WO2003011367A1 - Appareil de purification du sang permettant d'augmenter l'efficacite de la purification - Google Patents
Appareil de purification du sang permettant d'augmenter l'efficacite de la purification Download PDFInfo
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- WO2003011367A1 WO2003011367A1 PCT/JP2002/007777 JP0207777W WO03011367A1 WO 2003011367 A1 WO2003011367 A1 WO 2003011367A1 JP 0207777 W JP0207777 W JP 0207777W WO 03011367 A1 WO03011367 A1 WO 03011367A1
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- blood
- osmotic pressure
- purification
- patient
- blood purification
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/14—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis
- A61M1/16—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis with membranes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/34—Filtering material out of the blood by passing it through a membrane, i.e. hemofiltration or diafiltration
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/14—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/14—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis
- A61M1/16—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis with membranes
- A61M1/1601—Control or regulation
- A61M1/1613—Profiling or modelling of patient or predicted treatment evolution or outcome
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/34—Filtering material out of the blood by passing it through a membrane, i.e. hemofiltration or diafiltration
- A61M1/342—Adding solutions to the blood, e.g. substitution solutions
- A61M1/3455—Substitution fluids
- A61M1/3458—Substitution fluids having electrolytes not present in the dialysate
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/36—Other treatment of blood in a by-pass of the natural circulatory system, e.g. temperature adaptation, irradiation ; Extra-corporeal blood circuits
- A61M1/3621—Extra-corporeal blood circuits
- A61M1/3639—Blood pressure control, pressure transducers specially adapted therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/34—Filtering material out of the blood by passing it through a membrane, i.e. hemofiltration or diafiltration
- A61M1/342—Adding solutions to the blood, e.g. substitution solutions
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M2205/00—General characteristics of the apparatus
- A61M2205/33—Controlling, regulating or measuring
- A61M2205/3331—Pressure; Flow
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M2205/00—General characteristics of the apparatus
- A61M2205/33—Controlling, regulating or measuring
- A61M2205/3379—Masses, volumes, levels of fluids in reservoirs, flow rates
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M2230/00—Measuring parameters of the user
- A61M2230/20—Blood composition characteristics
- A61M2230/207—Blood composition characteristics hematocrit
Definitions
- the present invention relates to a blood purification apparatus capable of improving blood purification efficiency, and more particularly, to a blood purification apparatus capable of controlling a blood purification while confirming a patient's blood condition, such as water removal, waste matter and solute removal.
- the present invention relates to a blood purification apparatus capable of improving blood purification efficiency.
- Hemodialysis is a process of purifying blood by removing excess water, waste, and toxic substances in the blood through a hollow fiber-shaped semipermeable membrane. It is important for blood analyzers to maintain the patient's blood condition (circulating blood volume) properly in order to perform safe and effective hemodialysis. If the target dialysis conditions are too high for the patient, blood circulation will be excessively reduced, which may cause a drop in blood pressure and shock. Conversely, if the dialysis conditions are too slow, there are problems such as hypertension and heart failure due to insufficient water removal. Naturally, it is difficult to improve the symptoms of renal failure due to insufficient dialysis.
- hemodialysis is performed while measuring the hematocrit value
- dialysis is performed by linking and controlling the blood pump, water removal pump, and rehydration pump based on the blood circulation volume calculated from the hematocrit value. It controls the processing.
- the above device has a simple mechanism and can be used by anyone, but it is difficult to adjust the dialysis time (extending the dialysis time is fatal), cannot control the first half of dialysis, and is effective only for lowering blood pressure in the second half. was there.
- Japanese Patent Application Laid-Open No. 9-1499395 discloses a blood dialysis apparatus for controlling dialysis conditions while monitoring the blood condition.
- Japanese Patent Publication No. 6-833723 discloses a control device that estimates a body fluid state based on a hematocrit value, and controls a blood pump and an ultra-pressure based on the estimated fluid state.
- the devices shown above do not have a safety mechanism to prevent runaway of the feedpack control, or the blood condition is not as set. In this case, the operator had to operate dialysis conditions and equipment each time.
- the present inventors have also proposed a blood purification apparatus capable of performing hemodialysis treatment while monitoring the blood condition of a patient.
- a blood purifying apparatus as disclosed in Japanese Patent Application No. 10-110 13 24 (Japanese Patent Application Laid-Open No. 11-221275).
- this device gains water removal in the first half of dialysis, it can solve the problem of prolonged dialysis time and can control the amount of blood circulation during dialysis within a predetermined range, but has the following merit.
- it had the disadvantage that it was necessary to set the alarm zone to be controlled and to set the control parameters in detail.
- An object of the present invention is to solve the above problems. That is, a blood purification apparatus that can accurately and easily operate blood purification, can perform blood purification safely and physiologically on a living body, and can further improve (improve) dialysis efficiency. To provide.
- a blood purification apparatus which does not require complicated setting and control operations and can achieve a target blood purification processing.
- a device capable of performing physiological (gentle) dialysis for each patient so that the patient can be safely and comfortably protected from being in danger due to excessive purification treatment. Is to provide.
- the object of the present invention is to provide a blood purification apparatus that has improved (improved) the dialysis efficiency indicated by the removal of solutes from waste products and the removal of water.
- the object of the present invention is to provide a blood purification device capable of improving the efficiency of removing medium-sized waste products while retaining proteins required for living organisms.
- the present invention achieves the above object by artificially forming an osmotic pressure difference between the osmotic pressure of the patient's blood and the intracellular osmotic pressure of the patient during blood purification,
- the osmotic pressure difference between the osmotic pressure and the intracellular osmotic pressure in the patient's blood vessels is increased and decreased by creating an artificially repeated osmotic pressure increase / decrease (high / low).
- the basic technical idea is to increase the efficiency of water removal and solute removal by this, and this was completed based on this technical idea.
- the present invention provides a blood osmotic pressure changing means for artificially forming an osmotic pressure difference between the osmotic pressure of a patient's blood and the intracellular osmotic pressure of a patient during blood purification, and in particular, at least one of the blood purification steps. It is intended to provide a blood purification apparatus having blood osmotic pressure changing means for periodically changing and forming the osmotic pressure difference in the process of the section, particularly in the latter half of the blood purification process.
- Means for forming the osmotic pressure difference between the osmotic pressure of the patient's blood and the intracellular osmotic pressure of the patient include changing the purification conditions in the blood purification process and using an osmotic pressure differential substance.
- One of the technical means to artificially and periodically change the osmotic pressure difference is to cyclically change the purification conditions in the blood purification process.For example, by changing the water removal rate including stopping water removal, There is a means to do it.
- the osmotic pressure difference between the blood osmotic pressure and the intracellular is periodically changed. Therefore, water removal efficiency and solute removal efficiency can be increased. Also, the ability to remove specific solutes (especially medium-molecular solutes that are difficult to move) can be improved.
- Another technique for periodically changing the osmotic pressure difference between the osmotic pressure of the patient's blood and the intracellular osmotic pressure of the patient is to supply an osmotic pressure changing substance to a blood circuit or a dialysate supply circuit.
- an osmotic pressure changing substance to a blood circuit or a dialysate supply circuit.
- a rehydration means is provided in the blood circuit, the means for associating the osmotic pressure changing means with the osmotic pressure changing means, and the flow through the dialysate circuit is performed. There is a means to do this by changing the osmotic pressure of the dialysate.
- the latter means is a liquid injector containing an osmotic pressure changing substance capable of changing the content of the osmotic pressure changing substance in the dialysate flowing through the dialysate circuit, for example, a sodium-containing liquid injector (hereinafter also referred to as a sodium injector).
- the dialysate endotoxin filter
- the dialysate endotoxin filter
- the dialysate can be realized at a lower cost than the former, and the blood osmotic pressure can be changed quickly and over a wide range by using it together with a method for supplying a dialysate, which will be described later, by an online mechanism.
- the concentration should be high, for example, 145 to 15 OmE q / 1, and the blood osmotic pressure should be lowered. Is preferably low in concentration, for example 140 to 143 mE q / 1.
- Examples of the blood purification method include a hemodialysis method, a hemofiltration method (hemo fi 1 tration: HF), and a hemodiafiltration method (hemo diafiltration: HDF).
- HF or HDF to be supplied is preferable, but in particular using a UFR controller to make the amount of fluid flowing into and out of the dialyzer exactly the same.
- HDF changes blood osmotic pressure quickly, sharply, and widely. Is preferred.
- the substance used for performing the above-described operation of periodically changing the blood osmotic pressure to a high or low level is not particularly limited as long as the above-mentioned object can be achieved.
- sodium, canosome, magnesium An electrolyte selected from the group consisting of lactic acid and bicarbonate, an osmotic pressure-modifying substance of glucose, or a combination of any of them.
- osmotic pressure altering substances containing sodium ions are preferred in view of safety and effect.
- the blood in the blood vessel 3 was continuously injected from the dialysis circuit into the blood circuit by, for example, online HDF.
- the osmotic pressure between blood osmotic pressure and the intracellular osmotic pressure of the patient is made high by maintaining the osmotic pressure high. That is, in the first half of the blood purification step of the present invention, the blood osmotic pressure changing means as described above can be controlled so that the blood osmotic pressure is continuously increased to perform the purification step. Preferred in achieving the object of the invention.
- the dialysis efficiency is increased by continuously collecting liquid in a high Na state and increasing the plasma osmotic pressure to increase the PRR, thereby increasing the UFR (water removal rate). Can be further enhanced.
- the blood purification operation using the blood osmotic pressure changing means as described above is preferably controlled by blood volume (BV) control using a blood index value described later.
- BV blood volume
- the process proceeds to the latter half of the blood purification.
- the blood purification is performed in the latter half of the blood purification. It is preferable that the means for artificially forming the repeated increase and decrease of the blood osmotic pressure be performed in the latter half of the blood purification process.
- the blood osmotic pressure is high by alternately injecting the high electrolyte solution and the normal dialysate from the dialysate supply circuit into the blood circuit in the online HDF.
- the state and the low state are controlled to be alternately repeated.
- the number of repetitions is preferably at least two (low-high ⁇ low) or more, but too much is cumbersome and troublesome.
- the number of repetitions is also related to the period of rise and fall of blood osmotic pressure (low ⁇ low or high ⁇ high). If the period is too long or short, the effect is hard to appear, so the preferred period is set appropriately.
- FIG. 2 (b) schematically shows the movement of water 1 from the blood vessel 3 into the cell 2. Then, the high electrolyte solution is injected from the dialysate circuit into the blood circuit again by the online HDF mechanism.
- the blood osmotic pressure in the blood vessel 3 increases, As a result, water flows into the blood vessel 3 from the cells 2 having a relatively low osmotic pressure. Along with that, the solute in the cell 2 flows out into the blood vessel 3 as shown in FIG. In this way, by artificially changing the blood osmotic pressure periodically, the osmotic pressure difference between the blood vessel and the cell enhances the water removal and solute removal efficiency, thereby improving the dialysis efficiency. As a result, medium-molecular solutes that are difficult to move are also easily removed. Also, in the latter half of blood purification, dialysis can be performed while maintaining the PRR, so that the UFR can be made larger than before, and as a result, the dialysis time can be prevented from being prolonged.
- the amount of water in blood vessels and cells is large, and there is no room (space) for blood vessels and cells to exchange water. If the space is small, the efficiency of inflow and outflow is poor.
- the water in the blood vessel and the cells is removed by the water removal in the first half of the blood purification process, and the room (space) for the water inflow is made, it is better to create the blood osmotic pressure repeatedly. The osmotic pressure is easily increased and the inflow and outflow of water caused by the osmotic pressure difference are large, so that efficient water exchange is achieved.
- the concept of the second half of the blood purification step in the present invention is that the purification step is divided into two at an arbitrary time point, the purification step before the time point is the first half of the purification step, and the purification step after the time point is the This means the relative concept of the second half of the purification process.
- the purification process is started as described above, and the purification is performed by BV control. It is preferable that the time after reaching the BV% value be the latter half of the purification process.
- the blood volume (BV value) or a blood change amount (hereinafter referred to as a blood index) as described below is used when the blood osmotic pressure difference is provided.
- BV value blood volume
- a blood index blood change amount
- blood purification can be performed in a condition that is suitable for each patient or in a physiological condition.
- the blood purification apparatus of the present invention controls the repeated increase and decrease of the blood osmotic pressure based on the above-mentioned blood volume or each of the above-mentioned blood index values, so that the blood purification is performed only under conditions suitable for the patient. Therefore, more efficient blood purification can be achieved.
- a target control line composed of a blood index value described later is set, and blood purification is controlled using the target control line.
- blood purification is performed according to the target control line, and the blood purification proceeds to the second half of the blood purification when the blood volume reaches the set standard blood volume, target BV% value, or time.
- An example is the dani method.
- Japanese Patent Application No. 2002-19447 filed by the present applicant or PC TZ JP 02/0 There is a control method disclosed in 6 7 4 4.
- the blood purification apparatus of the present invention has the above-described purification conditions, blood index values, and the like recorded on a medium as software, and can perform blood purification using the medium.
- a blood index value such as a BV value used for control in the blood purification apparatus of the present invention will be described.
- V olum e value is an abbreviation of the circulating blood volume index, which is an index value for checking the status of circulating blood volume in each patient.
- PRR occurs because the turgor pressure in the cells is high and water flows into the intravascular space due to water removal. If the intracellular turgor pressure decreases in the second half of the dialysis and space is created in the cells, the possibility of water transfer from the blood to the cells is created due to the osmotic pressure difference and the turgor pressure, and blood pressure is easily reduced. Become. Therefore, it is considered preferable to consider the blood volume maintained during normal times as the standard blood volume as the blood volume to be maintained during dialysis, and to remove water so as to maintain that state.
- the blood volume is higher than the standard blood volume, so in the first half of dialysis, the goal was to reduce the blood volume of the patient to the standard blood volume promptly, and the exclusion was made. After water is supplied, and after the blood volume has substantially decreased to the standard blood volume, it is preferable to remove water while maintaining the standard blood volume.
- the standard blood volume is set in advance by a physician or the like in consideration of factors that affect the patient's blood volume, such as the patient's age, gender, height, etc., if the patient is healthy. Keep it.
- FIG. 3 (a) the body of the dialysis patient before the start of extracorporeal circulation has expanded to near the limits in both cells and blood vessels.
- extracorporeal circulation begins, the volume of the blood vessel increases, leaving room for water to enter the blood vessel.
- FIG. 3 (b) water flows from the cells into the blood vessels, and the blood volume becomes unstable immediately after the start of extracorporeal blood circulation.
- the intravascular space is filled with the water flowing from the cells and the sum of the turgor pressure and the osmotic pressure in the blood vessels and the cells is balanced, the flow of the water stops as shown in FIG. 3 (c).
- the exact blood volume can be calculated by measuring the hematotalit value, which is the basis for calculating the initial blood volume of the patient, after a certain period of time after the start of extracorporeal circulation. Also, immediately after starting extracorporeal circulation, You need to wait for the blood volume to settle without water.
- Calculation method 1 (method of obtaining initial blood volume by changing the water removal rate) The calculation method will be explained based on Fig. 4, taking dialysis as an example.
- the following relational expression holds among the change in blood volume, the inflow from cells (PRR), the amount of water removal, the rate of change in blood volume ( ⁇ BV%), and the initial blood volume.
- the amount of water that can be pooled in blood vessels in dialysis patients has reached the maximum value, and the blood volume before dialysis is considered to be constant for each patient.
- the extracorporeal circulation is started, the amount of blood (blood) circulating increases by the volume in the extracorporeal circuit, so that there is room for water in the blood (blood vessels) in the body, which is equivalent to the amount of circulated blood. Occurs. Hematocrit or blood index related to blood volume at early stage of dialysis It is for this reason that the values are rising.
- extracorporeal circulation if extracorporeal circulation is continued without removing water until the BV value becomes stable, it is considered that water equivalent to the increased blood circulation described above moves from cells to blood vessels. (Assuming that the intracellular turgor pressure is sufficiently high, water overflows from the cells and accumulates in the interstitium) At this time, if extracorporeal circulation is continued without water removal, the cells move into the blood vessels. Blood volume increases by the amount of drained water. The volume of the increased blood volume can be approximated to the volume in the circuit (extracorporeal circulation), and the volume in the circuit can be measured. Therefore, from the rate of blood change during extracorporeal circulation without water removal, The initial blood volume can be calculated.
- the initial blood volume corresponds to the sum of the internal blood volume and the extracorporeal blood volume.
- ABV [BV change amount] (Ht at the time of HtZ measurement at the start of dialysis)-1
- the Ht is an abbreviation for hematotalit, which indicates the volume ratio of red blood cells in whole blood.
- ratio (ratio) of the BV change amount is expressed as a percentage by dividing the ABV value at the time of measurement by ⁇ V 0 at the start of dialysis as shown in the following formula.
- ABV% ABV / BV. X 100
- the BV value at the time of measurement is the BV value at the start of dialysis. Divided by and expressed as a percentage.
- BV% BV value during measurement ZB V Q X 100
- the target (to be maintained) BV% can be calculated from the set standard blood volume and the initial dialysis blood volume calculated above. Therefore, the target BV% can be calculated automatically from the initial blood volume.
- Target BV% standard blood volume Z initial blood volume XI 00
- the meaning of the BV% value differs depending on the patient. It is. Furthermore, how long it takes to drop from the initial blood volume to the standard blood volume can be arbitrarily set at each facility. For example, as shown in Fig. 7, if the blood volume of a patient is represented by a blood volume ratio (% BV), the initial blood volume is defined at point A on the graph, and the target standard blood volume is defined at point B on the graph. Will be stipulated.
- the water removal time from point A to point B can be set while observing the situation of each patient. Depending on the length of the water removal time, the gradient C of the rate at which the blood volume changes becomes steep or gentle.
- a blood purification apparatus capable of achieving the following effects.
- the dialysis efficiency can be improved (improved). As a result, the effect of preventing the blood purification time from being prolonged and increasing the amount of removal of the waste of the molecular weight can be obtained.
- FIG. 6 is a diagram illustrating that a dialysate is periodically injected into a blood circuit or a dialysate supply circuit, thereby artificially creating a state where the osmotic pressure of blood is repeatedly increased and decreased to perform a purification process.
- a of FIG. 2 is a diagram schematically showing the movement of water 1 from the cell 2 to the blood vessel 3 due to the osmotic pressure difference between the blood vessel and the cell in the first half of dialysis.
- FIG. 3 is a diagram schematically showing movement of water from a blood vessel into a cell or in the opposite direction immediately before (a), immediately after extracorporeal circulation (b) and immediately after extracorporeal circulation (c).
- white and arrows indicate the direction of movement of water
- black and arrows indicate the direction of movement of solute components.
- FIG. 4 illustrates one method (with water removal) for calculating the initial blood volume of a patient It is a conceptual diagram for performing.
- FIG. 5 is a conceptual diagram for explaining another method (without water removal) for calculating the initial blood volume of a patient.
- FIG. 6 is a diagram for explaining the principle of periodically changing the osmotic pressure difference between the osmotic pressure of the patient's blood and the intracellular osmotic pressure of the patient by changing or stopping the water removal rate.
- Fig. 7 is a concept for explaining an example of setting the speed (slope) for decreasing the blood volume from the initial blood volume (BV 0 ) to the standard blood volume (target% BV) in the first half of dialysis. The lower part of FIG.
- FIG. 7 shows the water removal rate at each blood purification point in the Y-axis direction.
- A is the initial blood volume (100% BV)
- B is the standard blood volume (target% BV)
- C is the blood volume from the initial blood volume (BV.) To the standard blood volume (target% BV).
- the present embodiment is an example in which the dialysis efficiency is improved by combining a Na (sodium) infuser and online HDF, and will be described with reference to FIG.
- the upper half shows the time course of the blood volume index value
- the lower half shows the injection state of the high sodium dialysate.
- the Na (sodium) infuser is used in combination with the online HDF, and the amount of water pushed in from the dialysate and the amount of water removed from the dialyzer are made equal using a UFR controller. That is, they can be balanced. Thereby, the blood osmotic pressure can be changed quickly, sharply and widely.
- a sodium injector for injecting a high sodium-containing solution into the dialysate circuit is preferable.
- a sodium injector is provided upstream of the hemodialyzer in the dialysate circuit and is capable of flowing high sodium-containing fluid.
- the dialysate is brought to a high sodium state to increase blood osmotic pressure, thereby increasing PRR.
- the sodium injector is controlled so that the dialysate alternates between a high sodium state and a standard state.
- a high Na dialysate is made using a Na injector.
- Blood infused with high Na dialysate will have a high osmotic pressure, increase PRR, increase the rate of water removal, and increase the ability to remove substances from plasma.
- the Na injector is operated intermittently to alternately produce high Na dialysate and standard dialysate.
Description
Claims
Priority Applications (7)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
JP2003516597A JP4225198B2 (ja) | 2001-08-01 | 2002-07-31 | 浄化効率を向上できる血液浄化装置 |
EP02753211A EP1421958A4 (en) | 2001-08-01 | 2002-07-31 | BLOOD CLEANING DEVICE TO INCREASE CLEANING EFFICIENCY |
CA002456091A CA2456091A1 (en) | 2001-08-01 | 2002-07-31 | Blood purification apparatus for elevating purification efficiency |
KR1020047001251A KR100864397B1 (ko) | 2001-08-01 | 2002-07-31 | 정화 효율을 향상시킬 수 있는 혈액 정화 장치 |
US10/485,277 US20040262226A1 (en) | 2001-08-01 | 2002-07-31 | Blood purification apparatus for elevating purification efficiency |
AU2002313902A AU2002313902B2 (en) | 2001-08-01 | 2002-07-31 | Blood purification apparatus for elevating purification efficiency |
US11/428,178 US7402249B2 (en) | 2001-08-01 | 2006-06-30 | Blood purification apparatus for elevating purification efficiency |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
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JP2001-234141 | 2001-08-01 | ||
JP2001234141 | 2001-08-01 |
Related Child Applications (2)
Application Number | Title | Priority Date | Filing Date |
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US10485277 A-371-Of-International | 2002-07-31 | ||
US11/428,178 Continuation-In-Part US7402249B2 (en) | 2001-08-01 | 2006-06-30 | Blood purification apparatus for elevating purification efficiency |
Publications (1)
Publication Number | Publication Date |
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WO2003011367A1 true WO2003011367A1 (fr) | 2003-02-13 |
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ID=19065805
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
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PCT/JP2002/007777 WO2003011367A1 (fr) | 2001-08-01 | 2002-07-31 | Appareil de purification du sang permettant d'augmenter l'efficacite de la purification |
Country Status (8)
Country | Link |
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US (2) | US20040262226A1 (ja) |
EP (1) | EP1421958A4 (ja) |
JP (1) | JP4225198B2 (ja) |
KR (1) | KR100864397B1 (ja) |
CN (1) | CN1314463C (ja) |
AU (1) | AU2002313902B2 (ja) |
CA (1) | CA2456091A1 (ja) |
WO (1) | WO2003011367A1 (ja) |
Cited By (2)
Publication number | Priority date | Publication date | Assignee | Title |
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JP2005000649A (ja) * | 2003-05-16 | 2005-01-06 | Kita Kyushu Seimei Joho Kagakuin:Kk | 間欠的に注液、除水操作を繰り返す血液透析装置 |
JP2020174739A (ja) * | 2019-04-15 | 2020-10-29 | ニプロ株式会社 | 細胞外液量標準化装置、これを備える細胞外液量評価装置及び細胞外液量を標準化するためのコンピュータプログラム |
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US8753515B2 (en) | 2009-12-05 | 2014-06-17 | Home Dialysis Plus, Ltd. | Dialysis system with ultrafiltration control |
US8501009B2 (en) | 2010-06-07 | 2013-08-06 | State Of Oregon Acting By And Through The State Board Of Higher Education On Behalf Of Oregon State University | Fluid purification system |
JP5591629B2 (ja) * | 2010-08-30 | 2014-09-17 | 株式会社東芝 | 半導体装置、及び静電アクチュエータの駆動方法 |
AU2012318561B2 (en) | 2011-10-07 | 2017-04-20 | Outset Medical, Inc. | Heat exchange fluid purification for dialysis system |
US20150314055A1 (en) | 2014-04-29 | 2015-11-05 | Michael Edward HOGARD | Dialysis system and methods |
ES2908601T3 (es) | 2016-08-19 | 2022-05-03 | Outset Medical Inc | Sistema y métodos de diálisis peritoneal |
US11389576B2 (en) * | 2018-12-03 | 2022-07-19 | Fresenius Medical Care Holdings, Inc. | Determination of patient blood volume at start of a dialysis treatment |
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- 2002-07-31 CA CA002456091A patent/CA2456091A1/en not_active Abandoned
- 2002-07-31 EP EP02753211A patent/EP1421958A4/en not_active Withdrawn
- 2002-07-31 JP JP2003516597A patent/JP4225198B2/ja not_active Expired - Lifetime
- 2002-07-31 WO PCT/JP2002/007777 patent/WO2003011367A1/ja active Application Filing
- 2002-07-31 US US10/485,277 patent/US20040262226A1/en not_active Abandoned
- 2002-07-31 CN CNB028150309A patent/CN1314463C/zh not_active Expired - Lifetime
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JPH05115546A (ja) * | 1991-10-31 | 1993-05-14 | Asahi Medical Co Ltd | 透析装置 |
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JP2005000649A (ja) * | 2003-05-16 | 2005-01-06 | Kita Kyushu Seimei Joho Kagakuin:Kk | 間欠的に注液、除水操作を繰り返す血液透析装置 |
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JP2020174739A (ja) * | 2019-04-15 | 2020-10-29 | ニプロ株式会社 | 細胞外液量標準化装置、これを備える細胞外液量評価装置及び細胞外液量を標準化するためのコンピュータプログラム |
JP7218660B2 (ja) | 2019-04-15 | 2023-02-07 | ニプロ株式会社 | 細胞外液量標準化装置、これを備える細胞外液量評価装置及び細胞外液量を標準化するためのコンピュータプログラム |
Also Published As
Publication number | Publication date |
---|---|
EP1421958A1 (en) | 2004-05-26 |
US20070007209A1 (en) | 2007-01-11 |
EP1421958A4 (en) | 2008-10-08 |
AU2002313902B2 (en) | 2007-10-25 |
JPWO2003011367A1 (ja) | 2004-11-18 |
KR100864397B1 (ko) | 2008-10-20 |
CA2456091A1 (en) | 2003-02-13 |
CN1314463C (zh) | 2007-05-09 |
US20040262226A1 (en) | 2004-12-30 |
US7402249B2 (en) | 2008-07-22 |
KR20040023693A (ko) | 2004-03-18 |
JP4225198B2 (ja) | 2009-02-18 |
CN1537022A (zh) | 2004-10-13 |
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