JP5193794B2 - Home dialysis support system - Google Patents

Description

  The present invention provides home dialysis that can grasp the patient's condition and dialysis execution status by remote monitoring and can also grasp the operating state of the dialysis apparatus and the degree of deterioration of components constituting the apparatus in home dialysis treatment. An object is to provide an apparatus and a home dialysis support system using the same.

  As the number of patients with renal insufficiency increases, the number of patients undergoing hemodialysis is also increasing. Such patients are usually forced to undergo hemodialysis for several hours at a rate of once every few days in a hospital or dialysis center.

  With the progress of home nursing and home medical care in recent years, home artificial dialysis devices that allow dialysis of patients themselves at home have been developed as a way to solve the problem of dialysis patient visits, and the possibility of clinical application is increasing . For this reason, in order to perform artificial dialysis at home, the medical data management of dialysis patients and the equipment management of dialysis machines, which were conventionally performed by medical staff such as doctors, nurses, and clinical engineering engineers in hospitals Although it is necessary to do it by yourself or a caregiver, it is impossible to do it completely, and it becomes necessary to remotely monitor the management of devices and medical information. However, at present, home dialysis therapy itself is in a trial stage, and there is no system for monitoring it at present.

  In recent years, in hemodialysis treatment in hospitals, as described in JP-A-7-132141 and JP-A-11-342198, a central monitoring device that monitors a plurality of hemodialyzers as therapeutic devices together with a central monitoring device. A surveillance system is being introduced. In this system, a hemodialyzer having a communication function and a central monitoring device are connected to a communication network of a central monitoring system installed in a hospital to centrally manage treatment records and the like.

JP-A-7-132141 Japanese Patent Laid-Open No. 11-342198

  The conventional central monitoring system for hemodialysis treatment is premised on operation in a hospital, and has had a problem to be improved when trying to carry out hemodialysis treatment at home.

  First of all, the maintenance of hemodialyzers in hospitals is usually carried out using human hands as represented by medical staff such as nurses and clinical engineers, but in the case of home treatment, Medical staff will not be present at the treatment site. Therefore, the service staff periodically visits each patient's home to perform maintenance and inspection. However, if the visit interval is too long and the equipment is not satisfied with the specifications, it may be necessary to perform treatment. There were many cases in which the interval of was too short, resulting in an increase in cost.

  Secondly, in the home treatment, the patient himself or his / her caregiver operates the hemodialyzer, so it is necessary for the doctor to check the treatment schedule related to the actual dialysis and the treatment schedule related to the actual dialysis later. The patient must be filled in by the patient himself / herself or a caregiver, which not only requires time and effort, but also has a risk of error.

  Thirdly, in the case of a system that directly connects a patient's home and a hospital, it is necessary to manage and maintain the system on the hospital side, which may further increase the burden on a busy medical site.

  Accordingly, an object of the present invention is to provide a home dialysis support system that supports the maintenance of hemodialyzers in home treatment and the management of treatment results related to dialysis.

  As a result of earnestly examining this problem, the present inventor received an artificial dialysis apparatus capable of transmitting medical information and device information, and the information, medical information was delivered to the hospital, and device information was distributed to the device management center. We have discovered a system that supports efficient and safe home dialysis.

  That is, the present invention provides medical information input means for inputting medical information relating to dialysis, equipment information detection means for detecting dialysis equipment information during dialysis and / or during dialysis preparation, Home treatment comprising device information determination means for determining whether dialysis device information is normal or abnormal, and a transmission means for transmitting the medical information, the device information, and the determination result of the device information determination means to a central information collection center An artificial dialysis machine, receiving means for receiving information sent from the patient's home, placed at the central information collection center, and converting the received information into diagrams and characters as diagnostic medical information and device management information And a central information collection device comprising a transmission means for transmitting the diagnostic medical information to a hospital in charge of the patient, and a central information collection unit disposed in the hospital. There is provided a home dialysis support system comprising a medical information receiving apparatus comprising receiving means for receiving the diagnostic medical information transmitted from the coater.

  According to the present invention, the medical information input means includes dialysis execution information input means for inputting a setting value of dialysis conditions for artificial dialysis, and the device information detection means detects an actual measurement value of dialysis conditions during artificial dialysis. Dialysis execution information detection means, and the device information determination means includes dialysis execution information determination means for determining whether the detection result of the dialysis execution information detection means is normal or abnormal. The medical information input means includes means for inputting at least one information of a scheduled dialysis execution schedule, a dialysis time set value, a blood flow rate set value during dialysis, and a dialysate flow rate set value. A home artificial dialysis support comprising means for detecting at least one of information on the time (including time) when dialysis was performed, blood flow rate measured during dialysis, and dialysate flow rate It is intended to provide a system.

  The present invention also provides a home artificial dialysis support system, wherein the medical information input means includes means for inputting a patient's weight before and after dialysis and body temperature before and after dialysis.

  In the present invention, the device information detection means includes a dialyzer test value, an extracorporeal blood circuit test value, a pyrogen filter test value, a reverse osmosis membrane test value, a blood pump flow rate calibration value, and a dewatering pump flow rate. A home artificial dialysis support system comprising means for detecting at least one piece of information of calibration values, wherein the device information determination means includes a preset alarm action point and / or forecast action point, and Comparing means for comparing the detection result of the device information detecting means, and means for determining whether the operating state of the home treatment artificial dialysis device corresponds to a normal state, a forecast state, or an alarm state It is intended to provide a home dialysis support system that is characterized.

  Further, according to the present invention, the central information collecting apparatus includes a transmission unit for transmitting the device management information to the device management center, and is disposed in the device management center to receive the device management information. The present invention provides a home dialysis support system characterized by comprising a device management information receiving device comprising means.

  Further, the present invention provides medical information input means for inputting medical information related to dialysis, equipment information detection means for detecting dialysis equipment information during dialysis and / or during dialysis preparation, Home treatment comprising device information determination means for determining whether dialysis device information is normal or abnormal, and a transmission means for transmitting the medical information, the device information, and the determination result of the device information determination means to a central information collection center An artificial dialysis device is provided.

Hereinafter, preferred embodiments of the present invention will be described with reference to the drawings.
The present invention relates to an artificial dialysis apparatus capable of transmitting medical information inputted by a patient, information on whether or not dialysis has actually been performed, and information on the aging of constituent devices determined by the dialysis apparatus itself, and sent information. It is a home dialysis support system consisting of a centralized center that can receive, send medical information to a hospital, and send information about changes in components over time to a device management center.

  The central information collection center and the device management center may be in the same physical location, but the entire system operation should be performed by the person in charge of the central information collection center so that device management work is not imminent. preferable. In addition, receiving devices installed in hospitals should be equipment that is easy to maintain and manage, such as FAX, so as not to increase the burden on the medical site. It is preferable to be able to refer to the stored information.

1 and 2 show an embodiment of the present invention. FIG. 1 shows the overall configuration, and FIG. 2 shows the details of an artificial dialysis apparatus (10) having a communication function installed at home.
In FIG. 1, (1) is a home where a patient lives, and the patient performs home dialysis from the dialysis apparatus (10).

  As will be described in detail later, the artificial dialysis machine is equipped with a medical information input interface (15) having a touch panel in addition to information on dialysis execution, dialysis time set value, body weight before and after dialysis, body temperature before and after dialysis, and during dialysis The blood flow rate set value and the dialysate flow rate set value are input. These pieces of information are transmitted to the computer (21) installed in the central information collection center (20) via the public telephone line (51) by the modem (12) as a transmission means.

  With regard to such communication means, a public telephone line is used in this example. However, as long as data communication is possible, the communication means is not limited to a telephone line such as a wired, cellular phone, and PHS, but various communication means such as the Internet and a CATV line. Can be used. However, since medical information is personal information and is also used as data for doctors to perform diagnosis and treatment based on the data, it is necessary to ensure data reliability and security issues. It is preferable to directly connect the artificial dialysis machine at the patient's home and the central information center.

  A modem (22) is connected to the central information processing apparatus, thereby enabling communication with each home. Information transmitted from each home is recorded and managed in a large-capacity storage device (24). Here, as for the stored information, the following three types of reports are created for each of the outline, for doctor diagnosis and for device management, according to the intended use. That is, an emergency report, a regular report, and a monthly report.

  The form of information sent from the home is a character string or a numerical string obtained by quantizing blood flow velocity fluctuations. Therefore, the medical information is installed in the hospital (30) where the patient visits via the public telephone line (52) from the facsimile function modem (23) converted into the report form and connected to the computer. Sent to the facsimile (31) and delivered to the doctor in charge. Similarly, the device information is converted into a report format and then transmitted to the device management center (40) via the public telephone line (53), and the computer (41) installed in the device management information center is a modem. The data received in (42) is converted into a report form and output from the printer (43).

  Next, an artificial dialysis apparatus (10) having a communication function will be described with reference to FIG. The artificial dialysis machine includes a CPU (11), a central information collection center computer and a modem (12) for data communication via a public telephone line, an artificial dialysis circuit (13), a pressure sensor in the circuit, a flow sensor, A sensor (14) such as a temperature sensor, and a patient has a touch panel for inputting medical information such as dialysis time, body weight before and after dialysis, body temperature before and after dialysis, blood flow rate during dialysis, and dialysate flow rate setting value. It comprises an interface (15), a calendar function part (16) for performing time management, and a sound generation part (17) such as a buzzer.

  The artificial dialysis device informs the patient that the measurement time has come, and prompts the patient to input necessary input items from the sound generator at a fixed time due to the calendar function. The patient inputs the dialysis time, weight, body temperature, etc. displayed on the liquid crystal display while operating the touch panel. Thereafter, actual dialysis is started following the instructions on the liquid crystal display screen. After dialysis is completed, the weight and body temperature after dialysis are input while operating the touch panel according to the display on the liquid crystal display. By inputting whether or not the result is urgently delivered to the doctor's hand, one medical data measurement is completed.

  On the other hand, the operation information from the artificial dialysis circuit of the artificial dialysis apparatus is always taken into the CPU, and information on changes over time in blood flow rate and dialysate flow rate during dialysis is created. In the home dialysis machine, after the end of the dialysis, preparations for dialysis are automatically started in preparation for the next dialysis, cleaning and sterilization in the dialysate circuit, dialyzer, pyrogen filter, reverse osmosis membrane, etc Tests and preparation of dialysate. The data measured during the pre-dialysis preparation and the calculated calibration values are incorporated in the CPU, and information on the time-dependent changes of the devices constituting the dialysis circuit is created.

  The test value of such a dialyzer is, for example, a pressure value after filling the inside of the hollow fiber membrane constituting the dialyzer, for example, with water and pressurizing the outside to a specified pressure and holding it for a certain period of time. However, it is a test value that confirms the reliability of the hollow fiber membrane type dialyzer by using the fact that it is slightly lower than the applied pressure value, but significantly lowers if there is a hole. Regarding the test value of the pyrogen filter, the method is the same as the test value of the dialyzer.

  The test value of the extracorporeal blood circuit is, for example, a pressure value after the extracorporeal blood circuit is filled with air, pressurized to a certain pressure and held for a certain time, and is a test value for confirming whether the extracorporeal blood circuit is normal. is there.

  The test value of the reverse osmosis membrane is a test value of the reverse osmosis membrane for purifying water used for dialysis. For example, a certain amount of reverse osmosis water is generated through the reverse osmosis membrane, and the time taken for the generation is calculated. If the measured value is shorter than a predetermined range, it becomes a judgment material such as a hole being formed, and if longer than a predetermined time, clogging is caused.

The calibration value of the blood pump flow rate and the calibration value of the dewatering pump flow rate are test values for calibrating the blood pump for circulating blood during dialysis and the dewatering pump for removing water during dialysis. For example, the pump is rotated at a constant rotation speed, the time taken to feed a fixed amount of water is measured, and the calibration is performed by calculating the liquid feed amount per rotation.
Therefore, the device information detecting means of the present invention is a detecting means for performing the above-described test, and various pressure sensors, flow rate sensors, timer means and the like are used.

Next, the report will be explained.
The emergency report corresponds to a case in which the emergency report is urgently delivered to the doctor's hand or the device manager when it is in a state corresponding to the forecast or in a state corresponding to an alarm according to the determination result. When the computer of the central information collection center receives this forecast or alarm, it records it in the storage device, and immediately reports it to the doctor via facsimile, or to the device manager by the computer of the device management center. Send a letter. At this time, the doctor and the device manager can perform more appropriate diagnosis, treatment, and countermeasures by creating a report by giving medical information and device information for the last few days.

  Periodic reports gather information received from the artificial dialysis machine for a certain period and put it into a report. Medical information is sent to the doctor during the doctor's working hours (usually in the morning of the next morning), and device management information Is sent to the device management center. The period is individually determined according to the patient's symptoms, but is usually a daily cycle, and may be a 3-7 day cycle for a stable patient.

  Monthly report is a summary of information received from an artificial dialysis machine for one month, so that changes over time for one month can be grasped, for example, the results of weight test before and after dialysis, dialyzer pressure test results, etc. It is a report including

It is the schematic which shows the whole structure of the home dialysis assistance system of this invention. It is the figure which showed the detail of the artificial dialysis apparatus (10) which has a communication function installed at home.

Claims (6)

Medical information input means arranged at each patient's home for inputting medical information related to dialysis,
Device information detection means for detecting dialysis equipment information during dialysis and during dialysis preparation, dialysis equipment information, equipment information judgment means for judging whether the dialysis equipment information is normal or abnormal, medical information, dialysis equipment information And a transmission means for transmitting the determination result of the device information determination means to the central information collection center,
The dialysis device information includes at least one of a dialyzer test value, an extracorporeal blood circuit test value, a pyrogen filter test value, a reverse osmosis membrane test value, a blood pump flow rate calibration value, and a dewatering pump flow rate calibration value. only contains one of the information,
The central information collection center transmits the medical information, the dialysis device information, and the determination result of the device information determination means to different places, respectively, and an artificial dialysis apparatus for home treatment.   The device information determination means includes a comparison means for comparing a preset alarm operation point and / or forecast operation point with a detection result of the device information detection means, and the operating state of the home treatment artificial dialysis device is in a normal state The home dialysis artificial dialysis apparatus according to claim 1, wherein the dialysis apparatus is a means for determining whether the state corresponds to a prediction state or an alarm state.   The home treatment artificial dialysis device according to claim 1 or 2, wherein the patient's weight and body temperature are input to the medical information input means as the medical information before and after dialysis.   The dialysis machine information during dialysis is information on changes over time in blood flow rate and dialysate flow rate during dialysis, and the artificial dialysis apparatus for home treatment according to any one of claims 1 to 3 .   The dialysis apparatus for home treatment according to any one of claims 1 to 4, wherein after completion of dialysis, preparation for dialysis is automatically performed in preparation for the next dialysis.   The dialysis device information during dialysis preparation includes at least a calibration value of a blood pump flow rate and a calibration value of a water removal pump flow rate, and the artificial dialysis for home treatment according to any one of claims 1 to 5, apparatus.

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