JPS6121424B2 - - Google Patents
Info
- Publication number
- JPS6121424B2 JPS6121424B2 JP11614881A JP11614881A JPS6121424B2 JP S6121424 B2 JPS6121424 B2 JP S6121424B2 JP 11614881 A JP11614881 A JP 11614881A JP 11614881 A JP11614881 A JP 11614881A JP S6121424 B2 JPS6121424 B2 JP S6121424B2
- Authority
- JP
- Japan
- Prior art keywords
- dialysate
- blood
- membrane oxygenator
- gas
- hemodialysis
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired
Links
- 239000008280 blood Substances 0.000 claims description 45
- 210000004369 blood Anatomy 0.000 claims description 45
- 239000012528 membrane Substances 0.000 claims description 41
- CURLTUGMZLYLDI-UHFFFAOYSA-N Carbon dioxide Chemical compound O=C=O CURLTUGMZLYLDI-UHFFFAOYSA-N 0.000 claims description 30
- 229910002092 carbon dioxide Inorganic materials 0.000 claims description 15
- 238000001631 haemodialysis Methods 0.000 claims description 14
- 230000000322 hemodialysis Effects 0.000 claims description 14
- 239000007789 gas Substances 0.000 claims description 13
- 102000003846 Carbonic anhydrases Human genes 0.000 claims description 10
- 108090000209 Carbonic anhydrases Proteins 0.000 claims description 10
- QVGXLLKOCUKJST-UHFFFAOYSA-N atomic oxygen Chemical compound [O] QVGXLLKOCUKJST-UHFFFAOYSA-N 0.000 claims description 8
- 239000001569 carbon dioxide Substances 0.000 claims description 8
- 239000001301 oxygen Substances 0.000 claims description 8
- 229910052760 oxygen Inorganic materials 0.000 claims description 8
- 239000012159 carrier gas Substances 0.000 claims description 7
- IJGRMHOSHXDMSA-UHFFFAOYSA-N Atomic nitrogen Chemical compound N#N IJGRMHOSHXDMSA-UHFFFAOYSA-N 0.000 claims description 6
- 239000000203 mixture Substances 0.000 claims description 6
- BVKZGUZCCUSVTD-UHFFFAOYSA-M Bicarbonate Chemical compound OC([O-])=O BVKZGUZCCUSVTD-UHFFFAOYSA-M 0.000 claims description 5
- 238000006243 chemical reaction Methods 0.000 claims description 5
- 239000003570 air Substances 0.000 claims description 3
- 150000001875 compounds Chemical class 0.000 claims description 3
- 229910052757 nitrogen Inorganic materials 0.000 claims description 3
- 229920000642 polymer Polymers 0.000 claims description 3
- 239000007788 liquid Substances 0.000 description 16
- 150000002500 ions Chemical class 0.000 description 13
- 238000000502 dialysis Methods 0.000 description 8
- 210000003734 kidney Anatomy 0.000 description 6
- 210000004072 lung Anatomy 0.000 description 6
- 238000000034 method Methods 0.000 description 6
- 208000004756 Respiratory Insufficiency Diseases 0.000 description 4
- 201000004193 respiratory failure Diseases 0.000 description 4
- WQZGKKKJIJFFOK-GASJEMHNSA-N Glucose Natural products OC[C@H]1OC(O)[C@H](O)[C@@H](O)[C@@H]1O WQZGKKKJIJFFOK-GASJEMHNSA-N 0.000 description 3
- FAPWRFPIFSIZLT-UHFFFAOYSA-M Sodium chloride Chemical compound [Na+].[Cl-] FAPWRFPIFSIZLT-UHFFFAOYSA-M 0.000 description 3
- 230000004087 circulation Effects 0.000 description 3
- 239000008103 glucose Substances 0.000 description 3
- 238000001356 surgical procedure Methods 0.000 description 3
- XLYOFNOQVPJJNP-UHFFFAOYSA-N water Substances O XLYOFNOQVPJJNP-UHFFFAOYSA-N 0.000 description 3
- 241000283690 Bos taurus Species 0.000 description 2
- VEXZGXHMUGYJMC-UHFFFAOYSA-N Hydrochloric acid Chemical compound Cl VEXZGXHMUGYJMC-UHFFFAOYSA-N 0.000 description 2
- NBIIXXVUZAFLBC-UHFFFAOYSA-N Phosphoric acid Chemical compound OP(O)(O)=O NBIIXXVUZAFLBC-UHFFFAOYSA-N 0.000 description 2
- 230000017531 blood circulation Effects 0.000 description 2
- BVKZGUZCCUSVTD-UHFFFAOYSA-N carbonic acid Chemical compound OC(O)=O BVKZGUZCCUSVTD-UHFFFAOYSA-N 0.000 description 2
- 230000007423 decrease Effects 0.000 description 2
- 238000006297 dehydration reaction Methods 0.000 description 2
- 238000009792 diffusion process Methods 0.000 description 2
- 230000000694 effects Effects 0.000 description 2
- 238000002474 experimental method Methods 0.000 description 2
- 238000002618 extracorporeal membrane oxygenation Methods 0.000 description 2
- 239000012510 hollow fiber Substances 0.000 description 2
- -1 organic acid salts Chemical class 0.000 description 2
- 238000006213 oxygenation reaction Methods 0.000 description 2
- 238000010979 pH adjustment Methods 0.000 description 2
- 239000004627 regenerated cellulose Substances 0.000 description 2
- 239000000126 substance Substances 0.000 description 2
- CYDQOEWLBCCFJZ-UHFFFAOYSA-N 4-(4-fluorophenyl)oxane-4-carboxylic acid Chemical compound C=1C=C(F)C=CC=1C1(C(=O)O)CCOCC1 CYDQOEWLBCCFJZ-UHFFFAOYSA-N 0.000 description 1
- UXVMQQNJUSDDNG-UHFFFAOYSA-L Calcium chloride Chemical compound [Cl-].[Cl-].[Ca+2] UXVMQQNJUSDDNG-UHFFFAOYSA-L 0.000 description 1
- VMHLLURERBWHNL-UHFFFAOYSA-M Sodium acetate Chemical compound [Na+].CC([O-])=O VMHLLURERBWHNL-UHFFFAOYSA-M 0.000 description 1
- XSQUKJJJFZCRTK-UHFFFAOYSA-N Urea Chemical compound NC(N)=O XSQUKJJJFZCRTK-UHFFFAOYSA-N 0.000 description 1
- 238000010521 absorption reaction Methods 0.000 description 1
- 239000002253 acid Substances 0.000 description 1
- 229910000147 aluminium phosphate Inorganic materials 0.000 description 1
- 239000007864 aqueous solution Substances 0.000 description 1
- 210000004204 blood vessel Anatomy 0.000 description 1
- 238000007664 blowing Methods 0.000 description 1
- 210000001124 body fluid Anatomy 0.000 description 1
- 239000010839 body fluid Substances 0.000 description 1
- KGBXLFKZBHKPEV-UHFFFAOYSA-N boric acid Chemical compound OB(O)O KGBXLFKZBHKPEV-UHFFFAOYSA-N 0.000 description 1
- 239000004327 boric acid Substances 0.000 description 1
- 239000000872 buffer Substances 0.000 description 1
- 239000007853 buffer solution Substances 0.000 description 1
- 239000001110 calcium chloride Substances 0.000 description 1
- 235000011148 calcium chloride Nutrition 0.000 description 1
- 229910001628 calcium chloride Inorganic materials 0.000 description 1
- 239000004202 carbamide Substances 0.000 description 1
- XTEGARKTQYYJKE-UHFFFAOYSA-N chloric acid Chemical compound OCl(=O)=O XTEGARKTQYYJKE-UHFFFAOYSA-N 0.000 description 1
- 229940005991 chloric acid Drugs 0.000 description 1
- 230000003247 decreasing effect Effects 0.000 description 1
- 238000010586 diagram Methods 0.000 description 1
- 239000000385 dialysis solution Substances 0.000 description 1
- XLYOFNOQVPJJNP-ZSJDYOACSA-N heavy water Substances [2H]O[2H] XLYOFNOQVPJJNP-ZSJDYOACSA-N 0.000 description 1
- 239000001257 hydrogen Substances 0.000 description 1
- 229910052739 hydrogen Inorganic materials 0.000 description 1
- 230000004199 lung function Effects 0.000 description 1
- 150000007524 organic acids Chemical class 0.000 description 1
- 235000005985 organic acids Nutrition 0.000 description 1
- 238000000746 purification Methods 0.000 description 1
- 230000001172 regenerating effect Effects 0.000 description 1
- 230000001105 regulatory effect Effects 0.000 description 1
- 230000029058 respiratory gaseous exchange Effects 0.000 description 1
- 229920006395 saturated elastomer Polymers 0.000 description 1
- 239000011734 sodium Substances 0.000 description 1
- 239000001632 sodium acetate Substances 0.000 description 1
- 235000017281 sodium acetate Nutrition 0.000 description 1
- 239000011780 sodium chloride Substances 0.000 description 1
- 239000001540 sodium lactate Substances 0.000 description 1
- 229940005581 sodium lactate Drugs 0.000 description 1
- 235000011088 sodium lactate Nutrition 0.000 description 1
- 239000000243 solution Substances 0.000 description 1
- 239000002699 waste material Substances 0.000 description 1
- 239000002351 wastewater Substances 0.000 description 1
Description
本発明は、血液透析方式膜型人工肺装置に関す
るものである。より詳しくは、ECMO
（Extracorpor eal Membrane Oxygenation）用
の膜型人工肺、特に呼吸不全患者に対するCO2除
去性能の優れた小型補助肺に関するものである。
一般に、人工肺とは血液に酸素（O2）を添加す
ると同時に血液中から二酸化炭素（CO2）を除去
することを目的とした装置である。これまで、人
工肺は「開心術」即ち心臓を開いて手術を行う
際、停止した心臓と肺の機能を代行させる人工肺
装置のうち肺の機能を代行させる装置として臨床
使用されてきた。これに加えて最近では呼吸不全
患者の肺機能を補助する目的で人工肺を使用する
臨床例が報告されている。後者の目的に使用され
る人工肺は、比較的長時間、時には数日間連続し
て使用されるので、血液への損傷のすくない膜型
人工肺でなければならない。この様な目的で膜型
人工肺を使用することをECMOと呼んでいる。
呼吸不全患者では、血液中酸素分圧（PO2）が
低下していると同時に血液中炭酸ガス分圧
（PCO2）が高い値を示しており、PO2の低下より
もむしろPCO2の上昇の方が臨床上困難な問題で
あると云われている。血液中のPO2を上昇させる
ことは、例えば酸素吸入や陽圧人工呼吸器などを
使うことにより比較的容易に行うことができる。
しかし、血液中のPCO2を低下させることは酸素
吸入では不可能であるし、人工呼吸器によつても
不十分な場合が多い。また、場合によつては
PCO2を下げず高濃度O2を患者に吸わせると血液
中のPCO2が急上昇し死に到ることすらある。こ
の様な呼吸不全患者の治療法として血液を小流量
で体外循環してCO2を除去する方法があれば臨床
上非常に有効な手段となる筈である。
さて、血液を体外循環し、CO2を除去するため
の膜型人工肺としては、従来は開心術用の気液膜
型人工肺が用いられたが、この方式では毎分数リ
ツトルの血液を体外循環させねばならず、かつ一
般にCO2除去の性能が悪く、CO2を十分除くため
にO2流量を増すと血中酸素の過剰などの害が伴
う。そこで、現在広く用いられている人工腎臓用
の血液透析器を用いて、膜の一方に血液、他方に
透析液を流し、血液中の溶存CO2ならびにHCO− ３
イオンを透析液へ移動させれば、血液とガスを膜
を介して接触させる従来の膜型人工肺に比べて
CO2の除去をはるかに容易に行うことができる。
本発明はこのような血中CO2除去を目的とする血
液透析器、すなわち血液透析方式膜型人工肺を用
いる装置（システム）に関するものである。
このような装置として、新しい透析液を血液透
析方式膜型人工肺に供給し、人工肺からのCO2や
HCO− ３イオンを含んだ透析液を捨ててしまうシン
グルパス方式で使用することももちろん可能であ
る。しかし、一般に治療には前記した通り長時間
を要するので、この方式によるときには数百リツ
トルもの透析液が必要であり、またこの透析液を
調製するため人工腎臓の場合の様に水精製装置や
透析液供給装置などの大きな装置を要する。この
ため治療場所が固定され、また、多量の排水処理
についても問題がある。さらに、この場合には血
液中の有効なイオン類が透析液中に移行してしま
うので、透析液として0.9％食塩水や等張緩衝液
のような単純な組成のものを使用することができ
ない。そこで、一般の人工腎臓用透析液を使用す
ることも考えられるが、これには酢酸ソーダや乳
酸ソーダが含まれており、これらの有機酸塩は患
者体内に移行した後分解されてHCO− ３イオンを生
ずるので、本発明装置によりCO2やHCO− ３イオン
を除いても、代りにこれら有機酸が体内に移行
し、PCO2を上昇させることになるので実用的で
ない。本発明者は、上記の諸点に鑑み種々研究を
重ねた結果、透析器から出てくるCO2やHCO− ３イ
オンを含んだ透析液を再生し循環使用する小型の
簡便な膜型人工肺装置を得ることに成功したので
ある。即ち、本発明は、血液を体外循環し、膜を
介して血液と透析液とを接触させて血液中の二酸
化炭素並びに重炭酸イオンを透析液中に移動させ
る透析方式膜型人工肺において、前記透析液を前
記透析方式膜型人工肺系外でPHの変動を抑制しな
がら空気、窒素、酸素あるいはこれらの混合気体
等の同伴ガス（キヤリアー ガス）と接触させ、
前記血液中から透析液中に移動した二酸化炭素並
びに血液中から透析液中に移動した重炭酸イオン
より生じた二酸化炭素を前記同伴ガス（キヤリア
ー ガス）中に放散させることにより前記透析液
を再生し、該透析液を前記透析方式膜型人工肺に
戻し、透析液を循環使用するようにしたことを特
徴とする血液透析方式膜型人工肺装置である。
本発明に係る血液透析方式膜型人工肺装置に用
いる透析液は、CO2除去に適したものであり、血
液中の尿素その他の老廃物質を除くことを目的と
する人工腎臓用の血液透析器に用いる透析液とは
違つて、CO2やHCO− ３イオンを生ずるような成分
を含まないものである。
また、本発明において使用する「同伴ガス」
（キヤリアー ガス）とは、ガス吸収又はガス放
散において移動する成分（本発明の場合はCO2）
と反応せずにその成分に同伴してそれを運搬する
作用を有するものをいう。
次に、図面に基づき本発明の一実施例について
詳細に説明する。第１図において、１は透析方式
膜型人工肺であり、市販の人工腎臓用血液透析器
で代用してもよい。２は気液接触装置であり、こ
のものとしては気泡塔、充填塔、段塔などを用い
ることができる。３は除泡部であり、透析液中の
微小気泡を除くと同時に液面を調節し、患者体液
からの除水を調節することもできる。５は透析液
を血液透析方式膜型人工肺１に送るためのポンプ
である。６は熱交換器、７は流量計である。熱交
換器６は第１図では送液ライン中に挿入されてい
るが、気液接触装置２もしくは除泡部３に内蔵さ
せることもできる。４はPH電極であり、CO2の放
散により変動する透析液のPHを測定する。4′はPH
調節装置であり、必要に応じて酸又はアルカリ水
溶液を注入し、PHを調節する。８は血液入口、９
は血液出口、１０は透析液入口、１１は透析液出
口、１２はPH調節液タンクを示す。
PCO2の高い患者の血液は、体外循環され、血
液入口８から血液透析方式膜型人工肺１に挿入さ
れる。この血液はCO2及びHCO− ３イオン透過性を
有する膜を介して透析液入口１０から注入された
CO2及びHCO− ３イオンの濃度の低い透析液と接触
する。濃度勾配に従い、CO2及びHCO− ３イオンは
血液から透析液へと移動する。CO2及びHCO− ３イ
オン濃度の低下した血液は血液出口９より患者の
血管へ戻される。一方、CO2及びHCO− ３イオンの
濃度が増大した透析液は透析液出口１１より出
て、気液接触装置２内に送り込まれる。該気液接
触装置２の下方からは空気、窒素、酸素あるいは
これらの混合気体等の同伴ガス（キヤリアー ガ
ス）が送り込まれており、前記透析液は前記同伴
ガス（キヤリアー ガス）と接触し、透析液中の
重炭酸イオンと水素イオンとからできた炭酸の脱
水反応により生じたCO2や透析液中に溶存してい
るCO2は気体中に放散される。その結果、透析液
中のCO2及びHCO− ３イオンの濃度は低下し、透析
液は再生される。この再生された透析液は除泡部
３に導かれ、混在している微小な気泡が除かれ、
ポンプ５によつて再度血液透析方式膜型人工肺１
に送り込まれる。前記気液接触装置２でCO2を放
散させると透析液のPHは上昇するので、PH電極４
で測定し、PH調節装置４′によりPHを生理的範囲
を越えないように調節することが必要である。
尚、前記気液接触装置２でCO2を放散させる際、
炭酸の脱水反応を促進するため、炭酸脱水酵素ま
たは反応促進剤を透析液中に溶解させておくか、
または炭酸脱水酵素又は反応促進剤を高分子化合
物に固定化（吸着，包括等）したものを透析液中
に懸濁して用いるとCO2放散速度を一層速めるこ
とができる。尚、反応促進剤としてはリン酸、塩
素酸、ホウ酸等を用いることができる。本発明は
前記構成よりなるから次のような効果が奏され
る。
先ず、透析液は循環して使用されるから２〜３
以下の少量で済み、本発明に係る血液透析方式
膜型人工肺装置は小型で簡便なものとなる。ま
た、透析液としては一般の人工腎臓用透析液（例
えばNa+132mEq／、K+2.0mEq／、
Ca++2.5mEq／、Mg++1.5mEq／、
Cl-105mEq／、CH3COO-33mEq／、グルコ
ース200mg％）以外に、前記シングルパス方式で
は使用し得ない0.9食塩水や等張緩衝液のような
単純な組成のものでも使用することができる。
次に本発明の実験例を示す。
実験例 １
実験は第１図に示す装置によつて行つた。気液
接触装置は直径5.5cm、高さ70cm、容積1.66の
気泡塔型式で行つた。血液としてはヘパリン化新
鮮牛血２を使用し、CO2とN2との混合ガスを吹
き込み、PCO2を上げて静脈血とした。血液流量
は172ml／minで、透析液流量は500ml／minで行
つた。透析液としては0.9％NaClを2.5使用し
た。気液接触装置には水蒸気飽和の空気を20ml／
minの流量で吹き込んだ。CO2放散による透析液
PHの上昇を抑えるため1N塩酸を自動的に注入し
得るようにし、PH7.0〜7.4に調節した。透析方式
膜型人工肺としては再生セルロース中空糸型（膜
面積1.2m2）を用いた。第１表に示すように、透
析液はCO2放散速度52ml／minの速度で再生され
た。
The present invention relates to a hemodialysis membrane oxygenator. For more information, see ECMO
This invention relates to a membrane oxygenator for extracorporal membrane oxygenation (extracorporal membrane oxygenation), especially a small auxiliary lung with excellent CO 2 removal performance for patients with respiratory failure. Generally, an artificial lung is a device whose purpose is to add oxygen (O 2 ) to blood and simultaneously remove carbon dioxide (CO 2 ) from the blood. Until now, artificial lungs have been used clinically as an artificial lung device that takes over the functions of a stopped heart and lungs during open-heart surgery, that is, surgery that involves opening the heart. In addition to this, clinical cases have recently been reported in which artificial lungs are used to support lung function in patients with respiratory failure. Since the oxygenator used for the latter purpose is used for a relatively long period of time, sometimes several days in a row, it must be a membrane oxygenator that causes less damage to the blood. The use of a membrane oxygenator for this purpose is called ECMO. In patients with respiratory failure, blood oxygen partial pressure (PO 2 ) is decreased and blood carbon dioxide partial pressure (PCO 2 ) is high, and PCO 2 increases rather than PO 2 decreases. is said to be a more clinically difficult problem. Raising PO 2 in the blood can be achieved relatively easily, for example, by using oxygen inhalation or a positive pressure ventilator.
However, it is impossible to lower PCO 2 in the blood by oxygen inhalation, and even artificial respiration is often insufficient. Also, in some cases
If a patient inhales high concentrations of O 2 without lowering PCO 2 , the PCO 2 in the blood will rise rapidly and may even lead to death. If there were a method to remove CO 2 by extracorporeal circulation of blood at a small flow rate as a treatment for such patients with respiratory failure, it would be a very effective method clinically. Conventionally, an air-liquid membrane oxygenator was used for open-heart surgery as a membrane oxygenator to circulate blood outside the body and remove CO2 , but with this method, several liters of blood are pumped outside the body every minute. It must be circulated, and the performance of CO 2 removal is generally poor, and increasing the O 2 flow rate to sufficiently remove CO 2 is accompanied by harms such as excess blood oxygen. Therefore, using a hemodialyzer for artificial kidneys that is currently widely used, blood is passed through one side of the membrane and dialysate is passed through the other side, and dissolved CO 2 and HCO - 3 in the blood are collected.
By transferring ions to the dialysate, compared to traditional membrane oxygenators, which connect blood and gas through a membrane,
CO 2 removal can be done much more easily.
The present invention relates to a hemodialyzer for the purpose of removing CO 2 from the blood, that is, an apparatus (system) using a hemodialysis membrane oxygenator. Such a device supplies new dialysate to a hemodialysis membrane oxygenator and removes CO 2 and other gases from the oxygenator.
Of course, it is also possible to use a single pass method in which the dialysate containing HCO - 3 ions is discarded. However, as mentioned above, treatment generally takes a long time, so this method requires hundreds of liters of dialysate, and to prepare this dialysate, water purification equipment and dialysis equipment are required, as in the case of artificial kidneys. Requires large equipment such as a liquid supply device. For this reason, the treatment location is fixed, and there are also problems with the treatment of large amounts of wastewater. Furthermore, in this case, effective ions in the blood migrate into the dialysate, making it impossible to use a dialysate with a simple composition such as 0.9% saline or isotonic buffer. . Therefore, it is possible to use a general dialysis fluid for artificial kidneys, but this contains sodium acetate and sodium lactate, and these organic acid salts are decomposed after entering the patient's body and become HCO - 3 . ions are generated, so even if CO 2 and HCO - 3 ions are removed by the apparatus of the present invention, these organic acids will instead be transferred into the body and increase PCO 2 , which is not practical. As a result of various studies in view of the above points, the present inventor has developed a small and simple membrane oxygenator that regenerates and circulates dialysate containing CO 2 and HCO - 3 ions coming out of a dialyzer. He succeeded in obtaining the . That is, the present invention provides a dialysis-type membrane oxygenator in which blood is circulated extracorporeally and the blood and dialysate are brought into contact with each other through a membrane to transfer carbon dioxide and bicarbonate ions from the blood into the dialysate. Bringing the dialysate into contact with an accompanying gas (carrier gas) such as air, nitrogen, oxygen, or a mixture thereof while suppressing PH fluctuations outside the dialysis membrane oxygenator system,
Regenerating the dialysate by dissipating into the carrier gas carbon dioxide that has migrated from the blood into the dialysate and carbon dioxide generated from bicarbonate ions that have migrated from the blood into the dialysate. , a hemodialysis type membrane oxygenator apparatus characterized in that the dialysate is returned to the dialysis type membrane oxygenator and the dialysate is used for circulation. The dialysate used in the hemodialysis membrane oxygenator according to the present invention is suitable for removing CO2 , and is used in a hemodialyzer for artificial kidneys whose purpose is to remove urea and other waste substances from blood. Unlike the dialysate used for dialysis, it does not contain components that generate CO 2 or HCO - 3 ions. In addition, "entrained gas" used in the present invention
(Carrier gas) is a component that moves during gas absorption or gas dissipation (in the case of the present invention, CO 2 )
A substance that has the effect of accompanying and transporting its components without reacting with them. Next, one embodiment of the present invention will be described in detail based on the drawings. In FIG. 1, reference numeral 1 indicates a dialysis-type membrane oxygenator, which may be replaced with a commercially available hemodialyzer for artificial kidneys. 2 is a gas-liquid contacting device, and a bubble column, a packed column, a tray column, etc. can be used as this device. Reference numeral 3 denotes a bubble removal section, which removes microbubbles from the dialysate and at the same time adjusts the liquid level and can also adjust water removal from the patient's body fluid. 5 is a pump for sending dialysate to the hemodialysis type membrane oxygenator 1. 6 is a heat exchanger, and 7 is a flow meter. Although the heat exchanger 6 is inserted into the liquid feeding line in FIG. 1, it can also be built into the gas-liquid contacting device 2 or the bubble removal section 3. 4 is a PH electrode, which measures the PH of the dialysate, which fluctuates due to CO 2 dissipation. 4′ is PH
This is a regulating device that injects acid or alkaline aqueous solution as necessary to adjust the pH. 8 is blood inlet, 9
10 is a blood outlet, 10 is a dialysate inlet, 11 is a dialysate outlet, and 12 is a PH adjustment liquid tank. Blood of a patient with high PCO 2 is circulated extracorporeally and is inserted into a hemodialysis membrane oxygenator 1 through a blood inlet 8 . This blood was injected through the dialysate inlet 10 through a membrane permeable to CO2 and HCO - 3 ions.
Contact with dialysate having a low concentration of CO2 and HCO - 3 ions. Following a concentration gradient, CO2 and HCO - 3 ions move from the blood to the dialysate. Blood with reduced CO 2 and HCO − 3 ion concentrations is returned to the patient's blood vessel through the blood outlet 9. On the other hand, the dialysate with increased concentrations of CO 2 and HCO − 3 ions exits from the dialysate outlet 11 and is sent into the gas-liquid contact device 2 . An accompanying gas (carrier gas) such as air, nitrogen, oxygen, or a mixture thereof is fed from below the gas-liquid contacting device 2, and the dialysate comes into contact with the accompanying gas (carrier gas) and undergoes dialysis. CO 2 generated by the dehydration reaction of carbonic acid made from bicarbonate ions and hydrogen ions in the solution and CO 2 dissolved in the dialysate are released into the gas. As a result, the concentration of CO2 and HCO - 3 ions in the dialysate decreases and the dialysate is regenerated. This regenerated dialysate is led to the bubble removal section 3, where mixed minute air bubbles are removed.
Hemodialysis membrane oxygenator 1 is activated again by pump 5.
sent to. When CO 2 is diffused by the gas-liquid contact device 2, the PH of the dialysate increases, so the PH electrode 4
It is necessary to measure the pH using the pH adjustment device 4' and adjust the pH so that it does not exceed the physiological range.
In addition, when dissipating CO 2 with the gas-liquid contact device 2,
To accelerate the carbonic acid dehydration reaction, carbonic anhydrase or a reaction promoter should be dissolved in the dialysate, or
Alternatively, if carbonic anhydrase or a reaction accelerator is immobilized (adsorbed, entrapped, etc.) on a polymer compound and suspended in the dialysate, the CO 2 diffusion rate can be further increased. In addition, phosphoric acid, chloric acid, boric acid, etc. can be used as a reaction accelerator. Since the present invention has the above configuration, the following effects are achieved. First, the dialysate is used in circulation, so 2-3
The hemodialysis type membrane oxygenator according to the present invention can be small and simple since the following small amount is required. In addition, as a dialysate, general dialysate for artificial kidneys (for example, Na + 132mEq/, K + 2.0mEq/,
Ca ++ 2.5mEq/, Mg ++ 1.5mEq/,
Cl - 105mEq/, CH 3 COO - 33mEq/, glucose 200mg%), simple compositions such as 0.9 saline and isotonic buffer solutions that cannot be used in the single pass method can also be used. . Next, an experimental example of the present invention will be shown. Experimental Example 1 The experiment was conducted using the apparatus shown in FIG. The gas-liquid contacting device was a bubble column type with a diameter of 5.5 cm, a height of 70 cm, and a volume of 1.66 cm. Heparinized fresh bovine blood 2 was used as the blood, and a mixed gas of CO 2 and N 2 was blown into it to raise the PCO 2 to obtain venous blood. The blood flow rate was 172 ml/min, and the dialysate flow rate was 500 ml/min. 2.5% of 0.9% NaCl was used as the dialysate. The gas-liquid contact device is filled with 20 ml of water vapor-saturated air.
It was blown at a flow rate of min. Dialysate with CO2 dissipation
In order to suppress the rise in pH, 1N hydrochloric acid was automatically injected to adjust the pH to 7.0-7.4. A regenerated cellulose hollow fiber type (membrane area: 1.2 m 2 ) was used as the dialysis membrane oxygenator. As shown in Table 1, the dialysate was regenerated at a CO 2 emission rate of 52 ml/min.
【表】
実験例 ２
実験は第１図に示す装置で行つた。気液接触装
置は直径４cm、高さ50cm、容積約0.6の気泡塔
型式のもので空気流量は10／minで行つた。透
析方式膜型人工肺としては再生セルロース中空糸
型（膜面積1.2m2）を用いた。透析液としては
NaCl8.6ｇ／、KCl0.3g／、CaCl2・2H2O
0.33g／、ブドウ糖2.6g／の組成のものに炭
酸脱水酵素（カーボネイト ハイドロリアーゼ
４、２、１、１）30mg／溶解したものを2.5
使用した。血液としてはヘパリン化新鮮牛血２
を使用し、CO2とN2ガスを吹き込みPCO2を上げ
て静脈血とした。血液流量172ml／min、透析液
流量は500ml／minで行つた。結果は第２表に示
すようにCO2放散速度53.6ml／minで透析液を再
生することができた。[Table] Experimental Example 2 The experiment was conducted using the apparatus shown in Figure 1. The gas-liquid contacting device was of a bubble column type with a diameter of 4 cm, a height of 50 cm, and a volume of about 0.6 cm, and the air flow rate was 10/min. A regenerated cellulose hollow fiber type (membrane area: 1.2 m 2 ) was used as the dialysis membrane oxygenator. As a dialysate
NaCl8.6g/, KCl0.3g/, CaCl2・2H2O
2.5 mg of carbonic anhydrase (carbonate hydrolyase 4, 2, 1, 1) dissolved in 30 mg of carbonic anhydrase (carbonate hydrolyase 4, 2, 1, 1) in a composition of 0.33 g/glucose and 2.6 g/glucose.
used. As for blood, heparinized fresh bovine blood2
was used to raise the PCO 2 by blowing in CO 2 and N 2 gases to obtain venous blood. The blood flow rate was 172 ml/min, and the dialysate flow rate was 500 ml/min. As shown in Table 2, the dialysate could be regenerated at a CO 2 emission rate of 53.6 ml/min.
【表】
実験例１と比較すると気液接触装置の容積が1/
３、空気流量が1/2でほぼ同等のCO2放散速度が得
られた。また本実験例と同一条件で、前記炭酸脱
水酵素（カーボネイト ハイドロリアーゼ４、
２、１、１）を添加しない透析液を使用した場合
のCO2放散速度は14.9ml／minであつた。[Table] Compared to Experimental Example 1, the volume of the gas-liquid contact device is 1/
3. Almost the same CO 2 diffusion rate was obtained when the air flow rate was halved. In addition, under the same conditions as in this experimental example, the carbonic anhydrase (carbonate hydrolyase 4,
When using a dialysate without addition of 2, 1, 1), the CO 2 emission rate was 14.9 ml/min.
第１図は本発明の系統説明図を示す。
図中、１……透析方式膜型人工肺、２……気液
接触装置、８……血液入口、９……血液出口、１
０……透析液入口、１１……透析液出口。
FIG. 1 shows an explanatory diagram of the system of the present invention. In the figure, 1... dialysis membrane oxygenator, 2... gas-liquid contact device, 8... blood inlet, 9... blood outlet, 1
0... Dialysate inlet, 11... Dialysate outlet.
Claims (1)
とを接触させて血液中の二酸化炭素並びに重炭酸
イオンを透析液中に移動させる透析方式膜型人工
肺において、前記透析液を前記透析方式膜型人工
肺系外でPHの変動を抑制しながら空気、窒素、酸
素あるいはこれらの混合気体等の同伴ガス（キヤ
リアー ガス）と接触させ、前記血液中から透析
液中に移動した二酸化炭素並びに血液中から透析
液中に移動した重炭酸イオンより生じた二酸化炭
素を前記同伴ガス（キヤリアー ガス）中に放散
させることにより前記透析液を再生し、該透析液
を前記透析方式膜型人工肺に戻し、透析液を循環
使用するようにしたことを特徴とする血液透析方
式膜型人工肺装置。 ２ 透析液が炭酸脱水酵素を含有することを特徴
とする特許請求の範囲第１項に記載の血液透析方
式膜型人工肺装置。 ３ 炭酸脱水酵素が高分子化合物に固定されてい
ることを特徴とする特許請求の範囲第２項に記載
の血液透析方式膜型人工肺装置。 ４ 透析液が反応促進剤を含有することを特徴と
する特許請求の範囲第１項に記載の血液透析方式
膜型人工肺装置。 ５ 反応促進剤が高分子化合物に固定されている
ことを特徴とする特許請求の範囲第４項に記載の
血液透析方式膜型人工肺装置。[Scope of Claims] 1. A dialysis-type membrane oxygenator in which blood is circulated extracorporeally and the blood and dialysate are brought into contact with each other through a membrane to transfer carbon dioxide and bicarbonate ions from the blood into the dialysate, The dialysate is brought into contact with an accompanying gas (carrier gas) such as air, nitrogen, oxygen, or a mixture thereof outside the dialysis-type membrane oxygenator system while suppressing PH fluctuations, thereby removing the blood from the blood into the dialysate. The dialysate is regenerated by dissipating into the accompanying gas (carrier gas) the carbon dioxide generated from the carbon dioxide transferred from the blood and the bicarbonate ions transferred from the blood into the dialysate, and the dialysate is A hemodialysis membrane oxygenator, characterized in that the membrane oxygenator is reverted to a membrane oxygenator and the dialysate is circulated. 2. The hemodialysis membrane oxygenator according to claim 1, wherein the dialysate contains carbonic anhydrase. 3. The hemodialysis membrane oxygenator according to claim 2, wherein carbonic anhydrase is immobilized on a polymer compound. 4. The hemodialysis membrane oxygenator according to claim 1, wherein the dialysate contains a reaction accelerator. 5. The hemodialysis membrane oxygenator according to claim 4, wherein the reaction accelerator is fixed to a polymer compound.
Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| JP11614881A JPS5819265A (en) | 1981-07-23 | 1981-07-23 | Membrane type artificial lang apparatus by blood dialyzing system |
Applications Claiming Priority (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| JP11614881A JPS5819265A (en) | 1981-07-23 | 1981-07-23 | Membrane type artificial lang apparatus by blood dialyzing system |
Publications (2)
| Publication Number | Publication Date |
|---|---|
| JPS5819265A JPS5819265A (en) | 1983-02-04 |
| JPS6121424B2 true JPS6121424B2 (en) | 1986-05-27 |
Family
ID=14679934
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| JP11614881A Granted JPS5819265A (en) | 1981-07-23 | 1981-07-23 | Membrane type artificial lang apparatus by blood dialyzing system |
Country Status (1)
| Country | Link |
|---|---|
| JP (1) | JPS5819265A (en) |
Families Citing this family (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| JPS60249969A (en) * | 1984-05-25 | 1985-12-10 | テルモ株式会社 | Hollow fiber membrane type artificial lung |
| WO2018106185A2 (en) * | 2016-12-05 | 2018-06-14 | Temasek Polytechnic | Sorbent for a dialysis device and dialysis system |
-
1981
- 1981-07-23 JP JP11614881A patent/JPS5819265A/en active Granted
Also Published As
| Publication number | Publication date |
|---|---|
| JPS5819265A (en) | 1983-02-04 |
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