JP7085721B2 - Hemodialysis device - Google Patents

Description

The present invention relates to a hemodialysis apparatus, and more particularly to a hemodialysis apparatus provided with a fluid replacement means for replenishing fluid during dialysis treatment.

Conventionally, a blood dialysis apparatus including a dialysis machine for performing blood dialysis, a blood circuit connected to the dialysis machine and circulating blood, and a dialysate circuit connected to the dialysis machine to circulate dialysate is known. Among these, those provided with a replenishing means for replenishing a replenishing solution into the blood via a blood circuit during dialysis treatment are also known.
On the other hand, water is removed from the blood in a dialyzer during dialysis treatment, and in order to perform this water removal, the treatment time for performing dialysis treatment, the target amount of water removal to be removed during treatment, and the predetermined time It is necessary to set the setting values for various setting items such as the water removal speed, which is the amount of water removed per hit, in the control means. For example, the technology for setting the water removal speed by setting the target water removal amount and the treatment time. Is known (Patent Document 1).
It is also possible to change the above set values during dialysis treatment, for example, a technique in which the treatment time is updated when the water removal rate and the target water removal amount are changed during the dialysis treatment (Patent Document 2), and the target water removal amount. A technique (Patent Document 3) is known in which the water removal rate is calculated from the treatment time and the treatment time is updated when the dialysis treatment is delayed.

Japanese Unexamined Patent Publication No. 9-19497 Japanese Unexamined Patent Publication No. 7-328110 Japanese Patent No. 3250745

Here, when changing the setting value of the above setting item, there is a request to maintain a specific setting value, for example, whether to emphasize the target water removal amount or the treatment time.
However, it cannot be said that the structure of the above patent document sufficiently corresponds to such a request, and the attending physician and the medical staff who operates the hemodialysis apparatus review other setting values when changing the setting value. Work was sometimes required.
Further, in the case of performing fluid replacement during dialysis treatment as in the case of performing the above-mentioned water removal, the treatment time, the target amount of fluid replacement to be replenished during the treatment, and the amount of fluid replacement per predetermined time are determined in view of the above-mentioned Patent Documents 1 to 3. Various setting items such as replacement fluid speed may be changed, but even in this case, there is a request to maintain a specific set value.
In view of such a problem, the present invention provides a hemodialysis apparatus capable of maintaining an arbitrary set value when changing the set value of a setting item related to fluid replacement in dialysis treatment. be.

That is, the invention of claim 1 is a dialyzer that performs blood dialysis, a blood circuit that is connected to the dialyzer and distributes blood, a dialysate circuit that is connected to the dialyzer and distributes dialysate, and the above-mentioned dialysis . A replenishment passage provided between the dialysate supply passage and the blood circuit of the liquid circuit, a replenishment pump provided in the replenishment passage and supplying dialysate from the dialysate supply passage to the blood circuit, and treatment until the end of treatment. In a blood dialysis apparatus provided with a control means in which a set value is set as a setting item for dialysis treatment, which is a time, a target amount of replenishment to be replenished by the end of treatment, and a replenishment rate which is a replenishment amount per predetermined time . ,
Priority setting item selection means that displays the setting item of either the target fluid replacement amount or fluid replacement speed on the touch panel in a state where it can be selected and stores the selected setting item as the priority setting item, and the changed setting. It is equipped with a setting value updating means for updating the setting value of other related setting items based on the setting value of the item.
When the target fluid replacement amount is selected in the priority setting item selection means and the treatment time is changed during treatment , the set value updating means maintains the target fluid replacement volume and is based on the changed treatment time. Update the above fluid replacement rate,
When the replacement fluid rate is selected in the priority setting item selection means and the treatment time is changed during treatment , the setting value updating means maintains the replacement fluid rate and the target replacement fluid is based on the changed treatment time. It is characterized by updating the amount.

According to the above invention, for example, when the treatment time as a setting item is changed, if the target replacement fluid amount is selected in the priority setting item selection means, the replacement fluid rate is updated while maintaining the set value related to the target replacement fluid volume. Similarly, if the replacement fluid rate is selected in the priority setting item selection means, the target replacement fluid amount can be updated while maintaining the set value related to the above replacement fluid rate, and the medical worker can update the set value. It is possible to easily perform the work when changing.

The circuit diagram which shows the hemodialysis apparatus which concerns on this Example.

Explaining the present invention with respect to the illustrated examples below, FIG. 1 shows a circuit of a hemodialysis apparatus 1 for performing dialysis treatment, which is connected to a dialysis machine 2 for performing dialysis between blood and a dialysate and the dialysis machine 2. The blood circuit 3 and the dialysate circuit 4 connected to the dialyzer 2 are provided.
Further, the hemodialysis apparatus 1 is controlled by the control means 5, and setting items for the dialysis treatment such as the treatment time of the dialysis treatment and the flow rate of blood in the blood circuit 3 are set.
A touch panel 6 is connected to the control means 5 of the present embodiment, and it is possible to display the state of the hemodialysis apparatus 1 and input the setting values related to the setting items to the control means 5. Further, as will be described later, it is possible to change the above set value during the treatment.

The blood circuit 3 is composed of an arterial passage 11 that is connected to a blood vessel of a patient and takes out blood to the dialyzer 2, and a venous passage 12 that returns the blood that has been dialyzed by the dialyzer 2 to the patient. These passages are made of flexible resin tubes. Further, a blood pump 13 for sending blood is provided in the arterial side passage 11.

The dialysate circuit 4 includes two first dialysate chambers 21 and a second dialysate chamber 22 having the same shape, and the hemodialysis apparatus 1 of the present embodiment can prepare dialysate. It is provided with a liquid A tank TA and a liquid B tank TB for storing the liquid A and the liquid B which are the stock solutions of the dialysate.
Inside the first and second dialysate chambers 21 and 22, supply chambers 21a and 22a for supplying fresh dialysate and used dialysate are collected by partition walls such as diaphragms and pistons. It is divided into collection chambers 21b and 22b.
A water supply passage 23 for circulating purified water and a dialysate supply passage 24 for circulating fresh dialysate to the dialyzer 2 are connected to the supply chambers 21a and 22a, and used in the collection chambers 21b and 22b. The dialysate collection passage 25 for circulating the finished dialysate and the dialysate drainage passage 26 for draining the used dialysate into a drainage tank (not shown) are connected.

The water supply passage 23 is communicated with a purified water supply means (not shown) for supplying purified water, a water supply pump P1 controlled by the control means 5 is provided, and a liquid A tank TA is provided on the downstream side of the water supply pump P1. The liquid A passage 27A and the liquid B passage 27B connected to the liquid B tank TB are connected.
The downstream side of the water supply passage 23 is branched in two directions and connected to the supply chambers 21a and 22a of the first and second dialysate chambers 21 and 22, and the branched passages are controlled by the control means 5, respectively. Liquid supply valves V1 and V2 that are opened and closed by the dialysis valve V1 and V2 are provided.
Further, the A liquid passage 27A and the B liquid passage 27B are provided with the A liquid pump P2 and the B liquid pump P3 controlled by the control means 5, respectively, and supply a predetermined amount of the A liquid and the B liquid, respectively. The liquid is sent to the chambers 21a and 22a.
With such a configuration, purified water, liquid A, and liquid B flow into the supply chambers 21a and 22a, and the dialysate can be prepared inside the supply chambers 21a and 22a. It has become like.

The upstream portion of the dialysate supply passage 24 is branched in two directions and connected to the supply chambers 21a and 22a of the first and second dialysate chambers 21 and 22, respectively, and the branched passages are connected to the control means 5 respectively. Supply valves V3 and V4 that are opened and closed by the control of the above are provided.
Further, the downstream portion of the dialysate supply passage 24 is connected to the dialyzer 2, and the on-off valve V5 and the on-off valve that are opened and closed under the control of the control means 5 are on the upstream side of the connection portion with the dialyzer 2. V6 is provided in series.

The downstream portion of the dialysate recovery passage 25 branches in two directions and is connected to the recovery chambers 21b and 22b of the first and second dialysate chambers 21 and 22, respectively, and the control means 5 controls each of the branch portions. Recovery valves V7 and V8 that are opened and closed by the dialysis valve V7 and V8 are provided.
On the other hand, the upstream portion of the dialysate recovery passage 25 is connected to the dialysate 2 and is provided with an on-off valve V9 that is opened and closed under the control of the control means 5, and a dialysate pump P4 that feeds the dialysate.

The upstream portion of the dialysate drainage passage 26 branches in two directions and is connected to the collection chambers 21b and 22b, and the branch portions are opened and closed under the control of the control means 5, respectively. Is provided.

A bypass passage 31 is provided between the position on the dialysate supply passage 24 on the upstream side of the on-off valve V5 and the position on the dialysate recovery passage 25 on the downstream side of the on-off valve V9. ing.
The bypass passage 31 is provided with an on-off valve V12, and when a defect is detected in the concentration of the dialysate during the dialysis treatment, the on-off valve V5 of the dialysate supply passage 24 and the dialysate recovery passage 25 By closing the on-off valve V9 and opening the on-off valve V12 of the bypass passage 31, the defective dialysate can be sent from the bypass passage 31 to the dialysate recovery passage 25 without passing through the dialyzer 2. It is possible.

Further, a position adjacent to the upstream side of the branch portion in the dialysate recovery passage 25 and a position adjacent to the downstream side of the branch portion in the dialysate drainage passage 26 are removed as a water removing means. A water passage 32 and a water removal pump P5 are provided.
The water removal pump P5 is operated under the control of the control means 5, and by operating during dialysis treatment, water is removed from the blood in the dialyzer 2, and the removed water is used together with the used dialysate in the dialysate drainage passage 26. It is designed to be discharged to.

Further, a replacement fluid passage 33 as a replacement fluid means is provided between the on-off valve V5 and the on-off valve V6 in the dialysate supply passage 24 and the drip chamber 11a provided in the arterial side passage 11 in the blood circuit 3. And a replacement fluid pump P6 is provided.
The replacement fluid pump P6 is operated under the control of the control means 5, and by operating during the dialysis treatment, fresh dialysate flowing through the dialysate supply passage 24 is supplied to the arterial side passage 11 of the blood circuit 3 as a replacement fluid. The dialysate is supplemented to the patient.

Explaining the operation of the hemodialysis apparatus 1 having the above configuration, during hemodialysis, the blood pump 13 sends blood according to the blood flow rate set in the control means 5 in the blood circuit 3, and the blood is sent from the arterial side passage 11. After passing through the dialyzer 2, the inflowing blood flows through the venous side passage 12 and returns to the patient.
On the other hand, in the dialysate circuit 4, purified water, liquid A and liquid B alternately flow into the supply chambers 21a and 22a of the first and second dialysate chambers 21 and 22 from the water supply passage 23, and these are mixed. Fresh dialysate is prepared. Further, as the volume of the supply chambers 21a and 22a increases, the used dialysate is alternately discharged from the dialysate drainage passage 26 from the collection chambers 21b and 22b.
On the other hand, the used dialysate that has passed through the dialyzer 2 by the dialysate pump P4 alternately flows into the recovery chambers 21b and 22b of the first and second dialysate chambers 21 and 22, and the recovery chambers 21b and 22b. As the volume of the dialysis machine increases, dialysates prepared alternately are supplied to the dialyzer 2 from the supply chambers 21a and 22a.

When water is removed from the blood during the dialysis treatment, the control means 5 operates the water removal pump P5 provided in the water removal passage 32 to discharge the liquid containing waste products from the blood in the dialyzer 2. Then, the fluid is drained from the dialysate drainage passage 26 via the water removal passage 32.
When fluid replacement is performed during dialysis treatment, the control means 5 operates the fluid replacement pump P6 provided in the fluid replacement passage 33 to allow the dialysate in the dialysate supply passage 24 to pass through the fluid replacement passage 33 to the arterial side passage 11. It is supplied to the drip chamber 11a of the above, and the dialysate is supplied to the patient from the arterial side passage 11.

When performing dialysis treatment using the hemodialysis apparatus 1 having the above configuration, the attending physician or the medical staff may use the touch panel 6 connected to the control means 5 for dialysis treatment according to the physical condition of the patient or the like. The setting value of such a setting item is set.
The above setting items include, for example, the treatment time from the start to the end of the dialysis treatment, the dialysate flow rate of the dialysate by the dialysate pump, and the blood flow rate of the blood by the blood pump 13, and when water is removed during the dialysis treatment. The target amount of water to be removed by the end of treatment and the rate of water removal by the water removal pump P5 are determined by the target amount of replacement fluid to be replenished by the end of treatment and the replacement pump P6 when replenishing fluid is performed during dialysis treatment. There is a replenishment flow rate.
Each of these setting items has a set value, and when performing dialysis treatment, it is necessary to input the set value for each setting item to the control means 5 via the touch panel 6.
Here, for example, the target fluid replacement amount is a set value that can be calculated from the treatment time and the fluid replacement rate, and therefore, if the medical worker sets the treatment time and the fluid replacement rate in the control means 5, the control is performed. The means 5 can automatically calculate the target fluid replacement amount. On the contrary, if the treatment time and the target fluid replacement amount are set, the control means 5 can automatically calculate the fluid replacement rate.

Further, when the medical worker wants to change the set value of the setting items such as the treatment time and the replacement fluid rate after starting the dialysis treatment in the hemodialysis apparatus 1, the medical worker uses the touch panel 6 to change these set values. Can be changed.
However, for example, when shortening the treatment time, if only the treatment time is shortened and the setting values of other setting items are not changed, the dialysis treatment will be completed before the target fluid replacement amount set at the start of the treatment is reached. Become.
Therefore, there is known a technique for updating the setting value of the setting item related to the change of the setting value of the required setting item. For example, as described in the above patent document, the required setting value is set. When the change is made, the control means 5 automatically updates the setting value related to the change.
Here, the setting items for performing fluid replacement during dialysis treatment include the target fluid replacement amount and the fluid replacement rate, but depending on the thoughts of the attending physician and the patient's condition, the target fluid replacement volume should be emphasized or the patient should be replenished. In some cases, the replacement fluid speed is emphasized in consideration of the burden on the patient, or the set value to be changed is different.
However, in the conventional hemodialysis apparatus 1, when the setting value of one setting item is changed, the setting value of one setting item corresponding to the change is only updated, and the setting value of the other setting item is changed. It was never updated. Therefore, when updating the setting values of the other setting items, it is necessary for the medical staff to manually update the setting values.

In view of such a problem, the control means 5 of the hemodialysis apparatus 1 according to the present invention has priority setting item selection means for selecting either the target fluid replacement amount or the fluid replacement rate among the setting items related to the replacement fluid. 41 and a setting value updating means 42 for updating the setting value of another related setting item based on the setting value of the changed setting item are provided.
The priority setting item selection means 41 displays on the touch panel 6 a setting item of either the target fluid replacement amount or the fluid replacement rate in a selectable state, and when the medical worker selects one of the setting items, the medical worker selects one of the setting items. The setting item is stored.
When the target fluid replacement amount is selected in the priority setting item selection means 41, when the set value of the treatment time is changed, the set value updating means 42 maintains the set value of the target fluid replacement amount and changes the treatment time. The set value of the replenishment rate is updated based on the set value.
With such a setting, even if the treatment time is changed for some reason, fluid replacement can be performed by a predetermined target fluid replacement amount.
On the other hand, when the replacement fluid rate is selected in the priority setting item selection means 41, when the setting value of the treatment time is changed, the setting value updating means 42 maintains the set value of the replacement fluid rate and changes the treatment time. The set value of the above target fluid replacement amount is updated based on the set value.
With such a setting, even if the treatment time is changed for some reason, the dialysis treatment can be performed without changing the replacement fluid rate according to the physical condition of the patient or the like.

The upper limit value and the lower limit value of the replacement fluid rate are set in advance in the set value updating means 42, and when the set value of the replacement fluid rate is updated by the setting value updating means 42, the updated replacement fluid rate becomes the upper limit value. When it deviates from the range of the lower limit value, it is possible to display the fact on the touch panel 6 and prompt the setting again.
Further, not limited to the above setting items related to the replacement fluid rate, other setting items such as the setting value of the water removal rate related to water removal deviate from the upper limit value or the lower limit value due to the change of the treatment time. It is possible to display the fact on the touch panel 6 and prompt the setting again.
As described above, according to the above embodiment, when the setting values of other setting items are changed by selecting the setting items to be maintained in the priority setting item selection means 41 in advance, the selected setting values are the same. Other related settings can be updated while maintained, and the settings can be changed according to the needs of patients and healthcare professionals.

Although the hemodialysis apparatus 1 described in the above embodiment relates to a so-called personal dialysis apparatus, it can also be applied to a so-called dialysis monitoring apparatus, and in the above embodiment, the replacement fluid is dialysis. Although the dialysate flowing through the liquid supply passage 24 is used, the fluid may be supplemented from a replacement fluid bag containing a physiological saline solution as a supplementary fluid.

1 Hemodialysis device 2 Dialysis machine 3 Blood circuit 4 Dialysis fluid circuit 5 Control means 6 Touch panel 33 Replacement fluid passage 41 Priority setting item selection means 42 Setting value update means P6 Replacement fluid pump

Claims (2)

A dialysate for performing hemodialysis, a blood circuit connected to the dialyzer and circulating blood, a dialysate circuit connected to the dialyzer to distribute dialysate, and a dialysate supply passage of the dialysate circuit. A replenishment passage provided between the blood circuit, a replenishment pump provided in the replenishment passage and supplying dialysate from the dialysate supply passage to the blood circuit, treatment time until the end of treatment, and replenishment by the end of treatment. In a hemodialysis apparatus provided with a control means in which a target amount of replenishment to be replenished and a replenishment rate, which is the amount of replenishment per predetermined time, are set as setting items for dialysis treatment and the set values are set.
Priority setting item selection means that displays the setting item of either the target fluid replacement amount or fluid replacement speed on the touch panel in a selectable state and stores the selected setting item as the priority setting item, and the changed setting. It is equipped with a setting value updating means for updating the setting value of other related setting items based on the setting value of the item.
When the target fluid replacement amount is selected in the priority setting item selection means and the treatment time is changed during treatment , the set value updating means maintains the target fluid replacement volume and is based on the changed treatment time. Update the above fluid replacement rate,
When the replacement fluid rate is selected in the priority setting item selection means and the treatment time is changed during treatment , the setting value updating means maintains the replacement fluid rate and the target replacement fluid is based on the changed treatment time. A hemodialysis device characterized by updating the amount. The hemodialysis apparatus according to claim 1, wherein the set value updating means is set with an upper limit value and a lower limit value of a setting item to be updated when the treatment time is changed.

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