JP6017711B2 - Blood purification equipment - Google Patents

Description

  The present invention relates to a blood purification apparatus for purifying a patient's blood while circulating it extracorporeally, such as dialysis treatment using a dialyzer.

  Generally, at the time of dialysis treatment, a blood circuit for circulating the collected patient's blood extracorporeally and returning it to the body is used. Such a blood circuit is, for example, a dialyzer (blood purification means) having a hollow fiber membrane. It is mainly composed of an arterial blood circuit and a venous blood circuit that can be connected to each other. Then, an arterial puncture needle and a venous puncture needle are connected to the tips of the arterial blood circuit and the venous blood circuit, respectively, and the puncture needle is punctured by the patient to perform extracorporeal circulation of blood in dialysis treatment. .

  After completion of dialysis treatment, a blood return operation is required to return blood remaining in the blood circuit, dialyzer, artery side air trap chamber, vein side air trap chamber, and the like to the patient. In this blood return operation, for example, as disclosed in Patent Document 1, physiological saline (substitution fluid) is introduced from the middle of the arterial blood circuit, and the physiological saline is replaced with blood in the blood circuit. It was.

  In order to facilitate the automation of blood return work, for example, as disclosed in Patent Document 2, a blood pump is used while back-filtering dialysate (substitution fluid) from a dialysate flow path of a dialyzer to a blood flow path. The patient is driven from the arterial puncture needle and the venous puncture needle by driving the blood in the blood circuit and the dialyzer by replacing the dialysate that has been reverse filtered and the blood remaining in the blood circuit by driving in the opposite direction to that during dialysis treatment. It was done to return to the body.

JP 2006-280775 A JP 2009-131212 A

  However, in the above-mentioned conventional blood purification apparatus, since the uniform supply of replacement fluid and the operations and operations associated therewith are performed throughout the blood return for each facility, the replacement with replacement fluid in each patient is performed. It is impossible to perform an operation or work according to the progress, and for example, there arises a problem that the amount of replacement liquid used is increased or the patient's restraint time is increased.

  That is, when supplying the replacement liquid in returning blood, the replacement liquid stays in a diameter expansion portion such as an air trap chamber connected to the blood circuit or a connection portion with a branched flow path or a dialyzer (blood purification means). Therefore, it is necessary to set a larger amount of the replacement liquid to be supplied. As a result of setting a larger amount in this way, the amount of the replacement solution used is increased, and the blood return time is lengthened to increase the patient's restraint time.

  In recent years, there has been a growing demand for automation of blood return, and in order to achieve such automation, control related to the supply of replacement liquid and the operations and operations associated therewith depending on the progress of replacement with the replacement liquid. Making it happen is very important. In particular, at the end of blood return, various operations and operations different from those at the start of blood return may be required. However, with conventional blood purification devices, it is possible to grasp the progress of blood return and the end of blood return. It is not a thing.

  This invention is made | formed in view of such a situation, and is providing the blood purification apparatus which can perform the operation | movement and operation | work according to the final stage of blood return.

The invention according to claim 1 is composed of an arterial blood circuit and a venous blood circuit, a blood circuit capable of extracorporeally circulating a patient's blood from the tip of the arterial blood circuit to the tip of the venous blood circuit, and the blood A blood purification means for purifying blood flowing between the arterial blood circuit and the venous blood circuit of the circuit and flowing through the blood circuit; and a replacement fluid supply means capable of supplying a replacement fluid into the blood circuit. And a blood purification device for returning blood by replacing the replacement fluid supplied from the replacement fluid supply means after the treatment with the blood in the blood circuit, the blood purification circuit comprising the arterial blood circuit or the venous blood circuit. A detecting means arranged at a predetermined position and capable of detecting the presence or absence of blood flowing through the arterial blood circuit or the venous blood circuit at the predetermined position, and the presence or absence of blood detected by the detecting means at the time of returning blood; Based on the blood concentration, the a state ends close substituted by the substitution solution and recognizing means capable of recognizing the final stage of blood-return, subject to the recognition of the final stage of blood-return by the recognition means, the blood return Control means for performing a predetermined control related to the operation or work performed in the final stage, and the control means uses the replacement liquid supply means by the replacement liquid supply means on the condition that the recognition means has recognized the final stage of blood return. It is characterized in that the supply of is intermittently performed .

According to a second aspect of the invention, the blood purification apparatus according to claim 1 Symbol placement, the control means subject to the recognition of the final stage of blood-return by the recognition means, depending on the arrangement position of the detecting means The replacement liquid is supplied by the replacement liquid supply means by a predetermined amount.

According to a third aspect of the present invention, in the blood purification apparatus according to the first or second aspect , the detection means is disposed at a predetermined position on the distal end side of the arterial blood circuit or the venous blood circuit, and the predetermined position It comprises a blood discrimination means capable of discriminating the presence or absence of blood flowing through the arterial blood circuit or the venous blood circuit.

According to a fourth aspect of the present invention, in the blood purification apparatus according to the first or second aspect , the detection means is a concentration capable of detecting the blood concentration of the blood flowing through the arterial blood circuit or the venous blood circuit at a predetermined position. It comprises a sensor, and the recognition means is capable of recognizing the progress of replacement with the replacement liquid based on the blood concentration detected by the concentration sensor and recognizing the end stage of blood return.

  According to the first aspect of the present invention, the presence / absence or blood concentration of blood flowing in the arterial blood circuit or the venous blood circuit at the predetermined position is detected at the predetermined position of the arterial blood circuit or the venous blood circuit. And a detection means capable of recognizing the end stage of the return of blood that is nearing the end of the replacement with the replacement liquid based on the presence or concentration of blood detected by the detection means at the time of blood return. Therefore, the operation and work corresponding to the final stage of blood return can be performed.

In addition , since the recognition means has recognized that the end of the return of blood has been recognized, it has a control means for performing a predetermined control related to the operation or work performed at the end of the return of blood, operation according to the end of the return of blood And work can be performed automatically.

Furthermore , the control means causes the replacement liquid supply means to intermittently supply the replacement liquid on the condition that the recognition means has recognized the end of the return of blood, so that the thrombus and air bubbles staying in the blood circuit And the like can be prevented from reaching the patient's body together with blood.

According to the invention of claim 2 , the control means supplies the replacement liquid by the replacement liquid supply means by a set amount corresponding to the arrangement position of the detection means, on the condition that the recognition means has recognized the end of blood return. Therefore, the amount of the replacement liquid used can be reduced.

According to the invention of claim 3 , the detecting means is disposed at a predetermined position on the distal end side of the arterial blood circuit or the venous blood circuit, and blood that flows through the arterial blood circuit or the venous blood circuit at the predetermined position. Since it consists of blood discrimination means that can discriminate the presence or absence, the blood discrimination means used at the time of treatment can be used as detection means.

According to the invention of claim 4 , the detection means comprises a concentration sensor capable of detecting the blood concentration of blood flowing through the arterial blood circuit or the venous blood circuit at a predetermined position, and the recognition means is detected by the concentration sensor. Based on the blood concentration thus obtained, the progress of the replacement with the replacement liquid can be grasped to recognize the end stage of the return of blood, so that stepwise control according to the progress of return of blood can be performed.

1 is an overall schematic view showing a blood purification apparatus according to a first embodiment of the present invention. Side view showing detection means (blood discrimination means) in the blood purification apparatus Front view showing the detection means IV-IV line sectional view in FIG. Sectional view taken along line VV in FIG. Sectional view taken along line VI-VI in FIG. Flow chart showing control contents in the blood purification apparatus The flowchart which shows the control content in the blood purification apparatus which concerns on the 2nd Embodiment of this invention. The flowchart which shows the control content in the blood purification apparatus which concerns on the 3rd Embodiment of this invention. The flowchart which shows the control content in the blood purification apparatus which concerns on the 4th Embodiment of this invention.

Hereinafter, embodiments of the present invention will be specifically described with reference to the drawings.
The blood purification apparatus according to the first embodiment includes a dialysis apparatus for performing dialysis treatment. As shown in FIG. 1, a blood circuit including an arterial blood circuit 1 and a venous blood circuit 2, and an arterial blood. A dialyzer 3 (blood purification means) interposed between the circuit 1 and the venous blood circuit 2 to purify blood flowing through the blood circuit; a squeezing blood pump 4 disposed in the arterial blood circuit 1; Arterial air trap chamber 5 and venous air trap chamber 6 disposed in the arterial blood circuit 1 and venous blood circuit 2, respectively, a dialyzer body 8 capable of supplying dialysate to the dialyzer 3, and replacement fluid supply It mainly comprises a saline bag 7 and a replacement liquid supply line Lc as means, a blood discrimination means (13, 14) as a detection means, a recognition means 17 and a control means 18.

  The arterial blood circuit 1 has an arterial puncture needle a connected to the tip thereof and an iron blood pump 4 and an arterial air trap chamber 5 for defoaming disposed in the middle. A venous puncture needle b is connected to the distal end of the venous blood circuit 2, and a venous air trap chamber 6 is connected in the middle. The arterial side air trap chamber 5 and the venous side air trap chamber 6 are provided with a filtration network (not shown) therein so that, for example, a thrombus can be captured when returning blood. The arterial air trap chamber 5 is disposed between the blood pump 4 and the dialyzer 3 in the arterial blood circuit 1.

  Then, when the blood pump 4 is driven with the patient punctured with the arterial puncture needle a and the venous puncture needle b, the patient's blood passes through the arterial blood circuit 1 and reaches the dialyzer 3, Blood purification is performed by the dialyzer 3, and bubbles are returned to the patient's body through the venous blood circuit 2 while being defoamed in the venous air trap chamber 6. That is, the blood of the patient is purified by the dialyzer 3 while circulating externally from the tip of the arterial blood circuit 1 to the tip of the venous blood circuit 2 of the blood circuit.

  The dialyzer 3 is formed with a blood introduction port 3a, a blood outlet port 3b, a dialysate inlet port 3c, and a dialysate outlet port 3d in the casing. Among these, the blood inlet port 3a includes the arterial blood circuit 1. The base end of the venous blood circuit 2 is connected to the blood outlet port 3b. The dialysate introduction port 3c and the dialysate lead-out port 3d are connected to a dialysate introduction line La and a dialysate discharge line Lb extending from the dialyzer main body 8, respectively.

  A plurality of hollow fibers are accommodated in the dialyzer 3, the inside of the hollow fibers is used as a blood flow path (blood flow path), and between the hollow fiber outer peripheral surface and the inner peripheral surface of the housing portion. Is a dialysate channel (dialysate channel). A hollow fiber membrane is formed in the hollow fiber by forming a large number of minute holes (pores) penetrating the outer circumferential surface and the inner circumferential surface, and impurities in the blood are passed through the membrane in the dialysate. It is comprised so that it can permeate | transmit.

  On the other hand, the dialyzer body 8 is provided with a water removal pump (not shown) for removing water from the blood of the patient flowing through the dialyzer 3. Furthermore, one end of the dialysate introduction line La is connected to the dialyzer 3 (dialyte introduction port 3c), and the other end is connected to a dialysate supply device (not shown) for preparing a predetermined concentration of dialysate. Also, one end of the dialysate discharge line Lb is connected to the dialyzer 3 (dialysate outlet port 3d), and the other end is connected to a drainage means (not shown). By driving a dialysate supply means (not shown), The dialysate supplied from the dialysate supply device reaches the dialyzer 3 through the dialysate introduction line La, and then is sent to the drainage means through the dialysate discharge line Lb.

  A monitor tube L1 is extended from the upper part (air layer side) of the venous air trap chamber 6, and the tip of these is connected to a pressure sensor P in the dialyzer body 8. The pressure sensor P can detect the fluid pressure (venous pressure) in the venous air trap chamber 6. An overflow line L2 extends from the upper part (air layer side) of the venous air trap chamber 6 in addition to the monitor tube L1, so that the priming liquid can overflow, for example, during priming before treatment. Yes.

  The replacement liquid supply means is capable of supplying a replacement liquid (physiological saline) into the blood circuit, and in the present embodiment, is constituted by a saline bag 7 and a replacement liquid supply line Lc. The raw food bag 7 is formed of a flexible transparent container and can store a predetermined volume of physiological saline. For example, the raw food bag 7 is attached to the tip of a pole (not shown) protruding from the dialyzer body 8. The replacement fluid supply line Lc is connected to a portion between the distal end of the artery-side blood circuit 1 (a portion to which the artery-side puncture needle a is attached) and the blood pump 4, and a physiological saline solution (substitution fluid) in the saline bag 7. Can be supplied into the blood circuit.

  In the middle of the replacement liquid supply line Lc, an opening / closing means 21 capable of closing and opening the flow path of the replacement liquid supply line Lc by an opening / closing operation is provided. The opening / closing means 21 is composed of, for example, an electromagnetic valve, and is configured such that the opening / closing operation thereof is controlled by the dialyzer body 8 (specifically, the control means 18), as with the electromagnetic valves 11 and 12 described later. Instead of such an electromagnetic valve, general-purpose means such as forceps that can close and open the flow path of the replacement liquid supply line Lc by manual operation may be used.

  However, if the opening / closing means 21 is opened, the physiological saline solution (substitution fluid) in the saline bag 7 is supplied into the arterial blood circuit 1 by its own weight via the substitution fluid supply line Lc, and the blood pump 4 is driven to rotate forward or backward, so that the supplied physiological saline can flow toward the distal end of the arterial blood circuit 1 or the distal end of the venous blood circuit 2 to be sequentially replaced with blood in the blood circuit. It has become.

  Here, an arterial unit 9 having an electromagnetic valve 11, blood discriminating means 13 (detecting means), and bubble detecting means 15 is disposed at a predetermined position on the distal end side of the arterial blood circuit 1, and the vein side At a predetermined position on the distal end side of the blood circuit 2, a vein side unit 10 including an electromagnetic valve 12, blood discrimination means 14, and bubble detection means 16 is disposed. As shown in FIGS. 2 to 6, the arterial unit 9 and the venous unit 10 are provided with fitting grooves (9 a, 9 f) capable of fitting flexible tubes constituting the arterial blood circuit 1 and the venous blood circuit 2. 10a) is formed, and by closing the lid member H, the flexible tube fitted in the fitting grooves (9a, 10a) can be sandwiched up and down.

  Further, the solenoid valves (11, 12) and the blood discrimination are sequentially performed from the distal end side of the arterial blood circuit 1 and the venous blood circuit 2 along the fitting grooves (9a, 10a) of the arterial unit 9 and the venous unit 10. Means (13, 14) and bubble detection means (15, 16) are respectively disposed. Among them, the electromagnetic valves (11, 12) close and open the flow path at a predetermined position on the distal end side of the arterial blood circuit 1 and the flow path at a predetermined position on the distal end side of the venous blood circuit 2 by opening and closing operations. As with the opening / closing means 21 described above, the opening / closing operation is controlled by the dialyzer body 8 (specifically, the control means 18). In addition, the code | symbol R in FIG. 4 has shown the push rod arrange | positioned by the solenoid valve (11, 12), and it can block | close and open the flow path of a predetermined position by moving this push rod R back and forth. It has become.

  The blood discriminating means (13, 14) as detecting means is the presence / absence of blood flowing through the arterial blood circuit 1 and the venous blood circuit 2 at a position (predetermined position) where the arterial unit 9 and the venous unit 10 are disposed. As shown in FIG. 5, a light emitting element A1 made of, for example, an LED, and a light receiving element A2 are provided. The light emitting element A1 and the light receiving element A2 are arranged on the left and right sides of the fitting groove (9a, 10a), respectively, and the arterial blood circuit 1 fitted in the fitting groove (9a, 10a) and Light can be irradiated from the light emitting element A1 toward the flexible tube constituting the venous blood circuit 2, and the light can be received by the light receiving element A2.

  The light receiving element A2 is configured such that the voltage changes according to the amount of light received, and is configured to be able to determine the presence or absence of blood flowing through the arterial blood circuit 1 and the venous blood circuit 2 based on the detected voltage. ing. That is, the transmittance of light emitted from the light emitting element A1 is different between blood and the replacement fluid (in this embodiment, physiological saline) (the replacement fluid such as physiological saline has a light transmittance higher than that of blood). Therefore, when the voltage detected by the light receiving element A2 exceeds a predetermined threshold value, it is detected that the flowing liquid is replaced with the replacement liquid from the blood.

  The bubble detection means (15, 16) can detect bubbles (air) flowing through the artery-side blood circuit 1 and the vein-side blood circuit 2 at a position (predetermined position) where the artery-side unit 9 and the vein-side unit 10 are disposed. As shown in FIG. 6, for example, an ultrasonic vibration element A3 made of a piezoelectric element and an ultrasonic receiving element A4 made of a piezoelectric element are provided. The ultrasonic vibrating element A3 is disposed below the fitting grooves (9a, 10a), and the ultrasonic receiving element A4 is disposed on the lid member H located above the fitting grooves (9a, 10a). It is installed.

  And while being able to irradiate ultrasonic waves from the ultrasonic vibration element A3 toward the flexible tubes constituting the arterial blood circuit 1 and the venous blood circuit 2 fitted in the fitting grooves (9a, 10a), The vibration can be received by the ultrasonic receiving element A4. The ultrasonic receiving element A4 is configured such that the voltage changes in accordance with the received vibration. When the detected voltage exceeds a predetermined threshold, the arterial blood circuit 1 and the venous blood circuit 2 It is comprised so that it can detect that a bubble flowed. In other words, since the attenuation rate of the ultrasonic wave is higher than that of blood or the replacement liquid, it is detected that the bubble has flowed when the voltage detected by the ultrasonic wave receiving element A4 exceeds a predetermined threshold. It is.

  With the above configuration, blood purification treatment is performed by the dialyzer 3 while circulating the patient's blood extracorporeally in the arterial blood circuit 1 and the venous blood circuit 2, and a predetermined position is set by the blood discrimination means (13, 14). When it is detected that the flowing fluid has been replaced with replacement fluid from the blood, or when the flow of bubbles is detected by the bubble detection means (15, 16), the electromagnetic valve (11, 12) is closed and the dialysis treatment is completed. Can be interrupted.

  Here, the recognition means 17, the control means 18, the monitoring means 19, and the alerting | reporting means 20 are arrange | positioned in the dialysis apparatus main body 8 which concerns on this embodiment. The recognition means 17 is composed of, for example, a microcomputer or a part of the microcomputer, and the replacement by the physiological saline is almost completed based on the presence or absence of blood detected by the blood discrimination means (13, 14) when returning blood. It is possible to recognize the state “the end of blood return”. In the present invention, the “late stage of blood return” is not limited to just before the end of blood return, but may be the latter half of the actually required blood return time (after the intermediate point of blood return).

  The control means 18 is composed of, for example, a microcomputer or a part of a microcomputer or the like electrically connected to the recognition means 17, and is provided on the condition that the recognition means 17 recognizes the end of blood return. This is to perform predetermined control related to the operation or work performed in the above. More specifically, the control means 18 according to the present embodiment increases the supply flow rate of the physiological saline (substitution liquid) by the substitution liquid supply means on the condition that the recognition means 17 recognizes the end of blood return. Alternatively, the control is performed so that the physiological saline (substitution liquid) is intermittently supplied by the replacement liquid supply means on the condition that the recognition means 17 recognizes the end of the return of blood.

  That is, on the condition that the recognition means 17 recognizes the end of the return of blood, the supply flow rate of the physiological saline (substitution liquid) by the replacement liquid supply means is increased or decreased, so that the end of the return of blood and earlier The physiological saline supply flow rate can be changed at the time of blood return, and the physiological saline supply flow rate can be controlled in accordance with the progress of blood return. In particular, if the supply flow rate of the physiological saline (substitution liquid) by the replacement liquid supply means is decreased on the condition that the recognition means 17 recognizes the end stage of the blood return, the patient's sudden change at the end stage of the blood return. An increase in blood pressure can be suppressed.

  Further, on the condition that the recognition means 17 recognizes the end of blood return, the replacement liquid supply means intermittently supplies the physiological saline (substitution liquid), thereby replacing the replacement liquid with the blood. While performing intermittently, the thrombus, the bubble, etc. which were staying in the blood circuit can be made to stay in the staying place. In the present embodiment, the physiological saline (substitution liquid) can be intermittently supplied by the replacement liquid supply means by repeatedly driving or stopping the blood pump 4.

  Further, the control means 18 according to the present embodiment is provided on the condition that the recognition means 17 recognizes the end stage of the blood return, the position of the blood discrimination means (13, 14) (detection means) (arterial unit 9). In addition, it is possible to control the supply of the physiological saline (substitution liquid) by the substitution liquid supply means by a set amount corresponding to the predetermined position where the venous unit 10 is disposed. Specifically, the capacity of the flow path from a predetermined position where the arterial unit 9 is disposed to the tip of the arterial blood circuit 1 and the venous blood circuit from the predetermined position where the venous unit 10 is disposed. The volume of the flow path between the two tips is grasped in advance, and these volumes are set as set amounts, and the recognition means 17 recognizes the final stage of blood return, and then the physiological saline is supplied by the set amount. To make it happen. Thereby, the amount of the replacement liquid according to the blood concentration of each patient can be optimized.

  The monitoring means 19 is composed of, for example, a microcomputer or a part of a microcomputer for monitoring abnormalities when returning blood. Examples of such abnormalities at the time of returning blood include a case where bubbles are detected by the bubble detection means (15, 16), and a case where the venous pressure detected by the pressure sensor P rises above a threshold value. The monitoring means 19 according to this embodiment can monitor abnormalities (detection of bubbles and abnormal pressure in the blood circuit) over time not only when returning blood but also during blood purification treatment (during dialysis treatment). It is configured as follows.

  The notification means 20 can perform predetermined notification by outputting voice or sound effect or displaying on a monitor (for example, a touch panel provided in the dialysis apparatus body 8). In the notification means 20 according to the present embodiment, when an abnormality is detected by the monitoring means 19 at the time of blood purification treatment (during dialysis treatment) and at the time of blood return, an alarm corresponding to the abnormality is output and the surrounding medical care is output. It is supposed to be able to notify workers.

Next, control at the time of returning blood in the blood purification apparatus according to the first embodiment will be described based on the flowchart of FIG.
When blood return is started after the blood purification treatment is completed, the opening / closing means 21 is opened by the electrical signal from the dialyzer body 8, and the blood pump 4 is driven forward or reverse (S1). . The supply flow rate of the physiological saline supplied to the blood circuit is set according to the driving speed of the blood pump 4. When the blood pump 4 is driven forward, the electromagnetic valve 11 is closed, the electromagnetic valve 12 is opened, and blood is returned to the venous blood circuit 2 side. Is driven in reverse, the electromagnetic valve 11 is opened, and the electromagnetic valve 12 is closed, and blood is returned to the arterial blood circuit 1 side.

  Thereafter, it is determined whether or not the physiological saline (substitution fluid) has been detected by the blood discrimination means (13, 14) (detection means) (strictly, no blood is detected) (S2), and the physiological saline is detected. If it is determined that the replacement has been completed, the recognition means 17 recognizes “the end stage of blood return”, which is near the end of replacement with physiological saline. When the end stage of the return of blood is recognized by the recognition means 17, the process proceeds to S3, where the supply flow rate of the physiological saline (substitution liquid) is changed or the physiological saline (substitution liquid) is intermittently supplied.

  That is, on the condition that the recognizing means 17 recognizes the end of the blood return, the control for increasing or decreasing the supply flow rate of the physiological saline (substitution liquid) by the replacement liquid supply means or the recognition means 17 Under the condition that the end stage has been recognized, the control is performed to intermittently supply the physiological saline (substitution liquid) by the substitution liquid supply means. In S3, either the control of the supply flow rate of physiological saline (substitution liquid) or the intermittent supply of physiological saline (substitution liquid) may be performed, or these controls may be performed simultaneously or sequentially. You may go.

  Then, a set amount (in the present embodiment, the arterial side) according to the disposition position of the blood discrimination means (13, 14) (detection means) (predetermined position where the arterial unit 9 and the venous unit 10 are disposed). The volume of the flow path from the predetermined position where the unit 9 is disposed to the tip of the arterial blood circuit 1 or the distance between the predetermined position where the unit 9 is disposed and the distal end of the venous blood circuit 2 A physiological saline solution (substitution fluid) is supplied by the replacement fluid supply means by a set amount based on the volume of the flow path (S4), and the blood pump 4 is stopped when the supply amount reaches the set amount. When such replacement is completed for both the arterial blood circuit 1 and the venous blood circuit 2, a series of blood return is terminated.

  As described above, after the recognition means 17 recognizes the end of the blood return, the recognition means 17 recognizes the end of the blood return instead of the physiological saline being supplied by the set amount. As a condition, a predetermined amount of physiological saline (replacement solution) (flow path from a predetermined position where the arterial unit 9 and the venous unit 10 are disposed to the tips of the arterial blood circuit 1 and the venous blood circuit 2) It is also possible to supply only a fixed capacity regardless of the capacity.

  According to the first embodiment, the control means 18 increases the supply flow rate of the physiological saline (substitution liquid) by the substitution liquid supply means, on the condition that the recognition means 17 recognizes the end of blood return. Since it decreases, it can be set as the supply flow volume of the appropriate physiological saline (substitution liquid) in the final stage of blood return. In particular, if the supply flow rate of the physiological saline (substitution liquid) by the replacement liquid supply means is decreased on the condition that the recognition means 17 recognizes the end stage of the blood return, the patient's sudden change at the end stage of the blood return. An increase in blood pressure can be suppressed.

  Further, according to the first embodiment, the control means 18 intermittently supplies the physiological saline (substitution liquid) by the substitution liquid supply means on the condition that the recognition means 17 recognizes the end of blood return. Therefore, it is possible to suppress thrombus, air bubbles and the like remaining in the blood circuit from reaching the patient's body together with the blood. Further, the control means 18 is provided with the replacement liquid supply means by a set amount corresponding to the arrangement position of the blood discrimination means (13, 14) (detection means) on condition that the recognition means 17 recognizes the end of the return of blood. Since the replacement liquid is supplied by the above, the amount of physiological saline (substitution liquid) used can be reduced.

  However, in the above-described embodiment, blood discriminating means (13, 14) as detecting means are provided in both the arterial blood circuit 1 and the venous blood circuit 2, respectively, but only in one of them. It is good also as what to do. Further, in the above embodiment, the blood discrimination means (13, 14) as the detection means are disposed in the arterial unit 9 and the venous unit 10, respectively. You may make it arrange | position in not only the position of the front end side of the side blood circuit 2 but arbitrary positions).

Next, a blood purification apparatus according to a second embodiment of the present invention will be described.
As in the first embodiment, the blood purification apparatus according to the present embodiment includes a dialysis apparatus for performing dialysis treatment. As illustrated in FIG. 1, the blood includes an arterial blood circuit 1 and a venous blood circuit 2. Circuit, dialyzer 3 (blood purification means), blood pump 4, artery side air trap chamber 5 and vein side air trap chamber 6, dialyzer body 8, and saline bag 7 as a replacement liquid supply means and replacement liquid It is mainly composed of a supply line Lc, blood discrimination means (13, 14) as detection means, recognition means 17, control means 18, and monitoring means 19. In addition, the same code | symbol is attached | subjected to the component similar to 1st Embodiment, and those detailed description is abbreviate | omitted.

  The monitoring means 19 according to the present embodiment is the same as the first embodiment with respect to the main configuration and functions, but in this embodiment, in particular, the monitoring level of an abnormality (the alarm width to be determined as abnormal) And a threshold value) in stages, and an arbitrary monitoring level can be set. For example, when monitoring whether or not a bubble is detected by the bubble detection means (15, 16), the bubble is detected when the voltage detected by the ultrasonic receiving element A4 exceeds a predetermined threshold value. Therefore, in the present embodiment, the threshold value can be set between a high state (poor monitoring state) and a low state (supervised monitoring state), and these monitoring levels can be switched. is there.

  For example, when monitoring whether or not there is an abnormality in the venous pressure detected by the pressure sensor P, the fluid side (venous pressure) detected by the pressure sensor P exceeds the threshold value. Since the blockage (clogging) of the flow path in the blood circuit 1 or the venous blood circuit 2 is detected, in the present embodiment, the threshold value is high (the state where monitoring is unsatisfactory) and low (the monitoring is not performed). The monitoring level can be switched.

  As described above, the monitoring unit 19 is configured to be able to monitor abnormalities during the return of blood (detection of bubbles and abnormal values of venous pressure) at a plurality of monitoring levels (not limited to two as described above). However, other abnormalities during blood return may be monitored (in particular, abnormalities may be detected by monitoring detection values related to pressure during blood return). For the sake of convenience, such a state of poor monitoring is referred to as “low monitoring level”, and a state where monitoring is severe is referred to as “high monitoring level”.

  In the blood purification apparatus according to the present embodiment, the control means is set on the condition that at the start of blood return, the monitoring level in the monitoring means 19 is set low, and the recognition means 17 recognizes the end of blood return. 18 is changed so that the monitoring level in the monitoring means 19 becomes higher. That is, the control unit 18 according to the present embodiment is configured to strictly monitor the abnormality by the monitoring unit 19 (the monitoring level is increased) on the condition that the recognition unit 17 recognizes the end of blood return. It is.

Next, control at the time of returning blood in the blood purification apparatus according to the second embodiment will be described based on the flowchart of FIG.
When blood return is started after the blood purification treatment is completed, the opening / closing means 21 is opened by the electrical signal from the dialyzer body 8, and the blood pump 4 is driven forward or reverse (S1). . The supply flow rate of the physiological saline supplied to the blood circuit is set according to the driving speed of the blood pump 4. Then, the monitoring level by the monitoring unit 19 is set to a predetermined setting (a setting with a relatively low monitoring level) (S2).

  Thereafter, it is determined whether or not the physiological saline (substitution fluid) has been detected by the blood discrimination means (13, 14) (detection means) (strictly, no blood is detected) (S3), and the physiological saline is detected. If it is determined that the replacement has been completed, the recognition means 17 recognizes “the end stage of blood return”, which is near the end of replacement with physiological saline. When the end stage of the return of blood is recognized by the recognition means 17, the process proceeds to S4, the setting is changed so as to make the monitoring level in the monitoring means 19 relatively high, and the abnormality is strictly monitored.

  Then, a set amount (in the present embodiment, the arterial side) according to the disposition position of the blood discrimination means (13, 14) (detection means) (predetermined position where the arterial unit 9 and the venous unit 10 are disposed). The volume of the flow path from the predetermined position where the unit 9 is disposed to the tip of the arterial blood circuit 1 or the distance between the predetermined position where the unit 9 is disposed and the distal end of the venous blood circuit 2 A physiological saline solution (substitution fluid) is supplied by the replacement fluid supply means by a predetermined amount based on the volume of the flow path (S5), and the blood pump 4 is stopped when the supply amount reaches the set amount. When such replacement is completed for both the arterial blood circuit 1 and the venous blood circuit 2, a series of blood return is terminated.

  As in the first embodiment, after the end of blood return is recognized by the recognition means 17, the end of blood return is recognized by the recognition means 17 instead of the physiological saline being supplied by the set amount. On condition that it has been recognized, a predetermined amount of physiological saline (replacement solution) (from a predetermined position where the arterial unit 9 and the venous unit 10 are disposed) to the tips of the arterial blood circuit 1 and the venous blood circuit 2 is supplied. It is also possible to supply only a constant volume regardless of the volume of the flow path between them.

  According to the second embodiment, the monitoring means 19 for monitoring an abnormality at the time of blood return is provided, and the control means 18 is provided on the condition that the recognition means 17 recognizes the end stage of blood return. Since the monitoring of the abnormality by the monitoring means 19 is made stricter, it is possible to more reliably suppress thrombus, air bubbles, etc. that have accumulated in the blood circuit from reaching the patient's body. When an abnormality is detected by the monitoring unit 19, it is preferable to automatically notify the abnormality by the notification unit 20 or stop the blood return operation.

Next, a blood purification apparatus according to the third embodiment of the present invention will be described.
The blood purification apparatus according to the present embodiment includes a dialysis apparatus for performing dialysis treatment, as in the first and second embodiments, and includes an arterial blood circuit 1 and a venous blood circuit 2 as shown in FIG. A blood circuit, a dialyzer 3 (blood purification means), a blood pump 4, an arterial air trap chamber 5 and a venous air trap chamber 6, a dialyzer body 8, a saline bag 7 as a replacement fluid supply means, and It mainly comprises a replacement liquid supply line Lc, blood discrimination means (13, 14) as detection means, recognition means 17, control means 18, and monitoring means 19. In addition, the same code | symbol is attached | subjected to the component similar to 1st, 2 embodiment, and those detailed description is abbreviate | omitted.

  The notification means 20 according to the present embodiment is the same as the first embodiment with respect to the main configuration and functions, but in this embodiment, in particular, the patient is notified that the medication should be given. It is supposed to get. For example, when it is necessary to introduce a predetermined drug into the blood circuit (mainly the venous blood circuit 2) at the time of returning blood and to administer the drug into the body of the patient together with the blood, in this embodiment, the recognition means On the condition that the end of blood return is recognized at 17, the patient can be notified that the medication should be given.

Next, control at the time of returning blood in the blood purification apparatus according to the third embodiment will be described based on the flowchart of FIG.
When blood return is started after the blood purification treatment is completed, the opening / closing means 21 is opened by the electrical signal from the dialyzer body 8, and the blood pump 4 is driven forward or reverse (S1). . The supply flow rate of the physiological saline supplied to the blood circuit is set according to the driving speed of the blood pump 4.

  Thereafter, it is determined whether or not the physiological saline (substitution fluid) has been detected by the blood discrimination means (13, 14) (detection means) (strictly, no blood is detected) (S2), and the physiological saline is detected. If it is determined that the replacement has been completed, the recognition means 17 recognizes “the end stage of blood return”, which is near the end of replacement with physiological saline. When the end of the return of blood is recognized by the recognition unit 17, the process proceeds to S3, and the control unit 18 controls the patient to notify that the medication should be administered.

  After the notification, it is determined whether or not medication has been made (S4). In the dialysis machine main body 8 or the like, for example, operation means (operations such as operation buttons and touch panel) that can be operated by an operator when medication is completed is provided, and whether or not medication has been performed depending on whether or not the operation means is operated. It can be determined whether or not. However, if it is determined in S4 that the medication has been given, it depends on the position where the blood discriminating means (13, 14) (detecting means) is disposed (the predetermined position where the arterial unit 9 and the venous unit 10 are disposed). Set amount (in this embodiment, the volume of the flow path from the predetermined position where the arterial unit 9 is disposed to the tip of the arterial blood circuit 1 or the predetermined position where the venous unit 10 is disposed. The physiological saline solution (substitution fluid) is supplied by the replacement fluid supply means for a predetermined amount) based on the volume of the flow path from the venous blood circuit 2 to the tip of the venous blood circuit 2 (S5), At this point, the blood pump 4 is stopped. When such replacement is completed for both the arterial blood circuit 1 and the venous blood circuit 2, a series of blood return is terminated.

  As in the first embodiment, after the end of blood return is recognized by the recognition means 17, the end of blood return is recognized by the recognition means 17 instead of the physiological saline being supplied by the set amount. On condition that it has been recognized, a predetermined amount of physiological saline (replacement solution) (from a predetermined position where the arterial unit 9 and the venous unit 10 are disposed) to the tips of the arterial blood circuit 1 and the venous blood circuit 2 is supplied. It is also possible to supply only a constant volume regardless of the volume of the flow path between them.

  On the other hand, when it is determined in S4 that no medication is given, after a predetermined time has elapsed (S6), the drive speed of the blood pump 4 is reduced to reduce the supply flow rate of physiological saline (substitution fluid) (S7). . Thereafter, a certain prompt (such as re-notification by the notification means 20) is made (S8), a predetermined alarm is output, and the driving of the blood pump 4 is stopped (S9). Thereby, when a necessary medication is not made at the end of the blood return, the blood return can be stopped (suspended) to wait for the medication.

  According to the third embodiment, the control means 18 can notify the patient that the medicine should be administered on the condition that the recognition means 17 recognizes the end of the return of blood. Forgetting the medication to be performed at the end of blood return can be avoided, and the necessary medication can be surely performed. In the present embodiment, the notification of the medication is performed by the notification means 20, but the notification of the medication may be performed by a separate means capable of notification.

  Furthermore, the control unit 18 according to the present embodiment causes the notification unit 20 to notify the patient that the medication should be administered on the condition that the recognition unit 17 recognizes the end of the return of blood. As long as the end of the return of blood is recognized by the means 17, if the patient is notified that the predetermined treatment should be performed, the end of the return of blood such as blood collection or blood pressure or pulse measurement is performed. In this case, another treatment to be performed on the patient may be notified. As a result, it is possible to avoid forgetting a predetermined treatment for a patient who should be performed at the end of blood return by a medical worker or the like, and a necessary treatment can be surely performed.

Next, control at the time of returning blood in the blood purification apparatus according to the fourth embodiment will be described based on the flowchart of FIG.
When blood return is started after the blood purification treatment is completed, the opening / closing means 21 is opened by the electrical signal from the dialyzer body 8, and the blood pump 4 is driven forward or reverse (S1). . The supply flow rate of the physiological saline supplied to the blood circuit is set according to the driving speed of the blood pump 4.

  Thereafter, it is determined whether or not the physiological saline (substitution fluid) has been detected by the blood discrimination means (13, 14) (detection means) (strictly, no blood is detected) (S2), and the physiological saline is detected. If it is determined that the replacement has been completed, the recognition means 17 recognizes “the end stage of blood return”, which is near the end of replacement with physiological saline. When the end stage of the return of blood is recognized by the recognition means 17, the process proceeds to S3, where the blood discrimination means (13, 14) (detection means) are disposed (the arterial unit 9 and the venous unit 10 are disposed). The physiological saline solution (substitution liquid) is supplied by the substitution liquid supply means by a set amount corresponding to the predetermined position.

  Specifically, the capacity of the flow path from a predetermined position where the arterial unit 9 is disposed to the tip of the arterial blood circuit 1 and the venous blood circuit from the predetermined position where the venous unit 10 is disposed. The volume of the flow path between the two tips is grasped in advance, and these volumes are set as set amounts, and the recognition means 17 recognizes the final stage of blood return, and then the physiological saline is supplied by the set amount. To make it happen.

  According to the fourth embodiment, the control means 18 is provided on the condition that the recognition means 17 recognizes the end stage of the blood return, and the arrangement position (artery) of the blood discrimination means (13, 14) (detection means). Since it is possible to control the supply of the physiological saline (substitution liquid) by the substitution liquid supply means by a set amount according to the predetermined position) at which the side unit 9 and the venous side unit 10 are disposed, the substitution liquid The amount of use can be reduced. Moreover, the amount of the replacement fluid can be optimized according to the blood concentration of each patient.

  As described above, according to the first to fourth embodiments, the arterial blood circuit 1 or the venous blood circuit 2 is disposed at a predetermined position of the arterial blood circuit 1 or the venous blood circuit 2. Blood detection means (13, 14) (detection means) capable of detecting the presence or absence of blood flowing through the blood, and physiological saline (based on the presence or absence of blood detected by the blood discrimination means (13, 14) when returning blood Since it has the recognition means 17 capable of recognizing the end stage of the return of blood, which is near the end of the replacement by the replacement liquid), it is possible to perform operations and operations according to the end stage of the return of blood.

  In addition, according to the first to fourth embodiments, the control means for performing the predetermined control related to the operation or work performed in the final stage of blood return on condition that the recognition means 17 recognizes the final stage of blood return. Since 18 is provided, the operation | movement and operation | work according to the end stage of blood return can be performed automatically. Further, the detection means is disposed at a predetermined position on the distal end side in the arterial blood circuit 1 or the venous blood circuit 2, and determines whether or not there is blood flowing in the arterial blood circuit 1 or the venous blood circuit 2 at the predetermined position. Since the blood discriminating means (13, 14) can be used, the blood discriminating means used at the time of treatment can be used as the detecting means.

  Although the present embodiment has been described above, the present invention is not limited to these embodiments. For example, the arterial blood circuit 1 or the venous blood circuit 2 is used instead of the detection means including the blood discrimination means (13, 14). It is good also as a concentration sensor (for example, hematocrit sensor for detecting a hematocrit value etc.) which can detect the blood concentration which flows through. When a hematocrit sensor is used as such a concentration sensor, the concentration of blood flowing through the arterial blood circuit 1 or the venous blood circuit 2 can be detected over time (in real time).

  In such other embodiments, the recognition means can recognize the end stage of the return of blood based on the blood concentration detected by the concentration sensor and grasping the progress of replacement with a replacement solution such as physiological saline. It is supposed to be. As a result, for example, stepwise control by the control means (such as increasing the monitoring level stepwise) can be performed at the end of blood return, and stepwise control corresponding to the progress of blood return can be performed. Can do.

  Further, in the other embodiment, the recognition means can recognize the early stage of the return of blood in addition to the end of the return of blood based on the blood concentration detected by the concentration sensor. You may comprise so that the supply flow volume of the substitution liquid supplied with a substitution liquid supply means may be set largely in the early stage of blood return. In this case, the blood return time can be shortened by increasing the replacement fluid supply flow rate in the early stage of blood return, and the patient at the end of the return blood flow by reducing the replacement fluid supply flow rate at the end of the blood return. The rapid increase in blood pressure can be suppressed.

  Furthermore, the control means 18 is provided on the condition that the recognition means 17 has recognized the end of the return of blood based on the blood concentration detected by the detection means comprising the blood discrimination means (13, 14) and the concentration sensor. Although the control regarding the operation | movement or operation | work shown in the said Embodiment 1-4 is each performed independently, it is good also as what performs multiple control regarding these operation | movement or operations simultaneously by arbitrary combinations.

  Furthermore, in the above-described embodiment, the replacement liquid supply means is constituted by the saline bag 7 and the replacement liquid supply line Lc, and the physiological pump as the replacement liquid is supplied into the blood circuit by driving the blood pump 4. However, the present invention is not limited to this. For example, the dialysate 3 (blood purification means) is subjected to reverse filtration of the dialysate (the dialysate is filtered from the dialysate flow path to the blood flow path), It may be used as a replacement solution when returning blood. In addition, the replacement liquid used at the time of returning blood is not limited to a physiological saline solution or a dialysate, and other replacement liquids may be used.

Contact name in this embodiment, is applied to a dialysis apparatus used during dialysis treatment, other devices capable of purifying while the patient's blood is extracorporeally circulated (e.g. hemodiafiltration method, blood filtration, in AFBF You may apply to the blood purification apparatus used, a plasma adsorption apparatus, etc.).

A detecting means disposed at a predetermined position of the arterial blood circuit or the venous blood circuit and capable of detecting the presence or concentration of blood flowing through the arterial blood circuit or the venous blood circuit at the predetermined position; Based on the presence / absence of blood or blood concentration detected by the detection means, a recognition means for recognizing the end of the return of blood that is nearing the end of replacement with the replacement liquid, and the recognition means recognized the end of the return of blood And a control means for performing predetermined control related to the operation or work performed at the end of the return of blood, and the control means recognizes the end of the return of blood by the recognition means. Any blood purification apparatus that intermittently supplies the replacement liquid by the supply means can be provided with other functions.

1 Arterial blood circuit 2 Venous blood circuit 3 Dialyzer (blood purification means)
DESCRIPTION OF SYMBOLS 4 Blood pump 5 Arterial side air trap chamber 6 Vein side air trap chamber 7 Saline bag 8 Dialyzer main body 9 Arterial side unit 10 Vein side unit 11, 12 Electromagnetic valve 13, 14 Blood discrimination means (detection means)
15, 16 Bubble detection means 17 Recognition means 18 Control means 19 Monitoring means 20 Notification means

Claims (4)

A blood circuit comprising an arterial blood circuit and a venous blood circuit, and capable of extracorporeally circulating the patient's blood from the distal end of the arterial blood circuit to the distal end of the venous blood circuit;
A blood purification means for purifying blood flowing between the arterial blood circuit and the venous blood circuit of the blood circuit and flowing through the blood circuit;
A replacement fluid supply means capable of supplying a replacement fluid into the blood circuit;
A blood purification device that returns blood by replacing the replacement fluid supplied from the replacement fluid supply means after treatment with the blood in the blood circuit,
A detecting means disposed at a predetermined position of the arterial blood circuit or the venous blood circuit and capable of detecting the presence or concentration of blood flowing through the arterial blood circuit or the venous blood circuit at the predetermined position;
Recognizing means capable of recognizing the end stage of the return of blood, which is near the end of the replacement with the replacement liquid, based on the presence or concentration of blood detected by the detecting means at the time of returning the blood;
Control means for performing predetermined control related to operations or work performed at the end of blood return, on the condition that the end of blood return has been recognized by the recognition means;
And the control means causes the replacement liquid supply means to intermittently supply the replacement liquid on condition that the recognition means has recognized the end of the return of blood. The control means causes the replacement liquid supply means to supply the replacement liquid by a set amount corresponding to the arrangement position of the detection means on the condition that the recognition means has recognized the end of blood return. blood purification apparatus according to claim 1, wherein. The detection means is arranged at a predetermined position on the distal end side in the arterial blood circuit or the venous blood circuit, and can determine whether or not there is blood flowing in the arterial blood circuit or the venous blood circuit at the predetermined position. The blood purification apparatus according to claim 1 or 2 , characterized by comprising: The detection means comprises a concentration sensor capable of detecting the blood concentration of blood flowing through the arterial blood circuit or the venous blood circuit at a predetermined position, and the recognition means is based on the blood concentration detected by the concentration sensor. The blood purification apparatus according to claim 1 or 2 , wherein the progress of replacement by the replacement liquid can be grasped to recognize the end stage of blood return.

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