JP2014188219A - Hemodialysis device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a hemodialysis device which complements both demerits of a back-filtration system and an on-line system, can control appropriately even when UFR (ultrafiltration rate) is low or clogging is caused, and is not troublesome and is inexpensive.SOLUTION: During a back-filtration operation of activating a dewatering/back-filtration pump, when a dialysis fluid pressure sensor detects that an increase degree of a dialysis fluid pressure is equal to a predetermined value or larger, a control device switches to an on-line operation of feeding the dialysis fluid from a fluid feeding line.

Description

  The present invention relates to a hemodialysis apparatus for performing dialysis treatment.

  Conventionally, a dialysis treatment apparatus includes a hemodialyzer called a dialyzer, a blood circuit through which a patient's blood flows, and a dialysate circuit through which a dialysate flows. Then, while maintaining the extracorporeal circulation by directly connecting the two places of the blood circuit to the patient's blood vessel, the blood is allowed to flow into the compartment inside the hollow fiber of the hemodialyzer provided in the middle of the blood circuit. Dialysate is flowed into the compartment outside the hollow fiber of the vessel by a dialysate circuit. Inside the hemodialyzer, a dialysis membrane is provided to partition both compartments, and unnecessary substances are removed and deficient substances are replenished by the diffusion movement of particles according to the concentration gradient on both sides of the dialysis membrane.

  In recent years, the process of venting the circuit before dialysis (priming process), the process of introducing the patient's blood into the blood circuit (blood removal process), the process of performing replacement fluid during dialysis (replacement process), and after dialysis treatment An automatic hemodialysis machine has been developed that automatically performs each process such as the process of returning the blood in the blood circuit back to the patient's body (blood return process) by controlling the flow of dialysate in the blood circuit. ing.

  Automatic hemodialyzers can be broadly divided into reverse filtration type devices that allow dialysate to flow into the blood circuit via the hemodialyzer, and online methods that allow dialysate to flow directly into the blood circuit without going through the hemodialyzer. There are two types of devices.

  A reverse filtration type hemodialysis apparatus is disclosed in, for example, Patent Document 1, and a pressure difference between the outer and inner compartments of the hollow fiber of the hemodialyzer is adjusted by a water removal / reverse filtration pump, and the dialysate is used as a hemodialyzer. It is possible to flow into the blood circuit via the water or to remove water from the blood.

  On the other hand, an on-line type hemodialysis apparatus is disclosed in, for example, Patent Document 2, and is configured to allow dialysate to directly flow into a blood circuit by a replacement fluid pump and a liquid feeding line.

JP 2000-325470 A JP 2004-313522 A

  In a reverse-dialysis hemodialysis machine, dialysate can be filtered with a dialyzer membrane of a hemodialyzer, so that even if the dialysate contains bacteria or viruses, it will enter the patient's body. This is preferable in terms of safety.

  In the reverse filtration system hemodialysis apparatus, as shown in FIG. 11, a reverse filtration rate control pressure is set, and the dialysate pressure is controlled to be lower than the reverse filtration rate control pressure. FIG. 11 shows a case where a dialysis membrane having a high UFR (ultrafiltration rate) is used. If the UFR is high, the dialysis fluid pressure usually does not reach the reverse filtration rate control pressure. Within the range of.

  On the other hand, depending on the substance to be removed from the blood during dialysis treatment, a dialysis membrane having a low UFR may be used. When the UFR is lowered, the dialysate also becomes difficult to pass through the dialysis membrane, so that the dialysate pressure reaches the reverse filtration rate control pressure in a short time as shown in FIG. FIG. 12 shows a case where the reverse filtration rate increases due to an increase in dialysate pressure. When the dialysate pressure reaches the reverse filtration rate control pressure in a short time, the dialysate pressure is controlled to decrease, and the reverse filtration rate is reduced. In other words, since the dialysate pressure must be gradually increased so as not to reach the reverse filtration rate control pressure, it becomes difficult to control the amount of dialysate flowing into the blood circuit, resulting in a long dialysis treatment. There is a problem of time. The same applies to a case where the dialysis membrane is clogged with blood protein during dialysis.

  Furthermore, as shown in FIG. 13, there is a case where the dialysate pressure hardly decreases even when the reverse filtration rate is changed when the UFR is low. In this case as well, the inflow of dialysate into the blood circuit is limited. As a result, dialysis treatment takes a long time.

  The above-described problem does not occur in the on-line method in which dialysate is allowed to flow into the blood circuit without using a hemodialyzer. However, in the unlikely event that bacteria or viruses are included in the dialysate, it is necessary to provide a separate filter for filtering the dialysate in the online system. For this reason, there is a problem that the labor for managing and replacing the filter is increased and the cost is increased.

  In other words, the reverse filtration method of Patent Document 1 has the advantage of low cost and low cost, but has the demerit that control is difficult when the UFR is low or the dialysis membrane is clogged. In the online method of Patent Document 2, although it is possible to cope with a low UFR, there is a demerit that it takes time and costs are high, and the demerit has to be allowed in any of the apparatuses.

  The present invention has been made in view of the above points, and its purpose is to complement the disadvantages of both the reverse filtration method and the online method, and when the UFR is low or the dialysis membrane is clogged. However, an object of the present invention is to provide a hemodialysis apparatus that can be appropriately controlled and that is labor-saving and low in cost.

  In order to achieve the above object, in the present invention, when the UFR is low or when the dialysis membrane is clogged, it is estimated by the dialysate pressure or the reverse filtration speed, and the automatic operation is switched from the reverse filtration operation to the online operation. I was able to do it.

The first invention is
A hemodialyzer that contacts blood and dialysate through a dialysis membrane;
The blood circuit having an arterial system for flowing patient blood into the hemodialyzer and a venous system for returning blood from the hemodialyzer to the patient;
A dialysate circuit having an introduction system for flowing dialysate into the hemodialyzer and a discharge system for discharging dialysate from the hemodialyzer;
A liquid feed line connected to the blood circuit for supplying dialysate to the blood circuit;
Switching means for switching the supply state and non-supply state of the dialysate by the liquid supply line;
A water removal / backfiltration pump for performing water removal and reverse filtration by changing the dialysate pressure inside the hemodialyzer;
A dialysate pressure detector for detecting the dialysate pressure in the dialysate circuit;
In a hemodialysis apparatus provided with a control device for controlling the switching means and the dewatering / backfiltration pump based on an output signal from the dialysis fluid pressure detection unit,
The control device uses the switching means to bring the liquid supply line into a non-dialysis fluid supply state, and at the time of reverse filtration operation in which the water removal / backfiltration pump is operated, When the degree of increase in dialysate pressure is detected to be greater than or equal to a predetermined level, the switching means is configured to switch to online operation for bringing the liquid supply line into a dialysate supply state. To do.

  According to this configuration, the reverse filtration operation is continued when the degree of increase in dialysate pressure is lower than a predetermined value, such as when the reverse filtration operation is performed using a hemodialyzer with a high UFR. Therefore, it is possible to perform dialysis treatment with high safety, less labor, and low cost.

  On the other hand, when the UFR is low or the hemodialyzer is clogged, the dialysate pressure suddenly increases. In this case, if the dialysate pressure detection unit detects that the degree of increase in dialysate pressure is greater than or equal to the predetermined value, the dialysate is supplied to the blood circuit from the liquid feed line by switching to online operation. It will not be long.

The second invention is
A hemodialyzer that contacts blood and dialysate through a dialysis membrane;
The blood circuit having an arterial system for flowing patient blood into the hemodialyzer and a venous system for returning blood from the hemodialyzer to the patient;
A dialysate circuit having an introduction system for flowing dialysate into the hemodialyzer and a discharge system for discharging dialysate from the hemodialyzer;
A liquid feed line connected to the blood circuit for supplying dialysate to the blood circuit;
Switching means for switching the supply state and non-supply state of the dialysate by the liquid supply line;
A water removal / backfiltration pump for performing water removal and reverse filtration by changing the dialysate pressure inside the hemodialyzer;
A reverse filtration rate detection unit for detecting a reverse filtration rate by the water removal / reverse filtration pump;
In a hemodialysis apparatus comprising the control means for controlling the switching means and the dewatering / backfiltration pump based on an output signal from the backfiltration speed detection unit,
In the reverse filtration operation in which the liquid supply line is not supplied with the dialysate by the switching means and the dewatering / back filtration pump is operated, the control device uses the reverse filtration speed detection unit. When the reverse filtration speed is detected to be lower than a predetermined value, the switching means is configured to switch to the online operation in which the liquid feeding line is in a dialysate supply state.

  According to this configuration, the reverse filtration operation is continued when the reverse filtration speed is equal to or higher than the reverse filtration operation using a hemodialyzer having a high UFR. Therefore, it is possible to perform dialysis treatment at a low cost.

  On the other hand, when the UFR is low or the hemodialyzer is clogged, the reverse filtration rate does not increase. In this case, if the reverse filtration rate detection unit detects that the reverse filtration rate is less than the predetermined value, the operation is switched to online operation and the dialysate is supplied to the blood circuit from the liquid supply line, so that the dialysis treatment takes a long time. Never do.

According to a third invention, in the first or second invention,
The control device is configured to perform a reverse filtration operation at the start of operation of the hemodialysis device.

  According to this configuration, when the degree of increase in dialysate pressure is lower than a predetermined value, or when the reverse filtration speed is equal to or higher than a predetermined value, safe dialysis treatment by reverse filtration can be continuously performed from the start of operation to the end of treatment. It becomes possible.

  According to the first invention, during the reverse filtration operation, when it is detected that the degree of increase in the dialysate pressure is greater than or equal to the predetermined value, the dialysate can be supplied through the liquid feed line by switching to the online operation. Complementing the disadvantages of both the reverse filtration method and the online method, even when the UFR is low or when clogging occurs, it is possible to perform appropriate control, and it is time-saving and low-cost dialysis treatment. It can be carried out.

  According to the second invention, during reverse filtration operation, when it is detected that the reverse filtration speed is less than a predetermined value, it is possible to switch to online operation and supply dialysate through the liquid feed line. Complementing the disadvantages of both the online method and the online method, even when the UFR is low or when clogging occurs, it is possible to perform appropriate control, and it is possible to perform dialysis treatment at a low cost without much effort. it can.

  According to the third invention, the reverse filtration operation is performed at the start of operation of the hemodialyzer, so that when the degree of increase in dialysate pressure is low, or when the reverse filtration rate is equal to or higher than a predetermined value, from the operation start to the treatment end. Safe dialysis treatment by backfiltration can be continued.

It is a figure which shows schematic structure of the hemodialysis apparatus which concerns on embodiment of this invention. It is a block diagram of a hemodialysis apparatus. FIG. 2 is a view corresponding to FIG. 1 illustrating a priming process in a reverse filtration operation. FIG. 2 is a view corresponding to FIG. 1 illustrating a priming process in online operation. FIG. 2 is a view corresponding to FIG. 1 showing a rapid replenishment process in a reverse filtration operation. FIG. 2 is a view corresponding to FIG. 1 showing a rapid replenishment process in online operation. FIG. 2 is a view corresponding to FIG. 1 showing a blood return step in a reverse filtration operation. FIG. 2 is a view corresponding to FIG. 1 illustrating a blood return process in online operation. It is a flowchart which shows the control procedure by a control apparatus. It is a graph which shows the relationship between the dialysate pressure during operation | movement of the hemodialysis apparatus which concerns on embodiment, when a UFR is low, and a reverse filtration rate. FIG. 11 is a diagram corresponding to FIG. 10 when the UFR is high. It is a graph which shows the relationship between the dialysate pressure and the reverse filtration rate when the UFR is low and the reverse filtration rate increases due to an increase in dialysate pressure. FIG. 13 is a diagram corresponding to FIG. 12 when the UFR is low and the reverse filtration rate hardly changes even when the dialysate pressure is changed.

  Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings. It should be noted that the following description of the preferred embodiment is merely illustrative in nature, and is not intended to limit the present invention, its application, or its use.

  FIG. 1 is a diagram showing a schematic configuration of a hemodialysis apparatus 1 according to an embodiment of the present invention. The hemodialysis apparatus 1 is configured to purify the blood of patients with renal failure and drug addicts, remove excess water in the blood, and replenish water (replacement fluid) as needed. Has been.

  In addition, the hemodialysis apparatus 1 of this embodiment automatically and continuously performs each process such as a priming process, a blood removal process, a fluid replacement process, and a blood return process by controlling the flow of the dialysate in the blood circuit. Automatic hemodialysis machine to perform.

  The hemodialysis apparatus 1 includes a dialyzer hemodialyzer 5, a blood circuit 20, a dialysate circuit 30, a liquid feed line 40, an on-line clamp (switching means) 41, a dewatering / back-filtration pump P1, And a control device 50 (shown in FIG. 2).

  The hemodialyzer 5 is a conventionally known one provided between the arterial system 21 and the venous system 22 of the blood circuit 20, and in the present invention, both a hemodialyzer with a high UFR and a hemodialyzer with a low UFR are used. Can be used. Although not shown, the hemodialyzer 5 is partitioned by a hollow fiber that functions as a dialysis membrane, thereby forming a compartment inside the hollow fiber and a compartment outside the hollow fiber. The hemodialyzer 5 has a blood inlet 5a for allowing blood to flow into the compartment inside the hollow fiber, a blood outlet 5b for allowing blood to flow out from the compartment inside the hollow fiber, and a dialysate flowing into the compartment outside the hollow fiber And a dialysate outlet 5d for allowing the dialysate to flow out of a compartment outside the hollow fiber.

  The arterial system 21 of the blood circuit 20 is composed of a tube through which blood flows, and is connected to the blood inlet 5 a of the hemodialyzer 5. The arterial system 21 includes an arterial side connection portion 21a to which a needle punctured into a patient's blood vessel is connected, an arterial side bubble detector 21b that detects the presence or absence of bubbles in the tube, and blood that sends blood by squeezing the tube And a pump 21c. The blood pump 21c is controlled by the control device 50, and can switch between normal rotation and reverse rotation and change the rotation speed.

  A syringe pump 55 is connected to the arterial system 21. The syringe pump 55 is a general device used to administer a drug necessary for hemodialysis to a patient, and thus detailed description thereof is omitted.

  The venous system 22 of the blood circuit 20 is also composed of a tube through which blood flows. The venous system 22 is connected to the blood outlet 5 b of the hemodialyzer 5. The venous system 22 includes a vein-side connection portion 22a to which a needle punctured into a patient's blood vessel is connected, a vein-side bubble detector 22b that detects the presence or absence of bubbles in the tube, a drip tube 22c, and a bubble detector clamp. 22d, an overflow line 22e, and an automatic priming clamp 22f. The arterial side connection portion 21a and the venous side connection portion 22a can be in a so-called short-circuit state in which both the connection portions 21a and 22a are directly connected.

  The bubble detector clamp 22d is provided on the downstream side of the vein-side bubble detector 22b, and is controlled by the control device 50 to close the tube (clamped state) and open the open state (unclamped state). ). The bubble detector clamp 22d is closed when a bubble is detected by the vein-side bubble detector 22b, and is normally open.

  The overflow line 22e is connected to the drip tube 22c and is a line for draining in the priming process. The automatic priming clamp 22f is provided in the overflow line 22e, and is switched between a closed state in which the overflow line 22e is closed under the control of the control device 50 and an open state in which the overflow line 22e is opened.

  The dialysate circuit 30 includes an introduction system 31 that allows the dialysate to flow into the hemodialyzer 5, a discharge system 32 that discharges the dialysate from the hemodialyzer 5, and a chamber 33.

  The chamber 33 is for temporarily storing the dialysate, and is connected to an external dialysate generator (not shown) via a dialysate supply pipe A1 and a dialysate discharge pipe A2. . The introduction system 31 is composed of a tube through which the dialysate flows, and is connected to the dialysate inlet 5 c of the hemodialyzer 5. The introduction system 31 has a dialysate introduction pump 31 a for sending the dialysate in the chamber 33 to the hemodialyzer 5.

  The discharge system 32 is configured by a tube, and detects the pressure of the dialysate in the discharge system 32 of the dialysate circuit 30 and the dialysate discharge pump 32 a for sending the dialysate of the hemodialyzer 5 to the chamber 33. A dialysis fluid pressure sensor (dialysis fluid pressure detector) 32b.

  The liquid feeding line 40 is a line for directly supplying the dialysate to the blood circuit 20 and is constituted by a tube. Online operation is realized by the liquid feeding line 40. The upstream side of the liquid feed line 40 is connected between the dialysate introduction pump 31 a and the dialysate inflow port 5 c in the introduction system 31 of the dialysate circuit 30. The downstream side of the liquid feeding line 40 is connected between the blood pump 21 c and the hemodialyzer 5 in the arterial system 21 of the blood circuit 20.

  A replacement fluid pump 42 is provided on the upstream side of the liquid feed line 40. The replacement fluid pump 42 is for sending the dialysate in the chamber 33 to the blood circuit 20, and is controlled by the control device 50 to be able to stop, switch operation, and change the supply amount of the dialysate.

  The online clamp 41 is provided on the downstream side of the liquid feeding line 40. The on-line clamp 41 is controlled by the control device 50 to be switched between a closed state in which the liquid feeding line 40 is closed and an open state in which the liquid supply line 40 is opened. The closed state is a state in which dialysate is not supplied by the liquid supply line 40, and the open state is a state in which dialysate is supplied by the liquid supply line 40.

  The water removal / back filtration pump P1 is provided in the middle of the water removal / back filtration line L1 that connects the dialysate discharge pipe A2 and the discharge system 32 of the dialysate circuit 30. The dewatering / back-filtration pump P1 is controlled by the control device 50 and operates to allow the dialysate in the dialysate discharge pipe A2 to flow into the discharge system 32, so that the flow rate of the dialysate at that time can be changed. It has become.

  The control device 50 shown in FIG. 2 is configured by a microcomputer or the like that operates according to a predetermined program. The control device 50 is connected to operation buttons 51 and the like operated by an operator. The operation button 51 is, for example, a dialysis start button, various setting buttons, or the like.

  The control device 50 detects signals input from the dialysate pressure sensor 32b, the arterial bubble detector 21b, the venous bubble detector 22b, and the like, and the operation of the operation button 51 by the operator, and based on these, blood The pump 21c, dialysate introduction pump 31a, dialysate discharge pump 32a, dewatering / back-filtration pump P1, replacement fluid pump 42, automatic priming clamp 22f, bubble detector clamp 22d and online clamp 41 are controlled.

  The control device 50 includes a reverse filtration speed detection unit 50a. The reverse filtration speed detection unit 50a is for detecting the speed (ml / min) at which reverse filtration is performed. Specifically, the reverse filtration rate detection unit 50a is obtained based on the dialysate pressure output from the dialysate pressure sensor 32b and the dialysate supply flow rate by the water removal / reverse filtration pump P1. The dialysate feed flow rate by the water removal / back filtration pump P1 can be obtained from the rotational speed of the water removal / back filtration pump P1. Then, by controlling the reverse filtration rate obtained by the reverse filtration rate detection unit 50a, the dialysate pressure changes as a result. The change of the dialysate pressure is monitored by the dialysate pressure sensor 32b, and the reverse filtration speed is changed by controlling the water removal / reverse filtration pump P1, so that the dialysate pressure can be controlled. It has become.

  The control device 50 performs a reverse filtration operation in which the dialysate flows into the blood circuit 20 via the hemodialyzer 5, and an on-line in which the dialysate flows directly into the blood circuit 20 from the liquid feed line 40 without passing through the hemodialyzer 5. The operation is automatically switched according to the situation without requiring an operator's operation. Switching between the reverse filtration operation and the online operation will be described later.

  The control device 50 also includes a priming step, which is a preparatory step for washing and cleaning the blood circuit 20 and the hemodialyzer 5, a blood removal step for filling the blood circuit 20 with the patient's blood after puncture, and extracorporeal circulation, blood removal A dialysis process performed following the process, a rapid fluid replacement process during dialysis treatment, and a blood return process for returning the blood in the blood circuit 20 to the body of the patient are performed. The priming process, the rapid fluid replacement process, and the blood return process are different between the reverse filtration operation and the online operation, but the blood removal process and the dialysis process are the same in the reverse filtration operation and the online operation.

  In the priming process in the reverse filtration operation, as shown in FIG. 3, the automatic priming clamp 22f and the bubble detector clamp 22d are opened, and the online clamp 41 is closed. In addition, the artery side connection portion 21a and the vein side connection portion 22a of the blood circuit 20 are short-circuited.

  The dialysate introduction pump 31a and the dialysate discharge pump 32a are operated, and the water removal / back filtration pump P1 is operated. At this time, for example, the dialysate introduction pump 31a and the dialysate discharge pump 32a are fed at 500 ml / min, and the water removal / back-filtration pump P1 is fed at 400 ml / min, So-called reverse filtration can be performed by flowing from the compartment outside the hollow fiber to the compartment inside the hollow fiber while filtering through the dialysis membrane of the hemodialyzer 5. Thereby, the blood circuit 20 is filled with the dialysate. At this time, the replacement fluid pump 42 is stopped.

  The blood pump 21c is operated so as to send the dialysate in the blood circuit 20 in the opposite direction to the dialysis step. The dialysate in the blood circuit 20 is discharged from the overflow line 22e.

  In the priming process in the online operation, as shown in FIG. 4, the automatic priming clamp 22f, the bubble detector clamp 22d, and the online clamp 41 are opened. In addition, the artery side connection portion 21a and the vein side connection portion 22a of the blood circuit 20 are short-circuited.

  The dialysate introduction pump 31a, the dialysate discharge pump 32a, the dewatering / back filtration pump P1, and the blood pump 21c are set in the same manner as in the back filtration, and the replacement fluid pump 42 is operated. As a result, the dialysate is directly supplied from the liquid feeding line 40 to the arterial system 21 of the blood circuit 20. The dialysate in the blood circuit 20 is discharged from the overflow line 22e.

  As shown in FIG. 5, in the quick fluid replacement process in the reverse filtration operation, the automatic priming clamp 22 f and the online clamp 41 are closed, and the bubble detector clamp 22 d is opened. Since this rapid replenishment step is a step performed during the dialysis step, the artery side connection portion 21a and the vein side connection portion 22a of the blood circuit 20 are connected to the puncture needle, and the puncture needle is punctured into the blood vessel of the patient.

  The dialysate introduction pump 31a and the dialysate discharge pump 32a are operated, and the water removal / back filtration pump P1 is operated. At this time, for example, the dialysate introduction pump 31a and the dialysate discharge pump 32a are set to 500 ml / min, and the water removal / back-filtration pump P1 is set to 150 ml / min. Can be back-filtered. As a result, the dialysate flows into the blood circuit 20 to perform the replacement fluid. The amount of the replacement fluid can be adjusted by the amount of dialysate fed by the water removal / back filtration pump P1. At this time, the replacement fluid pump 42 is stopped. The blood pump 21c is operated in the same manner as in the dialysis process.

  As shown in FIG. 6, in the rapid replenishment process in the online operation, the automatic priming clamp 22f and the bubble detector clamp 22d are made the same as the rapid replenishment process in the reverse filtration operation, and the online clamp 41 is opened.

  The dialysate introduction pump 31a, the dialysate discharge pump 32a, the water removal / back-filtration pump P1, and the blood pump 21c are the same as the rapid fluid replacement process in the online operation. The replacement fluid pump 42 is operated. The amount of the replacement fluid can be adjusted by the supply amount of the replacement fluid pump 42.

  In the blood return process in the reverse filtration operation, as shown in FIG. 7, the automatic priming clamp 22f and the online clamp 41 are closed, and the bubble detector clamp 22d is opened. Since this blood return step is performed after the dialysis step, the artery side connection portion 21a and the vein side connection portion 22a of the blood circuit 20 are connected to the puncture needle, and the puncture needle is punctured into the blood vessel of the patient.

  The dialysate introduction pump 31a and the dialysate discharge pump 32a are operated, and the water removal / back filtration pump P1 is operated. At this time, for example, the dialysate introduction pump 31a and the dialysate discharge pump 32a are supplied at a rate of 500 ml / min, and the water removal / back filtration pump P1 is supplied at a rate of 100 ml / min. Can be back-filtered. As a result, the dialysate flows into the blood circuit 20 and the blood in the blood circuit 20 is returned to the patient. At this time, the replacement fluid pump 42 is stopped. The blood pump 21c is operated so as to send blood contrary to the dialysis step.

  As shown in FIG. 8, the blood return process in the online operation is the same as the blood return process in the reverse filtration operation in the automatic priming clamp 22f and the bubble detector clamp 22d. Further, the online clamp 41 is opened. The dialysate introduction pump 31a, the dialysate discharge pump 32a, the water removal / reverse filtration pump P1, and the blood pump 21c are the same as the blood return process in the online operation. The replacement fluid pump 42 is operated. As a result, the dialysate flows into the blood circuit 20 and the blood in the blood circuit 20 is returned to the patient.

  Next, the control performed by the control device 50 for switching between the reverse filtration operation and the online operation will be described based on the flowchart shown in FIG. This control starts when the start button in the operation button 51 is pressed.

  In step S1 after the start, the reverse filtration operation is started. For example, the operation state shown in FIG. 3 is set in the priming process, the operation state shown in FIG. 5 is set in the rapid replacement process, and the operation state shown in FIG. 7 is set in the blood return process. That is, the control device 50 is configured to perform a reverse filtration operation when the hemodialysis device 1 starts operation.

  In step S2, the reverse filtration speed is increased to the required speed by increasing the feed amount (rotational speed) by the water removal / reverse filtration pump P1. The required speed is a speed set in advance depending on the patient's condition and the type of treatment, and is, for example, 400 ml / min as shown in FIG.

  In step S3, it is determined whether or not the dialysate pressure detected by the dialysate pressure sensor 32b is equal to or higher than a predetermined pressure in the state where the reverse filtration rate is increased to the required rate in step S2. The predetermined pressure is, for example, 310 mmHg obtained by adding 10 mmHg to the filtration rate control pressure (300 mmHg) indicated by the solid line in FIG.

  If it is determined in step S3 that the dialysate pressure has not increased above the predetermined pressure, it is estimated that the hemodialyzer 5 has a high UFR, so the process proceeds to the end and the reverse filtration operation is continued.

  On the other hand, if it is determined in step S3 that the dialysate pressure is equal to or higher than the predetermined pressure, it is difficult for the dialysate to flow into the blood circuit 20, and thus the hemodialyzer 5 having a low UFR or clogging occurs. It is estimated that the hemodialyzer 5 is. In this case, the process proceeds to step S4, where the feed amount by the water removal / back filtration pump P1 is decreased to reduce the back filtration speed. In step S4, the reverse filtration rate is set to about 10% of the required rate. As a result, the dialysate pressure decreases as shown in FIG.

  Then, it progresses to step S5 and it is determined whether the dialysate pressure detected with the dialysate pressure sensor 32b is lower than the said predetermined pressure (310 mmHg). If NO is determined in step S5 and the dialysate pressure is equal to or higher than the predetermined pressure, the process returns to step S4 to further reduce the reverse filtration speed.

  If it is determined as YES in step S5 and the dialysate pressure is lower than the predetermined pressure, the process proceeds to step S6 to increase the feed amount by the water removal / back filtration pump P1 and increase the back filtration speed. The amount of increase in the reverse filtration speed in step S6 is a ratio of 10% of the current speed.

  Then, it progresses to step S7 and it determines again whether the dialysate pressure detected with the dialysate pressure sensor 32b is more than the said predetermined pressure (310 mmHg). If YES is determined in step S7 and the dialysate pressure has increased to a predetermined pressure or higher, the process proceeds to step S4, and the reverse filtration speed is reduced to 90% of the current speed, for example. If NO is determined in step S7 and the dialysate pressure is lower than the predetermined pressure, the process proceeds to step S8.

  In step S8, it is determined whether the reverse filtration speed is less than the required speed. When it is determined NO in step S8 and the reverse filtration speed is equal to or higher than the required speed, the process proceeds to the end and the reverse filtration operation is continued.

  Even if the reverse filtration rate is decreased and then increased again, if the result of the determination in step S8 is YES and the reverse filtration rate is less than the required rate, the reverse filtration rate is lower (for example, 50 ml / However, the dialysate pressure immediately rises and reaches the filtration rate control pressure. In this case, the reverse filtration rate cannot be increased to the required rate.

  In step S9, when the reverse filtration speed is equal to or lower than the online switching setting speed (shown in FIG. 10), it is determined whether or not the state continues for a certain time (tens of minutes). When it is determined NO in step S9 and the state where the reverse filtration speed is equal to or lower than the online switching set speed does not continue for a certain period of time, the process proceeds to the end and the reverse filtration operation is continued.

  On the other hand, if it is determined as YES in step S9 and the state where the reverse filtration speed is equal to or lower than the online switching set speed continues for a certain period of time, the process proceeds to step S10 to switch to online operation.

  That is, in the case of a hemodialyzer 5 with a low UFR or a clogged hemodialyzer 5, the dialysate pressure is low even though the control from the above steps S2 to S7 is performed even though the reverse filtration rate is in the low speed range. Since it immediately rises and reaches the filtration speed control pressure, the reverse filtration speed cannot be increased, and as a result, the dialysis time becomes longer. In this case, the process proceeds to step S10 through the determination of step S9. Switch to online driving at. Thereby, it can avoid that dialysis time is prolonged.

  In the case of the hemodialyzer 5 having a high UFR or the clogged hemodialyzer 5, NO is determined in step S3, step S8, and step S9, so that the reverse filtration operation can be performed. As a result, the dialysate can be filtered by the hemodialyzer 5 and introduced into the blood circuit 20, so that the safety is high. In addition, the number of management steps for the filter for filtering the dialysate is reduced, and the cost is reduced. be able to.

  Moreover, the control apparatus 50 can also detect the raise degree (rising speed) of a dialysate pressure by the step S1-S3 in the stage where the reverse filtration speed rose to the required speed from the start of operation. If the degree of increase in the dialysate pressure is abrupt above a predetermined level, it can be controlled that the hemodialyzer 5 has a high UFR and that the process proceeds to step S10 to switch to online operation.

  In addition, when switching to online operation in the priming process, it is preferable to perform the rapid fluid replacement process and the blood return process as online operation without performing the reverse filtration operation in the subsequent process (rapid fluid replacement process and blood return process). .

  Note that the switching control between the reverse filtration operation and the online operation shown in FIG. 9 may be performed not only in the priming process but also in the replacement liquid process and the blood return process.

  Moreover, although the on-line clamp 41 is provided as the switching means of the present invention, the present invention is not limited to this. For example, the supply state and the non-supply state may be switched by the operation of the replacement fluid pump 42. Alternatively, the supply state and the non-supply state may be switched by simply opening and closing the online clamp 41 without providing the replacement fluid pump 42.

  Alternatively, the downstream side of the liquid feeding line 40 may be connected to the venous system 22 of the blood circuit 20 so that the dialysate is directly supplied to the venous system 22.

  Alternatively, the upstream side of the liquid feed line 40 may be connected to the discharge system 32 of the dialysate circuit 30 to supply the dialysate from the discharge system 32.

  As described above, according to the hemodialysis apparatus 1 according to this embodiment, when it is detected that the reverse filtration speed is lower than the predetermined value during the reverse filtration operation, the operation is switched to the online operation by the liquid feeding line 40. Since dialysate can be supplied, the disadvantages of both the reverse filtration method and the online method can be complemented, and even when the UFR is low or clogged, it can be controlled appropriately, and it takes time and effort. Therefore, dialysis treatment can be performed at low cost.

  Further, during the reverse filtration operation, when it is detected that the degree of increase in the dialysate pressure is greater than or equal to a predetermined value, the dialysate can be supplied to the blood circuit 20 through the liquid supply line 40 by switching to the online operation.

  The above-described embodiment is merely an example in all respects and should not be interpreted in a limited manner. Further, all modifications and changes belonging to the equivalent scope of the claims are within the scope of the present invention.

  As described above, the hemodialysis apparatus according to the present invention can be used, for example, for dialysis treatment.

1 hemodialysis machine 5 hemodialyzer 20 blood circuit 21 arterial system 22 venous system 30 dialysate circuit 31 introduction system 32 discharge system 32b dialysate pressure sensor (dialysis solution pressure detector)
40 Liquid feed line 41 On-line clamp (switching means)
50 Control Device 50a Reverse Filtration Speed Detection Unit P1 Water Removal / Back Filtration Pump

Claims (3)

A hemodialyzer that contacts blood and dialysate through a dialysis membrane;
The blood circuit having an arterial system for flowing patient blood into the hemodialyzer and a venous system for returning blood from the hemodialyzer to the patient;
A dialysate circuit having an introduction system for flowing dialysate into the hemodialyzer and a discharge system for discharging dialysate from the hemodialyzer;
A liquid feed line connected to the blood circuit for supplying dialysate to the blood circuit;
Switching means for switching the supply state and non-supply state of the dialysate by the liquid supply line;
A water removal / backfiltration pump for performing water removal and reverse filtration by changing the dialysate pressure inside the hemodialyzer;
A dialysate pressure detector for detecting the dialysate pressure in the dialysate circuit;
In a hemodialysis apparatus provided with a control device for controlling the switching means and the dewatering / backfiltration pump based on an output signal from the dialysis fluid pressure detection unit,
The control device uses the switching means to bring the liquid supply line into a non-dialysis fluid supply state, and at the time of reverse filtration operation in which the water removal / backfiltration pump is operated, When the degree of increase in dialysate pressure is detected to be greater than or equal to a predetermined level, the switching means is configured to switch to online operation for bringing the liquid supply line into a dialysate supply state. Hemodialysis machine. A hemodialyzer that contacts blood and dialysate through a dialysis membrane;
The blood circuit having an arterial system for flowing patient blood into the hemodialyzer and a venous system for returning blood from the hemodialyzer to the patient;
A dialysate circuit having an introduction system for flowing dialysate into the hemodialyzer and a discharge system for discharging dialysate from the hemodialyzer;
A liquid feed line connected to the blood circuit for supplying dialysate to the blood circuit;
Switching means for switching the supply state and non-supply state of the dialysate by the liquid supply line;
A water removal / backfiltration pump for performing water removal and reverse filtration by changing the dialysate pressure inside the hemodialyzer;
A reverse filtration rate detection unit for detecting a reverse filtration rate by the water removal / reverse filtration pump;
In a hemodialysis apparatus comprising the control means for controlling the switching means and the dewatering / backfiltration pump based on an output signal from the backfiltration speed detection unit,
In the reverse filtration operation in which the liquid supply line is not supplied with the dialysate by the switching means and the dewatering / back filtration pump is operated, the control device uses the reverse filtration speed detection unit. When the reverse filtration speed is detected to be less than a predetermined value, the hemodialysis is characterized in that the switching means switches to the online operation for bringing the liquid feeding line into a dialysate supply state. apparatus. The hemodialysis apparatus according to claim 1 or 2,
2. The hemodialysis apparatus according to claim 1, wherein the control apparatus is configured to perform a reverse filtration operation at the start of operation of the hemodialysis apparatus.

Images