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WO2012001961A1 - Dispositif et procédé de purification du sang - Google Patents

Dispositif et procédé de purification du sang Download PDF

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Publication number
WO2012001961A1
WO2012001961A1 PCT/JP2011/003698 JP2011003698W WO2012001961A1 WO 2012001961 A1 WO2012001961 A1 WO 2012001961A1 JP 2011003698 W JP2011003698 W JP 2011003698W WO 2012001961 A1 WO2012001961 A1 WO 2012001961A1
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Prior art keywords
blood
purifier
dialyzer
liquid
inflow
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PCT/JP2011/003698
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English (en)
Japanese (ja)
Inventor
柴田　猛
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Individual
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Individual
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Priority to CN201180002080.9A priority Critical patent/CN102438675B/zh
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
    • A61M1/36—Other treatment of blood in a by-pass of the natural circulatory system, e.g. temperature adaptation, irradiation ; Extra-corporeal blood circuits
    • A61M1/3672—Means preventing coagulation

Definitions

  • the present invention relates to a blood purification apparatus and method for purifying blood.
  • Hemodialysis is widely known as a method for artificially performing the blood purification function of the kidney.
  • the number of hemodialysis patients in the world in 2007 has been reported to be about 2 million, and is increasing year by year.
  • Hemodialysis is a method in which blood taken out from an artery is continuously passed through a dialyzer equipped with a collection of hollow fibers to remove waste in the blood and return it to the vein.
  • Patients with renal dysfunction need to visit a hospital twice or three times a week and receive hemodialysis treatment for a predetermined time.
  • FIG. 8 is a diagram showing a configuration of a part of a typical blood purification apparatus.
  • the blood purification apparatus 200 removes blood taken out from the arterial blood access 210 from the arterial / venous shunt of the forearm P (the site where the artery and vein are connected by surgery) through the blood pump 220, the arterial air trap chamber 230, and the dialyzer 240.
  • the circuit configuration is such that the blood is continuously sent through the vein air trap chamber 250 and returned to the vein of the forearm P through the vein blood access 260.
  • the arterial blood access 210 and the venous blood access 260 are places where blood is taken out and returned by a puncture needle or the like.
  • the blood pump 220 is a pump for sucking blood from the movement / venous shunt (arrow A), supplying it to the dialyzer 240, and returning it to the vein (arrow B).
  • a blood pump 220 is moved in the direction of arrow C.
  • the arterial air trap chamber 230 is for preventing air and blood clots in the arterial blood circuit from entering the dialyzer 240
  • the venous air trap chamber 250 is the air in the blood circuit and the dialyzer 240. It is intended to prevent blood clots from entering the patient's body.
  • the dialyzer 240 has a number of hollow fibers, and has a function of removing waste products from blood flowing into the hollow fibers by perfusing dialysate. Dialysate is injected from the injection line 241 (arrow D), passes through the dialyzer 240 and exits the discharge line 242 (arrow E).
  • the physiological saline 211 is used for the purpose of cleaning the blood circuit and removing air before hemodialysis.
  • the supply line of the physiological saline 211 is closed by forceps 214 and the like.
  • the negative pressure detection pillow 213 is a device for checking whether or not the upstream side of the blood pump 220 becomes too negative during the operation of the blood pump 220, and whether it is excessive negative pressure visually by a medical staff. is there.
  • An anticoagulant injection device 225 is connected between the blood pump 220 and the artery side air trap chamber 230.
  • the anticoagulant injection device 225 includes a syringe 227 containing a blood anticoagulant (heparin or the like) 226, and drives the piston portion of the syringe 227 using a driving means such as a motor (arrow F).
  • a mechanism for injecting blood anticoagulant 226 in 227 into blood is provided. Blood usually clots in about 10 minutes when exposed to the atmosphere. When the blood coagulates, the hollow fiber in the dialyzer 240 is blocked and the dialysis efficiency decreases. Depending on the degree of coagulation, hemodialysis treatment must be interrupted. In order to effectively prevent such blood coagulation, blood anticoagulant 226 is injected into the blood.
  • a hemodialysis apparatus represented by the above-described blood purification apparatus 200 is also disclosed in Patent Documents 1 and 2, for example.
  • Blood anticoagulant 226 is never a safe drug for patients, and induces complications such as increased bleeding and abnormal lipid metabolism due to long-term use.
  • blood generally circulates in the blood purification apparatus 200 at a flow rate of about 200 ml / min.
  • the total volume of the blood route in the blood purification apparatus 200 is approximately 130 to 300 ml. Therefore, theoretically, blood is calculated to return to the body through the blood circuit of the blood purification device 200 in 1 minute 30 seconds at the longest, and the time for the blood to exist outside the body is 10 minutes required for coagulation. It is extremely short.
  • the dialyzer 240 is provided with a large number of hollow fibers having an inner diameter of about 200 microns inside thereof, and is a place that provides a great resistance to blood flowing into the inside.
  • the arterial air trap chamber 230 and the venous air trap chamber 250 are locations where blood and air are in contact with each other, and thus blood coagulation is likely to occur.
  • the arterial side air trap chamber 230 and the venous side air trap chamber 250 are typically provided with a mesh 231 at each downstream bottom as shown in FIG. And a mesh 251. These meshes 231 and 251 are suitable for trapping large blood clots, but at the same time, contribute to encouraging blood flow. As a result, the arterial side air trap chamber 230 and the venous side air trap chamber 250 are places where blood coagulation easily occurs after the dialyzer 240, and the fine blood coagulation clots that have passed through the meshes 231 and 251 There is a risk of being carried in 240 and into the patient's body.
  • blood drift or stagnation is likely to occur on the inner wall of the negative pressure detection pillow 213 and the inner wall of the tube handled by the blood pump 220.
  • blood pump 220 there are many places in the blood purification apparatus 200 where blood drifts or stays. For this reason, even in a short period of time, blood is coagulated in the blood purification apparatus 200, and there is a risk of adversely affecting patient health in order to reliably prevent blood coagulation.
  • the current situation is that excessive blood anticoagulant 226 is mixed into the blood.
  • the present invention has been made to solve such problems, and it is an object of the present invention to provide a blood purification apparatus and method capable of reducing blood anticoagulants.
  • an embodiment of the blood purification apparatus of the present invention is a blood purification apparatus that extracts blood and returns blood after purification, and reduces waste by dialysis of blood into a blood circulation circuit.
  • a blood purifier that supplies dialysate from the outside, a blood pump that transports blood in the blood circulation circuit, and an anticoagulant infusion device that mixes blood anticoagulant to suppress blood coagulation into the blood
  • the blood purifier is arranged under a negative pressure upstream of the blood pump.
  • Another embodiment of the blood purification apparatus of the present invention further includes a blood volume fluctuation device that varies the volume of blood flowing into the blood purification apparatus at a position branched from a dialysate supply line or discharge line in the blood purification apparatus.
  • the blood volume fluctuation device can repeatedly perform an inflow operation for flowing the liquid into the blood purifier from the inside and a drawing operation for drawing the liquid from the blood purifier into the blood volume fluctuation device.
  • the drawing speed at which the liquid is drawn from the blood purifier by the above-described drawing operation may be made lower than the inflow speed at which the liquid flows into the blood purifier by the inflow operation. it can.
  • the inflow speed at which the liquid is allowed to flow into the blood purifier can be set to be equal to or lower than the speed at which blood is fed by the blood pump.
  • the inflow speed at which the liquid is allowed to flow into the blood purifier can be increased in a range of 30 ml / min or less than the speed at which blood is fed by the blood pump.
  • blood is dialyzed into a blood circulation circuit to reduce waste products, and a blood purifier that supplies dialysate from the outside and transports blood in the blood circulation circuit.
  • a blood purifier that supplies dialysate from the outside and transports blood in the blood circulation circuit.
  • the blood purifier is disposed upstream of the blood pump. This is a blood purification method that is used under a negative pressure.
  • Another embodiment of the blood purification method of the present invention further comprises a blood volume fluctuation device that varies the volume of blood flowing into the blood purification apparatus at a position branched from the dialysate supply line or the discharge line in the blood purification apparatus.
  • a blood volume fluctuation device that varies the volume of blood flowing into the blood purification apparatus at a position branched from the dialysate supply line or the discharge line in the blood purification apparatus.
  • the pull-in speed at which the liquid is drawn from the blood purifier by the above-described pull-in operation may be made lower than the inflow speed at which the liquid flows into the blood purifier by the inflow operation. it can.
  • the inflow speed at which the liquid is allowed to flow into the blood purifier can be made lower than the speed at which blood is fed by the blood pump.
  • the inflow speed for flowing a liquid into the blood purifier can be increased in a range of 30 ml / min or less than the speed at which blood is fed by a blood pump.
  • the blood purification function can be maintained high even if the blood anticoagulant is reduced.
  • FIG. 1 shows a configuration of a main part of a blood purification apparatus according to an embodiment of the present invention.
  • FIG. 2 schematically shows a state of exchange of substances inside and outside the hollow fiber membrane disposed inside the dialyzer shown in FIG.
  • FIG. 3 shows the dialyzer shown in FIG. 1 and a dialysate supply apparatus connected to the dialyzer.
  • FIG. 4 is a diagram for explaining the necessity of the blood volume fluctuation device connected to the blood purification device according to the second embodiment.
  • FIG. 5 shows the configuration of the main part of the blood purification apparatus according to the second embodiment.
  • FIG. 6 is a graph showing an example of a change with time in the flow rate of the liquid between the blood volume fluctuation device and the dialyzer of the blood purification apparatus shown in FIG.
  • FIG. 1 shows a configuration of a main part of a blood purification apparatus according to an embodiment of the present invention.
  • FIG. 2 schematically shows a state of exchange of substances inside and outside the hollow fiber membrane disposed inside the dialy
  • FIG. 7 is a graph showing an example of the change over time of the blood flow rate flowing into the dialyzer when the change over time of the input / output flow rate shown in FIG. 6 is executed.
  • FIG. 8 shows a configuration of a main part of a conventional blood purification apparatus.
  • FIG. 1 shows the configuration of the main part of the blood purification apparatus according to the first embodiment of the present invention.
  • the blood purification apparatus 1 performs blood purification after drawing blood in the direction of arrow A from an arterial blood access 10 serving as a blood extraction port, and then performs vein purification as a blood return port.
  • a blood circulation circuit 2 for returning the purified blood in the direction of arrow B with respect to the access 50 is provided.
  • the blood circulation circuit 2 of the blood purification apparatus 1 suppresses coagulation of blood, a dialyzer 20 that is an example of a blood purifier that performs dialysis of blood, a roller pump 30 that is an example of a blood pump for transporting blood, and the like.
  • the dialyzer 20 is disposed on the upstream side of the roller pump 30 so as to perform blood dialysis under negative pressure.
  • the further detailed configuration of the blood purification apparatus 1 is as follows.
  • a dialyzer 20, a roller pump 30, and an air removal device 40 are connected in order from the arterial blood access 10 to the venous blood access 50, and between the arterial blood access 10 and the dialyzer 20.
  • An anticoagulant injection device 60 is arranged through the branch pipe 16.
  • the flow path 35 and the flow path 45 between the air removing device 40 and the venous blood access 50 are preferably composed of a soft tube made of vinyl chloride.
  • the roller pump 30 is arranged in the middle of the flow path 35 so as to sandwich the periphery of the flow path 35.
  • the arterial side blood access 10 is formed by inserting a puncture needle into a portion called a moving / venous shunt that connects an artery and vein of a part (preferably forearm) P of a patient's body by surgery. It is a bloody clan.
  • the venous blood access 50 is a blood return port formed by inserting a puncture needle into the vein of the forearm P.
  • FIG. 2 schematically shows a state of exchange of substances inside and outside the hollow fiber membrane disposed inside the dialyzer shown in FIG.
  • FIG. 3 shows the dialyzer shown in FIG. 1 and a dialysate supply apparatus connected to the dialyzer.
  • the dialyzer 20 includes a blood flow path formed by accumulating many hollow fibers 70 at the central portion thereof, and a dialysate flow path formed outside the blood flow path.
  • One hollow fiber 70 shown enlarged in FIG. 2 is a dialysis membrane having an inner diameter of about 200 ⁇ m and a film thickness of 15 to 45 ⁇ m, and has many pores 71 in the dialysis membrane.
  • the waste product 82 in the blood flowing into the dialyzer 20 is discharged from the inside of the hollow fiber 70 to the dialysate flow path through the pores 71 of the dialysis membrane.
  • blood cells 80, proteins 81, etc. larger than the pores 71 are not discharged from the pores 71.
  • the dialysate is present in the dialysate flow path, and the waste product 82 is discharged out of the dialyzer 20 by the dialysate.
  • the dialysate flow path of the dialyzer 20 connects a dialysate inflow path 21 and a dialysate discharge path 22.
  • the dialysate supplied from the dialysate supply device 90 disposed outside the dialyzer 20 enters the dialysate flow path of the dialyzer 20 from the dialysate inflow path 21 as indicated by an arrow D, As indicated by the arrow E, it is discharged from the dialysate discharge path 22.
  • the direction in which the dialysate flows in the dialysate channel (the direction of arrow I) is opposite to the direction in which the blood flows in the blood channel (the direction of arrow H). However, it can also be in the same direction.
  • a pressure gauge 91 is connected to a predetermined location of the dialysate flow path (in this embodiment, the dialysate discharge path 22). The pressure gauge 91 can monitor the pressure in the dialysate inflow path 21, the dialysate discharge path 22, the dialysate flow path in the dialysate supply apparatus 90, or the dialyzer 20.
  • roller Pump 30 is disposed in the middle of the flow path 35 and performs an operation for handling the flow path 35 by sandwiching a part of the flow path 35 and rotating the rotating portion in the direction of arrow C.
  • blood is forcibly transported from the arterial blood access 10 toward the venous blood access 50 by setting the dialyzer 20 side to a negative pressure and the air removal device 40 side to a positive pressure with the roller pump 30 as a reference. can do.
  • Air removal device 40 has a function of removing air and blood clots in blood, and even if air and blood clots are mixed in blood at any location in the blood circulation circuit 2, They can be surely removed before returning to the blood. This is because if air enters the blood vessels, the patient's life is threatened, and safety measures must be taken.
  • the air removing device 40 has blood in its lower layer and an air layer in its upper layer.
  • the air removal device 40 includes a connection pipe 41 connected to a syringe (not shown) above the air layer. For this reason, even if the blood contained in the air removing device 40 contains air, the air is trapped by the air layer and separated from the blood.
  • the lower part of the air removal device 40 is connected to the flow path 45 via the mesh 42.
  • the mesh 42 is a part corresponding to a filter for removing a blood clot. Suppressing the transport of blood clots formed by the air removal device 40, which is also an opportunity for air and blood to contact each other in the blood circulation circuit 2, to the downstream side after the flow path 45. Because it is necessary.
  • the anticoagulant injection device 60 includes a syringe 61 containing a blood anticoagulant (preferably heparin) 62 and a drive device (for example, a motor) that drives the piston side of the syringe 61. .
  • the drive device can inject blood anticoagulant 62 into blood circulation circuit 2 by driving the piston of syringe 61 in the direction of arrow F.
  • the blood anticoagulant 62 is a drug necessary for suppressing blood coagulation in the blood circulation circuit 2 (particularly in the dialyzer 20) and effectively purifying the blood, while providing long-term blood purification treatment. It brings risks such as complications to the patient. For this reason, it is preferable to reduce the blood anticoagulant 62 as much as possible. In this embodiment, the amount of blood anticoagulant 62 used can be reduced by about 20 to 30% than usual.
  • the fouling phenomenon is a phenomenon in which the pores 71 distributed in the dialysis membrane of the hollow fiber 70 are clogged by protein components in blood.
  • the removal of waste products 82 and water in the blood is not performed effectively, leading to a decrease in blood purification function.
  • FIG. 1 when the roller pump 30 is disposed downstream of the dialyzer 20 and the dialyzer 20 is used under negative pressure, unlike the conventional case, blood is not discharged into the dialyzer 20 from the upstream side. , Sucked from the downstream side.
  • the force of blood flowing from the inside of the hollow fiber 70 to the outside through the pores 71 is suppressed, the fouling phenomenon can be reduced, and clogging of the pores 71 is less likely to occur. Therefore, the blood purification efficiency can be maintained high.
  • albumin exists in the blood. Albumin is adsorbed to a part of the waste product 82 in the blood under a positive pressure as in a living body. For this reason, it is difficult to remove the waste product 82 from the pores 71 of the hollow fiber 70. However, since the waste 82 is easily separated from albumin under negative pressure, it can be expected that the waste 82 is effectively removed.
  • a negative blood pressure detection pillow 213 is connected to the conventional blood purification apparatus 200 shown in FIG.
  • the negative pressure detection pillow 213 is arranged in the blood circulation circuit so that whether or not the negative pressure detection pillow 213 is in an overly negative pressure can be visually checked.
  • the current situation is that medical staff manually handle excessive negative pressure.
  • the pressure sensor 91 attached to the dialysate flow path of the dialyzer 20 does not connect the negative pressure detection pillow 213 to the roller pump 30.
  • the excess negative pressure on the upstream side can be monitored.
  • an automatic measure such as an alarm or stoppage of the roller pump 30 can be performed.
  • the blood purification apparatus according to the first embodiment described above is connected to a blood volume fluctuation apparatus having a function of varying the blood volume flowing into the blood purification apparatus.
  • a blood purification apparatus will be described. Since the blood purification apparatus according to the second embodiment includes many common parts with the blood purification apparatus according to the first embodiment, the common parts are denoted by the same reference numerals, and overlapping thereof. Description is omitted as appropriate.
  • FIG. 4 is a diagram for explaining the necessity of the blood volume fluctuation device connected to the blood purification device according to the second embodiment.
  • FIG. 4 shows an enlarged view of the inside X of the blood inflow side of the dialyzer 20, which is a constituent member of the blood purification apparatus according to the second embodiment.
  • the dialyzer 20 includes blood ports 110 that cover the bundle of hollow fibers 70 at both ends of the blood inflow side and the blood discharge side.
  • the blood inflow side has a funnel shape in which the blood inflow side has a small diameter and the bundle of hollow fibers 70 has a large diameter.
  • the blood that has entered the dialyzer 20 from the flow path 17 spreads inside the blood port 110 and enters the bundle of hollow fibers 70 (in the direction of arrow H).
  • the outside of the bundle of hollow fibers 70 is covered with a cylindrical container (not shown), and the outer wall of the cylindrical container and the inner wall of the blood port 110 are sealed by an O-ring or the like. Because of the need for such a sealing structure, the opening of the blood port 110 is configured to be slightly larger than the bundle of hollow fibers 70.
  • blood heading from the inside of the blood port 110 toward the bundle of hollow fibers 70 tends to form a laminar flow mainly in the region 112 inside the boundary 111 indicated by the dotted line.
  • the staying blood is particularly likely to clot at the downstream end portion of the region 113.
  • the coagulated blood 114 that has been coagulated or has been coagulated extends toward the bundle of hollow fibers 70 and adheres to the opening of the hollow fibers 70. As a result, a part of the hollow fiber 70 is blocked and the blood purification function is lowered.
  • the blood purification apparatus solves this problem, and can maintain the blood purification function of the dialyzer 20 satisfactorily.
  • FIG. 5 shows the configuration of the main part of the blood purification apparatus according to the second embodiment.
  • the blood purification apparatus 100 is an apparatus in which a blood volume fluctuation device 120 is added to the blood purification apparatus 1 according to the first embodiment described above.
  • the blood volume fluctuation device 120 has a function of changing the blood inflow amount into the dialyzer 20, and is preferably attached via a branch pipe 119 connected to a dialysate inflow path 21 which is a dialysate supply line.
  • the blood volume fluctuation device 120 includes a syringe 121 and a drive device (for example, a motor) that drives the piston 122 of the syringe 121.
  • the drive device is controlled so that the piston 122 of the syringe 121 can be reciprocated in both directions indicated by arrows K.
  • the liquid 123 can move in both directions inside and outside the hollow fiber 70 through the permeable membrane of the hollow fiber 70. For this reason, the blood flow velocity flowing through the hollow fiber 70 can be changed by the drawing operation and the inflow operation of the liquid 123 by the blood volume changing device 120.
  • the dialysate is supplied to the dialyzer 20 from the dialysate supply device 90 (see FIG. 3) at a flow rate of 400 ml / min, and the dialysate is discharged from the dialyzer 20 at the same flow rate.
  • the operation of 120 will be described. It is assumed that the roller pump 30 is sending blood at a flow rate of 200 ml / min. In this state, when the piston 122 is pulled so as to draw the liquid 123 into the syringe 121 at a drawing speed of 50 ml / min by the driving device, the blood in the dialyzer 20 has a volume of 50 ml / min. Pressure corresponding to the pull-in speed of min is applied.
  • the flow rate of the roller pump 30 for feeding blood is maintained at 200 ml / min, the flow rate of blood flowing into the dialyzer 20 is 50 ml / min at which the liquid 123 is drawn by the blood volume fluctuation device 120 and the roller pump 30 is used.
  • a flow rate of 200 ml / min for feeding blood is added to 250 ml / min.
  • the piston 122 is pushed by the drive device so that the liquid 123 flows from the syringe 121 side toward the dialyzer 20 at an inflow rate of 200 ml / min
  • the blood in the dialyzer 20 is transferred from the outside of the hollow fiber 70 to the inside.
  • a pressure corresponding to an inflow rate of 200 ml / min is applied. Since the flow rate of feeding blood from the roller pump 30 is maintained at 200 ml / min, the flow rate of blood flowing into the dialyzer 20 is changed from the flow rate of 200 ml / min at which blood is fed by the roller pump 30 to the liquid 123 from the blood volume fluctuation device 120. 0 ml / min minus the inflow rate of 200 ml / min. That is, the inflow of blood from the artery side blood access 10 into the dialyzer 20 is stopped.
  • the blood flow rate from the arterial blood access 10 into the dialyzer 20 alternately repeats 250 ml / min and 0 ml / min. .
  • FIG. 6 is a graph showing an example of a temporal change in the flow rate of the liquid between the blood volume fluctuation device of the blood purification apparatus shown in FIG. 5 and the dialyzer.
  • the inflow speed in the direction in which the liquid is sent to the dialyzer side is positive, and the drawing speed in the opposite direction is negative and is shown on the vertical axis.
  • FIG. 7 is a graph showing an example of the change over time of the blood flow rate flowing into the dialyzer when the change over time of the input / output flow rate shown in FIG. 6 is executed. 6 and 7, the vertical axis represents V (ml / min) and the horizontal axis represents T (sec).
  • the piston 122 is pulled for a time T1 (sec) so that the drawing speed of the liquid 123 becomes 50 ml / min, and then the inflow speed of the liquid 123 into the dialyzer 20 becomes 200 ml / min.
  • the piston 122 is pushed in for a time T2 (sec), and this is repeated alternately.
  • the flow rate of the blood flowing into the dialyzer 20 from the arterial blood access 10 is a kind of one in which 250 ml / min is time T1 (sec) and then 0 ml / min is time T2 (sec). This causes pulse fluctuations.
  • the flow rate of the blood flowing into the dialyzer 20 can be 50 ml / min instead of 0 ml / min.
  • the flow rate of the blood flowing into the dialyzer 20 can be changed in pulses.
  • specific examples of the pull-in operation and the inflow operation are given. Now, assume that the blood flow rate by the roller pump 30 is 200 ml / min, and the fluctuation volume per stroke of the piston 122 is 100 ml.
  • the variable volume per stroke of the piston 122 and the time (frequency) per operation of the piston 122 can be variously changed, but the preferable variable volume is 30 to 100 ml / stroke, and the preferable frequency is 0.5. ⁇ 3 min / times.
  • the fluctuation of the flow velocity of blood flowing into the dialyzer 20 causes turbulent flow in the blood inside the blood port 110 on the blood inflow side of the dialyzer 20, and thereby the blood staying in the region 113 outside the blood port 110.
  • the effect of suppressing blood coagulation is obtained.
  • the drawing speed at which the liquid 123 is drawn from the dialyzer 20 by the drawing operation of the blood volume fluctuation device 120 is smaller than the inflow speed at which the liquid 123 flows into the dialyzer 20 by the inflow operation in the opposite direction.
  • the drawing speed of the liquid 123 is decreased and the inflow speed of the liquid 123 into the dialyzer 20 is increased, the blood viscosity in the dialyzer 20 is not increased excessively and the effect of disturbing the blood in the blood port 110 is further increased. Because it can.
  • the inflow speed of the liquid 123 into the dialyzer 20 can be made relatively higher than the pull-in speed within a range that does not exceed the speed at which blood is fed by the roller pump 30.
  • the drawing speed and the inflow speed may be the same speed or the drawing speed may be increased under the condition that the blood in the dialyzer 20 is not excessively thickened and the blood in the blood port 110 can be disturbed. Is possible.
  • the blood volume fluctuation device 120 can obtain the same effect even when connected to the dialysate discharge path 22 which is a dialysate discharge line, instead of the dialysate supply path 21 which is a dialysate supply line.
  • the blood purification apparatus 200 includes a blood pump 220 on the upstream side of the dialyzer 240, and maintains a constant blood flow rate. For this reason, even if the inflow operation and the draw-in operation of the liquid 123 are alternately repeated in the vicinity of the blood inlet of the dialyzer 240, the blood flow velocity at the blood port portion of the blood inlet does not change. Further, when the inflow speed of the liquid 123 is high, the speed at which blood is returned to the venous blood access 260 becomes too high, and there is a risk of rupture of the veins.
  • the blood volume fluctuation device 120 since the roller pump 30 is disposed on the downstream side of the dialyzer 20, the blood volume fluctuation device 120 alternately performs the drawing operation and the inflow operation. Even if it goes, the blood flow velocity downstream of the roller pump 30 is kept constant without being affected by it. For this reason, even if the fluctuation range of the blood flow rate due to the operation of entering and exiting the liquid 123 is increased, it is not necessary to place a risk of rupture of the veins on the patient. However, if the flow rate of the liquid 123 from the blood volume fluctuation device 120 into the dialyzer 20 is too high, the blood withdrawal amount is reduced, and the removal of the waste product 82 is hindered.
  • the inflow of the liquid 123 into the dialyzer 20 by the blood volume fluctuation device 120 does not exceed the speed at which blood is fed by the roller pump 30. It is preferable to carry out. As long as the liquid 123 is allowed to flow into the dialyzer 20 within such a range, there is no problem in blood flow from the arterial blood access 10 to the dialyzer 20.
  • the inflow speed at which the liquid 123 is allowed to flow into the dialyzer 20 can be increased in a range of 30 ml / min or less than the speed at which blood is fed by the roller pump 30.
  • increasing the flow rate of the liquid 123 into the dialyzer 20 is not usually preferable because it may cause a decrease in the amount of blood drawn.
  • the inflow rate in the range of 30 ml / min or less than the blood flow rate by the roller pump 30 so as not to cause a significant decrease in the amount of blood drawn, the blood in the blood port 110 is directed toward the inlet of the dialyzer 20. It is also possible to prevent blood coagulation effectively by returning to a little.
  • a blood pump other than the roller pump 30 can be used.
  • a drug other than heparin can be used.
  • the anticoagulant injection device 60 is not a type including a syringe 61 but may be a form such as an infusion bag, and the injection amount of the blood anticoagulant 62 may be adjusted.
  • the air mixed in the blood may be removed by means having a form other than the air removing device 40.
  • a member having a balloon-like shape having a diameter larger than that of the flow path 35 and capable of storing air above may be connected to the blood circulation circuit 2.
  • the form of the blood volume fluctuation device 120 is not limited to the one provided with the syringe 121, and may be any form as long as the liquid 123 can be introduced into the dialyzer 20 side and the liquid 123 can be drawn from the dialyzer 20 side. .
  • Example 1 A dialyzer manufactured by Asahi Kasei Kuraray Medical Co., Ltd. as a dialyzer 20 (product name: APS-25SA, dialysis membrane area) so as to have the same configuration as that of the blood purification apparatus 1 shown in FIG. : 2.5 m 2 ) and the reassembled blood circuit H-702FBX manufactured by Toray Medical Co., Ltd. Connected to the upstream side of the dialyzer 20 was a syringe 20 ml containing 500 units / ml for blood anticoagulant heparin Na dialyzed by Nipro Corporation. In addition, a dialysis patient monitoring device (product name: TR-3000) manufactured by Toray Medical Co., Ltd. was used.
  • TR-3000 dialysis patient monitoring device manufactured by Toray Medical Co., Ltd.
  • a dialyzer 240 As a dialyzer 240, a dialyzer manufactured by Asahi Kasei Kuraray Medical Co., Ltd. (product name: APS-25SA, dialysis membrane area: 2.5 m 2 ) so as to have the same configuration as that of the blood purification device 200 shown in FIG. And a blood circuit H-702FBX manufactured by Toray Medical Co., Ltd., and 500 units / ml for blood anticoagulant heparin Na dialyzed by Nipro Co., Ltd. are placed between the dialyzer 240 and the blood pump 220. A 20 ml syringe was connected. Moreover, the same apparatus as Example 1 was used for the dialysis patient monitoring apparatus.
  • the conditions were the same as in Example 1 except for the increase.
  • Example 1 and Comparative Example 1 The dialysis evaluation of Example 1 and Comparative Example 1 was performed based on the rate of decrease (%) of ⁇ 1 microGLB (molecular weight: 33000) before and after dialysis.
  • Example 1 As a result, in Example 1, ⁇ 1 microGLB before dialysis was 133.7 mg / dl, ⁇ 1-microGLB after dialysis was 121.7 mg / dl, and the decrease rate before and after dialysis was about 9.0%. there were. In contrast, in Comparative Example 1, the ⁇ 1 microGLB before dialysis was 138.7 mg / dl, the ⁇ 1-microGLB after dialysis was 128.0 mg / dl, and the rate of decrease before and after dialysis was about 7.7. %Met. This result means that even when Example 1 has a heparin Na injection amount smaller than that of Comparative Example 1, the removal efficiency of ⁇ 1 microGLB in hemodialysis is higher. Therefore, in the case of the blood purification apparatus of Example 1, it is considered that the blood anticoagulant can be reduced without hindrance.
  • the present invention can be used as an apparatus for purifying blood, for example, an apparatus for performing each treatment of hemodialysis and plasma exchange.

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  • Health & Medical Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Biomedical Technology (AREA)
  • Engineering & Computer Science (AREA)
  • Anesthesiology (AREA)
  • Cardiology (AREA)
  • Hematology (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
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Abstract

La présente invention concerne un dispositif et un procédé de purification du sang grâce auxquels il est possible de réduire la quantité d'anticoagulant sanguin. L'invention consiste en un dispositif de purification du sang (1) pour prélever du sang et ensuite le retourner purifié, ledit dispositif de purification du sang (1) comprenant : un circuit permettant au sang de circuler (2) doté d'un purificateur du sang (20) pour dialyser le sang afin de réduire les produits déchets et pour charger le sang dialysé depuis l'extérieur ; une pompe à sang (30) pour transférer le sang au sein du circuit de circulation du sang (2) ; et un dispositif d'introduction d'un anticoagulant (60) pour mélanger dans le sang un anticoagulant sanguin (62) qui empêche la coagulation du sang. Le purificateur du sang (20) est placé sous pression négative en amont de la pompe à sang (30).
PCT/JP2011/003698 2010-06-29 2011-06-29 Dispositif et procédé de purification du sang Ceased WO2012001961A1 (fr)

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Cited By (2)

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CN102716518A (zh) * 2012-06-21 2012-10-10 重庆山外山科技有限公司 带枸橼酸抗凝装置的血液净化设备
CN110769870A (zh) * 2017-06-14 2020-02-07 费森尤斯医疗护理德国有限责任公司 用于将抗凝剂添加到患者血液中的方法和装置

Families Citing this family (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN105214157B (zh) * 2015-11-02 2017-06-30 珠海健帆生物科技股份有限公司 血液净化装置及系统
CN106110750B (zh) * 2016-08-15 2018-10-16 鲁绍荣 一种高效血液回收机
CN111202880A (zh) * 2020-02-03 2020-05-29 深圳汉诺医疗科技有限公司 一种净化血液的净化柱、装置及方法

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JPH11262521A (ja) * 1997-12-09 1999-09-28 Hospal Ind 体外血液処置の経過を示すパラメータを判定する方法
JPH11276575A (ja) * 1998-03-26 1999-10-12 Sanyo Electric Works Ltd 血液体外循環装置
JP2003093503A (ja) * 2001-09-25 2003-04-02 Jms Co Ltd 血液回路自動脱気システム
JP2004510521A (ja) * 2000-10-12 2004-04-08 リナル・ソリューションズ・インコーポレーテッド 体外流体処理時における体液の流れを制御する装置及び方法

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JPH05506788A (ja) * 1989-06-20 1993-10-07 ザ　ボード　オブ　リージェンツ　オブ　ザ　ユニヴァーシティ　オブ　ワシントン 血液濾過および血液透析組み合わせ装置
JPH11262521A (ja) * 1997-12-09 1999-09-28 Hospal Ind 体外血液処置の経過を示すパラメータを判定する方法
JPH11276575A (ja) * 1998-03-26 1999-10-12 Sanyo Electric Works Ltd 血液体外循環装置
JP2004510521A (ja) * 2000-10-12 2004-04-08 リナル・ソリューションズ・インコーポレーテッド 体外流体処理時における体液の流れを制御する装置及び方法
JP2003093503A (ja) * 2001-09-25 2003-04-02 Jms Co Ltd 血液回路自動脱気システム

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN102716518A (zh) * 2012-06-21 2012-10-10 重庆山外山科技有限公司 带枸橼酸抗凝装置的血液净化设备
CN110769870A (zh) * 2017-06-14 2020-02-07 费森尤斯医疗护理德国有限责任公司 用于将抗凝剂添加到患者血液中的方法和装置

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CN102438675B (zh) 2014-09-17
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