executed for control.

A control program for the entire device is stored in the ROM 41, and data acquisition from the sphygmomanometer 21 via the sphygmomanometer I / F 23, body temperature data acquisition, A / D conversion by the A / D converter 44, Capture of a signal from the drip number counter 27, control of dialysate temperature associated with changes in body temperature, alarm processing associated with blood pressure drop, and dialysis data including patient blood pressure data and body temperature data via the IC card I / F 51.
A program for storing the data in the C card 52 and transferring these data to the central monitoring unit via the external output terminal 50 is also included therein.

The RAM 42 stores measured data, alarm flags and the like.

The control program stored in the ROM 41 is divided into a background routine and an interrupt routine that occurs every 0.5 seconds by the timer 43, and takes in data from the sphygmomanometer 21, determines whether the blood pressure has dropped, and replaces fluid. The same applies to the programs for measuring the number of drops during the operation, capturing body temperature data, controlling the dialysate temperature in the case of body temperature fluctuation, and alarm processing in the case of blood pressure decrease.

FIG. 3 is a schematic flowchart of the timer interrupt routine showing the blood pressure data processing in this embodiment. The presence or absence of the dialysis start flag is checked in S1. When this routine is first passed, the same flag is not set, so the same flag is set in S2. Next, in S3, the blood pressure data measured at the start of dialysis is read.

FIG. 4 shows an output data format of the sphygmomanometer 21 in this embodiment. From the blood pressure monitor 21, the header,
Each channel signal (2 bits) of systolic blood pressure, diastolic blood pressure, and pulse and each data signal (8 bits) are periodically output. In this example, systolic blood pressure = 125 (mmH
g), minimum blood pressure = 71 (mmHg), pulse 56, and header signal = 136. The channel signal and the data signal are latched by the blood pressure I / F 23, and the latch output is I / F 23.
045 is connected, and the CPU 41 reads the state of the corresponding port to take in the data. For example, the connection port (2 bits) for channel data is "01".
In the case of, the systolic blood pressure is indicated, and at the same time, the data port (8 bits) is read and the value is “0111110”.
Know that it is 1 ”(125 in decimal).

Note that the header signal is output at the beginning of each cycle, and indicates that blood pressure data is output from the next channel. Note that this example shows an example of a data output format of a commercially available blood pressure monitor, and the blood pressure monitor I / F 23 has a simple configuration.
For example, when the output of the sphygmomanometer is serial, the sphygmomanometer I / F
It is necessary to use a serial-parallel conversion element as 23.

An allowable value is set in S4 for the blood pressure data captured according to the data format in FIG. 4 in S3 in FIG. In this example, the risk threshold is set when the systolic blood pressure is lowered by 15% or more as compared with the start of dialysis, or when the difference between the systolic blood pressure and the diastolic blood pressure is decreased by 10 mmHg or more as compared with the start of dialysis. When this interrupt routine is passed from the second time onward, the dialysis start flag has already been set in S1, so the flow jumps to S5 to capture blood pressure data. The threshold value set in S6 is compared with the previously set threshold value, and if it is out of the normal range, it is determined in S7 whether or not replacement fluid is being performed.
To set the replacement fluid flag. If the replacement fluid has already been supplied, the replacement fluid rate increase flag is set in S9.

Whether or not replenishment is being performed can be determined by whether or not the drip number sensor 26 in FIG. 1 is set in the replenishment drip chamber, and when it is set, the drip state in the chamber 26. If not set, it may be considered that the detection medium is air.

The connector for connecting the drop number sensor and the drop number counter can be detected by the presence or absence of connection. This is done because a resistor is connected between the collector terminal of the phototransistor, which is a light receiving element, and the power supply on the side of the drop counter 27, and the voltage at this connection point is monitored. When the connector is not connected, the collector connection terminal of the phototransistor, which is a light receiving element, is in an open state, so that no current flows and the equipotential is "H". On the other hand, when the connector is connected, the collector current flows, so that the tie point level becomes "L". When the replacement fluid is being applied, the same-point level changes in a pulsed manner in accordance with the replacement fluid amount. From the above, it is possible to determine whether or not replacement fluid is being performed.

The pulse change frequency at the same point according to the replacement fluid amount is waveform shaped and counted by the drop number counter circuit 27, and the drop number is stored in the RAM 42 each time the interrupt routine passes.

FIG. 5 is a schematic flowchart of a background routine for the timer interrupt routine of FIG. 3 showing the blood pressure data processing in this embodiment. In this routine, warning processing is performed depending on the presence or absence of the replacement fluid flag and the replacement fluid rate increase flag set in the timer interrupt routine of FIG. First, the presence or absence of the replacement fluid flag is checked in S1, and if the flag is set, the buzzer 31 is alarmed via the alarm circuit 29 of FIG. 1 in S3. In addition, the alarm display 30 displays replacement liquid on the operation panel (not shown) on the front of the device.
The LED is turned on (S4). If the replacement fluid flag is not set, the presence or absence of the replacement fluid rate increase flag is checked in S2. If the flag is set, the buzzer 31 is sounded via the alarm circuit 29 in S5, and the replacement fluid increase LED of the device front operation panel is turned on in the alarm display 30 in S6. If neither flag is set, this routine ends. Due to the cholera alarm process, the dialysis worker must set the replacement fluid line when the replacement fluid has not been performed, and the replacement fluid rate must be increased if the replacement fluid has already started. You can know.

Further, in this embodiment, the serial output I / O is provided in the control unit 20.
EIA-RS-2 for external equipment such as central monitoring equipment
Although data can be transferred via the 32C serial interface 50, this standard is already known and will not be described here.

FIG. 6 is a diagram showing a transfer format of dialysis data including blood pressure data, body temperature data and ultrafiltration amount data of a patient to a central monitoring device or the like. Dialysis data for Patient I
D, dialysis date, start time, end time, elapsed time, venous circuit side pressure, dialysate pressure, TMP (membrane pressure), dialysate temperature, ultrafiltration amount, systolic blood pressure, diastolic blood pressure, pulse and body temperature . Transfer is done from the header part, followed by patient I
D is transferred in the order of dialysis date.

The header consists of, for example, 2 bytes and is AF (decimal 17
5), ED (237 in decimal) is used as an identifier. Patient ID is 4 bytes, dialysis date is 3 bytes, dialysis start time, end time, venous circuit side pressure, dialysate pressure, TMP,
The dialysate temperature, ultrafiltration volume, maximum, minimum blood pressure, pulse, and body temperature data each consist of 2 bytes. Therefore, one transfer is 33 bytes.

Further, in this example, the dialysis data are PIO45 and I
The data is stored in the IC card 50 via the C card I / F 51, and these data are stored in the IC card 50 every 5 minutes. (The data of the systolic blood pressure, the diastolic blood pressure, and the pulse do not change until they are newly measured.) The memory capacity of the IC card in this embodiment is 200 Kbytes, and when the dialysis time is 5 hours, 100 Can remember dialysis data of strong recovery. This means that if dialysis is performed twice a week, it will be for 50 weeks, and dialysis data for about 1 year can be recorded.

The storage format conforms to the transfer format described above.

Although the drip adjusting roller 10 is used in the replacement liquid line in FIG. 1, a replacement liquid pump 61 may be used instead of the dropping adjustment roller 10 as shown in FIG. As the replacement liquid pump 61, a roller type or a finger type can be used. As in the case of the embodiment shown in FIG. 1, an alarm is issued when the blood pressure of the patient is lowered to prompt an increase in the infusion rate of the pump. When the blood pressure of the patient is lowered, if the fluid replacement is not performed, the drop number counter 27 detects it and issues an alarm. In this case, since the replacement fluid pump is stopped, there is no replacement fluid dripping and the detection is possible because it is not counted. Also, in the case of continuous flow instead of dripping, the amount of light passing through the optical axis in the drip chamber is clearly different from that in the case of air, so it is possible to distinguish it from the case without replacement fluid, so a false alarm is issued. Never emit.

[Advantage of the Invention] According to this invention, when the blood pressure drop of the patient under dialysis is automatically detected and the replacement fluid is not performed, an alarm process prompting the replacement fluid operation is performed and the replacement fluid is already performed. If it is, an alarm process is performed to prompt an increase in the replacement fluid rate.
It enables safe and high-quality dialysis.

In addition, dialysis data including patient blood pressure data, body temperature data, and ultrafiltration volume data is recorded, for example, on a portable recording medium at regular intervals, and dialysis data can be stored multiple times. If not set, it can be set on an external read-out device to enable accurate dialysis data management. This is very important for grasping the time-series dialysis tendency of patients, and ultimately contributes to the execution of safe and high-quality dialysis.

In addition to the patient, the burden on the dialysis worker can be significantly reduced. Thus, the present invention can remarkably improve the application range and operability of the hemodialysis machine.

[Brief description of drawings]

FIG. 1 is a block system diagram showing an embodiment of the hemodialysis apparatus of the present invention, FIG. 2 is a block system diagram showing an essential part of the embodiment of FIG. 1, and FIG. 3 is a blood pressure of the embodiment of FIG. FIG. 4 is a flow chart showing an interrupt routine of a control program for data processing, FIG. 4 is a diagram showing an output data format of the sphygmomanometer in the embodiment of FIG. 1, and FIG. 5 is a control program for blood pressure data processing of the embodiment of FIG. FIG. 6 is a flow chart showing a background routine of FIG. 6, FIG. 6 is a diagram showing a transfer format of dialysis data including blood pressure data and body temperature data in the embodiment of FIG. 1 and a storage format to an IC card, and FIG. FIG. 8 is a block diagram showing a part of the embodiment of FIG. 8, and FIG. 8 is a block system diagram showing a conventional hemodialysis apparatus.

Claims (1)

[Scope of utility model registration request] 1. The amount of water removed while the extracorporeal blood of a patient with renal failure is brought into contact with a dialysate with a dialyzer to move excess ions, unnecessary waste products, and water in the patient's blood into the dialysate. In a hemodialysis device that performs fluid replacement according to, for example, a means for cuffing a dialysis patient and measuring blood pressure data thereof, a means for measuring body temperature data of the dialysis patient, a means for outputting an ultrafiltration amount, and A means for monitoring the drip of the replacement fluid, an alarm is generated when the blood pressure data is lowered, and as a treatment, the start of the replacement fluid is promoted if the replacement fluid is not performed, and if the replacement fluid is continuing, the replacement fluid is Means for promoting an increase in the rate, means for storing dialysis data including the blood pressure data, body temperature data and ultrafiltration amount data in multiple dialysis, and the blood pressure data, body temperature data and the ultrafiltration And a means for transferring dialysis data including an excessive amount of data to a central monitoring device, wherein the storage medium in the storage means is portable, and the blood pressure data, the body temperature data and the limit stored in the storage medium. A hemodialysis device characterized in that dialysis data including data on the amount of extrafiltration can be read by a reading device other than this device.