JPS59115051A - Blood purifying apparatus - 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 Technical field to which the invention pertains The present invention is directed to a blood purification device, particularly to a blood purification device that effectively achieves blood purification while preventing the occurrence of a drop in blood pressure, an imbalance syndrome, etc. that are often observed in blood purification operations. The present invention relates to an improvement in a blood purification device that appropriately automatically controls the distribution of body fluid within a patient's body and the total amount of body fluid during blood purification.

Prior Art In recent years, in the treatment of patients whose ability to remove waste products or excess water from body fluids is impaired due to renal failure, etc., the blood removed from the body is purified by dialysis or filtration through a bovine permeable membrane. A blood purification device is used that returns the blood to the body.

In order to perform safe and effective blood purification with this type of device, it is important to efficiently remove waste products or excess water accumulated in the body while maintaining the appropriate amount of blood circulating in the patient's body. be.

That is, rapid or excessive water removal can excessively reduce the patient's circulating blood volume, which can lead to complications such as hypotension, shock, or peripheral circulatory insufficiency, whereas slow water removal can reduce blood volume. It is known that purification takes a long time and if sufficient removal is not possible, it can cause high blood pressure, heart failure, etc.

For this reason, the present inventors have already proposed a device for automatically controlling the rate of water removal from a patient in order to maintain the appropriate amount of circulating blood in the body during blood purification in Japanese Patent Application No. 57-37457. 1. Deer 1L 'lx dE et al., it is not possible to efficiently (and safely) remove water accumulated in the patient's body and solutes such as urea, uric acid, creatinine, and electrolytes by controlling the water removal rate alone. In recent years, it has become clear that it is less effective.

In other words, the change (reduction) in the volume of blood circulating in the body due to blood purification is due to the change in body fluid distribution based on the adjustment effect of the effective osmotic pressure difference and the mechanical pressure difference in the body, that is, the change in intracellular and intertissue lJ. The amount of water that passes through the pleura and capillary walls and migrates into the blood vessels (as it may migrate in the opposite direction, the tissue @ll force/transfer into the blood vessels is taken as a positive value), This occurs due to the difference in the amount of water removed from the blood during blood purification outside the body.

At this time, all the solutes accumulated in the body,
□Contains no chain components of the solute for rapid removal;
Alternatively, if a low-concentration dialysate or replacement solution is used, the osmotic pressure of the extracellular fluid decreases, and the movement of water from the inside of the cells to the interstitial fluid and further into the blood vessels is reduced by 1, thereby maintaining the circulating blood volume at an appropriate level. Therefore, the water removal rate must be reduced. On the other hand, if a solution with a high osmotic pressure is used as a dialysate or a replenisher in order to avoid the above-mentioned situation, there is a problem in that solutes that have been made highly concentrated to obtain the high osmotic pressure accumulate in the body.

Therefore, in order to remove water and various solutes in a well-balanced manner without excessively reducing the amount of blood circulating in the patient's body, it is necessary to maintain an appropriate water removal rate and reduce the amount of blood, interstitial fluid, and intracellular fluid in the patient's body. The distribution of body fluids must be maintained appropriately, and for this purpose, it is necessary to maintain an appropriate osmotic pressure of the patient's blood (plasma) during blood purification, that is, the concentration of various solutes in the blood. The concentration of various solutes in this blood changes depending on the concentration of various solutes contained in the dialysate or replacement fluid used for blood purification. It is necessary to appropriately control the concentration of solutes in liquids, etc.

However, the appropriate value of the solute concentration in the dialysate, replacement fluid, etc. varies depending on the osmotic pressure of the desired body fluid and the therapeutic or physiological conditions of each patient. As a result, it was virtually difficult to perform an optimal blood purification procedure for each patient.

Purpose of the Invention The present invention has been made in view of the above-mentioned conventional problems. An object of the present invention is to provide a blood purification device that can stably perform a good old stone removal process while maintaining a patient's body circulating blood at an appropriate level in blood purification. .

Structure of the Invention In order to achieve the above object, the present invention has been provided with a blood circulation system that circulates the blood of an outcast outside the body, a blood purifier installed in the blood circulation system, and a blood purification device that adjusts specie permeation in the blood plasma to circulate the blood of an outcast outside the body. A circulating blood volume adjustment system that adjusts the circulating blood volume to a desired value, a circulating blood volume measuring device that measures changes in the circulating blood volume, and a program for changing the circulating blood volume during blood purification according to the patient's condition. and a control system that controls a circulating blood volume adjustment system based on the circulating blood volume measured during blood purification and a predetermined program, to adjust the circulating blood volume to a desired value. It is characterized by its optimal purification effect while maintaining its properties.

The present invention also provides a blood circulation system that circulates a patient's blood outside the body, a blood purifier installed in the blood circulation system, and an internal circulation system that adjusts plasma osmotic pressure to adjust the amount of blood circulating in the body to a desired value. A blood volume adjustment system, a circulating blood volume meter that measures changes in blood volume circulating in the body, a plasma osmolarity measurement that essentially measures the osmotic pressure of plasma, and internal circulation during blood purification according to the patient's condition. Internal circulating blood volume memory for storing blood volume change programs and plasma osmolarity memo IJk for storing plasma osmolarity set values; internal circulating blood volume and plasma osmolarity measured during blood purification and the programs and set values and a control system that controls the blood volume adjustment system in the body by comparing the total blood volume in the body to maintain the total blood volume in the body at a desired value while performing an optimal purification effect. Furthermore, the present invention controls the blood circulation system that circulates the patient's blood outside the body, the blood purifier installed in the blood circulation system, and the plasma osmotic pressure and water removal rate to maintain the blood volume circulating in the body at a desired value. A circulating blood volume adjustment system that adjusts the amount of blood circulating in the body, a circulating blood volume measuring device that measures changes in the amount of blood circulating in the body, a water removal amount measuring device that measures the amount of water removed, and blood circulating in the body that is being purified depending on the patient's condition. It has an internal circulating blood volume memory that stores a volume change program and a water removal amount memory that stores a water removal amount program, and compares the internal circulating blood volume and water removal amount measured during blood purification with a predetermined program to determine the internal circulating blood volume. and a control system that controls the adjustment system, and is characterized in that it performs optimal purification while maintaining the amount of blood circulating in the body at a desired value.

Furthermore, the present invention fully controls the blood circulation system that circulates the patient's blood outside the body, the blood purifier installed in the blood circulation system, the plasma osmotic pressure and the water removal rate, and adjusts the blood volume circulating in the body to a desired value. A circulating blood volume adjustment system that measures changes in circulating blood volume in the body, a circulating blood volume measuring device that measures changes in circulating blood volume, a plasma osmolarity measuring device that essentially measures the osmotic pressure of plasma, and a water removal amount measuring device that measures the amount of water removed. and a body circulating blood volume memory that stores a program for changing body circulating blood volume during blood purification according to the patient's condition, a plasma osmolarity memory that stores plasma osmolarity, and a water removal amount memory that stores a water removal amount program. and a control system that controls the internal circulating blood volume adjustment system by comparing the internal circulating blood volume, plasma osmotic pressure, and water removal amount measured during blood purification with a predetermined program and set value. The entire feature is to perform optimal purification while maintaining blood volume at a desired value.

Hereinafter, preferred embodiments of the present invention will be described based on the drawings.

First Embodiment FIG. 1 shows the basic configuration of a first embodiment in which the present invention is used for hemodialysis. Control for adjusting the volume of circulating blood in the body according to changes in blood volume circulating in the body detected in the dialysis liquid system 12 that supplies dialysate to the purifier and the blood circulation system 10, and in accordance with the hematocrit value in the embodiment. system 14.

A blood circulation system 10 introduces the patient's blood through a dialyzer 1 through an introduction tube 16.
After the blood is purified by dialysis and ultrafiltration in cooperation with the dialysate system 12, the purified blood is returned to the patient's body from the return tube 2o, and the blood circulation at this time is carried out by the circulation pump 22. It's been done a lot.

In the present invention, a hematocrit measuring device 24 is provided in the blood circulation system 10 in order to perform a safe and efficient waste removal function in the above-described dialysis device, and this continuously measures the electrical resistivity of the blood. The hematocrit is determined, and the plasma osmolarity is adjusted so that the blood volume circulating in the body, which is inversely proportional to the hematocrit, matches the preset program for changing the volume of blood circulating in the body during blood purification according to the patient's condition. It is characterized by performing optimal purification while maintaining the amount of circulating blood in the body at a desired value. In the embodiment of FIG. 1, the plasma osmotic pressure is adjusted by controlling the electrolyte concentration of the dialysate, such as the concentration of sodium chloride.

The dialysate system 12 is provided with a well-known dialysate supply device 26, which supplies dialysate to a dialyzer 18, and a vacuum pump 28 is connected to the discharge side of the dialyzer 18. Therefore, negative pressure is applied to the semipermeable membrane of the dialyzer 18 mainly due to the depressurizing action of the vacuum pump 28, and water in the blood and solutes with a molecular weight of about 10,000 or less are limited to the dialysate side through the semipermeable membrane. Tozawa passed away.

Further, a mixer 30 and a saline injector 32 are provided on the supply path for supplying dialysate from the dialysate supply device 26 to the dialyzer 18, which form a circulating blood volume adjustment system in the body. The saline syringe 32 supplies a controlled amount of concentrated sodium chloride solution to a mixer 30 which mixes the supplied dialysate and concentrated sodium chloride solution and supplies it to the dialyzer 18. In this embodiment, the control system 14 changes the injection speed of the saline injector 32 according to the hematocrit value described above, and the sodium chloride concentration in the dialysate is appropriately controlled according to the condition of each individual patient. As a result, the amount of blood circulating in the patient's body can be maintained at a desired value, and an optimal purification effect can be achieved without causing complications during blood purification.

The control system 14 includes a control device 34 for controlling the saline injector 32 based on the measured value of the hematocrit measuring device 24 and a predetermined program, and a control device 34 for controlling the saline injector 32 based on the measured value of the hematocrit measuring device 24 and a predetermined program, and a control device 34 for controlling the saline injector 32 based on the measured value of the hematocrit measuring device 24 and a predetermined program. a setting device 36 for storing a program of desired hematocrit changes;
Reference numeral 6 includes a body circulating blood volume memory that stores a body circulating blood volume change program during blood purification according to the patient's condition.

FIG. 2 shows the specific configuration of the hemaclit measuring device 24 described above, which includes a resistance measuring section 37 for measuring the total electrical resistivity of the blood introduced into the blood introduction tube 16, and temperature correction of the measured value. Temperature correction unit 38 and calculation unit 40
including.

+iiJ resistance sub-resistance measurement section 37 has a measurement cell 42 connected in communication with the tube 16, and electrical resistivity is measured by a four-electrode method. In this example, in order to eliminate the influence of anisotropy in resistivity due to the flow of blood, the resistivity is measured in a direction in which the resistivity is equivalent to that when the blood is at rest.

That is, a pair of current electrodes 46.48 and a pair of voltage electrodes 50.52 are arranged in the insulating tube 44, but the current electrodes 46.48 are symmetrical with respect to the central axis of the insulating tube 44 and are centered. The voltage electrodes 50.52 are installed at a predetermined distance apart from each other in the axial direction, and the voltage electrodes 50.52 are connected to the current electrodes 46.4.
As a result, the resistivity of blood in a diagonal direction with respect to the blood flow direction is measured. A measurement current is supplied from an AC constant current source 54 to the current electrodes 46, 48, and the voltage electrodes 5
A voltmeter 56 is connected to 0.52, and its output is supplied to the temperature correction section 38.

Further, in order to perform correction based on the temperature of the blood, the insulating tube 44 is provided with a thermistor 58 for temperature measurement, the output end of which is connected to the temperature correction section 38.

In this embodiment, in order to maintain safety for the human body and to avoid the influence of polarization, two sources are connected to the AC constant current source 54.
A current of 5 KHz, 30 pA r, m, s is supplied, and a voltmeter 56 converts the AC voltage into a DC voltage and supplies it to the temperature correction section 38 .

The electrical resistivity obtained by the resistance measuring section 36 as described above is subjected to desired temperature correction by the temperature correcting section 38 based on the resistance value of the thermistor 58. Generally, temperature correction is performed to convert the electrical resistivity to the electrical resistivity at 37° C., taking into account that when the temperature rises by 1° C., the electrical resistivity decreases by about 2° near the body temperature.

Furthermore, this temperature-corrected resistivity is calculated into hematocrit by the calculating section 40. That is, 25K of blood
However, the electrical resistivity b [Ω・α] near Hz and the hematocrit hHt [%] measured by centrifugation are ``4'' in Kl.
7. In K2 54 From this, the hematocrit H1 is determined by , and the calculation section 4o includes an attenuator 60 and a logarithmic amplifier 62 for obtaining equation (2).

The present invention is characterized in that the control system 14 controls the amount of blood circulating in the body by using the hematocrit determined from the electrical resistivity of the blood as described above, and FIG. 3 shows a preferred embodiment of the control system. It is shown.

In this embodiment, the setting device 36 for storing the change in blood volume in the body during dialysis determined from the past records of the patient has a keyboard 64 for inputting all the programs, and a memory for the blood volume in the body for storing all the programs. In the example, a hemadcrit memory 66 is included.

The control device 34 has a configuration for driving and controlling the saline injector 32 of the dialysate system 12 based on the program in the hematocrit memory 66 and the measured value of the hematocrit measuring device 24. a subtractor 68 that calculates the difference between the program and the hematocrit during dialysis (Hl) detected by the hematocrit measuring device 24, an integrator 70 that integrates the nuclear ship, and a disintegrator 72 that differentiates the nuclear ship. , an adder 74 that weights and adds the outputs of the subtracter 68, the integrator 70, and the differentiator 72 to obtain a control signal.

In the present invention, when the hematocrit 3Ht is smaller than the programmed setting value, the injection speed of the syringe 32 is gradually decreased, and conversely, when the hematocrit Ht is larger than the programmed setting value, the injection speed of the syringe 32 is decreased. The amount of blood circulating in the body is maintained based on the adjustment of plasma osmotic pressure by controlling the gradual increase.

The first embodiment of the present invention consists of the above configuration.
Its action will be explained below.

Before starting hemodialysis, a program regarding the optimal hematocrit for the patient is recorded in the setting device 34 based on the patient's past dialysis records, weight gain from the end of the previous dialysis to the start of the current dialysis, blood pressure, and other patient records. After this, well-known hemodialysis is started.

In the present invention, hematocrit measurement is performed continuously during hemodialysis, and the control system 12 thereby controls the purification action according to the set program.

Generally, in hemodialysis, mechanical pressure from the blood circulation circuit side, mechanical pressure from the vacuum pump 28, and osmotic pressure of blood and dialysate are applied to the semipermeable membrane of the dialyzer 18.
This provides the desired extreme f-pass. That is, by keeping the pressure on the dialysate side lower than the pressure on the whole blood side, water in the blood is allowed to pass through to the dialysate side through the semipermeable membrane.

At this time, the amount of water that passes through the ultraf per unit time is not equal to the amount of water that moves from the body tissues into the blood vessels, and as a result,
During hemodialysis, there will be fluctuations in the amount of blood circulating in the patient's body. Normally, one hemodialysis session (approximately 4 to 6 hours) removes about 1 to 31 parts of water, and the amount of blood circulating in the body decreases with this water removal. The present invention is characterized in that the blood volume circulating in the body is controlled to be constantly maintained at a predetermined programmed value during hemodialysis. Can not)
Noting that the blood volume circulating in the body is inversely proportional to hematocrit, the hematocrit is measured, and the saline injector 32 is controlled by comparing it with a predetermined program.

Therefore, in the first embodiment, when the movement of water from intracellular tissues into blood vessels decreases and the amount of circulating blood in the body decreases rapidly due to water removal, the hematocrit at this time becomes larger than the set value ( Therefore, the injection volume of the saline injector 32 is increased to increase the total plasma osmotic pressure and promote the movement of water from the tissue side into the blood vessels to prevent a decrease in the blood volume circulating in the body, and vice versa. Similarly, the amount of circulating blood is appropriately controlled. Therefore, by performing control according to such a predetermined program, waste products can be removed appropriately according to the patient's condition. .

Second Embodiment FIG. 4 shows a second embodiment in which the present invention is applied to a blood extraction device, and the same members as those in the first embodiment are given the same reference numerals, and a complete explanation thereof will be omitted.

In the second embodiment, as in the first embodiment, the amount of blood circulating in the body during blood purification is compared with the patient's program, and the plasma osmotic pressure during purification is also compared with a predetermined set value to optimize the purification effect. It is characterized by carrying out the following.

In the blood filtration device of the present embodiment, a purifying action is performed by hemofiltration, which is different from that of the first embodiment, and the hemofiltration is carried out by the hemofilter 74 provided in the blood circulation system 10 and the filtration of the hemofilter 74. A part of plasma components containing waste products is ultrafiltered by a pressure reducing pump 84 of a drainage system 82 connected to the drainage side, and at the same time, a part of plasma components containing waste products is supplied to the blood circulation system 10 from a replenishing fluid system 76. Replacement fluid is supplied and the purified blood is returned to the patient's body.

In this embodiment, the replacement fluid system 76 has a sodium concentration that is normally used in hemofiltration therapy, or even slightly lower (eg, 135 mEq/A!).
~140 mEq/A) of replenishment fluid, source 77 and a first supply pump 79 for supplying this replenishment fluid to the blood circulation system 10
, a second replenisher source 78 that stores concentrated sodium chloride (hereinafter referred to as NaC) solution, and a second supply pump 80 that supplies this replenisher (concentrated NaC7 solution) to the blood circulation system 10.
The first supply pump 79 of this replenisher system 76 forms a water removal amount adjustment section, the second supply pump 80 forms a plasma osmotic pressure adjustment section, and the water removal amount adjustment section and plasma osmotic pressure The regulating section forms an internal circulating blood volume regulating system. The control system 1 controls the rotational speed of both supply pumps 79 and 80.
By changing the amount of replenisher supplied into the blood circulation system 10 and the NaC/concentration by changing it according to the control signal from 4, the amount of blood circulating in the body and NaC in the circulating blood are
CA! The concentration can be controlled to a predetermined amount.

In this embodiment as well, the replenishment fluid system 76 is controlled by measuring the hematocrit in the blood of the blood circulation system 10 and adjusting the amount of circulating blood in the body. When the electrolyte yield and electrical resistivity of plasma change due to, for example, injecting a large amount of replenisher with an electrolyte concentration different from that of body fluids into the body, the hematocrit H1' ( Therefore, in this example, the electrical resistivity ps (Ωcm) of the filtration liquid, which is a part of the plasma, is determined together with the electrical resistivity ρb (ΩcIrL) of the blood, and both electrical resistances are calculated. The hematocrit Ht (ch) is determined from the ratio using the following equations (3) and (4).

ρ − to 2・ρ5 ・・・・・・・・・・・・
(3) However, Equation (3) is the electrical resistivity ρ5 of r excess liquid.
The electrical resistivity of plasma ρp1- is determined by the formula K2
There may be slight differences depending on the protein concentration in plasma.
~1.05, K1 = 47 is suitable.

FIG. 5 shows the configuration of a hemocrit measuring device 24 according to a second embodiment, in which a hemofilter 7 is used in the blood circulation system 10.
The effluent of No. 4 is supplied to the hematocrit measuring device 24.

As is clear from FIG. 5, resistance measuring portions 37a and 3 are provided on the blood inlet side and the filtered waste liquid outlet side of the hemofilter 74, respectively.
7b is provided, both measuring parts having the same structure as in FIG. The electrical resistivities obtained from both resistance measuring units 37 are subjected to temperature correction using temperature correctors 86a and 86b of the temperature correcting unit 38, respectively, with 37°C as a reference.
The electrical resistivity of blood ρb and the electrical resistivity of superfluid ρ5
The signal is supplied to the calculation unit 40 as a hematocrit calculation, and a desired hematochrysothorithmetic operation is performed.

The calculation unit 40 calculates ρ using the relationship of equations (3) and (4).
It calculates the hematocrit (Ht'z) from b and ρ3 and outputs it. That is, first, an amplifier 87 with an amplification factor of 2 calculates ρp from ρ5, and then an arithmetic circuit 88 calculates the hematocrit output based on equation (4).

Furthermore, in this example, as mentioned above, the NaC7 concentration in the replenisher is changed to control the NaC7 concentration in the plasma (that is, the plasma osmotic pressure), and the water accumulated in the cells is transferred to the outside of the cells. In order to prevent an excessive or unnecessary rise in the concentration of Na (4! The concentration of NaC in the liquid is controlled. The amount of NaCl in plasma is divided into Na ions and C7 ions, and these account for most of the electrolytes in plasma, so the electrical resistivity of plasma is
.

The concentration of NaC1 in plasma can be determined from
7. The temperature compensator 86b and the amplifier 87 form a plasma osmolarity measuring section.

As described above, the hematocrit Ht considering the change in electrical resistance of plasma accompanying blood overload and its influence.
Once obtained, the control system 14 controls the replenisher system 76, which forms the body circulating blood volume adjustment system in this embodiment, based on the plasma electrical resistivity ρ and hematocrit Ht.

FIG. 6 shows the control system of the second embodiment.

Separately from the hematocrit memory 66, the setting device 36 is configured to set the upper limit of the NaCl concentration in the plasma to the electrical resistivity p of the plasma.
A plasma osmotic pressure memory (in this embodiment, a plasma resistance memory 90) is provided to store p (p decreases as the NaCl concentration increases, thus providing a lower limit for ρ), and a hematocrit program. The set plasma resistance value is then individually supplied to the control device 34.

As in the first embodiment, the control device 34 controls the program in the memory 66 and the hematocrine continuously measured during blood purification.
A subtracter 68a, an integrator 70, and a differentiator 7 generate control signals for the supply pumps 79 and 80 of the replenisher system 76 from Ht.
2. In addition to the adder 74a and the adder 74b, a subtracter 68b is used to calculate the total difference of 1 between the set value of the plasma resistance memory 90 and the measured plasma electrical resistivity ρ, and the error is O or close to negative. A limiter 92 is provided which completely limits or reduces the output signal of the adder 74b and outputs it to the supply pump 80. , a water removal amount adjustment section comprising a supply pump 79 that supplies a replenisher with an osmotic pressure equal to or slightly lower than that normally used to the blood circulation system; and a supply pump 80 that supplies a high osmotic replenisher with a high osmotic pressure. The control device 34 includes an adder 74 that generates all control signals for each of the two adjustment sections.
(a) An adder 74b is provided independently and performs an addition operation by appropriately weighting the deviation signal outputted from the subtracter 68a, its differential signal, and its integral signal.

The second embodiment of the present invention has the above configuration, and its operation will be explained below.

In the second embodiment, before the start of blood purification, the internal circulating blood volume change program and plasma osmolarity set value during blood purification, which are tailored to the patient's condition, are recorded in the hematocrit memory 66 and plasma resistance memory 90, respectively. , hematocrit H1 and plasma electrical resistivity ρ, which are measured from the patient's blood and ultrafluid fluid at the onset of blood overflow and correspond to the circulating blood volume and plasma osmolality, are compared with the program and set values, respectively, and replenishment is performed. The supply of liquid is appropriately controlled, and the amount of blood circulating in the body during purification is maintained at a predetermined value.

In other words, if water is not sufficiently removed from the patient, the hematocrit H1 will become smaller than the predetermined program.
As a result, the output of the adder 74a completely decreases the injection speed of the injection pump 79 to increase the amount of water removed, and the output of the adder 74b completely decreases the injection speed of the injection pump 80 to reduce the N a C71 concentration in the replenisher. It effectively removes excess water accumulated in the patient's body and completely prevents the patient's plasma osmolarity from increasing. On the other hand, if the circulating blood volume in the body is smaller than the programmed value,
By increasing the injection speed of both the injection pumps 79 and 80 to completely reduce the amount of water removed and increasing the NaCl concentration in the replenisher, the movement of water from inside the cells to the outside of the cells is promoted and blood circulating in the body is improved. The amount can be supplemented.

Furthermore, in this embodiment, when the above-mentioned control is performed, when the injection volume of the injector 8o increases and the patient's plasma osmotic pressure rises, and the plasma electrical resistivity becomes smaller than the set value, the injection volume is increased. It is possible to completely limit the injection rate of the device 8o to prevent an excessive increase in plasma osmotic pressure.

As described above, according to the second embodiment, by preventing an excessive decrease in the blood volume circulating in the patient's body and an excessive increase in plasma osmolarity, the balance can be maintained without causing any complications. It can perform a good waste removal effect.

Third Embodiment FIG. 7 shows a third embodiment of the present invention.
The same members as those in the embodiment are given the same reference numerals, and the description thereof will be omitted.

Similar to the second embodiment, the third embodiment is characterized in that control is performed using hematocrit and plasma osmotic pressure, and the amount of water removed is continuously measured, so that appropriate blood purification control is performed by these three factors.

In the third embodiment, a drain tank 94 is provided to store the ultrafiltrate discharged from the drain system 82 in order to measure the amount of water removed. It is held together with the liquid supply devices 77 and 78 by a holding stand 96. The total weight or weight change on the holding table 96 is then measured by the weighing device 98. Therefore, the difference between the amount of fluid drained from the patient's blood and the amount of replenisher refilled into the bloodstream is measured, and this is sent as a water removal amount signal from the weighing device 98 to the controller 3 of the control system 14. supplied to

FIG. 8 shows the configuration of the control system 14 in the third embodiment. The setting device 34 includes a hematocrit memory 6.
6 and plasma resistance memory 90, there is provided a water removal amount memory 100 that stores a preferred water removal amount program during purification based on patient records, and the hematocrit program, plasma resistance, and water removal amount program are controlled separately. is supplied to device 34.

In addition to the components of the second embodiment, the control device 34 of the third embodiment continuously measures the amount of water removed using the weighing device 98 during purification and records the amount of water removed from the water removal lid. /100 output per trowel
an integrator 102 that integrates the output of the subtracter 68c, and an adder 74 that integrates the output of the integrator 102.
An adder 104 is provided which adds weights to the outputs of a and outputs a control signal to the supply pump 79 of the water removal amount adjustment section.

The control system 14 of the third embodiment has the above configuration, and when the hematocrit and water removal amount measured during purification are large, the injection speed of the injection pump 79 is increased, and conversely, each measured value is lower than the set value. If it is small, the injection rate is completely reduced. In addition, if the measured water removal amount is smaller than the set value but the hematocrit measurement value is larger than the set value, or vice versa, replenishment is performed based on the difference between each measured value and the predetermined set value. Control of whether the total liquid injection rate is increased or decreased is arbitrarily performed, and how much importance is given to both hematoclin and water removal amount is determined by the adder 74a and the integrator 102 in the addition operation of the adder 104. This is determined by applying weighting to the output that is appropriate for each patient.

Furthermore, control of the plasma osmotic pressure adjusting section is performed in the same manner as in Example 2, based on the hematocrit and electrical resistance of plasma.

Therefore, according to the third embodiment, the amount of circulating blood in the body can be properly maintained during blood purification and the necessary water removal can be carried out, and the above two requirements can be met because a large amount of waste products have accumulated in the patient's body. If they are not compatible, it is possible to remove waste while maintaining an appropriate balance between the two, according to preset weighting.

Other Modifications of the Invention In each of the embodiments described above, blood resistivity is measured using a measurement cell connected to an extracorporeal blood circulation tube, but this is not limiting (for example, in the present specification). Although the explanation is omitted in this book, measurements can also be made by placing electrodes that are not affected by blood flow as described above at the bottom of a well-known air chamber that is usually installed on the extracorporeal blood circulation circuit to remove air bubbles. can.

Further, in each of the embodiments described above, hematocrit is directly input to the control system, but in the present invention, it is also possible to input the reciprocal of hematocrit and other calculation results to the control system.

Furthermore, in each of the above embodiments, hematocrit measurement is performed as a stable means of measuring the circulating blood volume in order to control the circulating blood volume in the body with high reliability, but in the present invention, in addition to this, It is also possible to determine the concentration of protein in the blood by measuring osmotic pressure using a semipermeable membrane, and calculate changes in circulating blood volume from changes in protein concentration.

In addition, in measuring circulating blood volume using this osmotic pressure, it is necessary to measure a minute pressure difference (30 to 35 mmHg) through a semipermeable membrane, and the characteristics of the semipermeable membrane must be strictly controlled. There is.

Furthermore, in each of the above embodiments, the adjustment unit is the N of the replenisher.
Although the amount of concentrated Na (J' bath solution injected is adjusted to control the aC1 concentration, the present invention is not limited to this) (for example, the upper and lower limits of the sodium concentration (
For example, 180mE e q/A' and 135mE
eq/]) may be controlled, and further, substances other than sodium such as evamannitol, glycerol, albumin, etc. may be used as substances that change plasma osmotic pressure. can. However, when these substances are used to control plasma osmolality, a means that can accurately measure changes in their concentration should be used to measure plasma osmolarity, and these substances should be used to measure circulating blood volume. It is necessary to use means that are not affected. For example, when albumin is used to control plasma osmotic pressure, it is necessary to use a hematocrit meter or the like as a means for measuring circulating blood volume.

Furthermore, in the first embodiment, in order to change the ultrafiltration rate of the blood purifier (dialyzer), the water removal amount adjusting section of the body circulating blood volume adjusting system changes the ultrafiltration rate of the blood purifier (dialyzer). pressure(
However, the present invention is not limited to this; for example, the pressure (positive pressure) applied to the blood side of the blood purifier can also be adjusted.

DETAILED DESCRIPTION OF THE INVENTION According to the present invention, the circulating blood volume and plasma osmotic water removal rate of a patient during blood purification are measured, and thereby plasma is purified according to a predetermined program or set value suitable for the patient. Osmotic pressure or water removal rate can be controlled automatically, making it possible to perform a well-balanced waste removal action while maintaining the amount of circulating blood in the body at an appropriate value.

[Brief explanation of drawings]

FIG. 1 is a block circuit diagram showing a preferred first embodiment of the blood purification device according to the present invention, FIG. 2 is an explanatory diagram showing a hematocrit measuring device of the first embodiment, and FIG. 3 is a first embodiment. 4 is a block circuit diagram of the second embodiment of the present invention, FIG. 5 is an explanatory diagram showing the hematocrit measuring device of the second embodiment, and FIG. 6 is the second embodiment. FIG. 7 is a block circuit diagram of a third embodiment of the present invention, and FIG. 8 is a block circuit diagram of a control system of the third embodiment. 10... Blood circulation system, 12... Dialysate system, 14.
... Control system, 18... Dialyzer, 24... Hematocrit measuring device, 28... Decompression pump 30... Air mixture, 32...
- Saline solution injector, 34... Control device, 36... Setting device, 37... Resistance measurement unit, 42... Measurement cell, 44... Absolute = V, 46.48... Current Electrode, 50.52... Voltage electrode, 54... AC constant current source, 56... Voltmeter, 66...
- Hematocrit memory, 74... Hemofilter, 76... Replenishment fluid system, 79.
80... Supply pump - 90... Plasma resistance memory, 98... Weighing device, 100... Water removal amount memory. Figure 1 Figure 2? 4 Figure 4 Figure 5 Figure 6 Figure 7

Claims (1)

[Scope of Claims] (1) A blood circulation system that circulates the patient's blood outside the body, a blood purifier installed in the blood circulation system, and a plasma osmotic pressure that is adjusted to adjust the blood volume circulating in the body to a desired value. A circulating blood volume adjustment system that adjusts the volume of circulating blood in the body, a circulating blood volume measuring device that measures changes in the volume of blood circulating in the body, and a circulating blood system that stores a program for changing the volume of circulating blood in the body during blood purification according to the patient's condition. A control system that has a volume memory and controls the body circulating blood volume adjustment system based on the body circulating blood volume measured during blood purification and a predetermined program, and performs optimal purification while maintaining the body circulating blood volume at a desired value. A blood purification device characterized by performing an action. (2. The blood purification device according to claim (1), characterized in that the body circulating blood volume regulating system is provided with a water removal amount regulating section. (3) Blood purification of the patient is carried out outside the body. A blood circulation system that circulates the blood, a blood purifier installed in the blood circulation system, and a body circulating blood volume adjustment system that adjusts the blood volume circulating in the body to a desired value by adjusting plasma osmotic pressure and water removal rate. A circulating blood volume measuring device that measures changes in the amount of circulating blood in the body, a plasma osmotic pressure measurement device that essentially measures the osmotic pressure of plasma, and a program for changing the amount of circulating blood in the body during blood purification according to the patient's condition. It has a body circulating blood volume memory for storing therein and a plasma osmolality memory for storing plasma osmolarity set values, and compares the body circulating blood volume and plasma osmolality measured during blood purification with the program and set values. A blood purification device that includes a control system that controls a blood volume adjustment system that circulates in the body, and performs an optimal purification effect while maintaining the blood volume that circulates in the body at a desired value. a blood circulation system that circulates blood to the blood circulation system, a blood purifier installed in the blood circulation system, and a body circulating blood volume adjustment system that controls plasma osmotic pressure and water removal rate to adjust the volume of blood circulating in the body to a desired value; A circulating blood volume measuring device that measures changes in the amount of blood circulating in the body, a water removal amount measuring device that measures the amount of water removed, and a circulating blood volume that stores a program for changing the amount of circulating blood in the body during blood purification according to the patient's condition. a control system that has a memory and a water removal amount memory that stores a water removal amount program, and controls the internal circulating blood volume adjustment system by comparing the internal circulating blood volume and water removed amount measured during blood purification with a predetermined program; (5) A blood circulation system that circulates the patient's blood outside the body; a blood purifier, an internal blood volume adjustment system that controls plasma osmotic pressure and water removal rate to adjust the internal circulating blood volume to a desired value, and a circulating blood volume measuring device that measures all changes in internal circulating blood volume. , a plasma osmolarity measuring device that essentially measures the osmotic pressure of plasma, a water removal amount measuring device that measures the amount of water removed, and an internal circulation device that stores the internal circulating blood volume change program during blood purification according to the patient's condition. It has a blood volume memory, a plasma osmolarity memory that stores plasma osmolarity, and a water removal amount memory that stores a water removal amount program, and has a predetermined internal circulating blood volume, plasma osmolarity, and water removal amount measured during blood purification. A control system that controls the body circulating blood volume adjustment system by comparing the program and the set value, Device. (6) Percentage Permissible In the device according to any one of claims (1) to (5), the plasma osmotic pressure adjustment section of the body circulating blood volume adjustment system changes the electrolyte concentration in the dialysate or the replenishment fluid. Blood purification device with all features. (7) In the device according to any one of claims (3) and (5), the plasma osmolarity measuring device measures the electrolyte concentration of plasma, and the plasma osmolarity of the blood circulating in the body is adjusted. A blood purification device characterized in that the adjustment section changes the electrolyte concentration in the dialysate or the replenisher. (8) % In the device described in claim (7), the plasma osmolarity measuring device is a blood purification device that is characterized in that it measures the total concentration of specific ions in plasma using an ion electrode. 9) Claims (A blood purification device characterized in that the plasma osmolarity measuring device measures electrolyte concentration from the electrical resistivity of plasma. 9) A blood purification device characterized in that the electrolyte whose concentration is changed consists of sodium chloride in the device according to any one of claims (1) to α. A blood purification device characterized in that the blood volume measuring device is a hematocrit measuring device that detects changes in blood volume circulating in the body by changes in hematocrit.
The hematocrit measuring device includes a resistance measuring section for measuring blood electrical resistivity in the blood circulation system, a temperature correcting section for temperature compensating the measured electrical resistivity, and a calculating section for calculating hematocrit from this electrical resistivity. A blood purification device characterized by: a3 In the device set forth in claim a2, the resistance measuring section for measuring blood electrical resistivity is arranged in an insulating tube connected to the blood circulation system on a symmetrical side with respect to its central axis and at a predetermined distance in the direction of the central axis. A blood purification device characterized by having a measurement cell having a pair of electrodes, which is provided in a resistance measuring section. A blood purification device is provided with a measurement cell for measuring the electrical resistivity of a plasma component in blood, and calculates hematocrit from both the electrical resistivity of the blood and the electrical resistivity of the plasma component. a) The device according to claim I, which is provided with a filter that treats a part of the plasma in the blood circulation system to ultraviolet rays, and a measurement cell that measures the electrical resistivity of plasma components in the filtration waste liquid path of the filter. Blood purification device with % characteristics.