WO2024009994A1 - Système intermédiaire et système de purification du sang - Google Patents

Système intermédiaire et système de purification du sang Download PDF

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Publication number
WO2024009994A1
WO2024009994A1 PCT/JP2023/024755 JP2023024755W WO2024009994A1 WO 2024009994 A1 WO2024009994 A1 WO 2024009994A1 JP 2023024755 W JP2023024755 W JP 2023024755W WO 2024009994 A1 WO2024009994 A1 WO 2024009994A1
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WIPO (PCT)
Prior art keywords
blood
pump
flow rate
line
ecmo
Prior art date
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PCT/JP2023/024755
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English (en)
Japanese (ja)
Inventor
数磨 角南
Original Assignee
株式会社ジェイ・エム・エス
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Priority claimed from JP2022109253A external-priority patent/JP2024007878A/ja
Priority claimed from JP2022141236A external-priority patent/JP2024036776A/ja
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
Publication of WO2024009994A1 publication Critical patent/WO2024009994A1/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
    • A61M1/34—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
    • A61M1/36—Other treatment of blood in a by-pass of the natural circulatory system, e.g. temperature adaptation, irradiation ; Extra-corporeal blood circuits
    • 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
    • A61M60/00—Blood pumps; Devices for mechanical circulatory actuation; Balloon pumps for circulatory assistance
    • A61M60/10—Location thereof with respect to the patient's body
    • A61M60/104—Extracorporeal pumps, i.e. the blood being pumped outside the patient's body
    • A61M60/109—Extracorporeal pumps, i.e. the blood being pumped outside the patient's body incorporated within extracorporeal blood circuits or systems
    • A61M60/113—Extracorporeal pumps, i.e. the blood being pumped outside the patient's body incorporated within extracorporeal blood circuits or systems in other functional devices, e.g. dialysers or heart-lung machines
    • 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
    • A61M60/00—Blood pumps; Devices for mechanical circulatory actuation; Balloon pumps for circulatory assistance
    • A61M60/20—Type thereof
    • A61M60/247—Positive displacement blood pumps
    • A61M60/253—Positive displacement blood pumps including a displacement member directly acting on the blood
    • A61M60/268—Positive displacement blood pumps including a displacement member directly acting on the blood the displacement member being flexible, e.g. membranes, diaphragms or bladders
    • A61M60/279—Peristaltic pumps, e.g. roller pumps
    • A61M60/284—Linear peristaltic pumps
    • 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
    • A61M60/00—Blood pumps; Devices for mechanical circulatory actuation; Balloon pumps for circulatory assistance
    • A61M60/30—Medical purposes thereof other than the enhancement of the cardiac output
    • A61M60/36—Medical purposes thereof other than the enhancement of the cardiac output for specific blood treatment; for specific therapy
    • A61M60/37—Haemodialysis, haemofiltration 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
    • A61M60/00—Blood pumps; Devices for mechanical circulatory actuation; Balloon pumps for circulatory assistance
    • A61M60/30—Medical purposes thereof other than the enhancement of the cardiac output
    • A61M60/36—Medical purposes thereof other than the enhancement of the cardiac output for specific blood treatment; for specific therapy
    • A61M60/38—Blood oxygenation
    • 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
    • A61M60/00—Blood pumps; Devices for mechanical circulatory actuation; Balloon pumps for circulatory assistance
    • A61M60/50—Details relating to control
    • A61M60/508—Electronic control means, e.g. for feedback regulation
    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B01—PHYSICAL OR CHEMICAL PROCESSES OR APPARATUS IN GENERAL
    • B01D—SEPARATION
    • B01D63/00—Apparatus in general for separation processes using semi-permeable membranes
    • B01D63/02—Hollow fibre modules

Definitions

  • the present invention relates to an intermediate system provided at a connection point between an extracorporeal membrane oxygenation system and a blood purification system, and a blood purification system connected to the extracorporeal membrane oxygenation system.
  • ECMO extracorporeal membrane oxygenation
  • CRRT continuous renal replacement therapy
  • Patients on ECMO receive anticoagulants within the ECMO circuit and are prone to bleeding. If blood is sent and removed from another blood vessel for CRRT, it may be necessary to further administer an anticoagulant within the CRRT circuit, which is not preferable because the bleeding tendency increases.
  • multiple catheters are often inserted into the central vein for systemic management, and it is difficult to newly insert a vascular access for CRRT. Therefore, attempts have been made in clinical settings to connect the CRRT circuit directly to the ECMO circuit (see Patent Document 1).
  • the CRRT system As a blood purification system has a lower blood flow than the ECMO system, and is operated at a low positive pressure in the circuit downstream of the pump. Therefore, in order to prevent the CRRT circuit from being affected by excessive positive pressure or negative pressure of the ECMO circuit, it is necessary to connect the CRRT circuit to a portion of the ECMO circuit where the internal pressure is small.
  • an appropriate connection method is to provide a bypass line in the ECMO circuit that connects the upstream side of the pump and the downstream side of the oxygenator, and connect the side of the ECMO circuit closer to the oxygenator out of the relatively low pressure section of the bypass line.
  • a method has been proposed in which the blood removal line of the CRRT circuit is connected to the pump, and the blood return line is connected to the side of the ECMO circuit near the pump (see Non-Patent Document 1).
  • Non-Patent Document 1 it is possible to connect the blood removal line and blood return line of the CRRT circuit to the low positive pressure portion of the ECMO circuit.
  • the pressure in the CRRT circuit will also become negative. If negative pressure is transmitted into the CRRT circuit, air drawn in by the CRRT circuit may be sent to the patient through the ECMO circuit, potentially causing air embolism.
  • the connection method described in Non-Patent Document 2 the CRRT circuit is connected to the positive pressure section of the ECMO circuit, so it is not affected by negative pressure from the ECMO circuit and no recirculation occurs.
  • the internal pressure of the CRRT circuit becomes a positive pressure higher than normal, it becomes difficult to monitor the internal circuit pressure during operation of the CRRT system. Specifically, when the circuit internal pressure exceeds a predetermined value, an alarm is issued and the operation of the CRRT system is stopped. Therefore, there is a problem in that coagulation and clogging are likely to occur in the CRRT circuit. Furthermore, if the ECMO system continues to operate when the CRRT system has stopped, there is a risk that blood clots that have formed at the junction with the ECMO circuit may be sent into the ECMO system due to the stoppage of blood flow in the CRRT circuit.
  • an object of the present invention is to provide an intermediate system and a blood purification system that can reduce the influence of pressure that the blood purification system receives from the ECMO system when the blood purification system is connected to the ECMO system.
  • the present invention provides an extracorporeal membrane oxygenator system having an ECMO blood pump and an oxygenator located downstream of the ECMO blood pump, and a blood purification pump and a blood purification pump located downstream of the blood purification pump. and a blood purification system having a purifier, the upstream end of the blood purification system being connected to the downstream side of the ECMO blood pump in the extracorporeal membrane oxygenation system,
  • the intermediate system includes an intermediate blood return line whose upstream end is connected to the downstream end of the blood purification system and whose downstream end is connected to the extracorporeal membrane oxygenation system, and a blood return line provided on the intermediate blood return line.
  • the present invention relates to an intermediate system including a control unit that controls the amount of liquid stored in the liquid to be within a predetermined range.
  • the intermediate system includes an intermediate blood removal line whose upstream end is connected to the downstream side of the ECMO blood pump in the extracorporeal membrane oxygenation system, and whose downstream end is connected to the upstream end of the blood purification system; a flow rate adjustment section provided in the intermediate blood removal line to adjust the flow rate of the intermediate blood removal line; and a flow rate adjustment section provided downstream of the flow rate adjustment section in the intermediate blood removal line, capable of storing a predetermined amount of liquid.
  • the control unit further includes a blood removal side pressure buffer section and a blood removal side detection section that detects a storage state of the blood removal side pressure buffer section; It is preferable that the flow rate of the flow rate adjusting section is adjusted according to the storage state of the blood side pressure buffer section, and the amount of liquid stored in the blood removal side pressure buffer section is controlled to be within a predetermined range.
  • downstream end of the intermediate blood return line be connected to the oxygenator or upstream of the oxygenator in the extracorporeal membrane oxygenator system.
  • the present invention also provides a blood purification system connected to an extracorporeal membrane oxygenator system having an ECMO blood pump and an oxygenator disposed downstream of the ECMO blood pump, wherein the upstream end is connected to the extracorporeal membrane oxygenator system.
  • a blood removal line connected to the downstream side of the ECMO blood pump in the membrane oxygenator system, a blood purifier connected to the downstream end of the blood removal line, and a feeder for sending liquid to the blood purifier.
  • liquid means, a blood return line whose upstream end is connected to the blood purifier and whose downstream end is connected to the extracorporeal membrane oxygenation system, a blood return pump provided on the blood return line, and the blood return line.
  • the present invention relates to a blood purification system including a control unit that controls the blood purification system so that the following is achieved.
  • the blood purification system includes a flow rate adjusting section that is provided upstream of the blood removal line and adjusts the flow rate of the blood removal line, and a flow rate adjustment section that is provided downstream of the blood removal line and stores a predetermined amount of liquid.
  • the controller further includes a blood removal side pressure buffering section capable of detecting a blood removal side pressure buffer, and a blood removal side detection section that detects a storage state of the blood removal side pressure buffer section, It is preferable to adjust the flow rate of the flow rate adjusting section according to the storage state of the blood removal side pressure buffer section so that the amount of liquid stored in the blood removal side pressure buffer section is controlled to be within a predetermined range.
  • the liquid feeding means is a blood purification pump provided downstream of the blood removal side pressure buffer section in the blood removal line.
  • the liquid feeding means is configured by a height difference adjusting means that allows a relative change in the height direction position of the blood removal side pressure buffer section and the height direction position of the blood return side pressure buffer section. It is preferable that
  • downstream end of the blood return line be connected to an upstream side of the oxygenator in the extracorporeal membrane oxygenator system.
  • the present invention also provides a blood purification system connected to an extracorporeal membrane oxygenation system having a blood pump and an oxygenator disposed downstream of the blood pump, wherein the upstream end is connected to the extracorporeal membrane oxygenation system.
  • a blood removal line connected to the downstream side of the blood pump in the artificial lung system, a blood purifier connected to the downstream end of the blood removal line, and a blood purifier provided in the blood removal line, the flow rate of the blood removal line being connected to the blood removal line.
  • the present invention relates to a blood purification system including a control unit that controls the blood purification system to achieve the desired results.
  • the blood purification system further includes a storage section that is provided upstream of the blood return pump in the blood return line and is capable of storing a predetermined amount of liquid, and the pressure gauge measures the pressure of the storage section. Preferably, it is measured.
  • the flow rate adjustment section is a roller pump or a finger pump, and the control section adjusts the flow rate of the roller pump or the finger pump to control the inflow amount of the blood purifier, and the control section controls the flow rate of the blood purifier. It is preferable to control the flow rate so that the measured value of the pressure gauge falls within a predetermined range.
  • the flow rate adjustment section is an adjustment clamp whose opening degree can be adjusted, and the control section adjusts the flow rate of the blood return pump to control the inflow amount of the blood purifier, and the control section controls the opening of the adjustment clamp. It is preferable to adjust the pressure so that the measured value of the pressure gauge falls within a predetermined range.
  • downstream end of the blood return line be connected to the oxygenator on the upstream side of the oxygenator in the extracorporeal membrane oxygenator system.
  • the present invention when connecting a blood purification system to an ECMO system, it is possible to provide an intermediate system and a blood purification system that can reduce the influence of pressure that the blood purification system receives from the ECMO system.
  • FIG. 1 is a diagram showing a schematic configuration of an ECMO system, a CRRT system, and an intermediate system according to a first embodiment of the present invention.
  • FIG. 1 is a block diagram of a CRRT system and an intermediate system according to a first embodiment of the present invention.
  • FIG. 2 is a diagram showing a schematic configuration of an intermediate system, an ECMO system, and a CRRT system according to a modification of the first embodiment of the present invention.
  • FIG. 2 is a block diagram of a CRRT system and an intermediate system according to a modification of the first embodiment of the present invention.
  • FIG. 2 is a diagram showing a schematic configuration of an ECMO system and a CRRT system according to a second embodiment of the present invention.
  • FIG. 2 is a block diagram of a CRRT system according to a second embodiment of the present invention. It is a figure showing a schematic structure of an ECMO system and a CRRT system concerning modification 1 of a 2nd embodiment of the present invention.
  • FIG. 2 is a block diagram of a CRRT system according to Modification 1 of the second embodiment of the present invention. It is a figure showing a schematic structure of an ECMO system and a CRRT system concerning modification 2 of a 2nd embodiment of the present invention. It is a block diagram of a CRRT system concerning modification 2 of a 2nd embodiment of the present invention. It is a graph showing the relationship between the measured flow rate and the height difference in an example of modification 2 of the second embodiment of the present invention.
  • FIG. 3 is a block diagram of a CRRT system according to a third embodiment of the present invention.
  • FIG. 3 is a block diagram of a CRRT system according to a fourth embodiment of the present invention. It is a graph showing the relationship between the post-pump pressure of the ECMO system and the flow rate of the CRRT system in Example 4 of the present invention. It is a figure which shows another example of the connection method of the ECMO system and CRRT system in 3rd Embodiment and 4th Embodiment of this invention. It is a figure which shows another example of the connection method of the ECMO system and CRRT system in 3rd Embodiment and 4th Embodiment of this invention.
  • the intermediate system of the present invention is provided at the connection point between an extracorporeal membrane oxygenator (ECMO) system and a continuous renal replacement therapy (CRRT) system.
  • ECMO extracorporeal membrane oxygenator
  • CRRT continuous renal replacement therapy
  • the ECMO system described herein is indicated for patients with weakened heart and lung functions, and uses a pump to pump blood from the patient to an oxygenator, where the oxygenated blood is returned to the patient. It assists the patient's heart and lung function.
  • the CRRT system is indicated for patients with acute renal dysfunction, and removes waste products and water from the blood little by little over time to avoid sudden changes in blood concentration, circulation volume, and blood pressure. It is.
  • CRRT includes continuous hemodialysis (CHD), continuous hemofiltration (CHF), and continuous hemodiafiltration (CHDF).
  • CHD continuous hemodialysis
  • CHF continuous hemofiltration
  • CHDF continuous hemodiafiltration
  • the blood purification system of the present invention is applied to a CRRT system, but the present invention is not limited to this.
  • the blood purification system may be applied to a direct hemo perfusion (DHP) system.
  • DHP direct hemo perfusion
  • Blood adsorption therapy is a treatment method in which inflammatory substances are adsorbed and removed using an adsorption type blood purification device as a blood purification device.
  • the blood purification system may also be applied to a plasma adsorption therapy system.
  • FIG. 1 is a diagram showing a schematic configuration of an ECMO system 100, a CRRT system 200, and an intermediate system 300 according to a first embodiment of the present invention.
  • FIG. 2 shows a block diagram of the CRRT system 200 and intermediate system 300.
  • the ECMO system 100 includes an ECMO blood circuit 110, an ECMO blood pump 120, an oxygenator 130, and a control unit 140.
  • the ECMO blood circuit 110 is a circuit for extracorporeally circulating a patient's blood, and includes a blood removal line 110a, a connection line 110b, and a blood return line 110c.
  • Blood removal line 110a is connected to blood removal cannula 111 at one end and connected to ECMO blood pump 120 at the other end.
  • Connection line 110b is connected to ECMO blood pump 120 at one end and to oxygenator 130 at the other end.
  • the connection line 110b has a first branch 110b1 and a second branch 110b2.
  • a connector such as a three-way stopcock is attached to each of the first branch portion 110b1 and the second branch portion 110b2.
  • the connection line 110b is provided with a bypass line 113 that bypasses the first branch portion 110b1 and the second branch portion 110b2.
  • the connection portion between the bypass line 113 and the connection line 110b is connected by, for example, a three-way stopcock (not shown).
  • a flow meter 114 is attached to the blood return line 110c to monitor the operating status of the ECMO system 100.
  • an ultrasonic flowmeter is used as the flowmeter 114.
  • an optical flowmeter or the like may be used as the flowmeter 114.
  • the ECMO blood pump 120 extracts blood from the patient's veins via the blood removal cannula 111 and blood removal line 110a.
  • the extracted blood is sent to the oxygenator 130 through the connection line 110b, and then returned to the patient via the blood delivery cannula 112 through the blood return line 110c.
  • a known centrifugal pump is used as the ECMO blood pump 120.
  • the artificial lung 130 is equipped with a hollow fiber membrane (not shown) that bundles hollow fibers having many micropores, and allows oxygen to flow inside the hollow fibers and blood to flow outside, thereby allowing blood to flow from the ECMO blood pump 120. It adds oxygen to the blood being pumped and removes carbon dioxide. Additionally, the oxygenator 130 captures air bubbles present in the blood being pumped and prevents it from flowing downstream to the ECMO circuit. As the oxygenator 130, a known membrane oxygenator is used. Further, the oxygenator 130 may have a heat exchange function.
  • the control unit 140 is configured by an information processing device (computer), and controls the operation of the ECMO system 100 by driving each pump included in the ECMO system 100 by executing a control program.
  • the CRRT system 200 includes a CRRT blood circuit 210, a CRRT blood pump 220 as a blood purification pump, a blood purifier 230, a dialysate supply line 240, and a dialysate drain line 250. , a replenisher line 260 , and a control section 270 .
  • the CRRT blood circuit 210 is a circuit for circulating the extracted blood, and includes a blood removal line 210a and a blood return line 210b.
  • the blood removal line 210a has one end (upstream end) connected to the downstream end of an intermediate blood removal line 310 of the intermediate system 300 described later, and the other end (downstream end) connected to the blood purifier 230.
  • a CRRT blood pump 220 is provided in the blood removal line 210a.
  • a pressure gauge P1 is attached to the upstream side of the CRRT blood pump 220, and a pressure gauge P2 is attached to the downstream side.
  • a drip tube 211 is attached to the blood return line 210b, and a pressure gauge P3 is attached to this drip tube 211.
  • the drip tube 211 stores a certain amount of blood in order to remove air bubbles mixed in the blood, coagulated blood, and the like.
  • the pressure gauge P3 measures the circuit internal pressure of the blood return line 210b.
  • the pressure inside the circuit may be measured by attaching a pressure gauge P3 to the blood return line 210b without providing a drip tube in the blood return line.
  • CRRT blood pump 220 removes blood from ECMO system 100 via intermediate blood withdrawal line 310.
  • the extracted blood is sent to the blood purifier 230 through the blood removal line 210a, and then returned to the ECMO system 100 via the blood return line 210b and the intermediate blood return line 320.
  • the blood purifier 230 includes a dialysis membrane (not shown) housed inside a cylindrical container body.
  • the inside of the container body is divided into a blood side flow path and a dialysate side flow path by a dialysis membrane (both not shown), and water and water are transferred from the blood side flow path to the dialysate side flow path via the dialysis membrane.
  • the blood is purified by the movement of waste products.
  • the dialysate supply line 240 is equipped with a dialysate pump 241 and is a line for supplying dialysate to the blood purifier 230, and connects the dialysate supply source D and the dialysate side flow path of the blood purifier 230. Connecting.
  • a known roller pump is used as the dialysate pump 241.
  • the dialysate drain line 250 is equipped with a drain pump 251 and drains dialysate from the blood purifier 230.
  • the dialysate drain line 250 connects the dialysate side flow path of the blood purifier 230 and the drain fluid reservoir F.
  • a pressure gauge P4 is attached to the dialysate drain line 250.
  • the replenisher line 260 is equipped with a replenisher pump 261, and supplies the replenisher supplied from the replenisher supply source R to the blood return line 210b via the drip tube 211 provided in the blood return line 210b.
  • a replenisher pump 261 supplies the replenisher supplied from the replenisher supply source R to the blood return line 210b via the drip tube 211 provided in the blood return line 210b.
  • the replenishing fluid dialysate or physiological saline is used.
  • the control unit 270 is configured by an information processing device (computer), and drives each pump included in the CRRT system 200 by executing a control program to control the blood flow rate, dialysate volume, and drainage volume to the blood purifier 230. to perform continuous hemodiafiltration (CHDF).
  • the control unit 270 controls the dialysate pump 241 disposed in the dialysate supply line 240, the drain pump 251 disposed in the dialysate drain line 250, and the replenisher pump 261 disposed in the replenisher line 260.
  • the driving of each pump may be controlled based on the flow rate measured by a metering unit (not shown) that monitors each flow rate and measures the liquid (dialysate and replenisher) flowing through the CRRT system 200.
  • the intermediate system 300 includes an intermediate blood removal line 310, a flow rate adjustment section 311, an intermediate blood return line 320, a blood return pump 321, a blood return side pressure buffer section 322, and a blood return side pressure buffer section 322. It includes a blood side detection section 3221 and a control section 330.
  • the intermediate blood removal line 310 is a line for taking out a part of the blood flowing through the connection line 110b of the ECMO system 100 and sending it to the CRRT system 200.
  • One end (upstream end) of the intermediate blood removal line 310 is connected to the first branch 110b1 provided in the connection line 110b of the ECMO system 100, and the other end (downstream end) is connected to the upstream end of the CRRT system 200.
  • a flow rate adjustment section 311 is provided in the intermediate blood removal line 310.
  • a pressure gauge P5 is attached to the upstream side of the flow rate adjustment section 311, and a pressure gauge P6 is attached to the downstream side.
  • the intermediate blood removal line 310 has a flow rate in order to monitor whether the flow rate up to the connection part with the CRRT system 200 (the upstream end of the blood removal line 210a) is normal, and to monitor the inclusion of air bubbles.
  • a total of 314 are installed.
  • an ultrasonic flowmeter is used as the flowmeter 314.
  • an optical flowmeter or the like may be used as the flowmeter 314.
  • the flow rate adjustment unit 311 adjusts the flow rate of blood flowing through the intermediate blood removal line 310.
  • the flow rate adjustment unit 311 is attached to a location near the upstream end of the intermediate blood removal line 310. Thereby, when it becomes necessary to close the flow rate adjustment section 311 to stop the blood flow, it is possible to reduce the amount of blood to be discarded for coagulation.
  • the flow rate adjustment section 311 is composed of a clamp whose opening degree can be adjusted. As the flow rate adjustment section 311, a roller pump may be used instead of a clamp. By adjusting the flow rate of blood flowing through the intermediate blood removal line 310 by the flow rate adjustment unit 311, it becomes possible to adjust the internal pressure of the circuit on the downstream side.
  • One end (downstream end) of the intermediate blood return line 320 is connected to the second branch 110b2 provided in the connection line 110b of the ECMO system 100, and the other end (upstream end) is connected to the CRRT blood circuit 210 (blood return line 210b).
  • a blood return side pressure buffer 322 and a blood return pump 321 are arranged in order from the upstream side.
  • a drip barrel 323, a liquid outage sensor 324, and a clamp 325 are attached in this order to the intermediate blood return line 320 on the downstream side of the blood return pump 321.
  • a pressure gauge P7 is attached to this drip tube 323.
  • the drip tube 323 stores a certain amount of blood in order to remove air bubbles, coagulated blood, etc. that have entered the intermediate blood return line 320.
  • the clamp 325 is attached to a location near the downstream end of the intermediate blood return line 320.
  • the pressure gauge P7 measures the pressure inside the circuit on the downstream side of the blood return pump 321 in the intermediate blood return line 320.
  • the blood return pump 321 is a pump for sending blood flowing through the intermediate blood return line 320 to the positive pressure section of the ECMO system 100.
  • a known roller pump can be used as the blood return pump 321.
  • the blood return side pressure buffer section 322 is provided on the upstream side of the blood return pump 321 in the intermediate blood return line 320, and is capable of storing a predetermined amount of liquid.
  • a reservoir made of a soft bag is used as the blood return side pressure buffer section 322. It is desirable that the blood (liquid) inflow and outflow ports into the blood return side pressure buffer section 322 (reservoir) be provided at the bottom so as to be filled with blood (liquid). For example, two openings may be formed at the bottom of the reservoir as an inlet and an outlet. With such a configuration, if the storage amount of the reservoir suddenly decreases for some reason, it is possible to reduce the risk of sending air into the intermediate blood return line 320 on the downstream side of the reservoir.
  • a degassing line 3222 may be provided at the top of the reservoir.
  • the degassing line 3222 is basically closed during operation, and is used to check the liquid level during priming, and is also used to degas the air accumulated in the reservoir during operation.
  • a heating mechanism (not shown) may be provided in the blood return side pressure buffer section 322. This allows the blood returned to the ECMO blood circuit 110 to be warmed.
  • a small container for example, a pillow
  • a soft material may be used instead of the reservoir.
  • the blood return side detection section 3221 is attached to the blood return side pressure buffer section 322 and detects the storage state of the blood return side pressure buffer section 322.
  • a weight scale is used as an example of the blood return side detection section 3221 to measure the weight (reservation state) of the liquid stored in the blood return side pressure buffer section 322 (reservoir).
  • a pressure gauge may be used as the blood return side detection section 3221 to measure the internal pressure that changes depending on the storage state of the reservoir.
  • a pressure gauge is used as the blood return side detection section 3221 to detect expansion and contraction according to the internal pressure of the small container. good.
  • the control unit 330 controls the opening degree of the clamp as the flow rate adjustment unit 311 so that the pressure measured by the pressure gauge P6 falls within a predetermined pressure range (for example, 40 mmHg or more and 60 mmHg or less), and controls the connection line 110b of the ECMO system 100. Adjust the flow rate of blood taken from the Further, the control unit 330 adjusts the flow rate of the blood return pump 321 according to the storage state (weight) detected by the blood return side detection unit 3221 (weight scale), and adjusts the flow rate of the blood return side pressure buffer unit 322 (reservoir). The amount of blood stored in the blood is controlled to be within a predetermined range. Further, when the liquid shortage sensor 324 detects a liquid shortage, the control unit 330 operates the clamp 325 to close the intermediate blood return line 320 to prevent air bubbles from entering the ECMO system 100.
  • a predetermined pressure range for example, 40 mmHg or more and 60 mmHg or less
  • the various lines in the ECMO system 100, CRRT system 200, and intermediate system 300 described above are all mainly composed of flexible tubes that allow liquid to flow therethrough.
  • the blood taken out from the vein of the subject (patient) flows into the blood removal line 110a of the ECMO system 100, and part of the blood flows through the connection line 110b. flows into the intermediate blood removal line 310 of the intermediate system 300 at a predetermined flow rate, and the rest is sent to the oxygenator 130.
  • the flow rate of the blood sent to the intermediate system 300 is adjusted by the flow rate adjustment unit 311, and the blood is sent to the blood removal line 210a of the CRRT system via the intermediate blood removal line 310 to a predetermined level set by the CRRT blood pump 220.
  • the blood is introduced into the blood purifier 230 at a flow rate.
  • the CRRT blood pump 220 functions as a liquid feeding means for sending blood to the blood purifier 230, and also functions as a pressure partition that prevents the high positive pressure transmitted from the ECMO blood circuit 110 from being transmitted to the blood purifier 230. .
  • the blood purifier 230 water and waste products are removed via a dialysis membrane, and the purified blood is led out from the blood purifier 230.
  • the blood purified by the blood purifier 230 is replenished with a replenisher from the replenisher line 260 according to the amount of water removed, and then sent to the intermediate blood return line 320 of the intermediate system 300.
  • blood is stored within a predetermined range in the blood return side pressure buffer section 322.
  • the storage amount can be controlled by adjusting the set flow rate of the blood return pump 321.
  • the blood flow rate sent from the downstream end of the CRRT system 200 is slightly smaller than the set flow rate of the CRRT blood pump 220 by the amount of water removed. Therefore, when the storage amount of the blood return side pressure buffer section 322 exceeds a predetermined range, the set flow rate of the blood return pump 321 may be set larger than the set flow rate of the CRRT blood pump 220.
  • the set flow rate of the blood return pump 321 may be made smaller than the set flow rate of the CRRT blood pump 220.
  • a predetermined amount of blood is stored in the blood return side pressure buffer section 322, so that the blood return side pressure buffer section 322 can lower the internal pressure of the circuit. Therefore, since the downstream end of the CRRT system 200 can be set to a low positive pressure, the CRRT system 200 can be operated at a low positive pressure.
  • the intermediate blood return line 320 is equipped with a blood return pump 321, it is possible to increase the pressure within the circuit that has decreased due to the blood return side pressure buffer section 322 and send blood to the positive pressure section of the ECMO system 100 (downstream side of the ECMO blood pump 120). becomes possible.
  • the blood return pump 321 functions as a liquid feeding means for sending blood to the positive pressure section of the ECMO system, and also functions as a pressure partition that provides a low positive pressure on the upstream side and a high positive pressure on the downstream side.
  • the blood returned from the intermediate blood return line 320 of the intermediate system 300 to the connection line 110b of the ECMO system 100 is sent to the oxygenator 130 together with the blood flowing through the connection line 110b, where oxygenation and carbon dioxide are removed.
  • Blood pumped from the oxygenator 130 is returned to the patient's artery or vein via the blood return line 110c and the blood delivery cannula 112.
  • the flow rate of blood introduced into the blood circuit 210 of the CRRT system 200 can be controlled by the CRRT blood pump 220 provided in the CRRT system 200, the intermediate blood removal line 310 and the flow rate adjustment section 311 is not necessarily necessary. That is, the upstream end of the blood removal line 210a of the CRRT system 200 may be directly connected to the connection line 110b of the ECMO system 100.
  • An intermediate system 300 provided at the connection point between the ECMO system 100 and the CRRT system 200 is connected to an intermediate blood return line 320 whose upstream end is connected to the downstream end of the CRRT system 200 and whose downstream end is connected to the ECMO system 100.
  • a blood return pump 321 provided in the intermediate blood return line a blood return side pressure buffer section 322 provided upstream of the blood return pump 321 in the intermediate blood return line 320, and a storage of the blood return side pressure buffer section 322.
  • the blood return side detection unit 3221 detects the state, and the flow rate of the blood return pump 321 is adjusted according to the storage state of the blood return side pressure buffer unit 322 detected by the blood return side detection unit 3221, and the blood return side pressure buffer is and a control section that controls the amount of liquid stored in the section 322 to be within a predetermined range. Thereby, the pressure is buffered by the blood return side pressure buffer section 322, so that the downstream side of the CRRT blood pump 220 in the CRRT system 200 can be operated at a low positive pressure. Further, since the intermediate blood return line 320 is provided with the blood return pump 321, blood can be returned to the positive pressure section of the ECMO system 100.
  • the CRRT system 200 is connected to the positive pressure section of the ECMO system 100 via the intermediate system 300, even if blood removal failure occurs in the ECMO system 100, the risk of drawing air from the CRRT system 200 can be reduced.
  • the point where blood is returned from the CRRT system 200 to the ECMO system 100 is located downstream of the point where blood is removed from the ECMO system 100 to the CRRT system 200. This prevents recirculation.
  • An intermediate system 300A according to a modification of the first embodiment differs from the first embodiment in that the intermediate blood removal line also includes a pressure buffer section. Therefore, the same reference numerals are given to the same components as those in the first embodiment, and the explanation thereof will be omitted, and only the different points will be explained.
  • FIG. 3 is a diagram showing a schematic configuration of an ECMO system 100, a CRRT system 200, and an intermediate system 300A according to a modification of the first embodiment of the present invention.
  • FIG. 4 shows a block diagram of the CRRT system 200 and intermediate system 300A.
  • the intermediate system 300A includes an intermediate blood removal line 310, a flow rate adjustment section 311, a blood removal side pressure buffer section 312, a blood removal side detection section 3121, an intermediate blood return line 320, a blood return pump 321, and a blood return system. It includes a side pressure buffer section 322, a blood return side detection section 3221, and a control section 330.
  • the intermediate blood removal line 310 is a line for taking out a part of the blood flowing through the connection line 110b of the ECMO system 100 and sending it to the CRRT system 200.
  • One end (upstream end) of the intermediate blood removal line 310 is connected to the first branch 110b1 provided in the connection line 110b of the ECMO system 100, and the other end (downstream end) is connected to the upstream end of the CRRT system 200.
  • the intermediate blood removal line 310 is provided with a flow rate adjustment section 311, a blood removal side pressure buffer section 312, and a blood removal side detection section 3121, and a pressure gauge P5 is attached to the upstream side of the flow rate adjustment section 311. Further, a flow meter 314 is attached to the intermediate blood removal line 310 in order to monitor whether the flow to the blood removal side pressure buffer section 312 is normal and to monitor the inclusion of air bubbles.
  • the blood removal side pressure buffer section 312 is provided on the downstream side of the flow rate adjustment section 311 in the intermediate blood removal line 310, and is capable of storing a predetermined amount of liquid.
  • the configuration of the blood removal side pressure buffer section 312 can be similar to the blood return side pressure buffer section 322 described in the first embodiment.
  • a reservoir is used as the blood removal side pressure buffer section 312 as in the first embodiment.
  • a bypass line 313 for bypassing the blood removal side pressure buffer section 312 may be provided in the intermediate blood removal line 310.
  • the connecting portion between the bypass line 313 and the intermediate blood removal line 310 is connected by, for example, a three-way stopcock (not shown).
  • the pressure can be buffered using the blood removal side pressure buffer section 312, or the bypass line 313 can be used without using the blood removal side pressure buffer section 312.
  • the user can choose whether or not to use it to provide pressure buffering (in this case, it will be the same as in the first embodiment). If the blood removal side pressure buffer section 312 is not used, the priming volume can be reduced accordingly.
  • the blood removal side detection section 3121 is attached to the blood removal side pressure buffer section 312 and detects the storage state of the blood removal side pressure buffer section 312.
  • the configuration of the blood removal side detection section 3121 can be the same as the blood return side detection section 3221 described in the first embodiment.
  • a weight scale is used as the blood removal side detection unit 3121, as in the first embodiment.
  • the control unit 330 controls the opening degree of the clamp as the flow rate adjustment unit 311 according to the storage state (weight) detected by the blood removal side detection unit 3121 (weight scale), and adjusts the flow rate of the intermediate blood removal line 310. is controlled so that the amount of blood stored in the blood return side pressure buffer section 322 (reservoir) is within a predetermined range.
  • the flow rate of blood taken out from the connection line 110b may be adjusted based on the flow rate of the CRRT blood pump 220. Further, the control unit 330 adjusts the flow rate of the blood return pump 321 according to the storage state (weight) detected by the blood return side detection unit 3221 (weight scale), and adjusts the flow rate of the blood return side pressure buffer unit 322 (reservoir).
  • the amount of blood stored in the blood is controlled to be within a predetermined range. Further, when the liquid shortage sensor 324 detects a liquid shortage, the control unit 330 operates the clamp 325 to close the intermediate blood return line 320 to prevent air bubbles from entering the ECMO system 100.
  • the blood taken out from the vein of the subject (patient) flows into the blood removal line 110a of the ECMO system 100, and part of the blood flows through the connection line 110b. flows into the intermediate blood removal line 310 of the intermediate system 300A at a predetermined flow rate, and the rest is sent to the oxygenator 130.
  • the blood sent to the intermediate system 300A is stored within a predetermined range in the blood removal side pressure buffer section 312.
  • the storage amount can be controlled by adjusting the set flow rate of the flow rate adjustment section 311.
  • the amount of blood flowing out from the downstream side of the blood removal side pressure buffer section 312 is the set flow rate of the blood pump 220, so if the amount stored in the blood removal side pressure buffer section 312 exceeds a predetermined range, , the set flow rate of the flow rate adjustment section 311 may be made smaller than the set flow rate of the blood pump 220.
  • the set flow rate of the flow rate adjustment section 311 may be set larger than the set flow rate of the blood pump 220.
  • a predetermined amount of blood is stored in the blood removal side pressure buffer section 312, so that the blood removal side pressure buffer section 312 provided in the intermediate blood removal line 310 can lower the circuit internal pressure.
  • the blood stored in the blood removal side pressure buffer section 312 is introduced into the blood purifier 230 by the CRRT blood pump 220.
  • the blood removal side pressure buffer section 312 makes the circuit internal pressure a low positive pressure
  • the upstream side of the CRRT blood pump 220 has a low positive pressure.
  • the flow of blood after the blood purifier 230 is the same as that described in the first embodiment. Thereby, the circuit internal pressure of the entire blood circuit 210 of the CRRT system 200 can be made low positive pressure.
  • the intermediate system 300A is provided with an intermediate blood removal line 310 whose upstream end is connected to the downstream side of the blood pump 120 in the ECMO system 100, and an intermediate blood removal line 310.
  • the amount of liquid stored in the pressure buffer section 312 was controlled to be within a predetermined range.
  • the pressure is buffered by the blood removal side pressure buffer section 312, so that the CRRT blood pump 220 can be operated at a low positive pressure including the upstream side. Therefore, it is possible to prevent the device connected upstream of the CRRT blood pump 220 from being exposed to a high pressure state.
  • FIG. 5 shows a schematic configuration of an ECMO system 100 and a CRRT system 200A according to the second embodiment
  • FIG. 6 shows a block diagram of the CRRT system 200A according to the second embodiment.
  • the CRRT system and the intermediate system having the pressure buffer on the blood return side were configured independently, but in the second embodiment, as shown in FIGS. 5 and 6, the CRRT system 200A It includes a blood circuit 210, a CRRT blood pump 220 as a liquid feeding means, a blood purifier 230, a dialysate supply line 240, a dialysate drain line 250, a replenisher line 260, and a control unit 270.
  • the CRRT system 200A is configured to include a blood return side pressure buffer section 322 of the intermediate system, a blood return pump 321, a drip tube 323, etc., and a blood purifier 230.
  • the configuration is such that the drip tube 211 and the like that were provided near the downstream side of the system are not provided.
  • the blood removal line 210a and the blood return line 210b of the CRRT system are used as the intermediate blood removal line 310 and the intermediate blood return line 320 of the intermediate system, respectively.
  • the number of pressure gauges installed could be reduced from a total of seven to five.
  • the control section 270 of the CRRT system performs the control that was performed by the control section 330 of the intermediate system. In this way, by consolidating common configurations between the CRRT system and the intermediate system, the number of components can be reduced and manufacturing costs can be reduced compared to when the CRRT system and intermediate system are manufactured as separate systems. can do.
  • the CRRT blood pump 220 is arranged at the location where the flow rate adjustment section 311 was provided in the first embodiment.
  • the CRRT blood pump 220 serves as a liquid sending means for sending liquid to the blood purifier 230, and adjusts the flow rate of blood branched from the ECMO blood circuit 110 and flowing through the blood removal line 210a.
  • is in charge of CRRT blood pump 220 also functions as a pressure barrier that prevents high positive pressure transmitted from ECMO blood circuit 110 from being transmitted to blood purifier 230.
  • the liquid feeding means may be a roller pump or a clamp whose opening degree can be adjusted like the flow rate adjustment section 311. may also be used.
  • the CRRT blood pump 220 is attached to a location near the upstream end of the blood removal line 210a, that is, near the connection portion with the ECMO system 100 (first branch portion 110b1). This makes it possible to reduce the amount of blood discarded for coagulation when it becomes necessary to stop the CRRT blood pump to stop blood flow.
  • the other configurations are the same as those described in the first embodiment, so their description will be omitted.
  • the CRRT system 200A connected to the ECMO system 100 is connected to a blood removal line 210a whose upstream end is connected to the downstream side of the ECMO blood pump of the ECMO system, and a blood removal line 210a whose upstream end is connected to the downstream end of the blood removal line 210a.
  • the flow rate of the blood return pump 321 is adjusted according to the storage state of the blood return side pressure buffer section 322 detected at 3221, and the amount of liquid stored in the blood return side pressure buffer section 322 is controlled to be within a predetermined range.
  • the control unit 270 is configured to include a control unit 270 that performs the following steps. Thereby, the circuit internal pressure from the downstream side of the CRRT blood pump 220 to the upstream side of the blood return pump 321 can be made to be a low positive pressure.
  • the control unit 270 compared to manufacturing the CRRT system and intermediate system as separate systems, it is possible to reduce the number of components by consolidating common configurations, etc., so manufacturing costs can be reduced while maintaining the same functionality. Can be done.
  • control can be easily performed when a problem occurs in the system.
  • FIG. 7 shows a schematic configuration of an ECMO system 100 and a CRRT system 200B according to a first modification of the second embodiment
  • FIG. 8 shows a block diagram of a CRRT system 200B according to a first modification of the second embodiment.
  • the CRRT system 200B includes a CRRT blood circuit 210, a CRRT blood pump 220 as a liquid feeding means, a blood purifier 230, a dialysate supply line 240, and a dialysate drain line 250. , a replenisher line 260, and a control section 270.
  • the CRRT system 200B includes a blood removal side pressure buffer section 312, a blood return side pressure buffer section 322, a blood return pump 321, an infusion tube 323, etc. of the intermediate system.
  • the drip tube 211 and the like provided near the downstream side of the blood purifier 230 are not provided.
  • the blood removal line 210a and the blood return line 210b of the CRRT system are used as the intermediate blood removal line 310 and the intermediate blood return line 320 of the intermediate system, respectively. Additionally, the number of pressure gauges installed could be reduced from a total of seven to five.
  • control that was performed by the control unit 330 of the intermediate system is performed by the control unit 270 of the CRRT system.
  • the control unit 270 of the CRRT system is performed by the control unit 270 of the CRRT system.
  • the blood removal side pressure buffer section 312 is provided in the blood removal line 210a, so the internal pressure in the circuit downstream of the blood removal side pressure buffer section 312 becomes a low positive pressure. There is. Further, since the blood return pump 321 is arranged downstream of the blood return side pressure buffer section 322, negative pressure cannot be applied to the blood removal side pressure buffer section 312 by the blood return pump 321. Therefore, in order to send the liquid to the blood purifier 230, it is necessary to increase the internal pressure of the circuit by some means or to make the downstream side of the blood purifier 230 have a lower pressure than the blood removal side pressure buffer section 312.
  • a CRRT blood pump 220 composed of a roller pump is used as a liquid feeding means to increase the pressure inside the circuit.
  • a CRRT blood pump 220 By providing the CRRT blood pump 220 on the downstream side of the blood removal side pressure buffer section 312 in the blood removal line 210a, liquid is sent from the blood removal side pressure buffer section 312 to the blood purifier 230.
  • the other configurations are the same as those described in the modified example of the first embodiment or the second embodiment, so the description will be omitted.
  • the CRRT system 200B connected to the ECMO system 100 includes, in addition to the CRRT system 200A, a flow rate adjustment unit 311 that is provided upstream of the blood removal line 210a and adjusts the flow rate of the blood removal line 210a; A blood removal side pressure buffer section 312 that is provided on the downstream side of the line 210a and is capable of storing a predetermined amount of liquid, and a blood removal side detection section 3121 that detects the storage state of the blood removal side pressure buffer section 312.
  • the control section 270 adjusts the flow rate of the flow rate adjustment section 311 according to the storage state of the blood removal side pressure buffer section 312 detected by the blood removal side detection section 3121, and adjusts the flow rate of the blood removal side pressure buffer section 312.
  • the amount of liquid stored is controlled to be within a predetermined range.
  • the pressure is buffered by the blood removal side pressure buffer section 312, so that the CRRT blood pump 220 can be operated at a low positive pressure including the upstream side. Therefore, it is possible to prevent the device connected upstream of the CRRT blood pump 220 from being exposed to a high pressure state.
  • the liquid feeding means is constituted by the CRRT blood pump 220 provided downstream of the blood removal side pressure buffer section 312 in the blood removal line 210a. Thereby, the liquid can be sent from the blood removal side pressure buffer section 312 to the blood purifier 230.
  • FIG. 9 shows a schematic configuration of an ECMO system 100 and a CRRT system 200C according to a second modification of the second embodiment
  • FIG. 10 shows a block diagram of a CRRT system 200C according to a second modification of the second embodiment.
  • the second modification of the second embodiment differs from the first modification of the second embodiment in that, as shown in FIG. 10, the CRRT system 200C uses a height difference adjusting means 280 as a liquid feeding means.
  • the blood removal side pressure buffer section 312 is provided in the blood removal line 210a.
  • the internal pressure in the circuit downstream of this point is a low positive pressure.
  • the blood return pump 321 is arranged downstream of the blood return side pressure buffer section 322.
  • the blood removal side pressure buffer part 312 in order to send the liquid to the blood purifier 230, it is necessary to increase the internal pressure of the circuit by some means or to make the downstream side of the blood purifier 230 have a lower pressure than the blood removal side pressure buffer section 312.
  • the blood removal side pressure buffer part 312 by providing a height difference between the blood removal side pressure buffer part 312 and the blood return side pressure buffer part 322, the blood removal side pressure buffer part 312 to the blood return side pressure buffer section 322.
  • the height difference adjusting means 280 as a liquid feeding means provides a height difference between the blood removal side pressure buffer section 312 and the blood return side pressure buffer section 322, so that both can be moved relative to each other in the height direction. It is configured as follows. For example, the blood removal side pressure buffer section 312 is fixedly arranged above the blood removal side pressure buffer section 312, and the blood return side pressure buffer section 322 is arranged so as to be vertically movable below the blood removal side pressure buffer section 312. What is necessary is to adjust the relative height difference DH between the two (see FIG. 9). The height difference DH is calculated from the difference between the upper surface of the liquid stored inside the blood removal side pressure buffer section 312 and the highest position of the liquid level stored inside the blood return side pressure buffer section 322.
  • the height difference between the blood removal side pressure buffer section 312 and the blood return side pressure buffer section 322 is adjusted by the height difference adjustment means 280 so that the actual flow rate measured by the flow meter 314 becomes a desired value.
  • the desired value is the same flow rate as the flow rate set in the CRRT blood pump.
  • the height difference adjusting means 280 adjusts the height difference between the blood removal side pressure buffer section 312 and the blood return side pressure buffer section 322 so that the actual flow rate measured by the flow meter 314 becomes a desired value. , may be controlled by the control unit 270.
  • the CRRT system 200C is configured to include a height difference adjusting means 280 that allows the blood removal side pressure buffer section 312 and the blood return side pressure buffer section 322 to move relatively in the height direction. Thereby, by adjusting the height difference between the blood removal side pressure buffer section 312 and the blood return side pressure buffer section 322, the amount of liquid sent from the blood removal side pressure buffer section 312 to the blood purifier 230 can be adjusted. .
  • a pressurizing device that pressurizes the blood removal side pressure buffer section 312 may be used as the height difference adjusting means.
  • the pressurizing device as the height difference adjusting means is configured to apply a pressure corresponding to the head pressure defined by the height difference between the blood removal side pressure buffer section 312 and the blood return side pressure buffer section 322 corresponding to the desired actual flow rate.
  • the blood removal side pressure buffer section 312 is pressurized.
  • FIG. 13 is a diagram showing a schematic configuration of an ECMO system 400 and a CRRT system 500 according to the first embodiment of the present invention.
  • FIG. 14 shows a block diagram of a CRRT system 500.
  • the ECMO system 400 includes an ECMO blood circuit 410, an ECMO blood pump 420 (blood pump), an oxygenator 430, and a control unit 440.
  • the ECMO blood circuit 410 is a circuit for extracorporeally circulating the patient's blood, and includes a blood removal line 410a, a connection line 410b, and a blood return line 410c.
  • Blood removal line 410a is connected to blood removal cannula 411 at one end and connected to ECMO blood pump 420 at the other end.
  • Connection line 410b is connected to ECMO blood pump 420 at one end and to oxygenator 430 at the other end.
  • connection line 410b has a first branch 410b1 and a second branch 410b2.
  • a connector such as a three-way stopcock is attached to each of the first branch portion 410b1 and the second branch portion 410b2.
  • the connection line 410b is provided with a bypass line 413 that bypasses the first branch portion 410b1 and the second branch portion 410b2.
  • the connection portion between the bypass line 413 and the connection line 410b is connected by, for example, a three-way stopcock (not shown).
  • bypass line 413 By providing the bypass line 413, when some kind of malfunction occurs in the CRRT system 500 and the operation is stopped, the flow path from the ECMO blood pump 420 to the oxygenator 430 can be switched to the bypass line 413, thereby making the ECMO system safer. can drive.
  • the bypass line 413 which bypasses the 1st branch part 410b1 and the 2nd branch part 410b2 was provided, it is not limited to this.
  • the bypass line 413 may not be provided.
  • One end of the blood return line 410c is connected to the oxygenator 430, and the other end is connected to the blood feeding cannula 412.
  • a flow meter 414 is attached to the blood return line 410c to monitor the operating status of the ECMO system 400.
  • an ultrasonic flowmeter is used as the flowmeter 414.
  • an optical flowmeter or the like may be used.
  • the ECMO blood pump 420 extracts blood from the patient's veins via the blood removal cannula 411 and blood removal line 410a.
  • the extracted blood is sent to the oxygenator 430 through the connection line 410b, and then returned to the patient via the blood delivery cannula 412 through the blood return line 410c.
  • a known centrifugal pump is used as the ECMO blood pump 420.
  • the oxygenator 430 is equipped with a hollow fiber membrane (not shown) that is a bundle of hollow fibers having a large number of micropores, and allows oxygen to flow inside the hollow fibers and blood to flow outside, thereby allowing blood to flow from the ECMO blood pump 420. It adds oxygen to the blood being pumped and removes carbon dioxide. Additionally, the oxygenator 430 traps air bubbles present in the blood being pumped and prevents it from flowing downstream to the ECMO circuit. As the oxygenator 430, a known membrane oxygenator is used. Further, the oxygenator 430 may have a heat exchange function.
  • the control unit 440 is configured by an information processing device (computer), and controls the operation of the ECMO system 400 by driving each pump included in the ECMO system 400 by executing a control program.
  • the CRRT system 500 includes a blood removal line 510, a flow rate adjustment section 511, a blood purifier 520, a blood return line 530, a blood return pump 531, and a blood chamber as a storage section. 532, a dialysate supply line 540, a dialysate drain line 550, a replenisher line 560, and a control unit 570.
  • the blood removal line 510 is a line for taking out a part of the blood flowing through the connection line 410b of the ECMO system 400 and sending it to the blood purifier 520.
  • One end (upstream end) of the blood removal line 510 is connected to a first branch 410b1 provided in the connection line 410b of the ECMO system 400, and the other end (downstream end) is connected to the upstream end of the blood purifier 520.
  • Ru The blood removal line 510 is provided with a flow rate adjustment section 511.
  • a pressure gauge P8 is attached to the upstream side of the flow rate adjustment section 511, and a pressure gauge P9 is attached to the downstream side.
  • a flow meter 512 is attached to the blood removal line 510 in order to monitor whether the flow rate up to the blood purifier 520 is normal and to monitor the inclusion of air bubbles.
  • an ultrasonic flowmeter is used as the flowmeter 512.
  • an optical flowmeter or the like may be used as the flowmeter 512.
  • the flow rate adjustment unit 511 adjusts the flow rate of blood flowing through the blood removal line 510.
  • the flow rate adjustment unit 511 is attached to a location near the upstream end of the blood removal line 510. Thereby, when it becomes necessary to stop the flow rate adjustment section 511 to stop the blood flow, it is possible to reduce the amount of blood to be discarded for coagulation.
  • a roller pump or a finger pump is used as the flow rate adjustment section 511.
  • the roller pump is a pump that sucks blood and discharges blood at a set flow rate by rotating the tube constituting the blood removal line 510 with a roller while crushing it.
  • a finger pump is a pump that moves a number of fingers in peristaltic motion with respect to a tube to move the occlusion point in a certain direction, thereby squeezing the tube and transferring blood.
  • the blood purifier 520 includes a dialysis membrane (not shown) housed inside a cylindrical container body.
  • the inside of the container body is divided into a blood side flow path and a dialysate side flow path by a dialysis membrane (both not shown), and water and water are transferred from the blood side flow path to the dialysate side flow path via the dialysis membrane.
  • the blood is purified by the movement of waste products.
  • One end (upstream end) of the blood return line 530 is connected to the downstream end of the blood purifier 520, and the other end (downstream end) is connected to the second branch 410b2 provided in the connection line 410b of the ECMO system 400.
  • the second branch portion 410b2 is a portion of the ECMO system 400 on the downstream side of the first branch portion 410b1.
  • a blood chamber 532 (drip tube) as a storage section, a liquid outage sensor 533, a blood return pump 531, a clamp 534, and a pressure gauge P11 are arranged in order from the upstream side.
  • a drip tube is used as the blood chamber 532.
  • a pressure gauge P15 is attached to the blood chamber 532.
  • Pressure gauge P10 measures the pressure in blood chamber 532.
  • the blood chamber 532 stores a certain amount of blood in order to remove air bubbles, coagulated blood, etc. that have entered the blood return line 530.
  • the clamp 534 is attached to a location near the downstream end of the blood return line 530. This can reduce the amount of blood that is discarded for coagulation when it becomes necessary to close the clamp 534 to stop blood flow. Further, when the liquid shortage sensor 533 detects liquid shortage or air bubbles, the clamp 534 is closed, thereby preventing air bubbles from entering the ECMO system 400.
  • the pressure gauge P11 measures the pressure within the circuit on the downstream side of the blood return pump 531 in the blood return line 530.
  • the downstream end of the blood return line 530 is connected to the second branch portion 410b2, but it may be directly connected to the oxygenator 430.
  • the oxygenator 430 can trap the air bubbles. Therefore, the risk of the patient developing air embolism can be reduced.
  • the blood return pump 531 is a pump for sending blood flowing through the blood return line 530 to the positive pressure section of the ECMO system 400.
  • a known roller pump can be used as the blood return pump 531.
  • the dialysate supply line 540 is equipped with a dialysate pump 541 and is a line for supplying dialysate to the blood purifier 520, and connects the dialysate supply source D and the dialysate side flow path of the blood purifier 520. Connecting.
  • a dialysate pump 541 a known roller pump or finger pump is used.
  • the dialysate drain line 550 is equipped with a drain pump 551 and drains dialysate from the blood purifier 520.
  • the dialysate drain line 550 connects the dialysate side flow path of the blood purifier 520 and the drain fluid reservoir F.
  • the replenishment fluid line 560 includes a replenishment fluid pump 561, and supplies the replenishment fluid supplied from the replenishment fluid supply source R to the blood return line 530 via a blood chamber 532 (infusion tube) provided in the blood return line 530. supply As the replenishing fluid, dialysate or physiological saline is used.
  • the control unit 570 is configured by an information processing device (computer), and drives each pump included in the CRRT system 500 by executing a control program to control the blood flow rate, dialysate volume, and drainage volume to the blood purifier 520. to perform continuous hemodiafiltration (CHDF).
  • the control unit 570 controls the dialysate pump 541 disposed in the dialysate supply line 540, the drain pump 551 disposed in the dialysate drain line 550, and the replenisher pump 561 disposed in the replenisher line 560.
  • the drive of each pump may be controlled based on the flow rate measured by a metering unit (not shown) that monitors each flow rate and measures the liquid (dialysate and replenisher) flowing through the CRRT system 500.
  • the control unit 570 adjusts the set flow rate of the flow rate adjustment unit 511 (roller pump or finger pump) so that the measured value of the flow meter 512 becomes a predetermined flow rate (for example, 150 mL/min), and controls the flow rate to the blood purifier 520. Control the amount of inflow. Further, the control unit 570 adjusts the set flow rate of the blood return pump 531 so that the measured value of the pressure gauge P10 is within a predetermined range (for example, a range of 40 mmHg or more and 60 mmHg or less).
  • the blood taken out from the vein of the subject (patient) flows into the blood removal line 410a of the ECMO system 400, and a part of the blood flows through the connection line 410b to the CRRT system 500.
  • the blood flows into the blood removal line 510 at a predetermined flow rate, and the rest is sent to the oxygenator 430.
  • the flow rate of the blood sent to the CRRT system 500 is adjusted by a flow rate adjustment unit 511, and the blood is sent through a blood removal line 510 and introduced into a blood purifier 520 at a predetermined flow rate.
  • the flow rate adjustment unit 511 functions as a liquid feeding means for sending blood to the blood purifier 520 and also functions as a pressure partition that prevents the high positive pressure transmitted from the ECMO blood circuit 410 from being transmitted to the blood purifier 520. .
  • the blood purifier 520 water and waste products are removed through the dialysis membrane, and the purified blood is led out from the blood purifier 520.
  • the blood purified by the blood purifier 520 is sent to a blood chamber 532 (drip tube), and is replenished with replenisher from the replenisher line 560 according to the amount of water removed.
  • the set flow rate of the blood return pump 531 is adjusted so that the measured value of the pressure gauge P10 provided in the blood chamber 532 (infusion tube) is within a predetermined range (for example, 40 to 60 mmHg).
  • the capacity of the blood chamber 532 (drip barrel) is approximately 10 mL, and the storage amount thereof can be controlled by adjusting the set flow rate of the blood return pump 531.
  • the blood flow rate sent from the blood purifier 520 is slightly smaller than the set flow rate of the flow rate adjustment unit 511 by the amount of water removed.
  • the set flow rate of the blood return pump 531 may be set larger than the set flow rate of the flow rate adjustment section 511. Furthermore, if the measured value of the pressure gauge P10 is below a predetermined range, the set flow rate of the blood return pump 531 may be made smaller than the set flow rate of the flow rate adjustment section 511. Thereby, the internal pressure of the circuit upstream of the blood return pump 531 can be set to a low positive pressure. Therefore, the CRRT system 500 can be operated at low positive pressure.
  • the low positive pressure is, for example, a case where the circuit internal pressure is 0 to 150 mmHg.
  • the blood return line 530 includes the blood return pump 531, it is possible to increase the internal pressure in the circuit downstream of the blood return pump 531 and send blood to the positive pressure section of the ECMO system 400 (downstream of the ECMO blood pump 420). becomes.
  • the blood return pump 531 functions as a liquid feeding means for sending blood to the positive pressure section of the ECMO system, and also functions as a pressure partition that provides a low positive pressure on the upstream side and a high positive pressure on the downstream side.
  • the blood sent from the blood return line 530 of the CRRT system 500 to the connection line 410b of the ECMO system 400 is sent to the oxygenator 430 together with the blood flowing through the connection line 410b, where oxygenation and carbon dioxide removal are performed. Blood pumped from the oxygenator 430 is returned to the patient's artery or vein via the blood return line 410c and the blood delivery cannula 412.
  • the CRRT system 500 connected to the ECMO system 400 is connected to the blood removal line 510 whose upstream end is connected to the downstream side of the blood pump of the ECMO system, and the blood purification line 510 whose upstream end is connected to the downstream end of the blood removal line 510.
  • the flow rate of the blood line 530, the blood return pump 531 provided in the blood return line 530, the pressure gauge P10 that measures the pressure upstream of the blood return pump 531, the flow rate adjustment unit 511, and the blood return pump 531 is adjusted.
  • the pressure gauge P10 is configured to include a control section 570 that controls the measured value of the pressure gauge P10 to be within a predetermined range.
  • the blood return line 530 is provided with the blood return pump 531, blood can be returned to the positive pressure section of the ECMO system 400. Further, since the CRRT system 500 is connected to the positive pressure section of the ECMO system 400, even if a blood removal failure occurs in the ECMO system 400, the risk of drawing air from the CRRT system 500 can be reduced. Furthermore, since the point where blood is returned from the CRRT system 500 to the ECMO system 400 is downstream of the blood removal point, recirculation does not occur.
  • a blood chamber 532 is provided upstream of the blood return pump 531 in the blood return line 530 and is capable of storing a predetermined amount of liquid, and the pressure gauge P10 measures the pressure of the blood chamber 532.
  • the pressure on the upstream side of the blood return pump 531 can be easily measured in the blood chamber 532, and it becomes easy to control the measured value of the pressure gauge P10 to be within a predetermined range.
  • the flow rate adjustment unit 511 of the CRRT system 500 is a roller pump or a finger pump, and the control unit 570 adjusts the flow rate of the flow rate adjustment unit 511 (roller pump or finger pump) to control the inflow rate of the blood purifier 520.
  • the flow rate of the blood return pump 531 is adjusted so that the measured value of the pressure gauge P10 falls within a predetermined range. Thereby, the portion of the CRRT system 500 from the downstream side of the roller pump or finger pump to the upstream side of the blood return pump 531 can be operated at low positive pressure.
  • the downstream end of the blood return line 530 in the CRRT system 500 was connected to the upstream side of the oxygenator 430 in the ECMO system 400 or to the oxygenator 430. Thereby, when air bubbles are present in the blood return line 530, the air bubbles can be captured by the oxygenator 430. Therefore, the risk of the patient developing air embolism can be reduced.
  • the fourth embodiment will be described in detail with reference to FIGS. 15 and 16.
  • the CRRT system 500A according to the fourth embodiment has a different configuration in that the flow rate adjustment section provided in the blood removal line 510 is an adjustment clamp instead of a roller pump, and the inflow amount to the blood purifier and the circuit internal pressure are
  • the control method is different from the third embodiment. Therefore, the same reference numerals are given to the same components as those described in the third embodiment, and the explanation thereof will be omitted, and only the different points will be explained.
  • FIG. 15 is a diagram showing a schematic configuration of an ECMO system 400 and a CRRT system 500A according to a fourth embodiment of the present invention.
  • FIG. 16 shows a block diagram of the CRRT system 500A.
  • the CRRT system 500A includes a blood removal line 510, a flow rate adjustment section 511a, a blood purifier 520, a blood return line 530, a blood return pump 531, and a blood chamber as a storage section. 532 (drip tube), a dialysate supply line 540, a dialysate drain line 550, a replenisher line 560, and a control unit 570.
  • the flow rate adjustment unit 511a adjusts the flow rate of blood flowing through the blood removal line 510.
  • the flow rate adjustment section 511a is attached to a location near the upstream end of the blood removal line 510. Thereby, when it becomes necessary to close the flow rate adjustment section 511a to stop the blood flow, it is possible to reduce the amount of blood to be discarded for coagulation.
  • an adjustment clamp that can adjust the flow rate by adjusting the opening degree is used as the flow rate adjustment section 511a.
  • the adjustment clamp adjusts the flow rate of blood flowing through the tube by adjusting the opening degree of the tube that constitutes the blood removal line 510.
  • the flow rate adjustment unit 511a (adjustment clamp) is disposed in the blood removal line 510 near the positive pressure part of the ECMO system 400, so it adjusts the pressure caused by the blood sent by the ECMO blood pump 420 of the ECMO system 400.
  • the amount of blood flowing into the blood removal line 510 can be adjusted by adjusting the opening degree.
  • the flow rate adjustment unit 511a adjustment clamp
  • the flow rate of the blood return pump 531 it is possible to adjust the pressure inside the circuit on the downstream side.
  • the roller pump when a roller pump is used as the flow rate adjustment unit 511, the roller pump is configured to crush the tube and rotate, so the positive pressure of the ECMO system 400 is high pressure is applied.
  • an adjustment clamp when an adjustment clamp is used as the flow rate adjustment section 511a, the tube is held down by the adjustment clamp and the opening degree is adjusted, so that the positive pressure of the ECMO system 400 is This prevents high pressure from being applied to the inlet side of the adjustment clamp.
  • the adjustment clamp as the flow rate adjustment part 511a, the amount of hemolysis can be reduced compared to the case where a roller pump is used.
  • the amount of hemolysis can be further reduced.
  • the control unit 570 controls the flow rate of the blood purifier 520 by adjusting the set flow rate of the blood return pump 531 so that the measured value of the flow meter 512 becomes a predetermined flow rate (for example, 150 mL/min). Further, the control unit 570 adjusts the opening and closing of the flow rate adjustment unit 511a (adjustment clamp) so that the measured value of the pressure gauge P10 is within a predetermined range (for example, a range of 40 mmHg or more and 60 mmHg or less).
  • the blood taken out from the vein of the subject (patient) circulates through the ECMO system 400 and CRRT system 500A in the same manner as described in the third embodiment, and then It is returned to the patient via blood delivery cannula 412.
  • the flow rate adjustment unit 511a of the CRRT system 500 is an adjustment clamp whose opening and closing can be adjusted, and the control unit 570 adjusts the flow rate of the blood return pump 531 to control the inflow rate of the blood purifier 520, and the flow rate adjustment unit
  • the flow rate of 511a (adjustment clamp) is adjusted so that the measured value of pressure gauge P10 falls within a predetermined range.
  • the CRRT system is operated by setting the CRRT blood pump flow rate Qb to 100 mL/min, dialysate flow rate Qd to 350 mL/h, dialysate drainage flow rate Qf to 1080 mL/h, and replacement fluid flow rate Qr to 700 mL/h. went.
  • the inlet pressure Qbi measured by pressure gauge P2
  • the outlet pressure Qbo measured by pressure gauge P3
  • the pressure Qf of the dialysate drainage line is 8.7 kPa.
  • the ECMO system was operated by setting the rotation speed of the ECMO blood pump (centrifugal pump) to 5000 rpm. At this time, the flow rate of the ECMO blood pump was 3.63 L/min, and the pressure immediately after the ECMO blood pump (measured with pressure gauge P5) was 63 kPa. While operating under these conditions, an experiment was conducted to reproduce sudden poor blood removal and rapid depressurization in the ECMO system. As a result, there was no change in the operating status of the intermediate system and the CRRT system, and it was confirmed that the intermediate system and the CRRT system were not affected by poor blood removal in the ECMO system.
  • the ECMO system was operated by setting the rotation speed of the blood pump (centrifugal pump) to 3400 rpm. At this time, the pressure inside the circuit immediately after the blood pump was 35 kPa (measured with pressure gauge P5). A clamp with adjustable opening was used as the flow rate adjustment part of the intermediate system. When the ECMO system was operated under these conditions, the opening degree of the clamp was adjusted, and it was confirmed that the flow rate could be adjusted from 0 to 130 mL/min.
  • Example 1 is a circuit configuration corresponding to the first embodiment
  • Example 2 is a circuit configuration corresponding to a modification of the first embodiment, and a case where the rotation speed of the blood pump (centrifugal pump) of the ECMO system is changed.
  • Example 1 is a circuit configuration corresponding to the first embodiment
  • Example 2 is a circuit configuration corresponding to a modification of the first embodiment, and a case where the rotation speed of the blood pump (centrifugal pump) of the ECMO system is changed.
  • the rotation speed of the ECMO system indicates the rotation speed of the ECMO blood pump (centrifugal pump)
  • the flow rate indicates the flow rate of the ECMO blood pump
  • the post-pump pressure indicates the pressure immediately after the ECMO blood pump (measured with pressure gauge P5).
  • Qb of the CRRT system is the set flow rate of the CRRT blood pump
  • Qd is the set flow rate of the dialysate line pump
  • Qr is the set flow rate of the replacement fluid line pump
  • Qf is the set flow rate of the dialysate drainage line pump.
  • Qb, Qd, Qr, and Qf were set to the same conditions.
  • the inlet pressure indicates the pressure near the upstream end of the CRRT system
  • the inlet pressure indicates the pressure between the CRRT blood pump and the blood removal side pressure buffer in the blood removal line.
  • Pbi is the inlet pressure of the blood purifier (measured with pressure gauge P2)
  • Pbo is the outlet pressure of the blood purifier (measured with pressure gauge P3)
  • Pf is the pressure of the dialysate drainage line (measured with pressure gauge P4). measurement).
  • a circuit corresponding to Modification 2 of the second embodiment was constructed. Due to the height difference DH between the liquid levels between the blood removal side pressure buffer section 312 and the blood return side pressure buffer section 322, liquid can be sent from the blood removal side pressure buffer section 312 to the blood return side pressure buffer section 322 via the blood purifier 230. I checked to see if it was. At this time, all of the ECMO blood pump 120, dialysate pump 241, and replenisher pump 261 were stopped, and the clamp of the flow rate adjustment unit 311 was fully opened.
  • FIG. 11 A graph showing the relationship between the measured flow rate (L/min) and the height difference DH (cm) in Table 1 is shown in FIG. 11, and an approximate curve was calculated.
  • a blood flow rate of 0.1 L/min to 0.2 L/min is required. From the approximate curve, it was found that a blood flow rate of 0.1 L/min to 0.2 L/min was obtained when the height difference DH was 42 cm to 102 cm. Therefore, it was shown that by adjusting the height difference DH from 42 cm to 102 cm using the height difference adjustment means 280, the blood flow rate required by the CRRT system can be obtained by the head pressure difference.
  • the intermediate blood removal line and intermediate blood return line of the intermediate system or the blood removal line and blood return line of the CRRT system are connected to the connection line of the ECMO system. It is not limited to this. From the viewpoint of removing air bubbles mixed into blood in the oxygenator, it is possible to connect the intermediate blood removal line and intermediate blood return line of the intermediate system or the blood removal line and blood return line of the CRRT system to the upstream side of the oxygenator. If desired, the blood removal and return lines of the intermediate system may be connected downstream of the oxygenator of the ECMO system.
  • the intermediate blood return line or the downstream end of the blood return line is located downstream of the connection point with the intermediate blood removal line of the intermediate system in the ECMO system or the blood removal line of the CRRT system. connected, but is not limited to this. That is, the intermediate blood return line or the downstream end of the blood return line may be connected to the upstream side of the connection point with the intermediate blood removal line of the intermediate system in the ECMO system or the blood removal line of the CRRT system.
  • the downstream branch of the connection line of the ECMO system is used as an example of connecting the intermediate blood return line of the intermediate system or the blood return line of the CRRT system to the upstream side of the oxygenator.
  • the downstream branch of the connection line of the ECMO system is used.
  • intermediate blood removal line 310 of the intermediate system or blood removal line 210a of the CRRT system
  • intermediate blood return line 320 or blood return line 210b
  • oxygenator 130 of the ECMO system 100 may be connected to.
  • the intermediate blood return line 320 (or blood return line 210b) is preferably connected downstream of the intermediate blood removal line 310 (or blood removal line 210a) to prevent recirculation within the oxygenator 130.
  • This connection method may be used from the viewpoint that there is no need to provide a branch in the ECMO blood circuit 110 and from the viewpoint that air bubbles sent from the CRRT system are removed in the oxygenator 130.
  • the intermediate blood return line 320 of the intermediate system (or the blood return line 210b of the CRRT system) is connected to the inlet port.
  • the intermediate blood removal line 310 of the intermediate system (or the blood removal line 210a of the CRRT system) may be connected to the connection line 110b by providing a branch.
  • Such a connection method may be used from the viewpoint that only one branch is required in the connection line 110b of the ECMO blood circuit 110, and from the viewpoint that air bubbles sent from the CRRT system are removed in the oxygenator 130.
  • circuit pressure measurement of CRRT system As Example 3, the circuit configuration corresponding to the third embodiment is set such that the measured value (measured by pressure gauge P10 (Pbo)) of the blood chamber 532 (infusion tube) (capacity 10 mL) as a storage part is 40 to 60 mmHg. The flow rate of the blood return pump 231 was adjusted. At this time, an experiment was conducted to see how the internal pressure of the circuit of the CRRT system changes when the rotational speed of the blood pump (centrifugal pump) of the ECMO system is changed. The results are shown in Table 3.
  • the rotation speed of the ECMO system is the rotation speed of the ECMO blood pump (centrifugal pump)
  • the flow rate is the flow rate of the ECMO blood pump (measured by the flowmeter 414)
  • the post-pump pressure is the pressure immediately after the ECMO blood pump ( (measured with pressure gauge P8 or P11).
  • Qb represents the set flow rate of the roller pump
  • Qd represents the set flow rate of the dialysate line pump
  • Qr represents the set flow rate of the replenisher line pump
  • Qf represents the set flow rate of the dialysate drainage line pump.
  • Qb, Qd, Qr, and Qf were each set to the same conditions.
  • the inlet pressure indicates the pressure near the upstream end of the CRRT system (measured by pressure gauge P8).
  • Pbi is the inlet pressure of the blood purifier (measured with pressure gauge P9)
  • Pbo is the outlet pressure of the blood purifier (measured with pressure gauge P10)
  • Pf is the pressure of the dialysate drainage line (measured with pressure gauge P12). measurement).
  • Example 4 (Measurement of CRRT system flow rate when the flow rate adjustment part 511a (adjustment clamp) is fully opened)
  • the circuit configuration corresponding to the fourth embodiment is set such that the flow rate adjustment part 511a (adjustment clamp) is fully opened and the flow rate of the blood return pump 531 is adjusted so that the measured value of the pressure gauge P10 is in the range of 40 mmHg or more and 60 mmHg or less. It was controlled so that An experiment was conducted to see how the amount of blood sent to the CRRT system changes when the rotational speed of the blood pump (centrifugal pump) of the ECMO system is changed under these conditions. The results are shown in Table 4.
  • the rotation speed of the ECMO system is the rotation speed of the ECMO blood pump (centrifugal pump)
  • the flow rate is the flow rate of the ECMO blood pump (measured by the flow meter 414)
  • the post-pump pressure is the pressure immediately after the ECMO blood pump ( (measured with pressure gauge P8 or P11).
  • the flow rate of the CRRT system represents the measured value of the flow meter 512
  • the blood return pump set flow rate represents the set flow rate of the blood return pump 531.
  • Pbi is the inlet pressure of the blood purifier (measured with pressure gauge P9)
  • Pf is the pressure of the dialysate drainage line (measured with pressure gauge P12)
  • Pbo is the outlet pressure of the blood purifier (measured with pressure gauge P10). measurement).
  • a dial-type roller pump was used as the blood return pump. Therefore, since the blood return pump setting flow rate of the CRRT system when the rotational speed of the ECMO blood pump is 5000 rotations and 6000 rotations is unknown, estimated values are described.
  • FIG. 17 A graph showing the relationship between the post-pump pressure of the ECMO system and the maximum flow rate of the CRRT system obtained from the experimental results in Table 4 is shown in FIG. 17, and an approximate curve was calculated.
  • a blood flow rate of at least 0.1 L/min is required.
  • the post-pump pressure of the ECMO system that can obtain a flow rate of 0.1 L/min or more is 141 mmHg or more. From the above results, even if the CRRT system does not include a pump in the blood removal line 510, the pressure from the blood sent by the ECMO blood pump 420 of the ECMO system 400 can be used to supply the blood purifier of the CRRT system with a predetermined amount. It was confirmed that blood could flow in at the appropriate flow rate.
  • the dialysate pump 541 was set to 350 mL/h
  • the drain pump 551 was set to 1050 mL/h
  • the replenisher pump 561 was set to 750 mL/h.
  • the rotation speed of the ECMO system indicates the rotation speed of the ECMO blood pump (centrifugal pump)
  • the flow rate indicates the flow rate of the ECMO blood pump (measured by the flow meter 414)
  • the post-pump pressure indicates the rotation speed of the ECMO blood pump (centrifugal pump).
  • Indicates pressure (measured with pressure gauge P8 or P11).
  • the flow rate of the CRRT system indicates the measured value of the flow meter 512
  • the blood return pump set flow rate indicates the set flow rate of the blood return pump 531.
  • Pbi is the inlet pressure of the blood purifier (measured with pressure gauge P9)
  • Pf is the pressure of the dialysate drainage line (measured with pressure gauge P12)
  • Pbo is the outlet pressure of the blood purifier (measured with pressure gauge P10). measurement).
  • the target flow rates can be set to 0.10 L/min, 0.20 L/min, and 0.25 L/min by adjusting the opening and closing of the flow rate adjustment section 511a (adjustment clamp). Ta. Furthermore, it was confirmed that the circuit internal pressure was maintained at a low positive pressure when the CRRT system was operated at these flow rates.
  • the above results show that when the adjustment clamp is used as the flow rate adjustment section 511a, it is possible to control the flow rate of the CRRT system and to make the circuit internal pressure a low positive pressure.
  • the pressure upstream of the blood return pump is measured by measuring the pressure of the storage section provided upstream of the blood return pump, but the present invention is not limited to this.
  • the pressure upstream of the blood return pump may be measured by measuring the pressure of the blood return line upstream of the blood return pump.
  • the pressure may be measured by branching the tubes that make up the blood return line with a branch part such as a T-shaped tube, or by providing a cell for pressure measurement in the blood return line and connecting a pressure gauge to the cell. The pressure in the blood return line may be measured by doing this.
  • the blood removal line and the blood return line of the CRRT system are connected to the connection line of the ECMO system, but the present invention is not limited to this. From the viewpoint of removing air bubbles mixed into the blood in the oxygenator, it is desirable to connect the blood removal line and blood return line of the CRRT system upstream of the oxygenator. It may be connected downstream of the oxygenator.
  • the downstream end of the blood return line is connected to the downstream side of the connection point with the blood removal line in the ECMO system to prevent recirculation, but the configuration is not limited thereto. That is, the blood may be recirculated by connecting the downstream end of the blood return line to the upstream side of the connection point with the blood removal line in the ECMO system.
  • the ECMO blood circuit 410 is configured to include the blood removal line 410a, the connection line 410b, and the blood return line 410c, but the present invention is not limited to this.
  • the connection line may be formed by a part of the blood removal line 410a, or may be formed by a part of the blood return line 410c.
  • a blood withdrawal line 510 and a blood return line 530 of a CRRT system may both be connected to an oxygenator 430 of an ECMO system 400.
  • the blood return line 530 needs to be connected downstream of the blood removal line 510.
  • This connection method may be used from the viewpoint that there is no need to provide a branch in the ECMO blood circuit 410 and from the viewpoint that air bubbles sent from the CRRT system are removed in the oxygenator 430.
  • the blood return line 530 of the CRRT system may be connected to the inlet port as shown in FIG. 19, and the blood removal line 510 of the CRRT system may be connected to the inlet port.
  • a configuration in which the line 410b is connected by providing a branch may also be used. According to such a connection method, it is necessary to provide only one branch in the connection line 410b of the ECMO blood circuit 410, and from the viewpoint of removing air bubbles sent from the CRRT system in the oxygenator 430. This connection method may also be used.
  • Extracorporeal membrane oxygenation (ECMO) system 110 410 ECMO blood circuit 110b, 410b Connection line 120 ECMO blood pump 130, 430 Oxygenator 200, 200A, 200B, 200C, 500, 500A Continuous renal replacement therapy (CRRT) system 210 CRRT blood circuit 210a, 510 blood removal line 210b blood return line 220 CRRT blood pump (liquid feeding means) 230, 520 Blood purifier 280 Height difference adjusting means 300, 300A Intermediate system 310 Intermediate blood removal line 311 Flow rate adjustment section 312 Blood removal side pressure buffer 320 Intermediate blood return line 321, 531 Blood return pump 322 Blood return side pressure buffer 3121 Blood removal side detection unit 3221 Blood return side detection unit 420 ECMO blood pump (blood pump) 511 Flow rate adjustment section (roller pump, finger pump) 511a Flow rate adjustment part (adjustment clamp) 530 Blood return line 532 Blood chamber (reservoir) 570 Control section

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Abstract

L'invention concerne un système intermédiaire capable, lorsqu'un système CRRT est raccordé à un système ECMO, de réduire l'influence de la pression provenant du système ECMO sur le système CRRT. Système intermédiaire (300) disposé au niveau du point de raccordement entre un système ECMO (100) et un système CRRT (200), l'extrémité amont du système CRRT (200) étant raccordée en aval d'une pompe à sang ECMO (120) dans le système ECMO (100). Le système intermédiaire (300) comprend : une conduite intermédiaire de retour du sang (320) dont l'extrémité amont est raccordée à l'extrémité aval du système CRRT (200) et dont l'extrémité aval est raccordée au système ECMO (100) ; une pompe de retour du sang (321) ; un ensemble amortisseur pneumatique côté retour de sang (322) disposé en amont de la pompe de retour du sang (321) ; et une unité de commande (330) qui amène la quantité de liquide stocké à se situer au sein d'une plage prédéfinie en fonction de la situation de stockage de l'ensemble amortisseur pneumatique côté retour du sang (322).
PCT/JP2023/024755 2022-07-06 2023-07-04 Système intermédiaire et système de purification du sang WO2024009994A1 (fr)

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JP2022109253A JP2024007878A (ja) 2022-07-06 2022-07-06 中間システム及び血液浄化システム
JP2022-109253 2022-07-06
JP2022141236A JP2024036776A (ja) 2022-09-06 2022-09-06 血液浄化システム
JP2022-141236 2022-09-06

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Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2008534240A (ja) * 2005-03-24 2008-08-28 エスアイエフアール・２０００・アクツイエボラーグ 体外循環における気泡形成の抑制
JP2010528781A (ja) * 2007-06-06 2010-08-26 ジョージア テック リサーチ コーポレーション 体外膜酸素化療法における精密な持続的血液濾過のための新規な体液管理システム
US20200038574A1 (en) * 2017-04-07 2020-02-06 In10Sivecare S.R.L. Apparatus for the extracorporeal treatment of blood

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
JP2008534240A (ja) * 2005-03-24 2008-08-28 エスアイエフアール・２０００・アクツイエボラーグ 体外循環における気泡形成の抑制
JP2010528781A (ja) * 2007-06-06 2010-08-26 ジョージア テック リサーチ コーポレーション 体外膜酸素化療法における精密な持続的血液濾過のための新規な体液管理システム
US20200038574A1 (en) * 2017-04-07 2020-02-06 In10Sivecare S.R.L. Apparatus for the extracorporeal treatment of blood

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