JPH08191889A - Continuous hemocatharsis apparatus - Google Patents
Continuous hemocatharsis apparatusInfo
- Publication number
- JPH08191889A JPH08191889A JP7006185A JP618595A JPH08191889A JP H08191889 A JPH08191889 A JP H08191889A JP 7006185 A JP7006185 A JP 7006185A JP 618595 A JP618595 A JP 618595A JP H08191889 A JPH08191889 A JP H08191889A
- Authority
- JP
- Japan
- Prior art keywords
- pump
- flow rate
- blood
- circuit
- 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.)
- Granted
Links
Landscapes
- Separation Using Semi-Permeable Membranes (AREA)
- External Artificial Organs (AREA)
Abstract
Description
【０００１】[0001]
【産業上の利用分野】本発明は、静脈或いは動脈より脱
血した血液を血液浄化器に導入し、水分、代謝産物、電
解質等をろ過分離した後、有用物質を補給し、自己防御
機構の賦活、保持を図ることにより、生体の臓器機能を
補助あるいは代行する持続的血液浄化用装置に関する。BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention introduces blood removed from veins or arteries into a blood purifier, filters and separates water, metabolites, electrolytes, etc., and then replenishes useful substances to improve self-protection mechanism. The present invention relates to a device for continuous blood purification that assists or substitutes organ functions of a living body by activating and retaining it.
【０００２】[0002]
【従来の技術】従来、血液浄化法として、全血交換、血
漿交換、血液吸着、血液透析、血液ろ過、血液透析ろ
過、腹膜透析などが広く臨床に応用されている。腎機能
不全の患者やその他の原因で重篤な状態にあり、そのた
めに腎不全の兆候の現れた患者、あるいは術後の薬液注
入によって水分過多症になった患者などの重篤な状態を
改善するために臨床の場で血液透析や血液ろ過を行うこ
とはすでに実用化されて久しい。ここでいう血液透析と
は、膜を介して血液中の老廃物を透析の原理すなわち膜
を介して血液側と透析液側との溶質（血液中の代謝老廃
物たとえば、尿素、尿酸、クレアチニン、NaCl、KCl な
どの電解質物質) を濃度差と電荷差を利用していわゆる
ドナン膜平衡の原理によって溶解質を膜を通して選択的
に除去する方法であり、この場合溶媒の移動はなく、溶
質のみが膜を通って移動するものである。2. Description of the Related Art Conventionally, as blood purification methods, whole blood exchange, plasma exchange, blood adsorption, hemodialysis, hemofiltration, hemodiafiltration, peritoneal dialysis and the like have been widely applied clinically. Improves the serious condition of patients with renal insufficiency and other conditions that are in a serious condition and therefore show signs of renal insufficiency, or who have become hydrated due to postoperative drug infusion In order to achieve this, it has been a long time since it was put into practical use to perform hemodialysis and hemofiltration in a clinical setting. Hemodialysis here means the principle of dialysis of waste products in the blood through the membrane, that is, solutes between the blood side and the dialysate side through the membrane (metabolic waste products in the blood, for example, urea, uric acid, creatinine, This is a method of selectively removing solutes through the membrane by the principle of so-called Donnan membrane equilibrium by utilizing the concentration difference and charge difference (electrolyte substances such as NaCl and KCl). It moves through the membrane.
【０００３】一方、血液ろ過は、膜に孔を有し、膜間に
かけた圧力差によって溶質を含んだ溶媒そのものが膜の
孔を通って血液側から他の側へ移動するものであり、孔
を通過する溶質は溶質の大きさと膜の孔の大きさによっ
て規制され、これは透析と異なって、ろ過の原理によっ
て選択的な除去を可能にするものである。この場合、通
常除去した水分の体液成分を補充液（以後、補液とい
う）として補給することが行われる。血液中に老廃物を
蓄積した患者や、水分過多症の患者の治療にこの透析と
ろ過のいずれを用いるかは、それぞれの患者の状態を勘
案して臨床医によって判断され、選択されてきた。すな
わち従来の技術によれば、透析かろ過の二者択一の方法
がもっぱらとられてきたのである。二者を併用する方法
は極めて新しいものである。この療法を、短時間に施行
すると、患者の体液バランスが急激に変動し患者の状態
が急変し、これが患者に悪影響を与えるため、長時間か
けて患者を徐々に正常に戻す方法、即ち持続的血液浄化
療法が、患者に対する悪影響を最小にすることが認めら
れて急速に普及しつつある。この場合、透析液の使用流
量は通常の血液透析療法に比較し約１０分の１程度の低
流量でおこなわれる。この方法は、特に重症患者に対す
る有効性が明らかになりつつあり、主にICU、CCU 等に
おいて体液バランスを厳密に管理しながら実施される。
持続的血液浄化療法おいては、長時間かけて徐々に血液
浄化を行うことが必要であり、そのためのより厳密な患
者体液バランス管理が必要となる。従ってこれまでの常
識を越えた精度の高い装置の出現が必要となってきた。On the other hand, hemofiltration has pores in the membrane, and the solvent itself containing the solute moves from the blood side to the other side through the pores of the membrane due to the pressure difference applied between the membranes. The solute that passes through is regulated by the size of the solute and the size of the pores in the membrane, which, unlike dialysis, allows selective removal by the principle of filtration. In this case, the removed body fluid component is usually replenished as a replenisher (hereinafter referred to as a replenisher). Whether to use this dialysis or filtration for the treatment of a patient having accumulated waste products in the blood or a patient with hyperhydration has been judged and selected by a clinician in consideration of the condition of each patient. That is, according to the prior art, the alternative method of dialysis or filtration has been exclusively used. The method of using the two in combination is extremely new. If this therapy is given for a short period of time, the fluid balance of the patient will suddenly change and the patient's condition will change suddenly, which will adversely affect the patient. Blood purification therapies are rapidly becoming widespread with the recognition that they have a minimal adverse effect on patients. In this case, the flow rate of the dialysate used is about one-tenth the flow rate of ordinary hemodialysis therapy. The effectiveness of this method is becoming clear especially in critically ill patients, and it is mainly carried out while strictly controlling the body fluid balance in ICU, CCU, etc.
In continuous blood purification therapy, it is necessary to gradually perform blood purification over a long period of time, and for that purpose, more strict patient body fluid balance management is required. Therefore, it is necessary to develop a highly accurate device that goes beyond the conventional wisdom.
【０００４】[0004]
【発明が解決しようとする課題】血液透析ろ過療法で患
者の体液から水分や不要物質を除去するために体液の一
部を除去する場合には体液のバランスを保つため、電解
質などの有用物質を補液として補充添加する。その補液
容量は膜ろ過器によって血液中から除去された液容量に
バランスさせ、両者の容量が実質的に同一もしくは両者
の容量の差が所定の範囲内でないと、体液量が急激に減
少したり、急激に増加することで患者の状態を管理する
上で問題が生じる。集中治療室等で治療を受けている患
者の場合は特に体液バランスの管理が厳密に行われる必
要がある。[Problems to be Solved by the Invention] In hemodiafiltration therapy, when a part of body fluid is removed in order to remove water and unnecessary substances from the body fluid of a patient, in order to maintain the balance of the body fluid, a useful substance such as electrolyte is added. Replenish as a replacement fluid. The volume of the replacement fluid is balanced with the volume of the fluid removed from the blood by the membrane filter, and unless the volumes of both are substantially the same or the difference between the volumes is not within the predetermined range, the volume of body fluid may decrease sharply. The rapid increase causes problems in managing the patient's condition. In the case of a patient undergoing treatment in an intensive care unit or the like, it is necessary to strictly control the body fluid balance.
【０００５】これまでの血液透析ろ過治療における、透
析液容量、血液中から除去されたろ液容量、補液容量の
管理は、一つの方法として、透析液ポンプおよび補液ポ
ンプの流量設定値をそのまま実際の流量値と同一である
とみなして採用し、血液中から除去されたろ液容量はろ
過器を通過した透析液と血液中から除去されたろ液容量
の合計値である廃液容量をメスシリンダで計量し、廃液
容量から透析液容量を差し引くことで算出していた。こ
の場合、透析液ポンプや廃液ポンプは通常ローラーポン
プが採用されるが、チューブ径にばらつきがあったり、
送液時のチューブ内圧力変化でチューブ形状が変形した
りしてチューブ断面積が変動するため、ポンプ設定値と
実際量とに差が生じ、一般にその誤差は±５％〜±１５
％程度ある。また、使用する回路個々で誤差の程度に違
いがある。特に、廃液ポンプの場合は圧力変化の影響が
最も大きい。即ち、血液浄化器は治療の経過に伴って、
徐々に血栓や体液中の蛋白などが付着し、ろ過抵抗が次
第に増加する。廃液ポンプが一定回転数で回転している
と、ろ過抵抗の増大に伴い血液浄化器のろ過側の圧力が
低下し、これによりチューブの変形（断面積の減少）を
生じて流量が減少する。このことは治療現場ではよく知
られていることであり、実際には、廃液をメスシリンダ
等の計量容器に受け、逐次容量測定して、廃液量を一定
に保つように、廃液ポンプの回転数の調整を行ってい
る。しかし、メスシリンダによる測定精度は高くなく、
また、測定者が測定し忘れて、ろ液がメスシリンダをオ
ーバーフローするなどの測定ミスがおこることもある。In the conventional hemodiafiltration treatment, the volume of dialysate, the volume of filtrate removed from the blood, and the volume of replacement fluid are managed as one method by directly setting the flow rate set values of the dialysate pump and the replacement fluid pump as they are. The volume of filtrate removed from the blood is the sum of the volume of dialysate that has passed through the filter and the volume of filtrate removed from the blood, and the volume of waste fluid is measured with a graduated cylinder. It was calculated by subtracting the dialysate volume from the waste fluid volume. In this case, a roller pump is usually used for the dialysate pump and the waste fluid pump, but there are variations in the tube diameter,
Since the tube shape is deformed due to the pressure change in the tube during liquid transfer and the tube cross-sectional area changes, there is a difference between the pump setting value and the actual amount, and the error is generally ± 5% to ± 15.
There is about%. In addition, the degree of error differs depending on the circuit used. Especially, in the case of the waste liquid pump, the influence of the pressure change is the largest. That is, the blood purifier is
The blood clots and proteins in body fluids gradually adhere, and the filtration resistance gradually increases. When the waste liquid pump is rotating at a constant number of revolutions, the pressure on the filtration side of the blood purifier decreases as the filtration resistance increases, which causes deformation of the tube (decrease in cross-sectional area) and reduces the flow rate. This is well known in the field of treatment, and in reality, the waste liquid is received in a measuring container such as a graduated cylinder, the volume is sequentially measured, and the rotation speed of the waste liquid pump is kept to keep the waste liquid amount constant. Is being adjusted. However, the measuring accuracy with the graduated cylinder is not high,
In addition, the measurement person may forget to perform the measurement and a measurement error may occur such that the filtrate overflows the graduated cylinder.
【０００６】補液ポンプとしてはローラーポンプやフィ
ンガーポンプが使用される。フィンガーポンプは一般に
誤差を防ぐための専用のチューブを使用することで、ロ
ーラーポンプよりは精度は高いといわれているが、実際
はローラーポンプと同様に誤差が±５％〜±１０％程度
に及ぶこともある。従って、廃液ポンプと補液ポンプに
よる相対的な誤差は最大２０％に及ぶこともありうるの
で、長時間にわたる持続的血液浄化療法は蓄積してくる
液誤差量がかなり大きくなり患者体液量が予定以上に増
加したり、減少したりすることがあり、これにより患者
の状態に悪影響を与える。それを回避するためには、施
術者による十分な状態監視が必要となり、施術者への負
担が大きくなる。A roller pump or a finger pump is used as the replacement fluid pump. Finger pumps are generally said to be more accurate than roller pumps by using a dedicated tube to prevent errors, but in reality, error ranges from ± 5% to ± 10%, similar to roller pumps. There is also. Therefore, since the relative error between the waste fluid pump and the replacement fluid pump can reach up to 20%, the amount of accumulated fluid error becomes considerably large in continuous blood purification therapy for a long time, and the patient's body fluid volume is higher than expected. Can increase or decrease over time, which adversely affects the patient's condition. In order to avoid this, it is necessary for the practitioner to sufficiently monitor the condition, which increases the burden on the practitioner.
【０００７】もう一つの方法として、透析液と補液の合
計重量と廃液重量を一致させることで体液重量が変化し
ないようにする重量管理法が採られる場合があるが、全
体としては体液を一定にバランスさせることができるも
のの、透析液と補液のそれぞれが実際どれほど供給され
たかを逐次的に精確に把握することができず、補液中の
有効成分がどの程度患者体内に補充されたかが明らかに
ならないという問題がある。As another method, there is a case where a weight management method is adopted in which the weight of the body fluid does not change by making the total weight of the dialysate and the replacement fluid equal to the weight of the waste fluid, but the body fluid is kept constant as a whole. Although it can be balanced, it is not possible to sequentially and accurately grasp how much each of the dialysate and the replacement fluid was actually supplied, and it is not clear how much the active ingredient in the replacement fluid has been supplemented into the patient's body. There's a problem.
【０００８】いずれにせよ、従来の技術では、持続的血
液浄化療法において透析液、補液、廃液の流量管理は大
変であり、これに監視員が常にはりついていなければ、
患者に対して大きい変動をきたし、折角の持続的血液浄
化療法の特長を発揮できないばかりか、かえって患者を
重篤な状態にしてしまうおそれもあった。したがって、
信頼できる流量調整即ち本療法を行うに当たって、予め
設定した設定流量値に実際の流量が近づくように信頼度
高く自動的に調節する装置の出現が待望されていたので
ある。In any case, in the conventional technique, it is difficult to control the flow rates of the dialysate, the replacement fluid, and the waste fluid in the continuous blood purification therapy, and if the observer is not always clinging to this,
There was a great fluctuation in the patient, and not only the features of continuous blood purification therapy that could not be achieved at all could be exerted, but also the patient could be put in a serious condition. Therefore,
In carrying out reliable flow rate adjustment, that is, the present therapy, the advent of a device for highly reliable automatic adjustment so that the actual flow rate approaches a preset set flow rate value has been desired.
【０００９】[0009]
【課題を解決するための手段】本発明者らは、上記のよ
うに緩徐に体液調整を行う血液透析ろ過療法において、
それぞれ測定すべき３つの液容量（透析液容量、補液容
量、廃液容量）を自動的に精確に測定、制御する手段に
ついて鋭意研究した結果、血液透析と血液ろ過を同時に
並行して緩徐に行い体液調整を行うための機構をこれま
での常識を越えて高精度化することを見いだし、本願発
明にを成すに至った。[Means for Solving the Problems] In the hemodiafiltration treatment in which the body fluid is slowly adjusted as described above,
As a result of diligent research on means for automatically and accurately measuring and controlling the three fluid volumes (dialysis fluid volume, replacement fluid volume, and waste fluid volume) to be measured, hemodialysis and hemofiltration are performed simultaneously in parallel and slowly. The inventors have found that the mechanism for adjustment is highly accurate beyond the conventional wisdom, and has completed the present invention.
【００１０】即ち、本発明は、患者の静脈あるいは動脈
より血液を導出し、血液を浄化後患者の静脈に返血する
持続的血液浄化装置において、上記の静（動）脈−静脈
間の血液体外循環回路内に血液浄化器（血液透析ろ過
器）を配するようにし、血液透析と血液ろ過を同時に並
行して行える機能を備え、このために装置内に透析液タ
ンクより透析液を上記血液浄化器に導く回路とその回路
内に透析液を移送する透析液ポンプとを具備しており、
かつ血液ろ過後に体液を補充するための補液タンクより
前記血液体外循環回路の一部に補液を導入する回路とそ
の回路内に補液を移送する補液ポンプとを具備し、血液
浄化（透析およびろ過）を行った廃液を排出するための
回路とその回路内に廃液ポンプの３種のポンプを具備し
た装置であることを特徴とする持続的血液浄化用装置で
あって、該各ポンプはそれぞれ独立に機能し、透析液流
量、補液流量、廃液流量を個別に独立して間欠的に実測
する容積計量手段を備え、得られた実測値と設定値が合
致するように対応する各ポンプの回転数を調節できるよ
うにしたことを特徴とする持続的血液浄化用装置であ
る。また、上記各透析液ポンプ、補液ポンプ、廃液ポン
プの移送能力がそれぞれ100 〜2,000ml/時間、50〜1,00
0ml/時間、75〜3,000ml/時間を備えている持続的血液浄
化装置である。さらに、上記各透析液ポンプ、補液ポン
プ、廃液ポンプの各流量誤差が±１％以下である持続的
血液浄化用装置に関する。That is, the present invention provides a continuous blood purification apparatus for deriving blood from a patient's vein or artery, and purifying the blood and returning it to the patient's vein. A blood purifier (hemodialysis filter) is provided in the extracorporeal circulation circuit, and it has a function to perform hemodialysis and hemofiltration simultaneously in parallel. A circuit leading to the purifier and a dialysate pump for transferring the dialysate into the circuit are provided,
A blood purification (dialysis and filtration) is provided with a circuit for introducing a replacement fluid into a part of the extracorporeal circulation circuit from the replacement fluid tank for supplementing body fluid after blood filtration and a replacement fluid pump for transferring the replacement fluid into the circuit. An apparatus for continuous blood purification, characterized in that it is an apparatus equipped with a circuit for discharging the waste liquid that has been subjected to the above step and three kinds of pumps of a waste liquid pump in the circuit, wherein each pump is independent. It is equipped with a volume measuring unit that works independently and intermittently measures the dialysate flow rate, replacement fluid flow rate, and waste fluid flow rate, and adjusts the rotation speed of each pump so that the obtained actual measurement value matches the set value. It is a device for continuous blood purification characterized by being adjustable. In addition, the transfer capacity of each of the above dialysate pumps, replacement fluid pumps, and waste fluid pumps is 100 to 2,000 ml / hour and 50 to 1,00, respectively.
It is a continuous blood purification device with 0 ml / hour and 75-3,000 ml / hour. Further, the present invention relates to a continuous blood purification apparatus in which the flow rate error of each of the dialysate pump, the replacement fluid pump, and the waste fluid pump is ± 1% or less.
【００１１】本装置の計量手段は、一定容量を有する計
量容器を用い、所定時間間隔で液容量を測定することで
精度よく対象とする液の流量を算出するものである。こ
の値が、設定されたポンプの流量値より低い場合はポン
プの回転数を上昇させ、設定値よりも高い場合はポンプ
の回転数を低下させることにより、真の液流量が設定値
に近づくように調整される。通常のローラーポンプの誤
差が±５％〜±１５％程度あるのに対し、この方法によ
り流量調整することで１０時間運転時の流量誤差は±１
％以下に止めることができる。The measuring means of the present apparatus uses a measuring container having a fixed capacity and measures the liquid capacity at predetermined time intervals to accurately calculate the target liquid flow rate. When this value is lower than the set pump flow value, the pump speed is increased, and when it is higher than the set value, the pump speed is decreased so that the true liquid flow rate approaches the set value. Adjusted to. While the error of a normal roller pump is about ± 5% to ± 15%, by adjusting the flow rate by this method, the flow rate error during operation for 10 hours is ± 1%.
You can stop below%.
【００１２】[0012]
【作用】本装置の計量手段は、一定容量を有する計量容
器を用い、所定時間間隔で液容量を測定することで精度
よく対象とする液の液流量を算出するものである。この
値が、設定されたポンプの流量値より低い場合はポンプ
の回転数を上昇させ、設定値よりも高い場合はポンプの
回転数を低下させることにより、真の液流量が設定値に
近づくように調整される。この制御機構を採用すること
によって、緩徐に体液調整を行う血液透析ろ過療法を行
う装置としてはこれまでの常識を越えて高精度化された
装置を提供することができた。The measuring means of this apparatus is to accurately calculate the liquid flow rate of the target liquid by measuring the liquid volume at a predetermined time interval using a measuring container having a fixed volume. When this value is lower than the set pump flow value, the pump speed is increased, and when it is higher than the set value, the pump speed is decreased so that the true liquid flow rate approaches the set value. Adjusted to. By adopting this control mechanism, it was possible to provide a highly accurate device that exceeds conventional wisdom as a device for performing hemodiafiltration treatment that slowly adjusts body fluid.
【００１３】[0013]
【実施例】次に実施例について図面を参照して説明する
と、図１において、患者の状態に応じて採血量、抗凝固
剤注入量を設定し、抗凝固剤はシリンジポンプ１で注入
し、血液ポンプ２で血液浄化器１２を含む血液循環回路
２５内に血液を循環させる。患者の状態に応じて透析液
量および血液浄化器１２でろ過されるろ液量を決定し、
透析液ポンプ５流量および廃液ポンプ３流量を設定す
る。廃液流量は透析液流量とろ液流量の和に相当する。
透析液流量、廃液流量、補液流量が設定値通りに精確に
制御されるため、各ポンプ、各レベルセンサー、各クラ
ンプは以下のように作動する。EXAMPLES Next, examples will be described with reference to the drawings. In FIG. 1, a blood collection amount and an anticoagulant injection amount are set according to a patient's condition, and the anticoagulant is injected by a syringe pump 1, Blood is circulated in blood circulation circuit 25 including blood purifier 12 by blood pump 2. The amount of dialysate and the amount of filtrate filtered by the blood purifier 12 are determined according to the condition of the patient,
The dialysate pump 5 flow rate and the waste fluid pump 3 flow rate are set. The waste liquid flow rate corresponds to the sum of the dialysate flow rate and the filtrate flow rate.
Since the dialysate flow rate, the waste fluid flow rate, and the replacement fluid flow rate are accurately controlled according to the set values, each pump, each level sensor, and each clamp operate as follows.
【００１４】透析液流量;透析液ポンプ５を回転させ、
クランプ１３、１４を開とする。透析液が透析液回路２
６に送液されると同時に透析液容器液面と計量容器内液
面との高低落差により、計量容器６に透析液が流入す
る。液面が上部透析液レベルセンサー９ｃに到達すると
クランプ１３は開、クランプ１４は閉となり、計量容器
内の液は容器内から流出し透析液ポンプ側へ送液され
る。計量容器内の液面が下部透析液レベルセンサー９ｃ
を通過するとクランプ１４は開、クランプ１３は閉と
し、透析液の送液は継続する。所定の時間後、クランプ
１３は開とすると、再び透析液が容器内に流入し、液面
が上部透析液レベルセンサー９ｃを通過するとクランプ
１３は開、クランプ１４は閉とし、容器内から液が流出
する。このような動作が所定時間毎に繰り返される。計
量容器からの液流出に要する時間Ｔ1 は液面が上部の透
析液レベルセンサー９ｃを通過し下部の透析液レベルセ
ンサー９ｂを通過するまでの時間として測定される。透
析液計量容器６はプラスチック成形金型により製作され
誤差が殆どないことが予め確認されているので、一定容
量Ｖ1 であり、透析液ポンプ５を流れる透析液流量Ｌ1
は、 Ｌ1=Ｖ1/Ｔ1 である。この透析液流量Ｌ1 が設定値より低い場合はポ
ンプ５の回転数を上げ、高い場合はポンプ５の回転数を
下げることで設定値により近い流量となるように制御す
る。所定時間が短く、液流出が終わって直ちに再度測定
をおこなう場合はクランプ１３を閉とせずに繰り返すこ
ともできる。Dialysate flow rate; rotating dialysate pump 5,
The clamps 13 and 14 are opened. Dialysate circuit is dialysate circuit 2
Simultaneously with being sent to 6, the dialysate flows into the measuring container 6 due to the height difference between the liquid surface of the dialysate container and the liquid surface in the measuring container. When the liquid level reaches the upper dialysate level sensor 9c, the clamp 13 is opened and the clamp 14 is closed, and the liquid in the measuring container flows out of the container and is sent to the dialysate pump side. The liquid level in the measuring container is the lower dialysate level sensor 9c.
After passing through, the clamp 14 is opened and the clamp 13 is closed, so that the dialysate delivery is continued. After a predetermined time, when the clamp 13 is opened, the dialysate again flows into the container, and when the liquid level passes through the upper dialysate level sensor 9c, the clamp 13 is opened and the clamp 14 is closed, so that the liquid is removed from the container. leak. Such an operation is repeated every predetermined time. The time T 1 required for the liquid to flow out from the measuring container is measured as the time required for the liquid surface to pass through the upper dialysate level sensor 9c and the lower dialysate level sensor 9b. Since the dialysate measuring container 6 is manufactured by a plastic molding die and it has been confirmed in advance that there is almost no error, the dialysate measuring container 6 has a constant volume V 1 and the dialysate flow rate L 1 flowing through the dialysate pump 5.
Is L 1 = V 1 / T 1 . When the dialysate flow rate L 1 is lower than the set value, the rotational speed of the pump 5 is increased, and when it is high, the rotational speed of the pump 5 is decreased to control the flow rate to be closer to the set value. When the predetermined time is short and the measurement is to be performed again immediately after the outflow of the liquid, it is possible to repeat without closing the clamp 13.
【００１５】廃液流量;廃液ポンプ３を回転させ、クラ
ンプ１７を開、クランプ１８を閉とすると廃液が廃液計
量容器８に流入する。液面が下部廃液レベルセンサー１
１ａを通過し、上部廃液レベルセンサー１１ｂに到達す
るとクランプ１７は開、クランプ１８が開となり、廃液
計量容器８内の廃液は高低落差により容器外へ流出す
る。所定の時間後、クランプ１８を閉とすると再び廃液
が計量容器８内に流入し、液面が下部廃液レベルセンサ
ー１１ａを通過し上部廃液レベルセンサー１１ｂに到達
するとクランプ１８が開となり、計量容器内廃液は容器
内から流出する。このような動作が所定時間毎に繰り返
される。計量容器への流入に要する時間Ｔ2 は液面が下
部廃液レベルセンサー１１ａを通過し上部の廃液レベル
センサー１１ｂに到達するまでの時間として測定され
る。計量容器８はプラスチック成形金型により製作され
誤差が殆どないことが予め確認されているので、一定容
量Ｖ2 であり、廃液ポンプ３を流れる廃液流量Ｌ2 は、 Ｌ2=Ｖ2/Ｔ2 である。この流量Ｌ2 が設定値より低い場合は廃液ポン
プ３の回転数を上げ、高い場合は廃液ポンプ３の回転数
を下げることで設定値により近い流量となるように制御
される。Waste liquid flow rate: When the waste liquid pump 3 is rotated to open the clamp 17 and close the clamp 18, the waste liquid flows into the waste liquid measuring container 8. Liquid level is lower waste liquid level sensor 1
After passing through 1a and reaching the upper waste liquid level sensor 11b, the clamp 17 is opened and the clamp 18 is opened, and the waste liquid in the waste liquid measuring container 8 flows out of the container due to the height difference. After a predetermined time, when the clamp 18 is closed, the waste liquid again flows into the measuring container 8, and when the liquid level passes through the lower waste liquid level sensor 11a and reaches the upper waste liquid level sensor 11b, the clamp 18 is opened and the measuring container is closed. Waste liquid flows out from the container. Such an operation is repeated every predetermined time. The time T 2 required to flow into the measuring container is measured as the time required for the liquid surface to pass through the lower waste liquid level sensor 11a and reach the upper waste liquid level sensor 11b. Since it has been confirmed in advance that the measuring container 8 is manufactured by a plastic molding die and has almost no error, the measuring container 8 has a constant volume V 2 , and the waste liquid flow rate L 2 flowing through the waste liquid pump 3 is L 2 = V 2 / T 2. Is. When the flow rate L 2 is lower than the set value, the rotation speed of the waste liquid pump 3 is increased, and when the flow rate L 2 is higher than the set value, the rotation speed of the waste liquid pump 3 is decreased so that the flow rate becomes closer to the set value.
【００１６】補充液流量;補液ポンプ４を回転させ、ク
ランプ１５、１６を開とする。補液がポンプにより補液
回路２８に送液されると同時に補液容器液面と補液計量
容器７内液面との高低落差により、補液計量容器７に補
液が流入する。液面が上部補液レベルセンサー１０ｃに
到達するとクランプ１５は開、クランプ１６は閉とな
り、補液計量容器内の液は容器内から流出し、補液ポン
プ４へ送液される。補液計量容器内の液面が下部補液レ
ベルセンサー１０ｂを通過するとクランプ１６を開、ク
ランプ１５を閉とし、補液の送液は継続する。所定の時
間後、クランプ１５、１６は開となり、再び補液が補液
計量容器７に流入し、液面が上部補液レベルセンサー１
０ｃを通過するとクランプ１５は開、クランプ１６は閉
となり、補液容器内から液が流出する。このような動作
が所定時間毎に繰り返される。補液計量容器７からの補
液流出に要する時間Ｔ3 は液面が上部の補液レベルセン
サー１０ｃを通過し下部の補液レベルセンサー１０ｂを
通過するまでの時間として測定される。補液計量容器７
はプラスチック形金型により製作され誤差が殆どないこ
とが予め確認されているので、一定容量Ｖ3 であり、補
液ポンプ４を流れる補液流量Ｌ3 は、 Ｌ3=Ｖ3/Ｔ3 である。この流量Ｌ3 が設定値より低い場合は補液ポン
プ４の回転数を上げ、高い場合はポンプ４の回転数を下
げることで設定値により近い流量となるように制御され
る。所定時間が短く、液流出が終わってすぐ再び測定を
おこなう場合はクランプ１５を閉とせずに繰り返すこと
ができる。Replenisher flow rate: The replenisher pump 4 is rotated to open the clamps 15 and 16. At the same time that the replacement fluid is sent to the replacement fluid circuit 28 by the pump, the replacement fluid flows into the replacement fluid measuring container 7 due to the difference in height between the liquid surface of the replacement fluid container and the liquid surface in the replacement fluid measuring container 7. When the liquid level reaches the upper replacement fluid level sensor 10c, the clamp 15 is opened and the clamp 16 is closed, and the liquid in the replacement fluid measuring container flows out of the container and is sent to the replacement fluid pump 4. When the liquid level in the replacement fluid measuring container passes through the lower replacement fluid level sensor 10b, the clamp 16 is opened and the clamp 15 is closed, so that the delivery of the replacement fluid is continued. After a predetermined time, the clamps 15 and 16 are opened, the replacement fluid flows into the replacement fluid measuring container 7 again, and the liquid level becomes the upper replacement fluid level sensor 1.
After passing 0c, the clamp 15 is opened and the clamp 16 is closed, so that the liquid flows out from the replacement fluid container. Such an operation is repeated every predetermined time. The time T 3 required for the outflow of the replacement fluid from the replacement fluid measuring container 7 is measured as the time until the liquid surface passes through the replacement fluid level sensor 10c in the upper portion and the replacement fluid level sensor 10b in the lower portion. Replacement fluid measuring container 7
Since it was manufactured by a plastic mold and it was confirmed in advance that there was almost no error, it had a constant volume V 3 , and the replacement fluid flow rate L 3 flowing through the replacement fluid pump 4 was L 3 = V 3 / T 3 . When the flow rate L 3 is lower than the set value, the rotational speed of the replacement fluid pump 4 is increased, and when the flow rate L 3 is high, the rotational speed of the pump 4 is decreased so that the flow rate is controlled to be closer to the set value. When the predetermined time is short and the measurement is performed again immediately after the outflow of the liquid, the clamp 15 can be repeated without closing.
【００１７】所定時間としては、液流量によるが、精度
が十分上がるように1 分〜20分毎に設定され、流量が少
ないときは長めに流量が多いときは短めに設定されるこ
とが好ましい。The predetermined time depends on the liquid flow rate, but is preferably set every 1 to 20 minutes so that the accuracy is sufficiently improved, and is set long when the flow rate is low and short when the flow rate is high.
【００１８】本発明のシステムで実際に透析液ポンプ流
量を500ml/時間、所定時間を3 分毎に設定し、10時間継
続して液 (例えば、上水) を送液したときの積算流量を
電子秤で測定したところ、5013グラムであり、誤差は0.
26 %であった。また、このシステムで、廃液ポンプ流量
を500ml/時間、所定時間を3 分毎に設定し、密閉容器に
入れた液 (上水) を廃液ポンプで吸引排出し、3 時間30
分間に排出された液 (上水) はの積算流量を電子秤で測
定したところ、1756グラムであり、誤差は0.34% であっ
た。なお、密閉容器内の圧力は、吸引開始前の大気圧か
ら、3 時間30分後は-322mmHgまで低下していた。In the system of the present invention, the dialysate pump flow rate is actually set to 500 ml / hour, the predetermined time is set to every 3 minutes, and the accumulated flow rate when a liquid (for example, tap water) is continuously sent for 10 hours is shown. When measured with an electronic scale, it was 5013 grams, and the error was 0.
It was 26%. Also, with this system, the waste liquid pump flow rate is set to 500 ml / hour and the specified time is set every 3 minutes, and the liquid (clean water) contained in the closed container is sucked and discharged by the waste liquid pump,
When the integrated flow rate of the liquid (clean water) discharged per minute was measured by an electronic balance, it was 1756 g, and the error was 0.34%. The pressure inside the sealed container had dropped from atmospheric pressure before the start of suction to -322 mmHg after 3 hours and 30 minutes.
【００１９】さらに、本発明のシステムの効果と比較す
るため、計量容器８を使用せず、従って、計量結果によ
る廃液ポンプ３の回転数制御を行わないようにして、廃
液ポンプ３の流量を500ml/時間に設定し、密閉容器に入
れた液 (例えば、上水) を廃液ポンプ３で吸引排出し
た。この時の3 時間30分間に排出された液 (上水) の積
算流量を電子秤で測定したところ、1433グラムであり、
誤差は-18.1%であった。なお、密閉容器内の圧力は、吸
引開始前の大気圧から、3 時間30分後は-271mmHgまで低
下していた。Further, for comparison with the effect of the system of the present invention, the flow rate of the waste liquid pump 3 is set to 500 ml without using the measuring container 8 and therefore without controlling the rotation speed of the waste liquid pump 3 based on the measurement result. / Hour was set, and the liquid (for example, clean water) contained in the closed container was sucked and discharged by the waste liquid pump 3. At this time, the integrated flow rate of the liquid (clean water) discharged in 3 hours and 30 minutes was measured by an electronic balance, and it was 1433 g.
The error was -18.1%. The pressure inside the closed container was reduced from atmospheric pressure before the start of suction to -271 mmHg after 3 hours and 30 minutes.
【００２０】[0020]
【発明の効果】本発明の持続的血液浄化用装置では、施
術者が設定した透析液流量、補充液流量、廃液流量を独
立した容量計量手段で間欠的に測定し、測定値を各ポン
プ回転数制御に反映させることにより、自動的に高精度
にそれぞれの設定値通りの流量が実現されるので、厳密
な体液バランス管理が必要とされる重篤な患者に対する
持続的血液浄化用装置おいて、これまで常時監視が必要
であった施術者の患者体液バランス管理負担を軽減する
ことができまた、高精度であるため、治療上重大な問題
を引き起こす恐れがない。In the continuous blood purification apparatus of the present invention, the dialysate flow rate, the replenisher flow rate, and the waste fluid flow rate set by the operator are intermittently measured by independent volume measuring means, and the measured values are rotated by each pump. Since the flow rate according to each set value is automatically realized with high precision by reflecting it in the number control, it is a continuous blood purification device for serious patients who need strict body fluid balance management. Since it is possible to reduce the burden on the patient's body fluid balance management of the practitioner, which has always required constant monitoring, and because it is highly accurate, there is no risk of causing serious problems in treatment.
【図１】本発明の代表的なフロー図。FIG. 1 is a representative flow chart of the present invention.
1 シリンジポンプ 2 血液ポンプ 3 廃液ポンプ 4 補液ポンプ 5 透析液ポンプ 6 透析液計量容器 7 補液計量容器 8 廃液計量容器 9a,9b,9c 透析液レベルセンサー 10a,10b,10c 補液レベルセンサー 11a,11b 廃液レベルセンサー 12 血液浄化器 13〜19 クランプ 20〜22 圧力センサー 23 気泡センサー 24 圧力検知用ピロー 25 血液循環回路 26 透析液回路 27 廃液回路 28 補液回路 1 Syringe pump 2 Blood pump 3 Waste fluid pump 4 Replacement fluid pump 5 Dialysate pump 6 Dialysate measuring container 7 Replacement fluid weighing container 8 Waste fluid weighing container 9a, 9b, 9c Dialysate level sensor 10a, 10b, 10c Replacement fluid level sensor 11a, 11b Waste fluid Level sensor 12 Blood purifier 13 to 19 Clamp 20 to 22 Pressure sensor 23 Bubble sensor 24 Pressure detection pillow 25 Blood circulation circuit 26 Dialysate circuit 27 Waste fluid circuit 28 Replacement fluid circuit
Claims (3)
し、血液を浄化後患者の静脈に返血する持続的血液浄化
用装置において、上記の静（動）脈−静脈間の血液体外
循環回路内に血液浄化器（血液透析ろ過器）を配するよ
うにし、血液透析と血液ろ過を同時に並行して行える機
能を備え、このために装置内に透析液タンクより透析液
を上記血液浄化器に導く回路とその回路内に透析液を移
送する透析ポンプとを具備しており、かつ血液ろ過後に
体液を補充するための補液タンクより前記血液体外循環
回路の一部に補液を導入する回路とその回路内に補液を
移送する補液ポンプとを具備し、血液浄化（透析および
ろ過）を行った廃液を排出するための回路とその回路内
に廃液ポンプの３種のポンプを具備した装置であって、
該各ポンプはそれぞれ独立に機能し、透析液流量、補液
流量、廃液流量を個別に独立して間欠的に実測する容積
計量手段を備え、得られた実測値と設定値が合致するよ
うに対応する各ポンプの回転数を調節できるようにした
ことを特徴とする持続的血液浄化用装置。1. A continuous blood purification apparatus for deriving blood from a vein or artery of a patient, and purifying the blood and returning the blood to the vein of the patient. A blood purifier (hemodialysis filter) is installed inside the device, and it has a function to perform hemodialysis and blood filtration simultaneously in parallel. A circuit having a guiding circuit and a dialysis pump for transferring dialysate into the circuit, and a circuit for introducing a replacement fluid from a replacement fluid tank for replenishing body fluid after blood filtration to a part of the extracorporeal blood circulation circuit and its circuit A device comprising a replacement fluid pump for transferring replacement fluid in a circuit, and a circuit for discharging waste fluid that has undergone blood purification (dialysis and filtration), and three types of pumps of a waste fluid pump in the circuit. ,
Each of the pumps functions independently, and is equipped with a volume measuring means for individually and intermittently measuring the dialysate flow rate, the replacement fluid flow rate, and the waste fluid flow rate so that the obtained actual measurement value and the set value match. A device for continuous blood purification, characterized in that the rotation speed of each pump is adjusted.
の移送能力が、それぞれ100 〜2,000ml/時間、50〜1,00
0ml/時間、75〜3,000ml/時間であることを特徴とする請
求項１記載の持続的血液浄化用装置。2. A dialysate pump, a replacement fluid pump, and a waste fluid pump having transfer capacities of 100 to 2,000 ml / hour and 50 to 1,00, respectively.
The continuous blood purification apparatus according to claim 1, which is 0 ml / hour and 75 to 3,000 ml / hour.
の各積算流量誤差が±１％以下である請求項１及び請求
項２いずれか記載の持続的血液浄化用装置。3. The continuous blood purification apparatus according to claim 1, wherein the accumulated flow rate error of the dialysate pump, the replacement fluid pump, and the waste fluid pump is ± 1% or less.
Priority Applications (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| JP00618595A JP3180309B2 (en) | 1995-01-19 | 1995-01-19 | Continuous blood purification device |
| EP96300332A EP0722744A1 (en) | 1995-01-19 | 1996-01-17 | Apparatus for continous blood purification |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| JP00618595A JP3180309B2 (en) | 1995-01-19 | 1995-01-19 | Continuous blood purification device |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| JPH08191889A true JPH08191889A (en) | 1996-07-30 |
| JP3180309B2 JP3180309B2 (en) | 2001-06-25 |
Family
ID=11631505
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| JP00618595A Expired - Lifetime JP3180309B2 (en) | 1995-01-19 | 1995-01-19 | Continuous blood purification device |
Country Status (1)
| Country | Link |
|---|---|
| JP (1) | JP3180309B2 (en) |
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| JP2008246123A (en) * | 2007-03-30 | 2008-10-16 | Jms Co Ltd | Blood circuit |
| US8877063B2 (en) | 2007-03-30 | 2014-11-04 | Jms Co., Ltd. | Blood circuit, blood purification control apparatus, and priming method |
| WO2008120803A1 (en) | 2007-04-02 | 2008-10-09 | Nipro Corporation | Continuous blood purification system provided with syringe pumps |
| JPWO2008120803A1 (en) * | 2007-04-02 | 2010-07-15 | ニプロ株式会社 | Continuous blood purification device with syringe pump |
| WO2011118701A1 (en) * | 2010-03-25 | 2011-09-29 | 日機装株式会社 | Blood purification device |
| JP2011200407A (en) * | 2010-03-25 | 2011-10-13 | Nikkiso Co Ltd | Blood purification device |
| US8945037B2 (en) | 2010-03-25 | 2015-02-03 | Nikkiso Company Limited | Blood purification apparatus |
| JP2012115612A (en) * | 2010-12-03 | 2012-06-21 | Ｊｕｎｋｅｎ Ｍｅｄｉｃａｌ株式会社 | Measuring container with air accumulating bag |
Also Published As
| Publication number | Publication date |
|---|---|
| JP3180309B2 (en) | 2001-06-25 |
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