JPH0686810A - Hemocatharsis device - Google Patents

Abstract

PURPOSE:To prevent dialysis shock along with the reduction of blood pressure by removing water to adjust a replenishing liquid amount on the basis of the result in comparing a blood pressure signal corresponding to direct artery blood pressure with a set blood pressure value. CONSTITUTION:The personal information such as normal blood pressure value and pulse wave of a patient to be dialyzed is stored and held in a dialyzer body 40 to receive a blood pressure signal from a blood pressure measuring apparatus 70 at every predetermined time. The upper limit value/the lower limit value are set from the blood pressure value of the personal information. When the blood pressure signal sent from the blood pressure measuring apparatus 70 exceeds the upper limit value or the lower limit value, a process for removing water from a dialyzer 30 is stopped temporarily, or process speed or dosage is adjusted according to the change in the signal. Thus, when the patient under dialysis has a dialysis shock symptom, the shock is quickly detected to be coped with quickly without being helped by another. Since pressure in the artery branched from a blood access 101 is utilized, the blood pressure can be measured directly without damaging the blood vessel and giving no burden to the patient.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a blood purifying apparatus, and more particularly to a blood purifying apparatus capable of measuring blood pressure with high precision and simple operation without burdening a patient.

[0002]

2. Description of the Related Art Conventionally, blood removed from a living body is circulated in a box containing a semipermeable membrane, and the blood is exposed to a drug solution through the semipermeable membrane to purify it by dialysis or by filtration. A blood purification device that removes water by a predetermined amount has been used. According to this type of purifying apparatus, an appropriate amount of water is replenished to the blood after the water removal treatment described above to adjust its components, and the blood is returned to the living body again, so that the liver function or liver function of a person having a disease in the liver or kidneys can be obtained. It has been widely used as an effective therapeutic method because it can artificially perform renal function.

By the way, during the treatment for performing the above-mentioned dialysis treatment or filtration treatment of blood (hereinafter referred to as artificial dialysis), a patient undergoing artificial dialysis (hereinafter referred to as dialysis patient) has its blood extracorporeally circulated. To be done. That is, blood is normally sucked out from the body by driving the blood pump, but since such an external action affects the circulatory dynamics, the circulatory dynamics of the patient is unstable. Therefore, the blood pressure of dialysis patients often decreases sharply and significantly more than in normal times, and such a phenomenon causes symptoms such as vomiting and convulsions, and even makes dialysis patients unconscious. Sometimes. Such a phenomenon is called a so-called dialysis shock, and when it becomes a serious state, it causes a dialysis patient to die, which has been a serious life-threatening problem. It is the current situation that a considerable number of patients undergoing artificial dialysis have experienced such a dialysis shock as long as they are mild.

Therefore, in order to prevent such a dialysis shock during the artificial dialysis, the blood pressure of the patient is measured at regular intervals and the patient's condition is continuously monitored by the fluctuation of the blood pressure. The method is valid. That is, when the blood pressure value is compared with the normal blood pressure value, it is judged whether the artificial dialysis is suspended or continued depending on whether or not it exceeds a predetermined fluctuation amount, or the water removal operation during artificial dialysis or the blood The supply amount of replacement fluid is adjusted.

Now, in order to measure the blood pressure during the above-mentioned artificial dialysis, for example, the following measuring method has been carried out. That is, for example, by wrapping the cuff around a part of the patient's body, palpating that the artery under the cuff is compressed by increasing the air pressure in the cuff and the blood circulation is stopped, and the maximum air pressure in the cuff at that time, There are methods for measuring the lowest blood pressure, auscultation, and vibration. Since all of these blood pressure measurement methods are simple and highly accurate, they have been widely used for dialysis patients whose hemodynamics are unstable. And most of the current blood pressure measuring devices for medical institutions and homes
A method of measuring blood pressure in a non-invasive manner, as represented by such a vibration method, is adopted.

[0006]

By the way, when the blood pressure of a patient is measured by a non-invasive blood pressure measuring device during artificial dialysis, there are the following inconveniences. First, a patient with impaired liver function and renal function has a blood access that serves as an entrance / exit of blood for performing artificial dialysis, which limits the measurement site of blood pressure. Frequent and long-term blood pressure measurement with a cuff not only causes discomfort to a dialysis patient but also causes internal hemorrhage and erythema due to congestion. Further, in the non-invasive blood pressure measurement method, since blood pressure is measured from outside the blood vessel, differences in blood vessel compliance due to individual differences in blood vessels and medical history affect the measurement of accurate direct arterial blood pressure in dialysis patients. It was difficult. In particular, in the case of a dialysis patient, accurate blood pressure measurement may not be possible by the non-invasive blood pressure measurement method due to repeated puncture of blood vessels. In addition, some dialysis patients have not only one pathological condition but also complications such as heart disease, but in such a case, the arrhythmia cannot be detected by the conventional blood pressure measuring device, and the patient's condition Could only be partially understood. In addition, since the conventional blood purification apparatus does not have a means for measuring blood pressure, there is no method other than relying on the hands of a nurse or the like. Therefore, as the number of dialysis patients has increased in recent years, the burden of labor for blood pressure measurement has increased, resulting in a decrease in the safety of patient management.

Further, when the blood pressure is directly measured by the open blood pressure measuring method which overcomes the above-mentioned drawbacks, for example,
In addition to artificial dialysis, a typical method is to directly puncture an artery with an open blood pressure measuring instrument for measuring blood pressure. Such an open blood pressure measuring method has an advantage that the arterial pressure can be directly measured and that arrhythmia and the like can be detected in addition to the blood pressure measurement. There is a drawback in that the physical load on the patient is large, such as causing extra pain to the patient.

The present invention has been made in view of the above circumstances, and blood pressure fluctuations of a patient are automatically and substantially continuously monitored at regular intervals, and a dialysis shock accompanying a decrease in blood pressure during dialysis is performed. It is an object of the present invention to provide a blood purification device capable of effectively preventing the occurrence of, for example, arrhythmia and the like in addition to blood pressure measurement, and improving safety and operability. .

[0009]

A blood purification apparatus according to the present invention allows blood to flow through a box containing a semipermeable membrane and removes a predetermined amount of the blood through the semipermeable membrane by dialysis or filtration. In a blood purification apparatus for water treatment, branching means for branching the blood in a plurality of directions to supply it to the outside of the body, and measuring the arterial direct blood pressure of the blood supplied from the branching means every time a fixed time elapses, In the case where the pressure measuring means for outputting a blood pressure signal according to the arterial direct blood pressure and the blood pressure value obtained based on the blood pressure signal taken out by the blood pressure measuring device deviate from a preset predetermined blood pressure value, It is characterized by comprising a water removal / replacement fluid control device for stopping the water removal operation from the blood in the casing and / or increasing the amount of fluid replacement supplied to the blood.

[0010]

According to the above construction, when blood is circulated in the box through the branching means, a predetermined amount of water is removed by dialysis or filtration through the semipermeable membrane contained in the box. . When the predetermined time is measured by the time measuring means, blood is supplied to the pressure measuring means via the branching means. In this pressure measuring means, a blood pressure signal corresponding to the arterial direct blood pressure of blood is output. Then, the water removal / replacement fluid control device compares this blood pressure signal with a preset range of a predetermined blood pressure value, and based on the comparison result, the water removal operation and the adjustment of the amount of fluid replacement supplied into the blood. Is done. In this way, the blood pressure fluctuations of the patient are automatically and substantially continuously monitored at regular intervals, so that the dialysis treatment can be performed according to the blood pressure fluctuations.

[0011]

DESCRIPTION OF THE PREFERRED EMBODIMENTS A blood cleaning apparatus 1 according to an embodiment of the present invention will be described below with reference to the drawings. Normally, blood access is used as a blood inlet / outlet port for a dialysis patient. For this blood access, for example, a direct puncture of the artery used for the above-mentioned acute dialysis, or a means such as an internal shunt used for chronic dialysis and anastomosing the artery and vein under the skin is usually used.
Here, an example of a blood purification device using an internal shunt for blood access will be described, but up to 90% of patients with chronic renal failure currently undergoing maintenance dialysis depend on this internal shunt. Arteriovenous mixed blood is flowing in the site of the inner shunt, but this blood has many pulse wave components of arterial blood pressure, and thus can be used for blood pressure measurement. FIG. 1 is a diagram showing the configuration of a blood purification device according to an embodiment of the present invention. In this figure, 101 is a blood access, which is an internal shunt type blood access for removing / returning blood of a dialysis patient. 20
Is a blood pump, which removes blood from the inside of the body to the outside. Further, the dialyzer 30 is a blood purifier composed of a box body having a film-shaped, tube-shaped, or hollow fiber-shaped semipermeable membrane accommodated therein. That is, a certain amount of blood is supplied to the dialyzer 30 at a certain time by the action of the blood pump 20, and the purified blood is returned to the living body through the vein. That is, the dialysate body 40 is connected with the dialysate supply path 401 for supplying the dialysate to the dialyzer 30.
In the dialyzer 30, the blood is purified by bringing the dialysate and the blood into contact with each other through the semipermeable membrane. Furthermore, via the semipermeable membrane in the dialyzer 30,
The blood after discharging the dialysate is discharged by the dialysis action and the filtration action, and unnecessary substances and water in the blood are discharged by the dialysis action and the filtration action. Further, the dialyser main body 40 is connected with a replacement fluid supply path 402 for supplying an electrolyte solution such as physiological saline (hereinafter referred to as replacement fluid) to the dialyzer 30, and supplies the replacement fluid to the blood concentrated by the filtering action. The blood whose composition has been adjusted is
The dialyzer 30 returns the body to the patient.

Reference numeral 50 denotes a shutoff valve, the opening and closing of which is controlled by a control signal supplied by a shutoff valve control mechanism incorporated in the dialysis machine main body 40. Also, the dialyzer 30
The supply amount of the replacement fluid and the dialysate, the water removal amount, and the processing speed thereof are also controlled by the control signal from the dialyzer main body 40. That is, the dialysis machine main body 40 is connected to a blood pressure measuring device 70 including a pressure measuring device (transducer) 701 and a blood pressure display device (BP monitor) 702, and will be described in detail later, but is measured at predetermined time intervals. Input the blood pressure value or pressure pulse wave. Then, the measured blood pressure value is compared with the reference blood pressure value input or set in the dialyzer main body 40, and the supply amount of the replacement fluid / dialysis fluid, the water removal amount and the processing speed thereof are controlled based on the comparison data. It is.

The blood access 101 has a structure for removing blood from the living body side and supplying the blood pressure measuring device 70 and the shutoff valve 50. That is, when the shutoff valve 50 is in the open state, blood is sucked from the living body side by the action of the blood pump 20 and is supplied to the shutoff valve 50.
On the other hand, when the shutoff valve 50 is closed, the blood input from the living body side is supplied to the blood pressure measuring device 70. For example, during the dialysis process, the shut-off valve 50 described above is opened according to the control signal S1 of the dialysis machine main body 40. As a result, the blood removal side → blood access 101 → shutoff valve 50
-> Blood pump 20-> Dialyzer 30 is performed through the path of dialyzer 30 and purified blood is returned to the patient's body. Then, when a predetermined time elapses during the dialysis treatment, a control signal S for closing the shutoff valve 50 from the dialysis machine main body 40.
1 is sent. In this way, when the shutoff valve 50 is closed, blood is supplied from the blood access 101 to the blood pressure measuring device 70, but as described above, the inner shunt type blood access 101 is an arterialized vein. Therefore, the pressure measuring device 7 is connected via the blood access 101.
The blood supplied to 01 reflects arterial blood pressure. The pressure or pulse wave generated by the energization of the blood flow is measured by the pressure measuring device 70.
At 1, the signal is converted into an electric signal such as a blood pressure signal or a pressure pulse wave signal. As a result, accurate blood pressure and pressure pulse wave can always be directly measured. Here, the measured blood pressure and pulse wave are displayed on the blood pressure display device 702, for example, while the blood pressure value is displayed as a numerical value and the pulse wave is displayed as a waveform, while the blood pressure signal and the pulse wave signal are transmitted to the dialyzer main body 40.

Since the blood pump 20 is kept operating at a constant flow rate while the blood pressure measurement process is being performed,
The pressure in the blood flow path between the shutoff valve 50 in the closed state and the blood pump 20 is reduced. As described above, since the negative pressure of the blood pump 20 is generated during the blood pressure measurement process, when the shutoff valve 50 is opened in this state, the blood is sucked in at a stretch, and as a result, the blood pressure is suddenly increased to the living body side. Burdens you. In order to solve this problem, a partial recirculation path 80 is provided for the bypass circuit to enable partial recirculation. That is, when the shutoff valve 50 is closed, the blood flows from the blood pump 20 to the dialyzer 30 to the blood.
It circulates through the partial recirculation path 80, and when the shutoff valve 50 is opened next, the dialysis treatment can be smoothly performed. As described above, the opening / closing process of the shutoff valve 50 is controlled by the control signal S1 output from the shutoff valve control mechanism in the dialyzer main body 40, and the timing at which this control signal is output is as shown below. . That is, the time measured by the time measuring means (not shown) is constantly compared with a preset predetermined time, and when the predetermined time has elapsed, the control signal S1 is output.

The dialysis treatment rate, the doses of dialysate and replacement fluid, and the amount of water removed are controlled by the dialyzer body 40. The dialysis device main body 40 stores and holds personal information such as a blood pressure value and a pulse wave of a dialysis patient during normal times, and a blood pressure signal is sent from the blood pressure measurement device 70 at predetermined intervals. Then, the upper limit value / lower limit value is set from the blood pressure value of this personal information. Here, the blood pressure measurement device 7
When the blood pressure signal sent from 0 shows a change exceeding the upper limit value or the lower limit value, the water removal treatment for the dialyzer 30 is temporarily stopped or the treatment speed or dose is adjusted according to the change. The adjustment processing is performed in the dialysis device main body 40 according to the change amount of the blood pressure signal. Therefore, when a dialysis patient has a dialysis shock symptom, the dialysis shock can be detected early and can be dealt with promptly without manpower. As described above, since the arterial pressure branched from the blood access 101 is used, the blood pressure can be measured without directly injuring the blood vessel in order to measure the blood pressure as in the open blood pressure measurement method described above, which imposes a burden on the patient. It doesn't take.

[0016]

As described above, according to the present invention,
In a blood purification apparatus that circulates blood in a box containing a semipermeable membrane and removes a predetermined amount of water by dialysis or filtration through the semipermeable membrane, the blood is branched into a plurality of directions and Based on the blood signal taken out by the blood pressure signal measuring device for measuring the blood pressure signal according to the arterial blood pressure of the blood supplied from the branching device every time a predetermined time has elapsed, When the blood pressure value obtained by the deviation from the predetermined blood pressure value set in advance,
Since the water removal / replacement fluid control device for stopping the water removal operation from the blood in the box / or increasing the amount of fluid replacement supplied into the blood is provided, the blood pressure fluctuation of the patient is automatically monitored for a fixed time. It is carried out substantially continuously every time, and there is an effect that it is possible to effectively prevent the occurrence of dialysis shock and the like due to a decrease in blood pressure. In addition to blood measurement, arrhythmia and the like can be detected, and there is an effect that safety and operability can be improved.

[Brief description of drawings]

FIG. 1 is a diagram showing a configuration of a blood purification device according to an embodiment of the present invention.

[Explanation of symbols]

 1 ... Blood purification device, 20 ... Blood pump, 30 ... Dialyzer, 40 ... Dialysis device body, 50 ... Shutoff valve, 70 ... Blood pressure measuring device, 80 ... Partial recirculation path, 101 ... Blood access

Claims (1)

[Claims] 1. A blood purification apparatus for circulating a blood in a box containing a semipermeable membrane and removing a predetermined amount of the blood by dialysis or filtration through the semipermeable membrane. A branching means for branching in a direction and supplying it to the outside of the body, and every time a predetermined time has elapsed, an arterial direct blood pressure of the blood supplied from the branching means is measured, and a blood pressure signal corresponding to the arterial direct blood pressure is output. When the blood pressure value obtained based on the blood pressure signal taken out by the blood pressure measuring device and the pressure measuring means deviates from a preset predetermined blood pressure value, the water removing operation from the blood in the box is stopped. And / or a dewatering / replacement fluid control device for increasing the amount of fluid replacement supplied into the blood.