WO2021059573A1 - Dispositif de purification du sang - Google Patents

Dispositif de purification du sang Download PDF

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Publication number
WO2021059573A1
WO2021059573A1 PCT/JP2020/017746 JP2020017746W WO2021059573A1 WO 2021059573 A1 WO2021059573 A1 WO 2021059573A1 JP 2020017746 W JP2020017746 W JP 2020017746W WO 2021059573 A1 WO2021059573 A1 WO 2021059573A1
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WO
WIPO (PCT)
Prior art keywords
blood
flow rate
removal
circuit
dialysate
Prior art date
Application number
PCT/JP2020/017746
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English (en)
Japanese (ja)
Inventor
正岡　勝則
Original Assignee
株式会社ジェイ・エム・エス
Priority date (The priority date 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 date listed.)
Filing date
Publication date
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 JP2021548318A priority Critical patent/JP7396362B2/ja
Priority to CN202080066019.XA priority patent/CN114423468A/zh
Publication of WO2021059573A1 publication Critical patent/WO2021059573A1/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
    • A61M1/14—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis
    • A61M1/30—Single needle dialysis ; Reciprocating systems, alternately withdrawing blood from and returning it to the patient, e.g. single-lumen-needle dialysis or 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
    • A61M1/34—Filtering material out of the blood by passing it through a membrane, i.e. hemofiltration or diafiltration

Definitions

  • the present invention relates to a blood purification device that alternately performs blood removal and blood return with a single puncture needle.
  • the venous line 112 is connected to the blood outlet 122b of the blood purifier 120, which will be described later.
  • the venous side connection 112a, the venous air bubble detector 112b, the drip chamber 112c, and the venous side clamp 112d are arranged on the venous side line 112.
  • the venous side connecting portion 112a is arranged on the other end side of the venous side line, and is connected to the above-mentioned puncture needle SN via the branch tube BP to which the above-mentioned arterial side connecting portion 111a is connected.
  • the vein side bubble detector 112b detects the presence or absence of bubbles in the tube.
  • the drainage line 113 is connected to the drip chamber 112c.
  • a drainage line clamp 113a is arranged on the drainage line 113.
  • the drainage line 113 is a line for draining the priming liquid in the priming step of cleaning and cleaning the blood circuit 110 and the blood purifier 120.
  • the blood purifier 120 includes a container body 121 formed in a tubular shape and a dialysis membrane (not shown) housed inside the container body 121, and the inside of the container body 121 is made of blood by the dialysis membrane. It is divided into a side flow path and a dialysate side flow path (neither is shown).
  • the container body 121 is formed with 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.
  • the dialysate lead-out line 132b connects the dialysate outlet 123b of the blood purifier 120 and the dialysate chamber 1331, and leads the dialysate discharged from the blood purifier 120 to the drainage accommodating portion 1331b of the dialysate chamber 1331. To do.
  • the dialysate was introduced into the blood purifier 120 through the dialysate introduction line 132a at a predetermined flow rate (for example, 400 ml / min), and a second flow rate was added to the dialysate lead-out line 132b at a predetermined flow rate.
  • a dialysate containing water removed at a flow rate (eg 410 ml / mim) is derived. That is, in the blood purifier 120, a small amount of blood is removed at the same flow rate (second flow rate) as the water removal rate while removing excess water and waste products of the patient, and the blood introduced in the blood removal step and The newly introduced blood is circulated in the blood circuit 110.
  • the dialysate is circulated through the dialysate circuit 130 at 400 ml / min with the water removal / reverse filtration pump 1333 and the replacement liquid pump 151 stopped, and the blood pump 111c is used as an example to rotate forward at 200 ml / min. Driven in the direction, the remaining blood and dialysate are circulated and homogenized, and dialysis is performed.
  • either the dialysis step as the water removal step or the dialysis filtration step as the filtration step is selected and carried out in the blood removal circulation step.
  • the control method in the blood removal circulation step will be described below.
  • dialysis filtration in which the filtration flow rate in the blood purifier 120 is large to filter the replacement solution injected into the blood circuit 110, the amount of albumin leaked becomes excessive at the initial stage of treatment, and the amount leaked is small after a certain period of time.
  • the circulation flow rate of the blood circuit 110 determined by the flow rate of the blood pump 111c can be arbitrarily set without depending on the blood removal flow rate (second flow rate). Therefore, even if the blood removal flow rate (second flow rate) is small, the circulation flow rate can be increased, and especially in the case of the post-dilution method, it is limited to about 1/4 of the blood flow rate (circulation flow rate) from the viewpoint of blood concentration.
  • the filtration flow rate to be performed can be increased. Therefore, the efficiency of removing solutes can be further improved.
  • the dialysis efficiency is high, it can be applied to patients who have not been indicated for the treatment of the single needle method until now.
  • various pumps and clamps are controlled to inject dialysate as a replacement solution into the arterial side line 111 and the venous side line 112 of the blood circuit 110 via the replacement solution line 150, and one puncture needle SN.
  • Blood is drawn through and returned to the patient.
  • the internal volume (priming volume) of the blood circuit 110 and the blood purifier 120 is about 200 ml, it takes about 3.3 minutes for the injected replacement solution (dialysis solution) to reach the vicinity of the puncture needle SN. It takes time.
  • the blood circuit 110 has no residual blood and is almost filled with the replacement solution (dialysate solution). Therefore, the homogenization step described in the first embodiment is unnecessary, and the blood circuit 110 is removed in the next treatment step.
  • the time of the treatment step (dialysis time) can be shortened by that amount, and the removal efficiency (dialysis efficiency) can be improved.
  • the dialysate replacement solution
  • Blood may be returned by injecting a reverse filtration dialysate.
  • the control device 140 is allowed to remove water at the first flow rate in the blood purifier 120 and to introduce blood into the blood circuit 110 from both the upstream side and the downstream side of the blood purifier 120. It was. As a result, the blood circuit 110 is almost filled with blood, and the blood is not diluted as compared with unilateral blood removal in the blood removal circulation step, so that water can be efficiently removed, and when dialysis is performed, the concentration difference depends on the small amount. The efficiency of removing molecular weight substances can be improved.
  • the control device 140 was made to return blood by inflowing a replacement solution (dialysate solution) into all of the blood circuits 110.
  • a replacement solution dialysate solution
  • the amount of blood removed can be secured in the next blood removal step without performing the homogenization step after the blood return step, and the time required for the treatment step (dialysis time) is shortened, so that the removal efficiency (dialysis) Efficiency) can be improved.
  • the blood purification apparatus includes a blood removal step, a blood removal circulation step, a blood return step and homogenization. It is an automatic blood purification device that automatically performs each process such as a process continuously and automatically by controlling the flow of injecting a replacement solution into a blood circuit.
  • the third embodiment will be described in detail with reference to FIGS. 12 to 14.
  • the same components as those described in the first embodiment and the second embodiment are designated by the same reference numerals, and the description thereof will be omitted.
  • the dialysate circuit 130A is composed of a so-called closed capacity control type dialysate circuit 130A.
  • the dialysate circuit 130A includes a dialysate supply line 131a, a dialysate drainage line 131b, a dialysate introduction line 132a, a dialysate lead-out line 132b, and a dialysate delivery unit 133. Further, the dialysate circuit 130 is connected to the replacement liquid line 150, which will be described later, and is used as the replacement liquid supply source 152A.
  • dialysate circuit 130A Since each configuration of the dialysate circuit 130A is the same as that of the first embodiment and the second embodiment, the description thereof will be omitted, and the dialysate introduction line 132a and the dialysate lead-out line 132b which are connected differently will be described. ..
  • the dialysate lead-out line 132b connects the dialysate outlet 123b of the blood purifier 120 and the dialysate chamber 1331, and leads out the water discharged from the blood purifier 120 to the drainage accommodating portion 1331b of the dialysate chamber 1331. ..
  • the circulation flow rate can be increased, and especially in the case of the post-dilution method, it is limited to about 1/4 of the blood flow rate (circulation flow rate) from the viewpoint of blood concentration.
  • the filtration flow rate to be performed can be increased. Therefore, the efficiency of removing solutes can be further improved.
  • the filtration step a large amount of filtration is performed in the blood purifier 120 to mainly remove large molecular weight substances such as low molecular weight proteins.
  • the water removal step the blood circulating in the blood circuit 110 is gradually concentrated, the filtration step is completed based on the blood concentration, elapsed time, water removal amount (blood removal amount), etc., and the next return is performed. Move to the blood process.
  • the replacement liquid supply source 152B As the replacement liquid supply source 152B, a replacement liquid bottle or a replacement liquid bag filled with the replacement liquid is used. As shown in FIG. 15, the upstream side of the replacement liquid line 150 is connected to the replacement liquid supply source 152B.
  • the filtrate line 160 is connected to the dialysate outlet 123b of the blood purifier 120, and the filtrate filtered by the blood purifier 120 is discharged.
  • FIG. 16 shows a water removal step performed in the blood removal circulation step.
  • the blood pump 111c is gradually increased in speed until it reaches a predetermined flow rate (for example, 200 ml / min) in the forward rotation direction, and the filtrate pump 161 is used as a second flow rate to drive the blood pump 111c at a predetermined water removal rate. It is driven at (for example, 10 ml / min). That is, in the blood purifier 120, a small amount of blood is removed at the same flow rate (second flow rate) as the water removal rate while removing excess water from the patient, and the blood introduced in the blood removal step and newly introduced blood are introduced.
  • the blood to be produced is circulated in the blood circuit 110.
  • the replacement solution is not injected into the blood circuit 110, and the blood circulating in the blood circuit 110 is gradually concentrated. Since dialysis is not performed in this embodiment, the effect of removing a small amount of substance cannot be expected in the water removal step, but until the treatment step is repeated a predetermined number of times, the water removal step is performed in the blood removal circulation step to perform the subsequent procedure. The amount of albumin leaked can be reduced in the filtration step.
  • the blood purification apparatus has each step such as a blood removal step, a blood removal circulation step, a blood return step, and a homogenization step.
  • This is an automatic blood purification device that continuously and automatically performs the above by controlling the flow of injecting a replacement solution or dialysate in the blood circuit.
  • a blood removal circulation step of performing a dialysis step as a water removal step or a dialysis filtration step as a filtration step will be described with reference to FIGS. 19 and 20.
  • the blood return step (one side, both sides) and the homogenization step are the same as those described in the first and second embodiments, and thus the description thereof will be omitted.
  • the dialysate was introduced into the blood purifier 120 through the dialysate introduction line 132a at a predetermined flow rate (for example, 400 ml / min), and a second flow rate was added to the dialysate lead-out line 132b at a predetermined flow rate.
  • a dialysate containing water removed at a flow rate (eg 410 ml / mim) is derived. That is, in the blood purifier 120, a small amount of blood is removed at the same flow rate (second flow rate) as the water removal rate while removing excess water and waste products of the patient, and the blood introduced in the blood removal step and The newly introduced blood is circulated in the blood circuit 110.
  • FIG. 20 shows a dialysis filtration step performed in the blood removal circulation step.
  • the blood pump 111c is gradually increased in speed until it reaches a predetermined flow rate (for example, 200 ml / min) in the forward rotation direction, and the replacement liquid pump 151 is used as a third flow rate to drive the predetermined replacement liquid.
  • speed Q driven by R further water removal / inverse filtering pump 1333 a predetermined water removal speed (e.g., 10 ml / min) the replacement fluid rate Q R (third flow rate) added speed (Q R + 10 ml / It is driven by min).
  • the dialysate is led out to the blood purifier 120 from the dialysate chamber 1331 (the liquid feed accommodating portion 1331a) at a predetermined flow rate (for example, 400 ml / min).
  • a predetermined flow rate for example, 400 ml / min
  • the dialysate is introduced into the blood purifier 120 through the dialysate introduction line 132a at a predetermined flow rate (for example, 400 ml / min)
  • the dialysate lead-out line 132b has a second flow rate and a third flow rate at a predetermined flow rate.
  • the dialysate including dewatering and moisture at a flow rate of the added flow (e.g. 400 + 10 + Q R ml / mim) is derived.
  • a replacement liquid bottle or a replacement liquid bag is used as the replacement liquid supply source 152C, and the control device 140 and the blood circuit 110 are used.
  • the blood removal step of introducing blood at the first flow rate blood is introduced into the blood circuit 110 at a second flow rate smaller than the first flow rate, and the blood introduced in the blood removal step and the second flow rate are used.
  • a treatment step including a blood removal circulation step of circulating the introduced blood in the blood circuit 110 and a blood return step of injecting a replacement solution into the blood circuit 110 to draw blood from the blood circuit is repeated to perform a blood removal circulation step.
  • the blood purifier 120 water is removed at the same flow rate as the second flow rate and dialysis is performed, or the replacement solution is injected into the blood circuit 110 via the replacement solution line 150 at the third flow rate to obtain blood.
  • water was removed at a flow rate obtained by adding a third flow rate to the second flow rate, and one of the dialysis filtration steps of dialysis was performed. As a result, even in offline hemodialysis filtration therapy, filtration can be performed at a large filtration flow rate.

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  • Health & Medical Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Urology & Nephrology (AREA)
  • Hematology (AREA)
  • Anesthesiology (AREA)
  • Biomedical Technology (AREA)
  • Engineering & Computer Science (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Vascular Medicine (AREA)
  • Emergency Medicine (AREA)
  • External Artificial Organs (AREA)

Abstract

L'invention concerne un dispositif de purification du sang qui permet d'augmenter un débit de filtration même si un débit d'élimination de sang est faible dans un procédé à aiguille unique. L'invention porte sur un dispositif de purification du sang 100 qui fonctionne par un procédé à aiguille unique, comprenant : un purificateur de sang 120 ; un circuit sanguin 110 ; une source d'alimentation en liquide de substitution 152 ; une ligne de liquide de substitution 150 ; et une unité de commande 140. L'unité de commande 140 exécute de façon répétée un procédé de traitement comprenant : une étape d'élimination de sang dans laquelle du sang est introduit dans le circuit sanguin 100 ; une étape de circulation de sang retiré dans laquelle le sang introduit dans l'étape d'élimination du sang et le sang introduit à un deuxième débit sont mis en circulation dans le circuit sanguin 110 ; et une étape de retour du sang dans laquelle un liquide de substitution est injecté dans le circuit sanguin 110 et le sang est évacué du circuit sanguin 110. L'étape de circulation de sang retiré est effectuée dans : une étape d'élimination d'eau dans laquelle l'élimination de l'eau est effectuée à un même débit que le deuxième débit ; ou dans une étape de filtration dans laquelle un liquide de dialyse est injecté dans le circuit sanguin 110 à un troisième débit et l'élimination de l'eau est effectuée dans le purificateur de sang 120 à un débit obtenu par addition du troisième débit au deuxième débit.
PCT/JP2020/017746 2019-09-24 2020-04-24 Dispositif de purification du sang WO2021059573A1 (fr)

Priority Applications (2)

Application Number Priority Date Filing Date Title
JP2021548318A JP7396362B2 (ja) 2019-09-24 2020-04-24 血液浄化装置
CN202080066019.XA CN114423468A (zh) 2019-09-24 2020-04-24 血液净化装置

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
JP2019173229 2019-09-24
JP2019-173229 2019-09-24

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WO2021059573A1 true WO2021059573A1 (fr) 2021-04-01

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CN (1) CN114423468A (fr)
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Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP3277569B2 (ja) * 1992-09-30 2002-04-22 株式会社ジェイ・エム・エス 血液透析濾過装置
JP2005006980A (ja) * 2003-06-19 2005-01-13 Jms Co Ltd 血液透析濾過装置及びその方法
WO2012017959A1 (fr) * 2010-08-05 2012-02-09 日機装株式会社 Dispositif d'épuration du sang, et procédé pour l'inspection de fuite de liquide dans un tel dispositif
WO2018190433A1 (fr) * 2017-04-13 2018-10-18 株式会社ジェイ・エム・エス Procédé et dispositif pour déterminer l'état de raccordement d'une ligne de réapprovisionnement en liquide à un circuit sanguin dans un dispositif d'hémodialyse

Family Cites Families (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN106163585B (zh) * 2014-03-31 2019-07-16 株式会社美迪克 血液净化装置及血液净化装置的启动加注方法
JP5986258B1 (ja) * 2015-04-20 2016-09-06 日機装株式会社 血液浄化装置

Patent Citations (4)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP3277569B2 (ja) * 1992-09-30 2002-04-22 株式会社ジェイ・エム・エス 血液透析濾過装置
JP2005006980A (ja) * 2003-06-19 2005-01-13 Jms Co Ltd 血液透析濾過装置及びその方法
WO2012017959A1 (fr) * 2010-08-05 2012-02-09 日機装株式会社 Dispositif d'épuration du sang, et procédé pour l'inspection de fuite de liquide dans un tel dispositif
WO2018190433A1 (fr) * 2017-04-13 2018-10-18 株式会社ジェイ・エム・エス Procédé et dispositif pour déterminer l'état de raccordement d'une ligne de réapprovisionnement en liquide à un circuit sanguin dans un dispositif d'hémodialyse

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Publication number Publication date
CN114423468A (zh) 2022-04-29
JP7396362B2 (ja) 2023-12-12
JPWO2021059573A1 (fr) 2021-04-01

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