JPS58143763A - External recirculation apparatus of blood - Google Patents

Abstract

(57) [Summary] This bulletin contains application data before electronic filing, so abstract data is not recorded.

Description

DETAILED DESCRIPTION OF THE INVENTION The present invention provides an extracorporeal blood circulation device for refreshing and constantly circulating the blood of a patient on behalf of the patient's lungs and heart during lung and heart surgeries. Regarding.

An extracorporeal blood circulation device consists of a blood removal line that draws the patient's venous blood, an oxygenator installed in this blood removal line, a storage tank for the removed blood, and a blood removal tank that sends the blood from this storage tank to the patient's artery. It consists of a blood supply line and a blood supply pump as an artificial heart installed in the blood supply line. The most important thing in this device is to adjust the balance between the amount of blood removed from the patient's body and the amount of blood sent into the patient's body, and to always maintain a constant amount of blood circulating in the patient's body. In controlling the amount of blood circulating in the body, bleeding at the surgical site and other sites must also be taken into consideration. This is because when bleeding occurs, the amount of blood in the patient's body decreases. In conventional extracorporeal circulation devices, the amount of blood circulating in the body is controlled by the operator manually driving the blood removal pump, driving the blood pump, and replenishing the blood reservoir with commercial blood. was. In this control, there are a large number of operation items, and each item [1] is controlled by the ever-changing patient's condition.
In other words, it is necessary to make an immediate decision and make a quick decision while looking at the measured values of arterial and venous blood pressure, bleeding trowel, etc., the blood layer in the reservoir, and the electrocardiogram, so all 1 for this purpose is necessary. . Furthermore, if the surgery lasts a long time, the fatigue of the operator increases.

An object of the present invention is to automatically adjust the amount of blood to be delivered in an extracorporeal blood circulation device so as to maintain a patient's arterial pressure within an appropriate required range.
The purpose is to dynamically control the amount of blood removed so as to keep the venous pressure of the patient constant, thereby keeping the amount of blood circulating in the patient's body almost constant.

Another object of the present invention is to smoothly and automatically transition from spontaneous circulation of blood by the force of the patient's heart to forced circulation of blood by an extracorporeal circulation device, or vice versa.

Furthermore, it is an object of the present invention to provide an extracorporeal circulation device that can be
The aim is to assist the circulation of blood within the body, and to prevent the circulation of surface fluids within the body from being interrupted even if the heart temporarily stops.

The extracorporeal blood circulation device according to the present invention includes a blood removal tank, an artificial lung provided in the blood removal line, a storage tank for the removed blood,
A blood supply line that sends out blood from this storage tank, a blood supply pump as an artificial heart installed in the blood supply line, a venous pressure detection means for detecting that venous pressure exceeds a predetermined upper limit level, and an artery. a blood pressure transducer for measuring blood pressure, a blood withdrawal control means for increasing blood withdrawal when the venous pressure exceeds an upper limit level, and a blood withdrawal control means for increasing blood withdrawal when the venous pressure exceeds an upper limit level; It is characterized by being comprised of five stages that control the blood pump that is held within the range. Therefore, the amount of blood delivered can be automatically controlled to maintain the patient's arterial pressure within an appropriate required range, and the amount of blood removed can be automatically controlled to maintain the patient's venous pressure approximately constant. As a result, the amount of circulation within the patient's body can be maintained approximately constant.

Further, in the extracorporeal blood circulation device according to the present invention,
The blood pump is a pulsatile pump, and the blood pump control means is a means for detecting contraction of the patient's heart during spontaneous circulation and generating a trigger pulse, and a trigger according to a set heart rate during forced circulation. - Consists of a circuit that generates a pulse, means for selecting either one of the above-mentioned trigger pulses, and a drive device that drives a pulsatile pump using the selected trigger pulse. Therefore, the transition from spontaneous circulation of blood by the force of the patient's heart to forced circulation of blood by the extracorporeal circulation device, or vice versa, can be smoothly and automatically performed, and in turn, the blood circulation by the force of the patient's heart can be smoothly and automatically transferred. During the internal circulation of
The extracorporeal circulation device assists the circulation of blood within the body, and even if the heart temporarily stops, it is possible to prevent the circulation of blood within the body from being interrupted.

Embodiments of the present invention will be described in detail below with reference to the drawings.

In FIG. 1, the blood extracorporeal circulation device includes blood removal line 1.
, an overflow line 2, an aspiration line 3, and a blood delivery line 4.

Specifically, these lines 1 to 4 are all constructed from flexible tubes. Lines 1 to 3 contain 0
- Tali pumps 11 to 13 are provided respectively.

A rotary pump has a roller that moves in a circular motion, and the roller squeezes the tube to suck in blood and pump it out, thereby creating a continuous flow of blood. A pulsating pump 14 is provided in the line 4 . This pulsating pump is operated by intermittently supplied compressed air and intermittently pumps blood into line 4, creating a pulsating blood flow. Any type of pulsating pump other than one operated by compressed air can be used.

The blood removal line 1 draws venous blood from the patient's body, and two cannulas 15 are connected to one end of the line. As shown in FIG. 3, the cannula 15 includes an outer tube 16 having a slightly tapered tip, and an inner tube whose tip protrudes from the tip of the outer tube 16 and whose rear end is guided outside the outer tube 16. It is composed of a tube 17. A large number of holes 18 are bored at the tip of the outer tube 16. The rear end of this outer tube 16 is connected to the line 1.

The distal end of the cannula 15 is inserted into a patient's vein, respectively, and the venous surface is drawn out through the hole 18 and the outer tube 16 into the line 1. The line 1 is provided with an oxygen supplier and a heat exchanger 6. i! The raw material supply device is
An artificial lung that removes carbon dioxide from and oxygenates venous blood drawn from the patient's body.

The heat exchanger maintains the blood at the desired concentration and lowers the temperature if necessary. The blood thus refreshed is sent to the blood reservoir 7 and stored therein. The heat exchanger may be provided in the blood supply line 4 between the storage tank 7 and the pump 14, or may be provided before the pump in the blood supply line 4.

In the middle of the blood removal line 1, between a diversion line 5 and a cannula 15, which will be described later, there is a retractable bag 9 for inspecting whether the membrane surface is being cleaned smoothly. . When the drained blood flows smoothly through the line 1, the bag 9 is filled with blood and the bag 9 is swollen. If somewhere between the cannula 15 of the line 1 and the bag 9 is collapsed, or if blood is not drawn from the patient's body for some reason, the bag 9 will no longer be supplied with blood. Since the pump 11 is constantly operating and sucking blood from the line 1, the blood in the bag 9 runs out and the bag 9 deflates. A sensor 27 is provided to detect the state of the bag 9, that is, whether the bag 9 is inflated or deflated. The detection signal of the sensor 27 is sent to the Ill m device 40, which issues an alarm when the bag 9 deflates, and the blood removal line 1
An abnormality occurs in 1. :The caster will be notified. If necessary, the blood pump 14 is activated when an abnormality occurs in the blood removal line 1.
The operation may be stopped. However, in this embodiment, an overflow line 2 is provided in parallel with the blood removal line 1, and even if the blood removal line 1 is clogged, blood is removed through the overflow line 2. There is no need to stop 14.

The bottom of the blood reservoir 7 and the inlet port of the pump 11 in the line 1 are connected by a diversion line 5, and this line 5 is provided with a solenoid valve 32. This solenoid valve 32
The solenoid valve 33, which will be described later, is a pinch valve.

When the valve is open, blood in the reservoir 7 is drawn through the blood line 5 by the pump 11 and returned to the reservoir 7 via the oxygenator and heat exchanger 6.

Since most of the blood drawn and pumped by the pump 11 is supplied via the line 5, when the solenoid valve 32 is open, the amount of venous blood removed from the patient's body is small. Or O. In some cases, there is no problem even if some blood flows back toward the patient. Solenoid valve 32
When the cannula 15 is closed, blood is no longer supplied from the line 5, so all the suction force from the pump 11 is transferred to the cannula 15.
This increases the amount of venous blood removed from the patient.

The overflow line 2 is provided with a central venous pressure adjustment mechanism 20. Central venous pressure (hereinafter referred to as CVP) is the average pressure of the aortic artery pressure and the inferior venous pressure, and is obtained from the inner tube 17 of the pair of cannula 15. CV
The PIII mechanism 20 includes a support member 23 whose vertical position is freely adjustable.
and two vertical tubes 21 provided on this support member 23.
It is composed of 22. One vertical tube 21 is connected at its lower end to the inner tubes 17 of both cannulas 15, and the lower end of the other vertical tube 22 is connected to the inlet of the pump 12. The vertical pipe 210 [end is connected to the upper part of the vertical pipe 22 by a horizontal pipe, and the upper end of the vertical pipe 22 extends above this communication part and is open to the atmosphere.

At a position slightly below the communication part of the vertical pipe 22, there is an A-bar.
A sensor 24 is arranged to detect blood at 70-. This sensor 24, the above-mentioned sensor 27, and the below-mentioned sensors 25 and 26 are all photoelectric detectors, and it is preferable that infrared rays are used as the projection light. of course,
Other sensors such as those utilizing ultrasound or capacitance may also be used.

As described above, the tip of the inner tube 17 of the cannula 15 is
Since it is inserted into the superior vena cava, venous blood from both veins flows into both internal tubes 17 and merges, so that the blood pressures of both veins are averaged. Venous blood rises in the vertical tube 21 in accordance with this mean blood pressure or CVP. The top surface of the blood in the vertical tube 21 represents the CvP. The height from the patient's heart to the top of vertical tube 21 defines the upper level of CVP. If CVP is above this upper level, blood in vertical tube 21 will overflow into vertical tube 22 and this will be detected by sensor 24. The overflowing blood is sucked by the pump 12 and sent to the storage tank 7.

By adjusting the position of the support member 23, CVP
The upper limit level can be set to any value.

The suction line 3 is for suctioning blood that has bled at the surgical site of the patient, and this blood is sent to the storage tank 7 by the pump 13. In FIG. 1, the blood in lines 2 and 3 is sent directly to the storage tank 7, but if necessary, it can be supplied to the oxygenator and heat exchanger 6 and refreshed before the blood is sent to the storage tank 7.
You may also send it to

One end of the blood supply line 4 is connected to the bottom of the blood reservoir 7, and the other end is inserted into the patient's ascending aorta via a cannula. The refreshed blood stored in the reservoir 7 is pumped through a pulsatile pump 14, which is an artificial heart.
is delivered through line 4 into the patient's aorta. Since the blood flowing through line 4 is pulsating, it is similar to arterial blood pumped from the heart and has a physiologically beneficial effect on the patient. A storage tank 8 for storing blood for transfusion is arranged above the blood storage tank 7, and the bottom thereof is connected to a tube 3.
7 to the upper part of the storage tank 7. tube 3
7 is provided with a solenoid valve 33. The sensor 25 detects when the blood in the blood reservoir 7 is running low, and the sensor 26 detects when the reservoir 7 is filled with blood to the upper limit level. As shown later, when the sensor 25 detects that the blood in the storage tank 7 is low, the electromagnetic valve 33 is opened and blood is supplied from the storage tank 8. When the storage tank 7 is filled with blood and its upper limit level is detected by the sensor 26, the electromagnetic valve 33 is closed and the blood supply is stopped. Blood in reservoir 8 may be supplied to reservoir 7 through oxygenator and heat exchanger 6 -0
Alternatively, the storage tank 8 may be connected to the suction line 3. Storage tank 7
Ringer's solution and other solutions or drugs necessary for the patient during surgery are mixed into the blood. It is preferable to provide an artificial kidney (path shown) for straining out these components from the blood when the blood in the storage tank 7 becomes diluted with these solutions and its volume becomes too large.

Compressed air for driving the pulsating pump 14 is supplied through line 34 from a source of compressed air. this line 3
4 includes a pressure regulator 36, a tank 35, and a solenoid valve 31.
is provided.

The solenoid valve 31 is controlled to open and close intermittently, as will be shown later.

Control t11Hlf40 controls solenoid valves 31, 32 and 33. 111vA device 40 includes sensors 24.25.
．． Detection signals of 26 and 27, output signals of blood pressure transducers 41 and 42 that detect the patient's venous blood pressure and arterial blood pressure (hereinafter referred to as VP and AP, respectively), respectively, and the output of the electrocardiograph 43 that measures the patient's electrocardiogram. signal as well as the output pulses of the centroid frequency generator 44.

Blood pressure transducers 41 and 42 measure blood pressure in the vena cava and aorta, respectively. If necessary, the blood pressures of the superior and vena cava may be measured, and the average value of these blood pressures may be taken as VP (which becomes CVP).

A detailed configuration of the control device 40 is shown in FIG. The signal representing the AP of the blood transducer 42 and the signal of the electrocardiograph 43 are transmitted to a monitor 4 equipped with a cathode ray tube (CRT).
5, and the AP waveform and electrocardiogram are displayed on the CRT. When a patient's heart is working, blood is circulated through the body by the force of the heart's contractions. This white liquor circulation is called spontaneous circulation. On the other hand, the intracorporeal circulation of blood by the extracorporeal circulation apparatus according to the present invention, particularly the pulsating pump 14, is forced circulation. Also during spontaneous circulation of blood, the pump 14
A strong control ring is possible. This is because assistance from the pump 14 is required when transitioning from spontaneous circulation to forced circulation, and conversely from forced circulation to spontaneous circulation, and this assistance facilitates the above transition. be. The AP signal of the blood pressure transducer 42 and the output signal of the electrocardiograph 43 are used as triggers for activation of the pump 14 during spontaneous circulation. The trigger generation circuit 46 generates a trigger pulse at the timing when the AP signal waveform reaches its peak.

The trigger generation circuit (47) generates a trigger pulse at the timing of the rise of the R wave in the electrocardiographic signal. The operator looks at the AP waveform and electrocardiogram displayed on the monitor 45 and selects one of the two types of trigger pulses described above.
The selection can be made using the selection switch 48. The selected tri-pulse is determined by the AND circuit 54 and the timer 5.
Sent to 1.

The centroid frequency generator 44 generates a trigger pulse at a frequency set by its setter 44a for forced circulation. The centering temperature can be arbitrarily set using the setting device 44a. The trigger pulse from generator 44 is sent to AN[) circuit 55. switch 49
is for setting forced circulation. When forced circulation is set by this switch 49, the high level (hereinafter referred to as H
A signal (referred to as level) is sent to the OR circuit 52.

During the transition from spontaneous circulation to forced circulation or vice versa, the patient's heart may not contract periodically and may stop temporarily. In the case of spontaneous circulation, if the heart does not work, blood will not circulate within the body, so it is necessary to temporarily switch to forced circulation. Timer 51 is reset by a trigger pulse from generation circuit 46 or 47;
If it is not reset again even after a certain period of time, for example, 2 seconds, after being reset, an H level signal is generated. This H level signal is input to the OR circuit 52.

If forced circulation is set by the switch 49 or if the patient's heart does not contract repeatedly even after 2 seconds, the output of the OR circuit 52 becomes H level.

This H level signal is input to the AND circuit 55, so
The trigger pulse from the central frequency generator 44 passes through an AND circuit 55 and then an OR circuit 56 to a delay circuit 57.
sent to. The H level output of the OR circuit 52 is inverted by the NOT circuit, becomes a low level (hereinafter referred to as L level), and is input to the AND circuit 54.

Therefore, AND circuit 54 inhibits the passage of the trigger pulse from switch 48. When forced circulation is not set and the patient's heart is repeatedly contracting at a cycle of 2 seconds or less, the output of the OR circuit 52 is at L level,
The output of NOT circuit 53 becomes H level. In this case, the trigger pulse from generation circuit 46 or 47 is
After passing through the D circuit 54 and the OR circuit 56, the delay circuit 5
Enter 7. The AND circuit 55 prohibits the passage of the trigger pulse of the generator 44.

The delay circuit 57 delays the input pulse for a certain period of time. This is important during spontaneous circulation. In the case of spontaneous circulation, since the blood supply by the pump 14 assists the blood supply by the patient's heart, it is necessary to synchronize these two types of blood supply. It is preferable that the pump 14 performs the blood supply with a slight delay from the patient's heart supplying blood to the arterial surface. A delay circuit 57, called a counter pulsation, defines this delay time. Preferably, the delay time of circuit 57 is determined to depend on the contraction cycle of the patient's heart. For example, the time obtained by multiplying the last measured contraction cycle or the average value of a plurality of past cycles by an appropriate percentage is adopted as the delay time. Of course, the measurement of the contraction period and the calculation of the delay time can be performed automatically by a control circuit (not shown). The percentage to be multiplied is variable and can be set to any value.

Pulse width setting circuit 58 shapes the pulse width of the delayed trigger pulse to resemble the contraction time of the heart. A control pulse output from this circuit 58 is sent to the solenoid valve 31 via AND circuits 59 and 60, and opens the solenoid valve 31. When the electromagnetic valve 31 is opened, compressed air is supplied to the pump 14, so that the pump 14 contracts and blood is delivered. Therefore, circuit 5
The width of the output pulse of 8 determines the contraction time of the pump 14. Preferably, this contraction time corresponds to the contraction time of the heart.

The pulse width is also calculated based on the heart's contraction cycle. In the case of forced circulation, the delay time of circuit 57 and the pulse width of circuit 58 are preferably determined according to the frequency set in generator 44.

The AP is also used to control the start and stop of operation of the pulsating pump 14. The AP signal of the blood pressure transducer 42 is input to a peak hold circuit 61 and an average value calculation circuit 62. If the patient's heart is working,
and when pump 14 is activated, the patient's arterial surface is pulsating. Therefore, the waveform of the AP signal is pulse-like. The peak hold circuit 61 holds the peak value of this pulsed AP signal, which corresponds to the #l^ pressure plane of the arterial blood pressure, and outputs 4. This systolic blood pressure signal is input to an upper limit detection circuit 63 and a lower limit detection circuit 64.

The upper limit detection circuit 63 detects the upper limit of the systolic blood pressure (for example, 1
5011H! 2> is set, and when the input systolic blood pressure exceeds this upper limit value, an H level signal is output. The lower limit detection circuit 64 is set with a lower limit value of the systolic blood pressure (for example, 101001IH), and outputs an H level signal when the input systolic blood pressure signal becomes less than this lower limit value. Upper limit value and lower limit value is variable.

The signal from the upper limit detection circuit 63 is sent to a set input terminal of a flip-flop 69 via an OR circuit 67. The detection signal of the lower limit detection circuit 64 is sent to the reset input terminal of a flip-flop 69 via an OR circuit 68. Flip-flop 69 is initial reset. When the flip 70 knob 69 is reset, its inverted output is ), and the control pulse of the circuit 58 is then passed through the AND circuit 59 to the solenoid valve 31. When the flip 70 knob 69 is hit, its inverted output goes to the L level, so the passage of the control pulse is prohibited.

Therefore, when the #l high value of AP exceeds the upper limit value, the pulsating pump 14 stops operating, and when it falls below the lower limit value, the pump 14 starts operating. The highest value of AP is always maintained at the level of the circle between the upper limit value and the lower limit value. If necessary, set up a timer that starts when the maximum 1# of the AP exceeds the limit value.
If the maximum number of candies does not fall below the lower limit value, the operation of the pump 14 may be started by resetting the 7 lip 70 knob 69 using the output of the timer. This prevents the patient's life from being put in danger due to blood not being pumped into the patient's body.

No peaks appear in the AP signal when pump 14 is inactive. Further, if the pump for delivery is not a pulsatile pump but a rotary pump, blood is continuously pumped into the patient's artery, so no peak appears in the AP signal. In order to cope with such a case, an average value calculation circuit 62 is provided. The peak hold circuit 61 has a function of outputting a peak no signal when a pulse is not used for a predetermined period of time in the AP signal, and this signal is sent to the arithmetic circuit 62. The arithmetic circuit 62 operates when this peak no-signal is input, and calculates and outputs the average value of the AP signal at fixed time intervals. This average value is sent to upper and lower limit detection circuits 65 and 66, respectively. Upper and lower limit values are set for these detection circuits 65 and 66, respectively, and when the average value signal exceeds the upper limit value or becomes 1 step below the lower limit value, an I ” level detection signal is output. These detection signals are input to the flip-flop 69 in the same manner as in the above case.

The detection signal (1-level) of the sensor 24 of the CVP adjustment mechanism 20 is waveform-shaped by a waveform shaping circuit 73 and inputted to a set input terminal of a flip-flop 74 . VPPH4° of the blood pressure transducer 41 is input to the average value calculation circuit 71, where the average value is calculated at regular intervals,
This average value signal is input to the lower limit detection circuit 72. A lower limit value of venous blood pressure is set in this circuit 72, and VP
When the average value of
A level detection signal is output, which is input to the reset input terminal of the flip 70 knob 74. Flip-flops 7 and 4 are initially reset. When the flip-flop 74 is reset, its inverted output signal is at H level, and the solenoid valve 32 is opened by this H level signal. When the flip-flop 74 is set by the overflow detection signal of the sensor 24, its inverted output goes to L level and the solenoid valve 32 closes. As a result, the amount of blood removed by the pump 11 increases as described above. In this way, when CVP exceeds the upper limit level (for example, 10 to 20 mIIHg) due to blood congestion in the patient's body, the solenoid valve 32 closes, and the average value of V'P decreases to the lower limit level (for example, several mIIHg).
Since the solenoid valve 32 opens when the temperature drops below 1lHO), the CVP
always remains approximately constant.

The blood H" transducer 41 and the circuits 71 and 72 are not necessarily required, and the solenoid valve 32 may be controlled only by the detection signal of the sensor 24. In this case, the solenoid valve 32 is always open, The electromagnetic valve 32 is closed only while the sensor 24 detects an overflow.Even with this method, the CVP can be kept almost constant by setting the upper limit level of the CVP to an appropriate value. I can do it.

Detection signals from sensors 1125 and 26 are input to valve control circuit 81 . This control circuit 81 controls the electromagnetic valve until an i=limit level detection signal is input from the sensor 26 when the system 25 detects that the white liquid in the storage tank 7 has fallen below the required level. Outputs an H level signal that opens 33. This H level signal passes through the NOT circuit 82 and is
It is also sent to circuit 60. Therefore, when it is detected that the white liquid in the storage tank 7 is low, the control pulse from the circuit 58 does not pass through the AND circuit 60 and the pump 14
stops working.

This prevents air from entering the patient's artery. However, if the detection level by the sensor 25 is set at a relatively high level, even if a detection signal is generated from the sensor 25, the pump 14 does not necessarily need to be stopped.

4, 5 and 6 show other examples of the CVP:I adjustment mechanism. In FIG. 4, the vertical tube 21 is
It has a portion 21a that extends in the vertical direction beyond the communication portion to the vertical pipe 22, and this extension portion 21a has an upper end that extends to the vertical pipe 22.
It is connected to 2. If the CVP increases rapidly and exceeds its upper level, the extension 218 allows the magnitude of the pressure above the upper level to be measured. The sensor 24 may be provided near the communication portion of the vertical pipe 21.

In FIG. 5, a plurality of pairs of vertical pipes 21A and 22Δ, 2
1B and 22B and 21C and 22G are provided,
The heights of the communicating portions of the vertical pipes 21A to 21C are different from each other. Sensors 24A-2 for detecting blood overflow are provided in each of the other vertical tubes 22A-22C.
4C is provided. -This CVPIm! In the IIK configuration, multiple CvP1111 constant levels can be set. If the opening degree of the solenoid valve 32 is controlled by the detection signals of each sensor 24A to 24C, a more precise C
VP control is achieved. In the configuration of FIG.
A and 22B are provided with solenoid valves 38A and 38B, respectively. These solenoid valves 38A and 38B are normally open and are closed when the corresponding sensors 24A, 24B detect an overflow of blood. Then, when CVP decreases and no longer overflows, it is released again.

In FIG. 6, the overflow line 2 is provided with only a vertical pipe 21, and the upper end of the vertical pipe 21 is open to the atmosphere. A solenoid valve 39 is provided on the pump 12 side of the overflow line 2. The vertical tube 21 is fixed, and the sensor 24 is supported along the vertical tube 21 so as to be movable up and down. The solenoid valve 39 is normally closed, and when the sensor 24 detects blood that has reached that level, the solenoid valve 39 is opened and the blood is sucked out by the line 2, just as in the case of an overflow. Ru. The upper limit level of CvP can be arbitrarily set depending on the height position of the sensor 24.

FIG. 7 shows another example of the blood supply line.

Between the blood storage tank 7 and the pump 14 of the blood supply line, [-1
- A solenoid valve 93 is provided at the tally pump 91 and its outlet. A return path is connected in parallel with the rotary pump 91, and a solenoid valve 92 is also provided here. In forced circulation, both pumps 91.14 are activated, solenoid valve 92 is closed, and solenoid valve 93 is opened.
Blood in reservoir 117 is sucked by pump 91 and pumped out intermittently by pump 14. When the maximum value of AP exceeds the upper limit my, the solenoid valve 92 is opened and the solenoid valve 93 is closed, so that the blood circulates between the return path and the pump (91) and is not sent to the pump 14. At this time, the pump 14 may be operated or stopped. When the maximum value of AP becomes below the lower limit value, solenoid valve 9 is activated again.
2 is closed and solenoid valve 93 is opened.

When the patient's heart is working and spontaneous circulation is occurring,
It is possible to measure the pressure in the left atrium of the heart (hereinafter referred to as LAP). Therefore, it is possible to control the functions of the left heart system and right heart system of the patient's heart so that they work in a well-balanced manner. LAP reflects the function of the left heart system. The function of the right heart system is reflected by CVP. The target value range of LAP (for example, 8 to 15 mmtl) is determined in advance, and CvP is set so that LAP is always kept within this range.
is adjusted.

Referring to FIG. 8, LAP is detected by pressure transducer 101, and the average value of LAP is calculated by average value calculation circuit 102 at predetermined time intervals. The upper limit detection circuit 103 is set with an upper limit value of the target range of L A P (for example, 15+++eHO),
When the output of circuit 102 exceeds this upper limit, circuit 10
3 outputs an upper limit detection signal. Lower limit detection circuit 104
is the lower limit of the LAP target range (e.g. 8111-
1+7) is set, and when LAP becomes less than this lower limit value, a lower limit detection signal is output from the circuit 104. The elevation control device 105 controls the CVP in the CVP adjustment mechanism 20.
This is to raise or lower the upper limit level of. In the cvp* adjustment mechanism 20 in FIG.
The supporting member 23 is raised and lowered. Further, in FIG. 6, the blood sensor 24 is stirred down. When the detected LAP exceeds the upper limit setting value and becomes 0, the upper limit level of CVP is slowly lowered, and when the LAP becomes below the upper limit value, the lowering of the upper limit level of CvP is stopped. Conversely, when the detected LAP becomes below the lower limit, the CVP upper limit level is slowly raised, and when the LAP exceeds the lower limit, the increase in the CVP upper limit level is stopped. As described above, LAP is always kept within a certain range of values.

BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 shows a preferred embodiment of the invention;
FIG. 2 is a block diagram showing the detailed configuration of the control device; FIG. 3 is a sectional view of the cannula; FIG. 4 , FIG. 5 and FIG. 6 are block diagrams showing other examples of the central venous pressure adjustment mechanism, FIG. 7 is a block diagram showing other examples of the blood supply line, and FIG. 8 is a left shoulder pressure adjustment device. This is a block diagram showing the following. 1... Blood removal line, 2... Overflow line, 3... Suction line, 4... Blood supply line, 6...
Oxygen supplier and heat exchanger, 7... Blood storage tank, 11-
13... Rotary pump, 14... Pulsating pump, 15... Cannula, 16... Outer tube, 17...
Inner tube, 18... hole, 20... central venous adjustment mechanism, 2
1.22.21A~21C, 22A~22c... Vertical pipe, 23... Support member, 24.25.26.24A~
24C...Sensor, 31-33...Solenoid valve, 40.
...control device, 41.42.101...blood pressure transducer, 43,...electrocardiograph, 44...heart rate R
generator, 46.47...Trigger generation circuit, 48...Selection switch, 49...Forced circulation setting switch, 51.
...Timer, 57...Delay circuit, 58...Pulse width setting circuit, 61...Peak halt circuit, 62.71
... Average value calculation circuit, 63.65.103 ... Upper limit detection circuit, 64.66.72.104 ... Lower limit detection circuit, 69.74 ... Flip-flop, 73 ... Waveform shaping circuit , 81... valve control circuit, 105...
Lifting control device. Patent applicant Tsunekazu Hino

Claims (14)

[Claims] (1) Blood removal line, an artificial lung installed in the blood removal line, a storage tank for the removed blood, a blood supply line that pumps out the blood from the storage tank, a blood pump installed as an artificial heart in the blood supply line, and a vein. venous pressure upper limit detection means for detecting when the pressure exceeds a predetermined upper limit level; a blood pressure transducer for measuring arterial pressure; An extracorporeal blood circulation device comprising a volume control means and a means for controlling a blood pump to maintain arterial pressure within a predetermined required range based on the output of a surface pressure transducer. (2) The venous pressure upper limit detection means includes a vertical tube whose upper end is open to the atmosphere, and a blood level provided at a required height of this vertical tube to detect when the blood level has reached this height. An extracorporeal blood circulation device according to claim (1), comprising a sensor. (3) The venous pressure upper limit detection means includes two vertical tubes that communicate at their upper ends and can be raised and lowered, and a blood sensor that detects blood overflowing from one vertical tube to the other vertical tube through the communicating portion. The extracorporeal blood circulation apparatus according to claim 1, wherein the upper end of at least one of the vertical tubes is open to the atmosphere. (4) The venous pressure upper limit detection means comprises a blood pressure transducer and an upper limit level detection circuit that detects that the output of the blood pressure transducer exceeds a predetermined upper limit. Extracorporeal circulation of blood as described in item 1) III. (5) Claim No. 3, wherein the venous pressure is central venous pressure.
The extracorporeal blood circulation device according to item 1). (6) The blood pump control means includes an upper limit detection circuit that detects when the arterial pressure exceeds a predetermined upper limit, and a lower limit that detects when the arterial pressure falls below a predetermined lower limit. The extracorporeal blood circulation apparatus according to claim 1, comprising: a detection circuit; and a control circuit that stops the blood pump by detecting the -L limit and operates the blood pump by detecting the lower limit. (7) The extracorporeal blood circulation apparatus according to claim (1), wherein the blood pump is a pulsatile pump. (8) The blood pump is a pulsatile pump, and the blood pump control means detects the contraction of the patient's heart during spontaneous circulation and
The means of generating pulses, the number of birds according to the set point in forced circulation.
A circuit for generating a pulse, means for selecting one of the above trigger pulses,
and a drive device that drives the pulsatile pump using a selected trigger pulse. (9) The claim that the trigger pulse generation means in J3 during spontaneous circulation is a circuit that generates a trigger pulse synchronized with the pulse waveform in the output signal of a blood transducer for measuring arterial pressure. The extracorporeal blood circulation device according to item (8). (10) The means for generating trigger pulses in spontaneous circulation comprises an electrocardiograph and a circuit that generates trigger pulses synchronized with R waves in the output signal of the electrocardiograph. ) The extracorporeal blood circulation device described in item (11) The means for generating trigger pulses in spontaneous circulation includes a circuit that generates a first trigger pulse synchronized with a pulse waveform in an output signal of a blood pressure transducer that measures the artery 11, an electrocardiograph, and an electrocardiogram. Claim 1 comprising: a circuit that generates a second pulse in synchronization with the R wave in the output signal of the meter; and a switch that selects either the first or second pulse. The extracorporeal blood circulation device according to item (8). (12) The trigger pulse selection means is a switch that selects either spontaneous circulation or forced circulation, and detects that the trigger pulse based on spontaneous circulation is not repeated even after a certain period of time has elapsed, and The extracorporeal blood circulation apparatus according to claim (8), comprising: a compensation circuit that outputs a circulation selection signal; and a priority circuit that gives priority to the forced circulation selection of the compensation circuit over the selection by the selection switch. (13) The blood removal amount control means includes a blood removal pump provided in the blood removal line, a diversion line connecting the blood storage tank and the inlet side of the blood removal pump, a normally open valve provided in the separation line, and The extracorporeal blood circulation apparatus according to claim 1, comprising a valve control circuit that closes the valve when venous pressure exceeds an upper limit level. (14) A left atrial pressure control system consisting of a means for detecting the pressure in the atrium A, and a means for changing the upper limit level of the venous pressure upper limit detecting means according to the pressure in the left atrium to maintain the pressure in the left atrium within a predetermined range. Claim No. 1 (1) comprising an adjustment device
) The extracorporeal blood circulation device described in item