JP5560954B2 - Blood return operation method and blood purification apparatus in blood purification apparatus - Google Patents

Description

  The present invention relates to a blood purification device and a blood purification device for returning blood remaining in a blood purification device and a blood circuit to a patient's body after completion of the blood purification treatment.

As a method of recovering blood remaining in the blood circuit and the blood purifier after the blood purification treatment is completed, conventionally, the raw food is filled into the blood circulation circuit via the raw food line, and from the blood circuit and the blood purifier. A common method is to push the blood back into the patient's body.
However, in that case, since a large amount of saline (saline solution) is also used for priming before the start of dialysis, the treatment cost is high and the burden on the patient is large. Blood return has become widespread (Patent Documents 1 and 2).

On the other hand, in blood purification treatment, it is known that proteins such as albumin in the blood may clog the dialysis membrane. When returning blood using reverse filtration, the clogged protein is contained in the blood. When the blood was returned and returned to the blood, there was a risk that the CRP appearing in the blood could increase when an inflammatory reaction or tissue destruction occurred in the body. Also, the blood return method by back filtration is not preferable for patients because the amount of back filtered dialysate collected together with blood is large.

JP 2008-93193 A JP 2009-131212 A

The present invention has been made in view of the above circumstances, and provides a blood return operation method in a blood purification apparatus in which a protein clogged in a dialysis membrane is less likely to be returned to the blood and the amount of recovery at the time of blood return is small. To do. Moreover, the blood purification apparatus which enables such blood return is provided.

The blood return operation method in the blood purification apparatus of the present invention comprises a blood purification device , a blood circuit, a blood pump provided in a blood circuit upstream of the blood purification device, and a dialysate circuit, Blood return operation in a blood purification apparatus in which the dialysate circuit has a closed water removal control system, air introduction means for introducing air into the sealed dialysate circuit, and reverse filtration means are provided. A method,
The air introducing means, after the blood purification treatment completion, by introducing air into the dialysate supply circuit, the air is introduced into the desired film portion of the blood purifier, the inverse filtering means, the blood purification Back filtration is performed on the remaining membrane portion of the vessel where air has not been introduced, and blood is returned using the back-filtered dialysate.
Here, the membrane portion for performing reverse filtration is preferably 1/2 to 1/5 of the membrane area of the blood purifier, and more preferably about 1/4 of the membrane area of the blood purifier.

The blood purification apparatus of the present invention includes a blood purification device, a blood circuit, a blood pump provided in a blood circuit upstream of the blood purification device, and a vein provided in a blood circuit downstream of the blood purification device. In a blood purification apparatus comprising a chamber and a dialysate circuit, the dialysate circuit is of a sealed dewatering control system, and air introduction means for introducing air into the sealed dialysate circuit is provided Further, a reverse filtration means is provided.
Here, as the air introduction means, an air introduction line provided on the dialysate drain side of the dialysate circuit and a dialysate discharge line provided on the dialysate supply side of the dialysate circuit can be adopted. . Moreover, as an air introduction line, what is equipped with an on-off valve while providing an air filter in an air introduction port is employable.

As the sealed water removal control method, any of the double chamber method, the dual pump method, and the viscous control method can be adopted. However, the double pump method can use the same air introduction means as the viscous control method, and performs reverse filtration. Therefore, it is handled as a device similar to the viscous control method.
When the double chamber method is adopted as the sealed water removal control method, the fresh dialysate is stored and supplied to the blood purifier through the dialysate circuit, and flows from the blood purifier through the drain side of the dialyzer circuit. It consists of a chamber for storing used dialysate, and an equalizer in which these two chambers are separated by a flexible membrane is used. The reverse filtration means is on the dialysate supply side of the dialysate circuit so as to straddle this equalizer. And a reverse filtration pump provided in the reverse filtration circuit, in which the dialysate discharge line is provided with a dialysate discharge pump.
In addition, when the viscous control method is adopted as the sealed water removal control method, a room for storing fresh dialysate and supplying it to the blood purifier through the dialysate circuit, and the drainage side of the dialyzer circuit from the blood purifier It consists of a chamber for storing the used dialysate that flows in, and a chamber for water removal. These three chambers are partitioned by a flexible membrane, and a liquid such as silicon oil is stored in the chamber for water removal. A viscous chamber in which the liquid is filled and configured to allow the liquid to be taken in and out by a viscous pump is employed, and a dialysate discharge line having an on-off valve can be employed. In this case, the reverse filtration means includes a chamber for removing water from the viscous chamber and a viscous pump.

Although the present invention has been generally described above, a better understanding can be obtained by reference to certain specific embodiments. These examples are provided herein for illustrative purposes only and are not limiting unless otherwise specified.

According to the present invention, the following effects can be expected. That is, reverse filtration is performed on the membrane portion with less clogging, and blood is returned using the reverse filtered dialysis fluid, so that the amount of protein clogged in the dialysis membrane is returned to the blood and CRP increases. There is no fear. Moreover, since the area of the membrane part which performs reverse filtration becomes small, the amount of collection | recovery at the time of blood return decreases, and a patient's physical burden is reduced.

1 is a schematic explanatory diagram of Example 1. FIG. 6 is a schematic explanatory diagram of Example 2. FIG. It is a figure which shows the relationship between the pressure gradient on the blood side of a blood purifier, and the pressure gradient on the dialysate side.

A blood purifier, a blood circuit, a blood pump provided in a blood circuit upstream of the blood purifier, a venous chamber provided in a blood circuit downstream of the blood purifier, and a dialysate circuit In the blood purification apparatus, the dialysate circuit has a sealed water removal control system, air introduction means for introducing air into the sealed dialysate circuit, and back filtration means are provided. Yes. The air introduction means consists of an air introduction line provided on the dialysate drain side of the dialysate circuit and a dialysate discharge line provided on the dialysate supply side of the dialysate circuit. And an air filter and an open / close valve. The viscous control system is adopted as a sealed water removal control system, and the fresh dialysate is stored and supplied to the blood purifier through the dialysate circuit, and flows from the blood purifier through the drain side of the dialysis circuit. A chamber for storing used dialysate and a chamber for water removal. These three chambers are partitioned by a flexible membrane, and the chamber for water removal is filled with a liquid such as silicon oil. In addition, a viscous chamber is employed in which this liquid is configured to be freely taken in and out by a viscous pump, and the dialysate discharge line includes an on-off valve.

First, Example 1 will be described with reference to FIG.
FIG. 1 is a schematic explanatory view of Example 1, and shows a blood purification apparatus when a viscous control system is adopted as a sealed water removal control system.
The blood purification apparatus of Example 1 includes a blood purification device 1, a blood circuit 2, a blood pump 3 provided in a blood circuit upstream of the blood purification device 1 (arterial blood circuit 21), and a blood purification device 1. A venous chamber 23 provided in a blood circuit (venous side blood circuit 22) on the downstream side and a dialysate circuit 4 are included, and the dialysate circuit 4 is provided with a viscous chamber 6 for performing sealed water removal control. It is possible. Air introduction means 5 is provided in the dialysate circuit 4 on the blood purifier 1 side from the viscous chamber 6. The air introduction means 5 includes a dialysate discharge line 51 provided in a dialysate supply side circuit (dialyte supply circuit) 41 and an air introduction line provided in a dialysate drain side circuit (drainage circuit) 42. 52, and the dialysate flows from the lower side to the upper side of the blood purifier 1. The air introduction line 52 includes an air filter 521 at the air introduction port, and an automatic opening / closing valve V2 in the middle of the line, and the dialysate discharge line 51 includes an automatic opening / closing valve V1. Reference sign V3 is an automatic open / close valve provided in the venous blood circuit.

  The viscous chamber 6 contains a fresh dialysate storage chamber 61 for storing fresh dialysate supplied from a dialysate preparation device (not shown), and used dialysate used and supplied in the blood purifier 1. It consists of a used dialysate storage chamber 62 for storage and a viscous chamber 63 for storing silicon oil provided between the two storage chambers 61, 62. Each chamber 61, 62, 63 is partitioned by a flexible membrane. It has been. Two viscous chambers 6 are normally provided, and continuous dialysate can be supplied by switching the viscous chambers. The viscous chambers of the two viscous chambers are connected by a single viscous pump 7. The amount of silicon oil accommodated in the viscous chamber is controlled by the viscous pump 7 so that the silicone oil can be moved from one viscous chamber to the other viscous chamber.

During the blood purification treatment, both the on-off valves V1 and V2 of the air introduction means 5 are closed. The blood is supplied to the blood purifier 1 from the patient's body through the arterial blood circuit 21 by the blood pump 3, purified there, and returned to the patient's body through the venous blood circuit 22. On the other hand, the dialysate is supplied from the fresh dialysate storage chamber 61 through the dialysate supply circuit 41 to the blood purifier 1 by the dialysate supply pump 43, where unnecessary or harmful substances in the blood are received and drained. It is supplied to the spent dialysate storage chamber through the circuit 42 and stored. The amount of water removed during the blood purification treatment is determined by the amount of silicon oil discharged from the viscous chamber 63 by the viscous pump 7.

  When returning blood, first, the blood pump 3 and the dialysate supply pump 43 are stopped, and the dialysate circuit 4 is connected to the other viscous chamber (not shown). Next, the automatic open / close valves V1 and V2 of the air introduction means 5 are opened, and the air purified by the air filter 521 is introduced into the blood purifier 1 through the air introduction line 52 and the drain circuit 42, while blood purification. The dialysate in the vessel 1 is discharged through the dialysate discharge line 51. Air is introduced into the membrane portion of the blood purifier where it is thought that many clogging is occurring, and reverse filtration is performed at the membrane portion where there is little clogging. Therefore, a blood purification device of the type in which the dialysate is supplied from below the blood purifier is preferable. Unlike the present embodiment, in a blood purification apparatus of a type in which dialysate is supplied from above the blood purifier, it is necessary to reversely filter the blood purifier and introduce air to perform reverse filtration.

Clogging of the blood purifier occurs at a portion where the blood pressure is greater than the dialysate pressure. That is, pressure loss occurs while blood and dialysate flow through the blood purifier, and the relationship between the pressure gradient on the blood side and the pressure gradient on the dialysate side is as shown in FIG. Therefore, clogging is more frequent on the upper side where the pressure on the blood side is the largest, and on the lower side, the pressure on the dialysate side is larger, so reverse filtration occurs and clogging does not occur. The position where clogging does not occur is below the position where the pressure gradient on the blood side and the pressure gradient on the dialysate side intersect, and since the dialysate flow rate is usually higher than the blood flow rate, the membrane area of the blood purifier Even if there is clogging below the position of about 1/2 of this, it is very small.
The position where air is introduced is preferably a position where about 3/4 of the area of blood purifier 1 is in contact with air. As a method for detecting the air introduction position, methods such as liquid level detection by laser light, weight measurement of discharged dialysate, and use of a flow meter can be employed. Of course, when the automatic opening / closing valve is not used, a method of visually detecting the liquid level of the dialysate is also possible.

  When it is detected that the liquid level in the blood purifier 1 has reached a predetermined position, the liquid level detection information is transmitted to a control device (not shown), and the automatic opening / closing valves V1 and V2 of the air introduction means 5 are closed. . Next, the viscous pump 7 is driven, and a predetermined amount of silicon oil is supplied into the viscous chamber 63. Then, the same amount of silicone oil as that in the fresh dialysate chamber 61 is supplied to the blood purifier 1 through the dialysate supply circuit 41 and subjected to reverse filtration. The reversely filtered dialysate pushes the blood in the blood flow path downstream from the air introduction position back into the patient's body through the venous blood circuit 22. When the blood return on the venous blood circuit 22 side is completed, the automatic open / close valve V3 is closed. Next, when the blood pump 3 is removed from the arterial blood circuit 21 and the viscous pump is driven to supply a predetermined amount of silicone oil into the viscous chamber 63, fresh dialysis of the same amount as this silicone oil is supplied. Fresh dialysis fluid in the fluid chamber 61 is supplied to the blood purifier 1 through the dialysis fluid supply circuit 41 and back-filtered. The reversely filtered dialysate pushes the blood in the blood flow path upstream from the air introduction position back into the patient's body through the arterial blood circuit 21.

Next, Example 2 will be described with reference to FIG.
FIG. 2 is a schematic explanatory diagram of the second embodiment, and shows a blood purification apparatus when a double chamber system is adopted as a closed water removal control system.
The blood purification apparatus of Example 2 includes a blood purification device 1, a blood circuit 2, a blood pump 3 provided in an arterial blood circuit 21, a venous chamber 23 provided in a venous blood circuit 22), and dialysis. A liquid circuit 4 is included, and the dialysate circuit 4 is provided with an equalizer 8 to enable hermetic water removal control. The dialysate supply circuit) 41 is provided with a reverse filtration means 9, and the reverse filtration means 9 is provided in a reverse filtration circuit 91 provided across the equalizer 8, and the reverse filtration circuit 91. It consists of a reverse filtration pump 92. An air introduction means 5 is provided in the dialysate circuit 4 on the blood purifier 1 side. The air introduction means 5 includes a dialysate discharge line 51 provided in the dialysate supply circuit 41 and an air introduction line 52 provided in the drain circuit 42, and the dialysate flows from the lower side to the upper side of the blood purifier 1. It comes to flow. The air introduction line 52 includes an air filter 521 at the air introduction port and an automatic opening / closing valve V2 in the middle of the line, and the dialysate discharge line 51 includes a dialysate discharge pump 511. Reference sign V3 is an automatic open / close valve provided in the venous blood circuit.

  The equalizer 8 stores a fresh dialysate storage chamber 81 for storing a fresh dialysate supplied from a dialysate preparation device (not shown), and a used dialysate supplied and supplied in the blood purifier 1. The chambers 61 and 62 are partitioned by a flexible membrane. Two equalizers 8 are usually provided, and continuous blood purification is possible by switching the equalizers.

During the blood purification treatment, the on-off valve V2 of the air introduction means 5 is closed. The blood is supplied to the blood purifier 1 from the patient's body through the arterial blood circuit 21 by the blood pump 3, purified there, and returned to the patient's body through the venous blood circuit 22. On the other hand, the dialysate is supplied from the fresh dialysate storage chamber 61 through the dialysate supply circuit 41 to the blood purifier 1 by the dialysate supply pump 43, where unnecessary or harmful substances in the blood are received and drained. It is supplied to the spent dialysate storage chamber 62 through the circuit 42 and stored. The water removal amount during the blood purification treatment is controlled by a water removal pump (not shown).

  When returning blood, first, the blood pump 3 and the dialysate supply pump 43 are stopped, and then the automatic opening / closing valve V2 of the air introduction means 5 is opened, and the dialysate discharge pump 511 is driven. Then, the air purified by the air filter 521 is introduced into the blood purifier 1 through the air introduction line 52 and the drain circuit 42, while the dialysate in the blood purifier 1 passes through the dialysate discharge line 51. Discharged. Air is introduced into the membrane portion of the blood purifier where it is thought that many clogging is occurring, and reverse filtration is performed at the membrane portion where there is little clogging. Even when water removal is being performed (in this case, the pressure on the dialysate side becomes lower depending on the pressure of the water removal pump), the eye below the position of about 1/2 the membrane area of the blood purifier The clogging is small.

  When it is detected that the liquid level in the blood purifier 1 has reached a predetermined position, the liquid level detection information is transmitted to a control device (not shown), the automatic opening / closing valve V2 of the air introduction means 5 is closed, and dialysis is performed. The liquid discharge pump 511 stops driving. Next, the reverse filtration pump 92 is driven, and fresh dialysate is supplied to the blood purifier 1 through the reverse filtration circuit 91 and the dialysate supply circuit 41, and is subjected to reverse filtration. The reversely filtered dialysate pushes the blood in the blood flow path downstream from the air introduction position back into the patient's body through the venous blood circuit 22. When the blood return on the venous blood circuit 22 side is completed, the automatic open / close valve V3 is closed and the reverse filtration pump is stopped. Next, when the blood pump 3 is removed from the arterial blood circuit 21, the reverse filtration pump 92 is driven, and fresh dialysate is supplied to the blood purifier 1 through the reverse filtration circuit 91 and the dialysate supply circuit 41. , Back filtered. The reversely filtered dialysate pushes the blood in the blood flow path upstream from the air introduction position back into the patient's body through the arterial blood circuit 21.

DESCRIPTION OF SYMBOLS 1 Hemodialyzer 2 Blood circuit 21 Arterial blood circuit 22 Venous blood circuit 23 Venous chamber V3 Automatic open / close valve 3 Blood pump 41 Dialysate supply circuit 42 Drainage circuit 43 Dialysate supply pump 5 Air introduction means 51 Dialysate discharge line 511 Dialysate discharge pump 52 Air introduction line 521 Air filter V1, V2 Automatic open / close valve 6 Viscous chamber 61 Fresh dialysate storage chamber 62 Used dialysate storage chamber 63 Viscous chamber 7 Viscos pump 8 Equalizer 81 Fresh dialysate storage chamber 82 Use Dialysate storage chamber 9 Reverse filtration means 91 Reverse filtration circuit 92 Reverse filtration pump

Claims (8)

A blood purifier, a blood circuit, a blood pump provided in a blood circuit upstream of the blood purifier, and a dialysate circuit, and the dialysate circuit is in a closed water removal control system And a blood return operation method in a blood purification apparatus provided with an air introduction means for introducing air into the sealed dialysate circuit and provided with a reverse filtration means,
The air introducing means, after the blood purification treatment completion, by introducing air into the dialysate supply circuit, the air is introduced into the desired film portion of the blood purifier, the inverse filtering means, the blood purification A blood return operation method in a blood purification apparatus , wherein reverse filtration is performed on the remaining membrane portion of the vessel where air has not been introduced , and blood is returned using the back-filtered dialysate . 2. The blood return operation method according to claim 1, wherein the membrane portion for performing reverse filtration is 1/2 to 1/5 of the membrane area of the blood purifier. The blood return operation method according to claim 2, wherein the membrane portion for performing reverse filtration is 1/4 of the membrane area of the blood purifier.   A blood purifier, a blood circuit, a blood pump provided in a blood circuit upstream of the blood purifier, a venous chamber provided in a blood circuit downstream of the blood purifier, and a dialysate circuit In the blood purification apparatus, the dialysate circuit has a sealed water removal control system, air introduction means for introducing air into the sealed dialysate circuit, and back filtration means are provided. Blood purification device.   5. The blood purification apparatus according to claim 4, wherein the air introduction means comprises an air introduction line provided on the dialysate drain side of the dialysate circuit and a dialysate discharge line provided on the dialysate supply side of the dialysate circuit. .   The blood purification apparatus according to claim 5, wherein the air introduction line includes an air filter at an air introduction port and an on-off valve.   The closed-type water removal control method is a double chamber method, a chamber that stores fresh dialysate and supplies it to the blood purifier through the dialysate circuit, and a used that flows from the blood purifier through the drain side of the dialyzer It consists of a chamber that stores dialysate, and uses an equalizer in which the two chambers are partitioned by a flexible membrane, and a reverse filtration means is provided on the dialysate supply side of the dialysate circuit so as to straddle the equalizer. The blood purification apparatus according to any one of claims 4 to 6, comprising a reverse filtration circuit and a reverse filtration pump provided in the reverse filtration circuit, wherein the dialysate discharge line includes a dialysate discharge pump.   The sealed water removal control method is a viscous control method, a chamber that stores fresh dialysate and supplies it to the blood purifier through the dialysate circuit, and a used one that flows from the blood purifier through the drain side of the dialyzer circuit A chamber for storing dialysate and a chamber for water removal are further divided into three chambers by a flexible membrane, and the chamber for water removal is filled with a liquid such as silicon oil, A viscous chamber is used in which the liquid can be freely inserted and removed by a viscous pump. The reverse filtration means includes a chamber for removing water from the viscous chamber and a viscous pump, and the dialysate discharge line includes an on-off valve. The blood purification apparatus according to any one of claims 4 to 6.

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