JPS645909B2 - - Google Patents

Description

[Detailed Description of the Invention] [Field of Industrial Application] This invention relates to a blood processing device that performs extracorporeal blood circulation for renal failure patients such as artificial dialysis, and in particular, relates to a blood processing device that performs extracorporeal blood circulation for renal failure patients, and in particular, a blood processing device that automatically supplies a predetermined amount of fluid replacement to an extracorporeal blood circulation circuit. The present invention relates to an automatic fluid replacement device configured to perform water replenishment.

[Conventional technology]

Complications commonly seen during dialysis include disequilibrium syndrome and hard water syndrome.

Imbalance syndrome occurs before dialysis, when urea is evenly distributed in the blood and tissues. However, with dialysis,
In particular, due to the enormous work of artificial kidneys, urea from the blood is removed faster than from the tissues and brain.
An imbalance of urea concentration occurs.

When this imbalance syndrome occurs, severe headaches, nausea, vomiting, and in cases of high blood pressure, disturbances of consciousness occur. To prevent this, it is necessary to perform careful dialysis for a short time every day.

In addition, hard water syndrome is a symptom that occurs due to increased calcium and magnesium concentrations in the blood due to dialysis with calcium and magnesium-rich dialysate, and the symptoms include severe headaches, nausea,
Symptoms include vomiting, fever, difficulty breathing, and increased blood pressure.

Symptoms such as nausea and vomiting often appear when blood pressure drops. This drop in blood pressure occurs at the same time as dialysis starts because the patient's blood volume filling the dialyzer is at its lowest point.
200-300 ml is required, as this rapidly fills the extracorporeal circulatory system within a short period of time. in this case,
Dialysis starts slowly and can be prevented by slowly rotating the blood pump to fill the dialyzer. In addition, to prevent hypotension that occurs during dialysis, the blood pump should be slowly rotated, the negative pressure should be adjusted to zero, and strong excesses should be removed, or physiological saline should be injected through the entrance of the venous chamber or a soft plastic syringe should be used to pump the blood into the artery. Inject from the circuit. In that case, inject approximately 200ml relatively quickly. If the effect is not sufficient even after waiting a few minutes, add another 200~
Inject 400ml. Furthermore, muscle spasms that occur during dialysis are due in part to rapid overload (removal of water and salt), especially when large amounts of water and salt have accumulated. It tends to happen when At this time, rapidly inject 100 to 200 ml of saline, and repeat if there is no effect. In this way, conventional treatments in which blood is processed by extracting the patient's blood and circulating it extracorporeally have been used to evaluate the patient's condition (symptoms observed by observing the patient or the patient's own complaints) or the treatment. When necessary, in order to improve the patient's symptoms, physiological saline and/or other medicinal solutions are often injected into the extracorporeal circulation circuit or directly injected into the patient's blood vessels as fluid replacement. For example, in dialysis treatment using an artificial kidney, a large amount of blood is removed from the patient and circulated outside the body, and waste products and water are removed, which disrupts the patient's physiological balance and causes headaches, nausea, and decreased blood pressure. occurs. When urgently recovering from such a sudden change in condition, especially when blood pressure drops, rapid infusion of approximately 100 to 300 ml of physiological saline, etc. into the patient increases the patient's body fluid volume and improves the patient's condition. It will be done. At this time, a device is required that automatically and safely replaces fluids such as physiological saline in a predetermined amount at a predetermined rate.

Therefore, for example, in an extracorporeal blood circulation circuit equipped with a dialyzer that performs hemodialysis using dialysate, a device configured as shown in FIG. 1 is known as a device that performs fluid replacement using a fluid replacement pump. That is, in FIG. 1, reference numeral 1 indicates a patient, and 2 indicates an artery of the patient. A catheter 17 is placed in the artery 2 of the patient, and the blood of the patient 1 is taken out to the blood removal circuit 3 through this catheter 17. The blood taken out to the blood extraction circuit 3 is returned to the vein 20 through the blood pump 5, the dialyzer 6, the venous circuit 18, the drip chamber 7, and the catheter placed in the vein 20 of the patient 1. In the extracorporeal blood circulation circuit configured as described above, a fluid replacement circuit 8 that communicates a fluid replacement pump 19 with a fluid replacement bottle 9 is branch-connected to a part of the blood removal circuit 3, and by driving the fluid replacement pump 19, the patient It is possible to achieve the necessary supply of replacement fluid at each time. In this case, in the fluid replacement circuit 8, the required fluid replacement amount (the amount of fluid replacement required by the patient) of the fluid replacement pump 19 and the fluid replacement rate (the flow rate of the injected replacement fluid when supplied to the patient) are set in advance according to the patient's condition. ,
After the start of fluid replacement, a nurse or doctor must always strictly monitor whether the set required amount of fluid replacement has been reached by checking the time or the remaining amount in the fluid replacement bottle 9. In addition, it is necessary to ensure that the patient does not receive too much replacement fluid, that the replacement fluid bottle 9 does not become empty and air is injected into the patient's vein 20, and that the amount of replacement fluid injected (injection of replacement fluid into the patient until the required amount of replacement fluid is reached). Strict care must be taken to ensure that the amount (volume) does not become less than the required amount of replacement fluid set. Furthermore, if rapid treatment is required depending on the patient's symptoms, it is necessary to temporarily shut off the artery side and return the blood in the extracorporeal blood circulation circuit to the patient together with fluid replacement. At this time, for example, the blood extraction circuit 3 is clamped.

FIG. 2 shows a configuration in which a fluid replacement circuit 8 communicating with a fluid replacement bottle 9 is inserted directly into a vein 20 of a patient 1 via a fluid replacement injection needle, and fluid replacement is performed through an intravenous drip. In this case, there is no need to worry about air entering the blood because of the venous pressure, but frequent punctures of fluid replacement needles into Patient 1's blood vessels may cause problems in patients who undergo extracorporeal blood circulation every other day or two or three times a week. is not preferred because it causes significant damage to blood vessels. Also in this case, it is necessary to monitor the amount of replacement fluid injected. Furthermore, if rapid treatment is required depending on the patient's symptoms, it is necessary to clamp the blood extraction circuit 3 in the same manner as described above to temporarily shut off the artery side and return the blood in the extracorporeal blood circulation circuit to the patient. .

FIG. 3 shows a configuration in which the fluid replacement pump is omitted from the fluid replacement circuit connected to the extracorporeal blood circulation circuit shown in FIG. 1. In this configuration, the fluid replacement circuit 8 and the blood withdrawal circuit 3 are each manually clamped. Conventionally, physiological It is used as a means of supplying saline. Therefore, in this case as well, it is necessary to strictly monitor the appropriate amount of replacement fluid to be injected based on the amount remaining in the replacement fluid bottle 9 or the time.

[Problem that the invention seeks to solve]

As mentioned above, in conventional fluid replacement devices,
In either case, the decision to perform fluid replacement is made based on the physician's own observation or complaint of the patient's symptoms, and the nurse prepares fluid replacement, performs fluid replacement, monitors the patient during fluid replacement, confirms the specified fluid replacement rate, and confirms that the specified fluid injection amount is completed. It is necessary to perform confirmation and treatment after completion of fluid replacement injection, which is very complicated work and troublesome to handle.

In addition, a hypermorphic artificial kidney that does not use dialysate has been known, but this hypermorphic artificial kidney
Waste products and water are removed by passing blood through a sieve, and a fluid replacement device is provided because it is necessary to replace a large amount of fluid close to the excess volume in order to evacuate a large amount of blood. Therefore, the fluid replacement device in this case consists of a fluid replacement bottle and a fluid replacement pump, and there are two methods: fluid replacement on the upstream side of the filter (pre-hydration method);
Alternatively, a method of replenishing fluid downstream of the filter (post-replenishment method) is adopted. However, the present invention is not intended for such a fluid replacement device that performs control to perform fluid replacement in an amount that is close to an excessive amount.

Therefore, an object of the present invention is to be able to easily operate without causing pain to the patient, to set the required amount of fluid replacement for each patient in advance, and to calculate the fluid replacement flow rate (unit: By calculating the replacement fluid supply time for the required amount of fluid (the amount of fluid flowing per hour) and controlling the switching device during this time, it is possible to provide appropriate fluid replacement when necessary in response to sudden changes in the patient's condition without the need for a dedicated pump. An object of the present invention is to provide an automatic fluid replacement device that can programmably supply an injection amount, safely and with high precision, and facilitates fluid replacement management.

[Means for solving problems]

The automatic fluid replacement device according to the present invention has an extracorporeal blood supply system configured to connect a blood extraction circuit for taking out patient's blood outside the body to a blood processing device via a blood pump, and to circulate blood to be processed by the blood processing device outside the body. In the circulation circuit, a replenishment circuit is branched and connected to a part of the blood extraction circuit, and a switch is provided at this branch point to selectively switch and connect the circuit, and when the switch is switched, the flow rate of the replenishment fluid supplied from the blood pump is changed. A control calculation circuit is provided which compares and calculates the amount of replacement fluid injected with the amount of replacement fluid required by the patient set in advance, and an operation command to the switching device and its switching control are issued based on a coincidence signal output from the control calculation circuit. The present invention is characterized in that an automatic fluid replacement control means is provided, and the fluid replacement circuit is communicatively connected to the extracorporeal circulation circuit from the start to the stop of fluid replacement.

In this case, it is preferable that the control calculation circuit is configured to preset the replacement fluid flow rate and required replacement fluid amount required for the patient, and calculate the time for the required replacement fluid amount based on the replacement fluid flow rate supplied from the pump.

[Effect]

According to the automatic fluid replacement device according to the present invention, the fluid replacement circuit is branch-connected to a part of the blood extraction circuit constituting the extracorporeal blood circulation circuit, and a switch is provided at this branch point for selectively switching and connecting the circuit. This switching device is controlled and operated by automatic fluid replacement control means.
In this case, the automatic fluid replacement device integrates the fluid replacement amount until it reaches a preset fluid replacement amount for the patient, for example, based on the fluid replacement flow rate supplied from the blood pump,
The control calculation circuit performs comparison calculations until this replacement fluid injection amount matches the required replacement fluid amount, and the control calculation circuit calculates the replacement fluid supply time for the required replacement fluid amount until a match signal is output, or based on the replacement fluid flow rate from the blood pump. , the fluid replacement circuit is connected to the extracorporeal blood circulation circuit from the start to the stop of fluid replacement based on this replacement fluid supply time, and for this purpose, the operation command to the switching device and the switching control are transmitted to the automatic fluid replacement control means. This can be effectively achieved by

In addition, by selectively connecting the fluid replacement circuit to the extracorporeal blood circulation circuit and the blood extraction circuit via the switch, the patient's arterial side is temporarily cut off and the blood in the extracorporeal blood circulation circuit is removed together with the fluid replacement. can be returned to the patient, thereby quickly preventing the risk of developing a serious condition.

〔Example〕

Next, embodiments of the automatic fluid replacement device according to the present invention will be described in detail below with reference to the accompanying drawings.

FIG. 4 is a system diagram showing an embodiment of a blood processing system in which the automatic fluid replacement device of the present invention is incorporated into an extracorporeal blood circulation circuit. For convenience of explanation, the same reference numerals will be used for the same components as those of the conventional apparatus shown in FIGS. 1 to 3. In this embodiment, blood taken out from an artery 2 of a patient 1 passes through a blood extraction circuit 3 and a blood circuit 4, is pressurized by a blood pump 5, and passes through a dialyzer 6, a venous circuit 18, and a drip chamber 7. Patient 1 vein 2
Return to 0. For the extracorporeal blood circulation circuit configured as described above, the replacement fluid supplied to the patient 1 is stored in a replacement fluid bottle 9 provided in a fluid replacement circuit 8 connected to a part of the blood removal circuit 3, and is controlled by an automatic fluid replacement controller. 10
Under the action of , fluid is automatically replenished from the fluid replacement circuit 8 to the extracorporeal blood circulation circuit.

FIG. 5 is a block diagram showing the structure of the automatic fluid replacement controller 10. In FIG. 5, an automatic fluid replacement controller 10 is composed of a switching device 11 and a control section 12. As shown in FIG. The switch 11 is provided at a branch connection point between the blood extraction circuit 3 and the fluid replacement circuit 8, and is configured to selectively connect one of the circuits to the blood circuit 4. This switching device 11 can be driven using a solenoid, a motor, hydraulic pressure, air pressure, or the like. Further, the control section 12 includes a signal transmitter 13, a control calculation circuit 14, and a display setting circuit 15.

The signal transmitter 13 is connected to the control calculation circuit 14 by a transmission line 16, and transmits a fluid replacement start signal to the control calculation circuit 14 by operating a push button switch or a contact point. As a result, the control calculation circuit 14 outputs an operation command signal to the switching device 11 in conjunction with the start of supply of replacement fluid, and as a result, the switching device 11
is operated, and the fluid replacement circuit 8 is connected to the blood circuit 4. The display setting circuit 15 also includes a required replacement fluid amount setting switch, a replacement fluid flow rate setting switch, a power switch, etc., and controls and calculates the replacement fluid amount and replacement fluid flow rate set by these switches via the transmission line 16. Transfer to circuit 14. As a result, the control calculation circuit 14 calculates and determines the replacement fluid supply time using the following equation.

Replacement fluid supply time (min) = Required replacement fluid volume (ml) / Replacement fluid flow rate (m)
l/min)...(1) Therefore, after fluid replacement has started, the control calculation circuit 14 can inject the preset amount of fluid required by the patient by detecting the elapse of the fluid replacement time, and the switching device A fluid replacement stop command signal is outputted to 11, whereby the switching device 11 is activated, the blood extraction circuit 3 is connected to the blood circuit 4, and the extracorporeal blood circulation circuit is activated again to start blood dialysis processing.

Next, the operation of the apparatus of this embodiment will be explained in detail. First, a catheter 17 is placed in the artery 2 of the patient 1, and blood is taken out to the blood removal circuit 3 through this catheter 17. The blood extraction circuit 3 is connected to the fluid replacement circuit 8 and the blood circuit 4, and the junction of each circuit is set to the automatic fluid replacement controller 10. The fluid replacement circuit 8 is always connected to the switching device 11.
The blood extraction circuit 3 and the blood circuit 4 are connected to each other. Therefore, the blood taken out into the blood extraction circuit 3 passes through the blood circuit 4, flows into the dialyzer 6 by the blood pump 5, passes through the venous circuit 18 and the drip chamber 7, and passes through the catheter placed in the vein 20 of the patient 1. Blood is returned to the vein 20 via the blood.

Therefore, during dialysis treatment, if the patient becomes uncomfortable and requires fluid replacement, by pressing the push button switch of the signal transmitter 13, a fluid replacement start signal is transferred to the control calculation circuit 14. As a result, the control calculation circuit 14 outputs an operation command signal to the switching device 11 and operates the switching device 11 to connect the clamped fluid replacement circuit 8 to the blood circuit 4 and to clamp the blood extraction circuit 3. let In this way, the fluid replacement circuit 8 is connected to the blood circuit 4.
When connected to the dialyzer 6, the replacement fluid in the fluid replacement bottle 9 is supplied to the patient 1 through the dialyzer 6 together with the blood in the extracorporeal blood circulation circuit. In this case, the required amount of fluid replacement for the patient is determined by time conversion using equation (1), and the control calculation circuit 14 counts the previously calculated replacement fluid supply time, and after the predetermined fluid replacement time has elapsed, the switching device 11 is activated. On the other hand, a fluid replacement stop command signal is output, and the switching device 11 is operated to unclamp the blood removal circuit 3 and clamp the fluid replacement circuit 8. As a result, the extracorporeal blood circulation circuit returns to its original state, and the dialysis operation is performed again.

The preferred embodiments of the present invention have been described above. Regarding the configuration of the device of the present invention, the control section includes means for displaying the number of fluid replacements, the cumulative amount of fluid replacement, and the status of fluid replacement, as well as means for displaying the number of fluid replacements, the cumulative amount of fluid replacement, and the status of fluid replacement, as well as for starting and stopping fluid replacement, etc. A buzzer or the like can be provided to notify the user. Further, the signal transmitter 13 can also be provided outside the device to configure a remote control system. Furthermore, in this embodiment, the replacement fluid supply time is determined by calculation in the control calculation circuit 14 from the required replacement fluid amount and replacement fluid flow rate, but the replacement fluid supply time may be directly input from the display setting circuit 15 to the control calculation circuit 14. In addition, the replacement fluid flow rate can also be input from a flow meter to the control calculation circuit 14, or calculated by multiplying the number of revolutions of the blood pump 5 by the flow rate per revolution of the blood pump 5. It is.

〔Effect of the invention〕

As is clear from the embodiments described above, according to the present invention, blood is collected in an extracorporeal blood circulation circuit configured to take a patient's blood out of the body, perform dialysis treatment using a dialyzer, and then circulate the blood back into the body. By branching and connecting the fluid replacement circuit to the extraction circuit via a switching device, and operating this switching device as necessary, the fluid replacement circuit is connected to the extracorporeal blood circulation circuit,
Under the action of a blood pump, an automatic supply of the necessary replacement fluids as well as a return of blood in the extracorporeal blood circulation circuit can be achieved. In this case, the amount of fluid to be injected or the fluid replacement time to supply the patient's required amount of fluid that has been set in advance based on the fluid replacement flow rate by the blood pump is determined, and the switching device is used from the start to the stop of fluid replacement. The operation command can be properly and reliably given by the automatic control means.

Therefore, according to the automatic fluid replacement device of the present invention, it is possible not only to significantly reduce the burden on doctors and nurses during fluid replacement, which was a problem with conventional devices, but also to make it possible to check the amount of fluid injected during fluid replacement. This becomes unnecessary, making the fluid replacement work easier and increasing its safety.

In addition, in the above-mentioned embodiment, a case was explained in which it was applied to an extracorporeal blood circulation circuit that performs hemodialysis using a dialyzer, but the automatic fluid replacement device of the present invention is not limited to this embodiment. For example, the present invention can also be applied to an extracorporeal blood circulation circuit equipped with various blood processing devices such as an artificial heart-lung circuit, and it goes without saying that the same effects as in the above embodiment can be obtained in this case as well.

[Brief explanation of drawings]

FIG. 1 is a system diagram showing an example of the configuration of an extracorporeal blood circulation circuit equipped with a conventional fluid replacement device, and FIG. 2 is a system diagram showing another example of the configuration of an extracorporeal blood circulation circuit equipped with a conventional fluid replacement device. Figure 3 is a system diagram showing another configuration example of an extracorporeal blood circulation circuit equipped with a conventional fluid replacement device.
The figure is a system diagram of an extracorporeal blood circulation circuit showing one embodiment of the automatic fluid replacement device according to the present invention, and FIG. 5 is a block diagram showing the configuration of the automatic fluid replacement controller shown in FIG. 4. 1...Patient, 2...Artery, 3...Blood extraction circuit,
4...Blood circuit, 5...Blood pump, 6...Dylyzer, 7
...Drip chamber, 8...Fluid replacement circuit, 9...Fluid replacement bottle, 10...Automatic fluid replacement controller, 11...Switcher, 12
...Controller, 13...Signal transmitter, 14...Control calculation circuit, 15...Display setting circuit, 16...Transmission line, 17...
Catheter, 18... venous circuit, 19... fluid replacement pump, 20... vein.

Claims (1)

[Scope of Claims] 1. An extracorporeal blood circulation circuit configured to connect a blood extraction circuit for taking patient's blood out of the body to a blood processing device via a blood pump, and to circulate blood processed by the blood processing device outside the body. In this method, a replacement fluid circuit is branched and connected to a part of the blood extraction circuit, and a switching device is provided at this branch point for selectively switching and connecting the circuit, and by switching the switching device, the replacement fluid flow rate supplied from the blood pump is adjusted in advance. A control calculation circuit that compares and calculates the amount of replacement fluid injected with the set amount of replacement fluid required by the patient is provided, and an automatic control unit that issues an operation command to the switching device and controls its switching based on a coincidence signal output from the control calculation circuit. An automatic fluid replacement device, characterized in that a fluid replacement control means is provided, and the fluid replacement circuit is communicatively connected to an extracorporeal circulation circuit from the start to the stop of fluid replacement. 2. Claim 1, wherein the control calculation circuit is configured to preset the flow rate and amount of replacement fluid required for the patient, and calculate the time for the required amount of replacement fluid based on the flow rate of replacement fluid supplied from the pump. The automatic fluid replacement device described.