WO2020004603A1 - Dispositif de dialyse et procédé de commande - Google Patents

Dispositif de dialyse et procédé de commande Download PDF

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Publication number
WO2020004603A1
WO2020004603A1 PCT/JP2019/025757 JP2019025757W WO2020004603A1 WO 2020004603 A1 WO2020004603 A1 WO 2020004603A1 JP 2019025757 W JP2019025757 W JP 2019025757W WO 2020004603 A1 WO2020004603 A1 WO 2020004603A1
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Prior art keywords
rate
water removal
dialysate
blood
replacement
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PCT/JP2019/025757
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English (en)
Japanese (ja)
Inventor
田岡　正宏
正岡　勝則
Original Assignee
株式会社ジェイ・エム・エス
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Application filed by 株式会社ジェイ・エム・エス filed Critical 株式会社ジェイ・エム・エス
Priority to CN201980042155.2A priority Critical patent/CN112334171B/zh
Publication of WO2020004603A1 publication Critical patent/WO2020004603A1/fr

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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

Definitions

  • the present invention relates to a dialysis device capable of intermittently performing fluid replacement and a control method using the dialysis device.
  • a case where 2.4 L of water is removed in 4 hours (240 minutes) and 200 ml of replacement fluid is performed 7 times at a replacement fluid rate (reverse filtration rate) of 150 ml / min per time with reference to FIG. 6A.
  • the water removal rate is 10 ml / min.
  • FIG. 6A when a 200 ml replacement fluid is injected at 150 ml / min, water cannot be removed for 80 seconds each time, or 560 seconds (9.3 minutes) seven times. Therefore, the actual water removal time is 230.7 minutes, and the actual water removal rate is 10.4 ml / min. In this way, the water removal is performed in a state where the water removal rate is increased by about 4% compared to the assumed water removal rate of 10 ml / min, whereby the shortage of the water removal is adjusted.
  • the replacement fluid is executed as planned during the dialysis treatment, the water can be removed according to the control example of the setting of the water removal rate shown in FIG. 6A.
  • the device may be stopped for safety confirmation due to the occurrence of an alarm or the like and the treatment may be interrupted, and the scheduled replacement fluid may not be performed. It is also conceivable that the implementation of replacement fluid is added due to the extension of the treatment time.
  • an object of the present invention is to provide a dialysis apparatus and a control method capable of performing water removal for a body weight at a preset water removal rate regardless of the embodiment of replacement fluid.
  • the present invention provides a blood circuit, a blood purification means disposed in the blood circuit, capable of removing water in blood, and sending a dialysate so as to perform fluid replacement or back-filtration via the blood purification means.
  • a dialysate circuit connected to the blood purification means, the dialysate circuit having a dialysate solution sending section, and the dialysate solution sending section so as to perform water removal from the blood circuit and intermittent replenishment to the blood circuit.
  • a control unit for controlling the fluid replenishment wherein the control unit calculates a time for performing rehydration based on a predetermined fluid replacement amount and a predetermined fluid replacement speed, and is set in advance except during fluid replacement.
  • the present invention provides a blood circuit, a blood purification means disposed in the blood circuit, capable of removing moisture in blood, and a dialysis solution for performing fluid replacement or back-filtration via the blood purification means.
  • a dialysate circuit connected to the blood purification means, and a dialysate supply unit for removing water from the blood circuit and performing intermittent replenishment to the blood circuit.
  • a control unit for controlling the liquid unit, and a control method for a dialysis device comprising: calculating a time for performing rehydration based on a predetermined replacement fluid amount and a predetermined replacement fluid speed; The water removal for the body weight is performed at the set water removal rate, and the water removal for the replacement fluid recovery is performed at the replacement fluid recovery rate based on the predetermined replacement fluid amount. During the replacement, the set removal rate is reduced from the predetermined replacement fluid speed. Dialysis in which rehydration is performed at the reverse filtration rate calculated by reducing the water velocity A method of controlling the location.
  • the set water removal rate is calculated and set based on the increased weight of the patient and the dialysis time.
  • the set water removal rate is calculated based on the weight gain of the patient and the dialysis time, and is set to a predetermined value as the dialysis time elapses.
  • rehydration is performed at a reverse filtration rate calculated by subtracting the set water removal rate from a predetermined replacement fluid rate, and the replacement fluid is collected based on a predetermined replacement fluid amount.
  • the water removal for the body weight can be performed without recalculating the preset water removal speed set in advance.
  • FIG. 4 shows a control example of a water removal rate and a replacement fluid recovery rate in the first embodiment.
  • 9 shows a control example of a water removal rate and a replacement fluid recovery rate in the second embodiment.
  • 5 shows a control example of setting of a water removal speed in a conventional example. An example of actual control of a water removal rate in a conventional example is shown.
  • the dialysis apparatus and control method of the present invention are used for the treatment of intermittent replenishment-type hemofiltration dialysis (so-called I-HDF) in which replenishment is performed intermittently using a back-filtered dialysate.
  • I-HDF intermittent replenishment-type hemofiltration dialysis
  • Fluid replacement is performed intermittently to prevent such a rapid decrease in blood pressure.
  • blood pressure is prevented from lowering, peripheral circulation is improved, and the speed of plasma refilling is maintained.
  • the rate of decrease in the amount of circulating blood after dialysis can be reduced even at the same water removal rate (excluding the replacement fluid collection) as compared to the case where no replacement fluid is performed.
  • the increase in the amount of circulating blood due to the replacement fluid is removed by the blood purification means 120 from the start to the end of the dialysis. Therefore, the total water removal amount is the sum of the body weight removal water removal, which is the excess water that should be originally removed from the patient's body, and the replacement fluid recovery amount.
  • the amount of water that should be removed from the patient or the rate of water removal pertaining to the water removal is also referred to as the amount of water removal per body weight or the rate of water removal per body weight.
  • the speed is also referred to as a water removal amount for the replacement fluid recovery or a replacement fluid recovery speed.
  • FIG. 1 is a diagram showing a schematic configuration of a dialysis device 100 according to the first embodiment of the present invention.
  • the dialysis device 100 includes a blood circuit 110 for flowing blood, a blood purification unit 120, a dialysate circuit 130, and a control unit 140.
  • the blood circuit 110 has an arterial line 111, a venous line 112, a drug line 113, and a priming fluid discharge line 114.
  • the arterial line 111, the venous line 112, the drug line 113, and the priming liquid discharge line 114 are each mainly composed of a flexible soft tube through which a liquid can flow.
  • One end of the arterial line 111 is connected to a blood inlet 122a of a blood purification unit 120 described later.
  • an arterial connection section 111a In the arterial line 111, an arterial connection section 111a, an arterial bubble detector 111b, and a blood pump 111c are arranged.
  • the arterial connection 111a is arranged on the other end of the arterial line 111.
  • a needle inserted into a blood vessel of a patient is connected to the artery-side connection portion 111a.
  • the arterial-side bubble detector 111b detects the presence or absence of bubbles in the tube.
  • the blood pump 111c is arranged downstream of the arterial-side air bubble detector 111b in the arterial-side line 111.
  • the blood pump 111c delivers a liquid such as blood or priming liquid inside the arterial line 111 by squeezing a tube constituting the arterial line 111 with a roller.
  • the venous line 112 is connected to a blood outlet 122b of the blood purification means 120 described later.
  • the venous line 112 includes a venous connection 112a, a venous bubble detector 112b, a drip chamber 112c, and a venous clamp 112d.
  • the vein-side connection part 112a is arranged on the other end side of the vein-side line.
  • a needle inserted into a blood vessel of a patient is connected to the vein-side connecting portion 112a.
  • the vein side bubble detector 112b detects the presence or absence of bubbles in the tube.
  • the drip chamber 112c is disposed upstream of the vein-side bubble detector 112b.
  • the drip chamber 112c stores a certain amount of blood in order to remove bubbles, coagulated blood, and the like mixed in the venous line 112 and to measure venous pressure.
  • the vein-side clamp 112d is disposed downstream of the vein-side bubble detector 112b. The vein-side clamp 112d is controlled in accordance with the detection result of bubbles by the vein-side bubble detector 112b, and opens and closes the flow path of the vein-side line 112.
  • the drug line 113 supplies a drug required during hemodialysis to the arterial line 111.
  • One end of the drug line 113 is connected to the drug solution pump 113a for sending out a drug, and the other end is connected to the arterial line 111.
  • the medicine line 113 is provided with a clamp means (not shown), and the flow path is closed by the clamp means except when the medicine is injected.
  • the other end of the drug line 113 is connected to the arterial line 122 downstream of the blood pump 111c.
  • the priming liquid discharge line 114 is connected to the drip chamber 112c.
  • the priming liquid discharge line 114 is provided with a priming liquid discharge line clamp 114a.
  • the priming liquid discharge line 114 is a line for discharging the priming liquid in a priming step described later.
  • the blood purification means 120 includes a cylindrical container body 121 and a dialysis membrane (not shown) housed inside the container body 121. It is divided into a side channel and a dialysate side channel (neither is shown).
  • a blood inlet 122a and a blood outlet 122b communicating with the blood circuit 110, and a dialysate inlet 123a and a dialysate outlet 123b communicating with the dialysate circuit 130 are formed.
  • the blood extracted from the artery of the subject flows through the arterial line 111 by the blood pump 111c, and the blood-side flow path of the blood purification means 120 Will be introduced.
  • the blood introduced into the blood purification means 120 is purified by a dialysate flowing through a dialysate circuit 130 described later via a dialysis membrane.
  • the blood purified by the blood purification means 120 flows through the venous line 112 and is returned to the subject's vein.
  • the dialysate circuit 130 is constituted by a so-called closed volume control type dialysate circuit 130.
  • the dialysate circuit 130 includes a dialysate supply line 131a, a dialysate drain line 131b, a dialysate introduction line 132a, a dialysate derivation line 132b, and a dialysate delivery unit 133.
  • the dialysate sending section 133 includes a dialysate chamber 1331, a bypass line 1332, and a water removal / back-filtration pump 1333.
  • the dialysate chamber 1331 is formed of a hard container capable of storing a fixed volume (for example, 300 ml to 500 ml) of dialysate, and the inside of this container is formed by a soft diaphragm (diaphragm) and a liquid sending container 1331 a and a drain. It is partitioned into a housing 1331b.
  • the bypass line 1332 connects the dialysate outlet line 132b and the dialysate drain line 131b.
  • Water removal / back-filtration pump 1333 is arranged in bypass line 1332.
  • the water removal / back-filtration pump 1333 is a direction in which the dialysate in the bypass line 1332 flows toward the dialysate drain line 131b (water removal direction) and a direction in which the dialysate flows through the dialysate discharge line 132b (back filtration direction). It is constituted by a pump driven so as to be able to send liquid.
  • the dialysate supply line 131a has a proximal end connected to a dialysate supply device (not shown) and a distal end connected to the dialysate chamber 1331.
  • the dialysis fluid supply line 131a supplies the dialysis fluid to the fluid supply storage unit 1331a of the dialysis fluid chamber 1331.
  • the dialysate introduction line 132a connects the dialysate chamber 1331 and the dialysate inlet 123a of the blood purification means 120, and dialyses the dialysate stored in the liquid supply storage part 1331a of the dialysate chamber 1331 by the dialysis of the blood purification means 120. Introduce into the liquid side flow path.
  • the dialysate outlet line 132b connects the dialysate outlet 123b of the blood purification unit 120 and the dialysate chamber 1331 and leads the dialysate discharged from the blood purification unit 120 to the drainage storage unit 1331b of the dialysate chamber 1331. I do.
  • the dialysate drain line 131b has a proximal end connected to the dialysate chamber 1331 and discharges the dialysate drain contained in the drain reservoir 1331b.
  • the inside of the hard container constituting the dialysate chamber 1331 is partitioned by the soft diaphragm (diaphragm), so that the amount of dialysate drawn out from the dialysate chamber 1331 (liquid sending accommodation)
  • the amount of dialysate supplied to the portion 1331a) and the amount of drainage collected in the dialysate chamber 1331 (drainage storage portion 1331b) can be made equal. Accordingly, in a state where the water removal / back-filtration pump 1333 is stopped, the flow rate of the dialysate introduced into the blood purification means 120 and the amount of the dialysate (effluent) derived from the blood purification means 120 are equalized. Can be.
  • the dialysate outlet line 132b flows.
  • the amount of dialysate to be collected is obtained by adding the amount of dialysate flowing through the bypass line 1332 to the amount of dialysate recovered in the dialysate chamber 1331 (that is, the amount of dialysate flowing through the dialysate introduction line 132a). Amount.
  • the amount of dialysate flowing through the dialysate outlet line 132b is reduced by the amount / min of dialysate (drainage) discharged to the dialysate drain line 131b through the bypass line 1332 / min. Is larger than the amount of dialysis fluid flowing through. That is, when the water removal / back-filtration pump 1333 is driven so as to feed in the water removal direction, the blood purification means 120 removes a predetermined amount of water from the blood at the water removal rate F. On the other hand, as shown in FIG.
  • the amount of the dialysate discharged from the blood purification means 120 flows through the dialysate introduction line 132a by the amount of the dialysate (drained liquid) collected again in the dialysate chamber 1331 through the bypass line 1332.
  • the flow rate of the dialysate to be used is smaller. That is, when the water removal / back-filtration pump 1333 is driven to feed in the back-filtration direction, the blood purification means 120 injects a predetermined amount of dialysate into the blood circuit 110 at the back-filtration rate R (back-filtration). ) Is done.
  • the control unit 140 is configured by an information processing device (computer), and controls the operation of the dialysis device 100 by executing a control program. Specifically, the control unit 140 controls operations of various pumps, clamps, and the like arranged in the blood circuit 110 and the dialysate circuit 130, and controls various processes performed by the dialysis device 100, for example, a priming process, a removal process, and the like. A blood step, a dialysis step, a replacement fluid step, a blood return step, and the like are performed.
  • the blood circuit 110 and the blood purification means 120 are washed and cleaned using a back-filtration dialysate as a priming solution.
  • the blood removal step the blood of the patient is suctioned to fill the arterial line 111 and the venous line 112 with blood.
  • a dialysis step for purifying the blood and removing water is performed (see FIG. 2).
  • the fluid replacement step is performed intermittently during the dialysis step (see FIG. 3).
  • a blood return step of returning blood to the patient is performed.
  • the dialysis step will be described with reference to FIG.
  • the dialysis step will be described with reference to FIG.
  • excess water of the patient is removed, and the replacement fluid is also removed.
  • the blood of the patient introduced from the arterial connection 111a is purified by the blood purification means 120 through the arterial line 111, and returned to the patient from the venous connection 112a through the venous line 112. .
  • the arterial-side connecting portion 111a and the venous-side connecting portion 112a are each connected to a needle punctured in a patient's blood vessel, and the priming fluid discharge line clamp 114a is closed. In the state, the vein side clamp 112d is open.
  • the dialysate supply device (not shown) supplies and discharges the dialysate to and from the dialysate chamber 1331 at an average flow rate of 500 ml / min, and controls the water removal / reverse filtration pump 1333 to remove water at a water removal rate F in the water removal direction.
  • the blood purification means 120 removes water at Fml / min.
  • the blood pump 111c gradually increases the flow rate from 40 to 50 ml / min at the start of the dialysis step to, for example, about 200 ml / min, and sends the blood from the arterial side connection part 111a to the blood purification means 120 side.
  • the rehydration step is a step of injecting a back-filtration dialysate into the blood circuit 110 via the blood purification means 120, and intermittently injecting a predetermined amount of the replenisher at predetermined intervals at a reverse filtration rate R (ml / min). Done in
  • the artery-side connection part 111a and the vein-side connection part 112a are each connected to a needle punctured in a blood vessel of the patient, as in the dialysis step, and are provided with a priming liquid discharge line.
  • the clamp 114a is closed, and the venous clamp 112d is open.
  • the dialysate supply device (not shown) supplies and discharges the dialysate at an average flow rate of 500 ml / min to and from the dialysate chamber 1331, and switches the dewatering / reverse filtration pump 1333 in the reverse filtration direction (bypass in FIG. 3). It is operated so as to feed the liquid at the reverse filtration rate R in the direction indicated by the arrow in the line 1332).
  • the blood purification means 120 can inject 150 ml / min water in about 80 seconds. Done.
  • the blood pump 111c reduces the flow rate from 200 ml / min during the dialysis step to about 50 ml / min, and sends out the blood from the arterial side connection part 111a side to the blood purification means 120 side.
  • Blood flows into the blood purification means 120 at a flow rate of 50 ml / min from the blood introduction port 122a, and the back-filtration dialysate is injected at a flow rate of 150 ml / min, and 200 ml of the diluted blood is supplied from the blood outlet port 122b. / Min. In this manner, blood is rapidly replenished in blood in about 80 seconds in the rehydration step.
  • a detailed setting method of the reverse filtration rate R will be described later in detail.
  • the replacement fluid collection speed becomes a negative value, it indicates a case where the solution is sent in the reverse filtration direction (see FIG. 4).
  • the reduced volume) and the substantial fluid replacement volume (186.7 ml / time) are removed.
  • the substantial rehydration amount decreases from 200 ml / time to 186.7 ml / time, but the reduction rate is about 7%, so that the effect of the rehydration solution is not significantly impaired.
  • the dialysis time needs to be extended.
  • execution of replacement fluid is added accordingly.
  • the set water removal rate f1 for the body weight is 5 ml / min during the dialysis time of 210 minutes to 270 minutes
  • the substantial replacement fluid volume is a predetermined replacement fluid volume (200 ml / time) and the amount of water removal deficiency (6.7 ml / time) for the body weight is reduced (193.3 ml / time).
  • the reduced volume) and the substantial fluid replacement volume (193.3 ml / time) are removed.
  • the control unit 140 controls (1) a predetermined replacement fluid amount (for example, 200 ml / time) and a predetermined replacement fluid rate r (for example, 150 ml / min). Based on the calculated rehydration time (80 seconds / time), (2) except during rehydration, water removal for the body weight is performed at a preset water removal rate f1 (for example, 10 ml / min).
  • the dialysate feeding section 133 is controlled so as to remove water for the replacement fluid recovery at the replacement fluid recovery rate f2 based on the predetermined replacement fluid volume.
  • the dialysate feeding section 133 was controlled so that the fluid replacement was performed at the reverse filtration rate R calculated by subtracting the set water removal rate f1 (for example, 10 ml / min) from (min).
  • rehydration is performed at the reverse filtration rate R calculated by subtracting the set dehydration rate f1 from the predetermined rehydration rate r, and the rehydration rate is determined based on the predetermined rehydration rate, which is the sum of the substantial rehydration rate and the insufficient dehydration rate.
  • the water removal for the body weight can be performed at the set water removal rate f1 irrespective of the embodiment such as the non-execution or addition of replacement fluid, and the recalculation of the set water removal rate can be unnecessary.
  • water removal for the body weight is performed at a water removal rate slightly larger than the set water removal rate.
  • the water removal for the body weight can be performed at the set water removal rate without increasing the water content. This slight increase in the rate of water removal increases the risk of blood pressure decrease in patients with limited water removal rates, but in the present invention, water removal is performed at the set water removal rate, so blood pressure is reduced. Risks such as reduction can be reduced.
  • the amount of water removed from the patient's body weight is 2400 ml
  • dialysis is performed for 4 hours
  • the interval of replacement fluid is fixed at 30 minutes
  • a total of 7 replacement fluids out of the treatment for 4 hours is performed.
  • the control unit 140 sets a larger amount of water removal in the first half of dialysis and a smaller amount of water removal in the second half of dialysis based on the amount of water removal (2400 ml) corresponding to the patient's body weight and the dialysis time 240 minutes.
  • the second half of dialysis (dialysis time 120 to 240 minutes) ) Is set to 9 ml / min, which is 10% less than the reference water removal rate.
  • the time required for rehydration is calculated (80 seconds / time) from a predetermined rehydration rate r (for example, 150 ml / min) and a predetermined rehydration amount (for example, 200 ml / time).
  • the replacement fluid collection speed f2 is set so that the replacement fluid collection amount by performing the replacement fluid for the seventh time is moved forward.
  • the time required for rehydration is subtracted from the rehydration interval to calculate the water removal time (approximately 28.7 min / time x 6 times), and the rehydration recovery rate f2 is calculated (approximately 8.1 ml / min). It can be considered that the replacement fluid collection rate f2 is increased by about 1.1 ml / min compared to about 7.0 ml / min when the final replacement fluid is not collected ahead of time.
  • the water removal rate F when collecting the replacement fluid is the sum of the set water removal rate f1 and the replacement fluid recovery rate f2.
  • the set filtration rate f1 is virtually set. It can be considered that water removal for the body weight is continued.
  • the replacement fluid speed r is 0 ml / min.
  • the set water removal rate f1 was set to a different value according to the elapse of the dialysis time. As described above, in the case where the set water removal rate f1 changes as the dialysis time elapses, if the embodiment of the replacement fluid is changed in the related art, it is necessary to reset the water removal rate by a more complicated and complicated calculation. However, according to the present invention, it is not necessary to recalculate the set water removal rate.
  • the replacement fluid is collected after the first replacement fluid is performed has been described, but the embodiment is not limited thereto.
  • the collection of the replacement fluid may be performed from the start to the end of the dialysis.
  • the replacement fluid to be performed may be collected before the first replacement of the fluid.
  • the replacement fluid collection speed is set so as to collect a predetermined replacement fluid amount that was performed most recently, but the present invention is not limited to this.
  • the replacement fluid collection speed may be set such that the recovery of the final replacement fluid is performed earlier.
  • Reference Signs List 100 dialyzer 110 blood circuit 111 arterial line 111c blood pump 112 venous line 120 blood purification means 130 dialysate circuit 133 dialysate sending unit 140 control unit

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Abstract

L'invention concerne un dispositif de dialyse et un procédé de commande qui sont aptes à éliminer l'eau selon un volume proportionnel au poids corporel à un taux d'élimination d'eau prédéterminé, quel que soit le mode de réalisation d'un fluide de remplacement. Le dispositif de dialyse (100) est pourvu : d'un circuit sanguin (110) ; d'un moyen de purification de sang (120) ; d'un circuit de dialysat (130) possédant une unité de distribution de dialysat (133) qui distribue un dialysat à travers le moyen de purification de sang (120) de façon à effectuer un remplacement de fluide par rétrofiltration ou élimination d'eau ; et d'une unité de commande (140) qui effectue une commande de façon à amener l'unité de distribution de dialysat (133) à réaliser une élimination d'eau du circuit sanguin (110) et un remplacement intermittent de fluide du circuit sanguin (110). Le temps pour effectuer un remplacement de fluide est calculé sur la base d'un volume de remplacement de fluide prescrit et d'un taux de remplacement de fluide prescrit r. Lorsqu'un remplacement de fluide n'est pas effectué, l'élimination de l'eau selon un volume proportionnel au poids corporel est effectuée à un taux d'élimination d'eau prédéfini f1, et en même temps, l'élimination de l'eau selon un volume proportionnel au fluide de remplacement récupéré est effectuée à un taux de récupération de fluide de remplacement f2 sur la base d'un volume de fluide de remplacement prescrit. Lorsqu'un remplacement de fluide est effectué, le remplacement de fluide est réalisé à un taux de rétrofiltration R qui est calculé par soustraction du taux d'élimination d'eau prédéfini f1 du taux de remplacement de fluide prescrit r
PCT/JP2019/025757 2018-06-27 2019-06-27 Dispositif de dialyse et procédé de commande WO2020004603A1 (fr)

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