JPH11221275A - Blood treating device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To enable blood treatment for each patient suitable as time elapses by setting a prescribed blood index range against a blood index value of a patient obtained by a blood measuring means and instructing a change of the blood treating condition to a working part corresponding to the transition of blood index value as time elapses in the blood index range. SOLUTION: Blood data obtained by a blood measuring means 1 are converted to blood index values and stored and accumulated in a control unit 2. The position and the transition of the blood index value in the blood index range are confirmed in the control unit 2 to select a corresponding dialysis condition. The selected dialysis condition is transmitted to a bed side console 3 to monitor and control the blood dialysis to give instructions to each device 4 of the working part to execute the blood dialysis treatment. Blood parameters measured by the blood measuring means are not specially limited if a dialysis state is grasped by the measurement, and light transmittance, an amount of electrolyte, blood osmotic pressure, etc., are named as the parameters.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a blood processing apparatus, and more particularly to a blood processing apparatus, which monitors excessive changes in hematological parameters while monitoring changes over time in hematological parameters in order to prevent excessive water removal or reverse water removal that tends to occur during hemodialysis. So you can stay in blood
The present invention relates to a hemodialysis apparatus for controlling dialysis conditions.

[0002]

BACKGROUND OF THE INVENTION For the treatment of patients with impaired renal function,
Conventionally, a treatment for purifying blood by dialysis / filtration through a semipermeable membrane has been performed. In this device, it is important to properly maintain the amount of blood circulating in the patient's body in order to perform safe and effective blood purification. Abrupt or excessive fluid removal can excessively reduce the patient's circulating blood volume, thereby causing blood pressure drop, shock and the like. However, on the contrary, if the removal of water is slow, it takes a long time to purify the blood, and if the removal of water is not sufficient, there is a risk of causing high blood pressure, heart failure and the like.

[0003] Therefore, a hemodialysis apparatus has been developed which removes water while monitoring the blood condition of a patient. For example, Japanese Patent Publication No. 6-83723 describes an estimator for estimating a body fluid state using a hematocrit meter, and a control device for controlling a blood pump and an ultra-pressure by an output of the estimator. This device is convenient because the water removal is directly controlled by the measured body fluid state, but on the other hand, because the water removal is directly controlled by the measured value, the measurement means is inaccurate or causes abnormalities. And it will be a big problem. Therefore, in such feedback control, it is common to provide a line independent of the control line and attach a safety mechanism to the line. However, providing an independent line or a safety mechanism complicates the device and makes the operation cumbersome. In addition, the cost of the device increases.

Therefore, a simple device as described in Japanese Patent Application Laid-Open No. 9-149935 has been devised. In other words, while monitoring the patient's blood condition, sound an alarm depending on the condition,
The dewatering pump is stopped. But,
This device only recognizes whether or not the water removal control is being performed under the control conditions at the start of dialysis by comparing it with the blood concentration measured before the start of dialysis. If the water removal is not performed as required, the worker must adjust the water removal and replacement fluid each time. So while safe,
It was troublesome and burdensome to humans. Furthermore, since the above-mentioned device is provided with a means for measuring the blood condition in the venous fluid side line of the blood circuit, the blood condition after passing through the blood processor (dialyzer) is measured, and the patient's direct blood condition is measured. May not reflect blood status.

[0005]

SUMMARY OF THE INVENTION Accordingly, an object of the present invention is to provide a blood processing apparatus which solves the above-mentioned problems. That is, an object of the present invention is to provide a blood processing apparatus capable of performing blood processing adapted to each patient with time while monitoring the blood condition of each patient. It is another object of the present invention to provide a device which can perform blood treatment suitable for a patient, while reducing the burden on a worker when using the device. Another object of the present invention is to provide an apparatus that is easy to use and inexpensive by making the blood processing apparatus simpler.

[0006]

According to the present invention, there is provided a blood measuring means for measuring a blood parameter, a working part for performing blood processing, and a control for controlling the working part so as to perform blood processing under predetermined blood processing conditions. In the hemodialysis apparatus comprising a part, a predetermined blood index area is set for the blood index value of the patient obtained from the blood measurement means, and the transition of the blood index value over time in the blood index area is set. Correspondingly, the above problem has been solved by a blood processing apparatus characterized in that the control unit instructs the working unit to change the blood processing conditions. A blood measuring device for measuring blood parameters; a working unit for performing a hemodialysis process; and a control unit for controlling the hemodialysis process on the working unit, wherein the blood measuring device A predetermined blood index change area is set for the blood index change obtained from the control section, and the control section instructs the working section to perform the blood processing in accordance with the transition of the blood index change rate over time in the blood index change area. By a blood processing apparatus characterized by instructing a change in conditions,
The above problem has been solved. The blood processing apparatus of the present invention is particularly useful when used as a hemodialysis apparatus. This hemodialysis machine has a working unit for performing hemodialysis treatment on a patient,
Predetermined blood processing conditions (operating conditions when performing blood processing; in the case of performing hemodialysis, for example, a water removal rate, a blood flow rate, that is, an extracorporeal circulation blood flow rate, a replacement fluid rate, a dialysate concentration, a dialysate temperature, This includes the patient's posture during dialysis, the sodium infusion rate, etc. Hereinafter, the hemodialysis condition is referred to as dialysis conditions.), A control unit that controls the working unit to perform hemodialysis processing, and measures the patient's blood parameters. And a blood measuring means for converting the blood parameter into an appropriate blood index value and transmitting it to the control unit. The working part is a part for performing a substantial operation of hemodialysis, for example, a hemodialyzer, a blood circuit for communicating the hemodialyzer with the patient, and a blood circuit mounted on the blood circuit for sending blood of the patient. A pump, a dialysate circuit for communicating a dialysate supply source and a hemodialyzer, a water removal pump attached to the dialysate circuit and removing water from a patient's blood, etc. correspond to this.

The control section is a section that controls the working section to perform hemodialysis under predetermined conditions, and has several important functions. The first function is to set various dialysis conditions and processing / operations, and the second is to use data (blood parameters) obtained from the blood measuring means to set appropriate blood index values or the appropriate blood index values so as to be easy to use in the control unit. Converting to a change value, and selecting an appropriate preset dialysis condition based on the blood data, and thirdly, instructing the selected dialysis condition and processing / operation to the working unit, It is to control. First, the control unit selects a dialysis condition according to each patient, blood index region, dialysis time (time), etc., so that the water removal rate, blood flow rate, replacement fluid rate,
Dialysis conditions such as dialysate concentration and dialysate temperature are set in advance. In this case, these various conditions may be set to operate independently, or may be set to operate in combination with a plurality of dialysis conditions.

[0008] In the control unit, not only dialysis conditions,
With respect to the data indicating the blood condition of the patient obtained from the blood measuring means, it is possible to set an area that is classified according to the measured value and time. That is, an appropriate blood index region can be set in advance for each patient, and if necessary, the blood index region is set according to the hemodialysis time (meaning the time from the start to the end of dialysis). can do.
The area separated by the hemodialysis time is defined as a time area. Then, an appropriate dialysis condition is selected according to the transition (shift) of the blood index region of the blood index value over time of the patient. That is, depending on which blood index region the blood index value is in,
An appropriate dialysis condition set by the control unit is selected, and the selected dialysis condition and processing / operation are transmitted to the working unit. In addition, by separating the region by the dialysis time, the dialysis state at that time can be detected, and the dialysis condition according to the time can be selected.

In addition to the blood index value described above, the control unit can calculate a blood index change per unit time based on the blood index value of the patient over time obtained by the blood measuring means. May be. For example, FIG.
Circulating blood volume index in (b) (hereinafter also referred to as BV)
Is an example of the blood index change rate. Then, the control unit can not only control the dialysis condition based on the blood index value itself, but also control the dialysis condition based on the blood index change rate. The method of changing the dialysis condition based on the change of the blood index is basically the same as that based on the blood index value. An appropriate blood index change area is set in advance for each patient, and dialysis conditions and changes thereof are instructed by the position and transition of the blood index change value over time of the patient in the blood index change area. By adopting the blood index change rate instead of the blood index value itself, the direction of change in the blood state (that is, whether the blood index value is increasing or decreasing) can be confirmed, and more quickly. Control of hemodialysis can be achieved. As a specific example of the control unit, the above function can be achieved by a patient monitoring device (hereinafter, referred to as a console) provided with a computer, a personal dialysis device, or the like.

[0010] The blood measuring means is a device for measuring various blood parameters such as light transmittance and osmotic pressure of blood, and converts the measured parameters into blood index values which can estimate the blood condition of the patient. As an appropriate blood index value, a hematocrit value (shows the volume ratio of red blood cells in whole blood.
Ht value) and circulating blood volume index (index values for checking the state of circulating blood volume in each patient. Hereinafter, Blood Volume is also referred to as BV).
Etc. The change in BV is represented by the following equation.

[0011]

(Equation 1)

Next, a simple example will be described as to how the hemodialysis adapted to the blood condition of the patient is performed by measuring the blood parameters of the patient. FIG.
The curve (a) shows a change over time in the circulating blood volume index (BV), which is a blood index value of a patient. The BV or hematocrit value is obtained by converting the light transmittance of the patient's blood. In FIG. 8A, the X axis represents the dialysis time, and the Y axis represents the BV of the patient. FIG. 8B shows a time-dependent drive / stop of a water removal pump (also referred to as a UFR pump) which affects the water removal rate, which is one of the dialysis conditions, and FIG. 7 shows a temporal change in the speed of the blood pump affecting the time. The straight line drawn parallel to the X axis in the diagram of FIG. 8A is a BV defined in advance for this patient. In this manner, two circulating blood volume index regions (BV regions) having the prescribed BV as a boundary are set.

FIG. 8 shows a flow chart from the blood measuring means to the control unit.
The BV over time of the patient as shown in (a) is transmitted. Then, when the patient BV shifts between the two preset BV regions, as shown in FIGS. 8B and 8C, the driving / stopping of the water removal pump and the feeding speed of the blood pump are performed. Change is started. That is, when hemodialysis is started, water is removed from the patient's body, so that the patient's BV
Gradually decreases. Then, when the BV falls below a preset value (lower region) for each patient, the water removal pump is stopped, and the speed of the blood pump is reduced to reduce the water removal speed. When the water removal rate decreases in this manner, the BV of the patient, which has gradually decreased, starts to increase. When the BV becomes equal to or more than the set value (upper region),
The reduced water removal rate is returned to the original state. As described above, by measuring the blood parameter (light transmittance) of the patient, the water removal rate, which is one of the dialysis conditions, can be changed.

In the above example, hemodialysis is controlled by the blood index value BV itself.
Hemodialysis can also be controlled by the blood index change rate. This case is also basically the same as that based on the blood index value. That is, as shown in FIG.
A BV change region defined for each patient is set in advance.
Then, as shown in FIG.
The BV change rate (blood index change rate) represented by the slope of V (blood index value) is located in a set BV change area, and the BV change rate shifts from the BV change area to the dialysis. The user is instructed to select or change conditions. When controlling hemodialysis by the blood index change rate, it is convenient because the tendency of the blood condition can be confirmed depending on whether the patient's blood index change rate is positive or negative, and the dialysis conditions can be adjusted based on it. .

[0015]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS Various embodiments of the present invention will be described below according to their constituent requirements. First, regarding the blood measuring means, the blood parameters measured by the blood measuring means are not particularly limited as long as the dialysis state can be grasped by the measurement. Examples of parameters to be measured include light transmittance, electrolytic mass, and blood osmotic pressure. In order to select dialysis conditions, the measured parameters must be converted into appropriate blood index values, and the index values include the aforementioned Ht value and BV.

Next, the control section will be described. Here, as an example of the control unit, a configuration in which the configuration is divided into two according to functions is described below. That is, it sets various dialysis conditions and processing / operations, converts the data from the main control unit having the function of instructing and controlling the actual operation unit, and the data from the blood measurement means,
Two auxiliary control units (hereinafter, referred to as control units) having a function of selecting an appropriate dialysis condition set in advance based on the auxiliary control unit. The control unit is constituted by, for example, a computer with a display. In setting the blood index region, a predetermined blood index value for each patient is set in the control unit. Then, a plurality of separated blood index regions are set according to the prescribed blood index value.

As shown in FIG. 1, the classification of the blood index region is not limited to two, but if the index region is divided into five or more as shown in FIG. The changed dialysis conditions can be changed. FIG. 3A shows the transition of the patient BV over time in the five BV regions, and FIG. 3B shows the water removal rate changed corresponding to the BV. In the example shown in FIG. 3, a water removal rate is assigned to each of the separated blood index regions. In this case, when the patient's blood index value shifts to a different region, an instruction is issued to select the dialysis condition assigned to that region. Further, in addition to separating the blood index region into a plurality of regions, the hemodialysis time may be separated at predetermined time intervals to form a plurality of regions for each blood index value at each time. In this way, by performing classification based on both the hemodialysis time and the blood index value, a more detailed region can be set. For example,
In the example as shown in FIG. 7A, as many as 16 regions are formed at predetermined time intervals and separated into predetermined blood index ranges. Then, dialysis conditions (water removal rates) are assigned to the 16 areas, respectively.

Next, a setting mode of the blood index change area will be described. In this case, basically, similarly to the setting of the blood index value, the control unit sets a predetermined blood index change rate for each patient. Thereby, as shown in FIG. 4A, a plurality of separated blood index change areas are set. The control unit issues an instruction to the main control unit to change the dialysis conditions when the blood index change rate of the patient shifts to a different area. Also, when controlling hemodialysis based on the blood index change rate, the hemodialysis time may be separated not only from the blood index change region into a plurality of regions but also from a preset time. For example, the rate of change of the blood index in each of the early, middle and late stages of dialysis can be used to control dialysis conditions. Also, according to the dialysis time, set the prescribed blood index change rate as a critical value, issue an alarm when the patient's blood index change rate exceeds this critical value, stop the water removal pump, etc. Instruct dialysis conditions to be changed.

Further, the change in the dialysis condition is not synchronized with the transition (transition) of the blood index value, and the delay time (T
It is desirable to set so that the dialysis condition is changed after the elapse of (time). For example, as shown in FIG. 1, when the patient's blood index value shifts to a different blood index region, a change in dialysis conditions is instructed after a predetermined delay time, or dialysis under the changed conditions is started. You do it. Then, chattering of the pump can be prevented, and by providing this delay time, the blood index value of the patient can be kept constant within a desired range. Alternatively, instead of the delay time, a prescribed allowable range is set for a blood index value such as a hematocrit value or a BV value, and a change in dialysis conditions is not immediately instructed by a change in the blood index value. The instruction may be made when the value exceeds the allowable range.

Further, as shown in FIG. 4B, in order to eliminate the influence of unstable blood index changes after the start of dialysis, a predetermined time after the start of dialysis (hereinafter also referred to as lag time) Even if the blood index value or the blood index change rate of the patient is transmitted from the blood measurement means to the control unit, it is ignored. That is, the dialysis conditions are not changed in the control unit during the lag time. The above delay time setting and lag time setting may be performed by the control unit,
It may be performed by the main control unit. Alternatively, the blood measuring means may have this function.

As described above, the function of the control unit of this embodiment is mainly to convert the blood index value into a blood index change rate based on the blood index value, to set the blood index area and the blood index change area, An appropriate dialysis condition is selected by shifting to each region having a different blood index value or blood index change rate. However, as will be described later, there is no particular reason why the main control unit and the control unit, and furthermore, the two and the blood measurement means must be divided, and the functions of the above-mentioned constituent elements are important in the present invention. It doesn't mean anything. Therefore, whether each of the functions of the control unit is provided in the main control unit or in the control unit may be selected depending on the time and the case so as to be easy to use.

Next, the manner of setting and changing dialysis conditions in the main control unit will be described. Dialysis conditions that can be set include water removal rate, blood flow rate, replacement fluid rate, dialysate concentration, dialysate temperature,
It is the patient's posture during dialysis, the sodium infusion speed, and the like, and any one of them may be used, or a plurality of them may be set. Since the water removal speed is mainly affected by the ultrafiltration pressure, the speed of the water removal pump (driving / stopping), and the speed of the blood pump, the above devices are controlled so as to have an appropriate water removal speed. Conditions other than the water removal rate are also important factors in performing hemodialysis, and the dialysate temperature is changed or adjusted based on the water removal rate described above. The patient's posture during dialysis is adjusted by monitoring the patient's symptoms by changing the patient's posture during dialysis in the bed. The sodium injection selectively injects only sodium to maintain ion balance inside and outside the cell. The change of the dialysis condition of the patient may be performed in accordance with the dialysis condition (water removal rate) set in advance for each blood index (BV) region as shown in FIGS.
As shown in, when the blood index value or the blood index change rate of the patient shifts to a different zone, a predetermined change amount (Δ
The dialysis condition may be changed by adjusting only R).

As described above, the transition (transition) of the blood index value may not be synchronized with the change of the dialysis condition in the main control unit. As shown in FIG. 8, immediately after the set BV is reached, when the water removal pump starts to be driven,
The BV value drops again with the start of water removal. Then, the pump that has started to drive will stop again. If the on / off operation is repeated in such a short time, the pump may chatter, which is not preferable. Further, by providing the delay time as described above, the blood index value of the patient can be kept constant within a desired range. Alternatively, as described above, a prescribed allowable range may be set for a blood index value such as a hematocrit value or a BV value instead of the delay time. In this case, the change of the dialysis condition is not immediately instructed by the transition of the blood index value, but is instructed only when the blood index value exceeds the allowable range.

In the above-described embodiment, in order to make the present invention as embodied as possible, each function and setting are set to separate constituent requirements (actual operation unit, control unit: main control unit and auxiliary control unit, blood measurement means). Although described separately, it is not an important feature of the present invention. In particular, it is not necessary that the parts other than the working part are substantially separate, and it is not impossible that the control part and the blood measuring means are formed as an integrated device. What is important in the present invention is a system for controlling blood processing under conditions adapted to each patient by measuring blood parameters of the patient, and a blood processing apparatus operated by the system. Further, in the present invention, various variations can be obtained by replacing or combining the embodiments having the respective configuration requirements of the above-described example with the embodiments having the other configuration requirements. Then, in the embodiment of the present invention, the replacement or change of the non-characteristic part can be freely performed without departing from the gist of the present invention.

[0025]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS Various embodiments of the present invention will be specifically described below with reference to the drawings. FIG. 9 is a block diagram showing the configuration of the hemodialysis apparatus of the present invention. The blood data obtained by the blood measuring means 1 is converted into a blood index value,
Recorded and stored in the unit 2. After the position and transition (transition) of the blood index value in the blood index area are confirmed in the control unit, the dialysis condition to be adapted is selected. Dialysis conditions selected in the control unit
Bedside console 3 for monitoring and controlling hemodialysis
Is transmitted to The dialysis conditions and the like transmitted to the console 3 are respectively instructed and executed by each device 4 of the working unit that performs the hemodialysis process.

The curve in FIG. 5 (a) shows a change over time in the circulating blood volume index (BV), which is a blood index value of a patient. The X-axis in FIG. 1 (a) represents the dialysis time and the Y-axis represents the patient's BV. FIG. 5 (b) shows the driving / stopping of the water removing pump over time, and FIG. 5 (c) shows the temporal change of the blood pump speed. A straight line drawn in the center of FIG. 5A in parallel with the X axis is a BV defined in advance for this patient.
, And two BV regions are set with this as a boundary. As shown in FIG. 5A, the BV of the patient over time decreases with the elapse of the hemodialysis time, and the set BV
With the transition of the area, the water removal pump is stopped, the blood pump is decelerated, and the water removal speed is reduced.

At the same time, the rehydration device starts to operate,
The replacement fluid is injected into the patient, and a process is performed to increase the patient's reduced BV. In this case, it is not necessary to stop the water removal pump or to reduce the speed of the blood pump by replacing the fluid, so that efficient hemodialysis can be performed. It is also convenient when performing HDF (hemofiltration dialysis) in addition to the above. In addition, this rehydration fluid is also useful when urgent replenishment of blood circulation is required, such as when a patient experiences dehydration. FIG. 6 is the same as FIG. 5 except that the fluid replacement pump is driven and stopped in FIG. 5D by changing the fluid replacement speed as shown in FIG. 6D, so that finer control of hemodialysis can be performed. In order to restore the reduced water removal rate at this time, it is preferable to provide a delay time of T time (without immediately increasing the water removal rate) when the patient BV moves to the upper region.
Alternatively, as described above, instead of the delay time, a predetermined allowable range is set for a blood index value such as a hematocrit value or a BV value, and a change in the dialysis condition is not immediately instructed by a change in the blood index value. May be instructed when the blood index value exceeds the allowable range. The blood index value to be set and the allowable range thereof are not particularly limited. However, if the hematocrit value is Δ0.25, Δ0.50, Δ1.
It is preferable to set an allowable range of 00 (Δ indicates a change),
For the BV value, it is preferable to set an appropriate allowable range between 1% and 5%. For example, Δ0.25 in hematocrit value
When the blood index value (hematocrit value or BV value) moves to a predetermined value or area when the allowable range is set, the change of the hemodialysis condition is not immediately instructed, but the blood index value is further changed. Only when the value moves and exceeds the allowable range of change (Δ0.25), is it instructed to change the dialysis conditions.

FIGS. 2 and 3 show four or five BV regions in advance.
The patient BV is different from the patient BV.
When shifting to the V region, a change in the water removal speed is instructed. However, the method for changing the water removal speed is different between FIG. 2 and FIG. 3, and in FIG. 2, the water removal speed at the time of the change (during operation) is adjusted by a specified change amount (ΔR). FIG.
(A) shows the transition of the patient BV with time in the BV region classified into four, and FIG. 2 (b) shows the water removal rate changed by adjusting (ΔR) corresponding to the BV. Is shown. At this time, whether to reduce or add ΔR depends on the direction of transition between regions. That is, it is determined whether the transition of the patient's BV is decreasing (transition from zone A to zone B) or increasing (transition from zone B to zone A) (?). Further, a predetermined critical value may be set in the BV region, and when the patient BV value exceeds the critical value, a warning is issued and the water removal may be stopped. In this example, the Ht value during the dialysis is H
The water removal rate is set to be equal to or less than the water removal rate at the start of dialysis so as not to become larger than the t value (to prevent the patient BV from decreasing). In FIG. 3, a predetermined water removal rate is set in each area, and when the patient's BV shifts to a predetermined area, a change is instructed so that the water removal rate is set to that area. .

FIG. 4 shows an example in which the water removal rate is controlled by the BV change rate of the patient. FIG. 4A shows the BV
The BV change area classified into a plurality of areas by the change and the patient BV change rate located in each area are shown. FIG. 4 (b) shows the patient BV
Over time and the BV change rate (slope extrapolated to the curve in the figure) at each time. FIG. 4C shows the water removal speed changed according to the BV change rate. First, a BV change area is set in advance with a BV change rate specified for each patient. In FIG. 4A, when the BV change rate is decreasing, that is, when the BV change rate is negative, E, F, G, and H are shown, and the decreasing rate increases in that order. Conversely, the BV change value tends to increase,
That is, in the positive case, D, C, B, and A, and the increasing rate increases in that order. In this case, the trigger for changing the water removal speed is not the BV value of the patient itself but the BV change rate of the patient. This is obtained by dividing the BV change amount by the time required for the change.
It is indicated by the slope of the V curve from time to time.

As shown in FIG. 4 (b), a predetermined water removal rate is set depending on which BV change region (FIG. 4 (a)) the BV change rate is located in advance. Also,
By shifting to the BV change region where the patient's BV change rate is different, an instruction to change the water removal rate is issued. As shown in FIG. 4, the BV change rate of the patient gradually decreases as the dialysis time passes. Then, FIG.
4B, the BV change rate (slope e) of the patient who was initially in the BV change area (E) becomes (slope f) and shifts to the area (F). As shown in FIG. 4 (c), in that region, the water removal rate is reduced by a specified amount of change (ΔR), and an attempt is made to suppress the decrease in the patient BV change rate. However, the BV change rate of the patient further increases (decreases g) to the change rate (G). Then, as shown in FIG.
Since the V change rate (slope g) exceeded the critical value (slope g ') set in the change area (G), an alarm was activated and water removal was stopped. Then, after a while, the patient's BV change value (slope c) recovers and tends to increase, so that the water removal is restarted at a speed reduced by ΔR from the water removal speed before the stop. If the rate of increase in the BV change rate increases, the water removal rate is increased by ΔR to shift the change area from (slope c) to (slope d). As described above, by controlling hemodialysis with the blood index change rate, the BV value can be quickly changed.

The control system shown in FIG. 7 is a combination of the one shown in FIG. 3 and the one shown in FIG. FIG. 7A shows a blood index region classified into 16 according to time and BV (blood index value), and a water removal rate assigned to each of the 16 regions. FIG. 7B shows a threshold value set in each time domain and an allowable range divided according to the threshold value. FIG. 7C shows the change over time of the patient BV change rate. FIG. 7D shows the water removal rate changed in accordance with the patient BV change rate. First, the blood index region is divided into four by BV. And then dialysis time (time)
Then, as shown in FIG. 7A,
It is divided into a total of 16 areas. Then, a water removal rate adapted to each area is set. Basically, the change of the water removal speed is performed when the patient BV moves between the regions. Then, a BV change rate (slope) within a prescribed range is set for the four divided dialysis times, and the water removal rate is changed even when the patient BV change rate exceeds its critical value. The result is a double fail safe. In this case, the critical values of the upper limit and the lower limit corresponding to each patient are set at each time, and when the rate of change of the patient BV exceeds the range, an alarm sounds and the water removal speed is adjusted by a specified change amount. You may make it keep it. Alternatively, one of the upper and lower critical values may be set only when necessary.

[0032]

By using the blood processing apparatus of the present invention, it becomes possible to perform blood processing suitable for each patient over time. That is, while monitoring the blood condition of the patient, it is possible to make appropriate changes in the blood processing conditions according to the situation. In addition, since the blood processing conditions suitable for the patient are automatically changed, the burden on the medical staff is reduced. Furthermore, since the device of the present invention has a simple configuration, it can be easily introduced into a facility, and the cost of the device body can be reduced.

[Brief description of the drawings]

FIG. 1 is a diagram conceptually illustrating a system for controlling dialysis conditions according to a blood index value of a patient in one embodiment of the present invention.

FIG. 2 is a diagram conceptually showing a system as described above in another embodiment of the present invention.

FIG. 3 is a diagram conceptually showing a system as described above in another embodiment of the present invention.

FIG. 4 is a diagram conceptually showing a system for controlling dialysis conditions according to a change rate of a blood index of a patient in another embodiment of the present invention.

FIG. 5 is a diagram conceptually illustrating a system for controlling dialysis conditions according to a blood index value of a patient in another embodiment of the present invention.

FIG. 6 is a diagram conceptually showing a system as described above in another embodiment of the present invention.

FIG. 7 is a diagram conceptually showing a system as described above in another embodiment of the present invention.

FIG. 8 is a diagram conceptually showing a system as described above in another embodiment of the present invention.

FIG. 9 is a block diagram showing a configuration of a hemodialysis apparatus according to one embodiment of the present invention.

[Explanation of symbols]

 1. Blood measurement device 2. Control unit 3. Console 4. Each device of the working part

Claims (30)

[Claims] 1. A hemodialysis apparatus comprising: a blood measuring means for measuring a blood parameter; a working unit for performing blood processing; and a control unit for controlling the working unit to perform blood processing under predetermined blood processing conditions. A blood index value of a patient obtained from the blood measuring means is set to a predetermined blood index region, and the control unit is activated by a real-time operating unit in accordance with the transition of the blood index value over time in the blood index region. A blood processing apparatus for instructing a blood processing condition to be changed. 2. The blood processing apparatus according to claim 1, wherein the blood parameter is light transmittance. 3. The blood processing apparatus according to claim 1, wherein the blood index is a hematocrit value. 4. The blood processing apparatus according to claim 1, wherein the blood index is a circulating blood volume index. 5. The blood processing apparatus according to claim 1, wherein the blood index area is divided into a plurality of areas by a blood index value. 6. The blood processing apparatus according to claim 4, wherein the blood processing time is divided into a plurality of regions in advance for each time, and the blood index region is set in each time region. 7. The blood processing time is classified into a plurality of regions in advance for each time, and the blood index region is set in each time region, and a prescribed blood index value is set in each of the time regions. 6. The blood processing apparatus according to claim 4, wherein the blood processing apparatus is set as a critical value, and instructs to change blood processing conditions even when the blood index value of the patient exceeds the critical value. 8. The blood processing conditions include water removal rate, blood flow rate, fluid replacement rate, dialysate concentration, temperature, patient posture during dialysis,
The blood processing apparatus according to any one of claims 1 to 7, wherein the blood processing apparatus is any one of sodium injection rates. 9. The blood processing conditions include water removal rate, blood flow rate, replacement fluid rate, dialysate concentration, temperature, patient posture during dialysis,
The blood processing apparatus according to any one of claims 1 to 7, wherein the plurality is a plurality arbitrarily selected from sodium injection rates. 10. The blood processing apparatus according to claim 1, wherein the change of the blood processing condition is performed according to a blood processing condition preset for each blood index region. 11. The blood processing apparatus according to claim 1, wherein the change of the blood processing condition is started when the blood index value of the patient shifts to a blood index area having a different value. 12. The blood processing condition according to claim 1, wherein the change of the blood processing condition is performed by adding or subtracting a predetermined amount of change in the blood processing condition to the operating blood processing condition. A blood processing apparatus according to claim 1. 13. A prescribed blood index change rate is set as a critical value for each time domain, and an instruction to change blood processing conditions is given even when a patient's blood index change exceeds this critical value. The blood processing apparatus according to claim 6. 14. The method according to claim 1, wherein the change of the blood processing condition is not immediately instructed by the transition of the blood index value, but is performed after a predetermined delay time has elapsed. Blood processing equipment. 15. The method according to claim 1, wherein the change of the blood processing condition is not immediately instructed by the transition of the blood index value, but is performed when the blood index value exceeds a predetermined allowable blood index value. A blood processing apparatus according to any of the above items. 16. A hemodialysis apparatus comprising: a blood measuring means for measuring a blood parameter; a working unit for performing a hemodialysis process; and a control unit for controlling the hemodialysis process for the working unit. Set a predetermined blood index change area for the blood index change obtained from the blood measurement means,
A blood processing apparatus, wherein a control unit instructs a working unit to change blood processing conditions in response to a change in the blood index change rate over time in the blood index change area. 17. The blood processing apparatus according to claim 16, wherein the blood parameter is light transmittance. 18. The blood processing apparatus according to claim 16, wherein the blood index change is a hematocrit value change. 19. The blood processing apparatus according to claim 16, wherein the blood index change is a circulating blood volume index change. 20. The blood processing apparatus according to claim 16, wherein the blood index change area is divided into a plurality of areas by the blood index change. 21. The blood processing apparatus according to claim 19, wherein the blood processing time is classified into a plurality of regions in advance, and the blood index change region is set for each time region. 22. The blood processing time is classified into a plurality of regions for each time in advance, and the blood index change regions are set in the respective time regions, and the prescribed blood index change is set in each of the time regions. 21. The blood processing apparatus according to claim 19, wherein the rate is set as a critical value, and a change in blood processing conditions is instructed even when the blood index change rate of the patient exceeds the critical value. 23. The blood processing condition according to claim 16, wherein the blood treatment condition is any one of a water removal rate, a blood flow rate, a replacement fluid rate, a dialysate concentration, a temperature, a patient posture during dialysis, and a sodium infusion rate.
23. The blood processing apparatus according to any one of items 22. 24. The plurality of blood treatment conditions arbitrarily selected from a water removal rate, a blood flow rate, a replacement fluid rate, a dialysate concentration, a temperature, a patient posture during dialysis, and a sodium infusion rate. 23. The blood processing apparatus according to any one of Items 22 to 22. 25. The blood processing apparatus according to claim 16, wherein the blood processing condition is changed in accordance with a blood processing condition preset for each blood index change area. 26. The blood processing apparatus according to claim 16, wherein the change of the blood processing condition is started when the blood index change rate of the patient shifts to a blood index change area having a different rate. 27. The blood processing condition according to claim 16, wherein the blood processing condition is changed by adding or subtracting a predetermined amount of change to the blood processing condition during operation. A blood processing apparatus according to claim 1. 28. The change of the blood processing condition is not immediately instructed by the change of the blood index change rate, but is performed after a predetermined delay time has elapsed.
The blood processing apparatus according to any one of Items 6 to 27. 29. The method according to claim 16, wherein the change of the blood processing condition is not immediately instructed by the change of the blood index change rate, but is performed when a blood index value exceeds a predetermined allowable range. The blood processing apparatus according to any one of the above items. 30. During a predetermined lag time from the start of blood processing, the patient's blood index value or the blood index change rate transmitted from the blood measuring means is not used for changing the blood processing conditions. Item 30. The blood processing apparatus according to any one of Items 1 to 29.