JP2013135802A - Separation, solution return and blood return apparatus - Google Patents

Separation, solution return and blood return apparatus Download PDF

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JP2013135802A
JP2013135802A JP2011288807A JP2011288807A JP2013135802A JP 2013135802 A JP2013135802 A JP 2013135802A JP 2011288807 A JP2011288807 A JP 2011288807A JP 2011288807 A JP2011288807 A JP 2011288807A JP 2013135802 A JP2013135802 A JP 2013135802A
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JP5951252B2 (en
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Masanori Niiyama
正徳 新山
Hiromi Yamazaki
博実 山崎
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Nikkiso Co Ltd
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Abstract

PROBLEM TO BE SOLVED: To provide an apparatus capable of continuously separating blood from an isotonic solution containing the blood due to bleeding, condensing the blood and returning the condensed blood to a patient.SOLUTION: The separation, solution return and blood return apparatus 100 separates the isotonic solution 15 from a mixed solution 17 containing the blood 16 extracted from the abdominal cavity 10 of a patient and the isotonic solution 15, returns the isotonic solution 15 to the abdominal cavity 10 of the patient, and returns the blood 16 to the blood vessel. The apparatus performs, in parallel, extraction of the mixed solution 17 from the abdominal cavity 10, return of the isotonic solution 15 to the abdominal cavity 10, and return of the blood 16 to the patient.

Description

本発明は、体腔内から取り出した血液と等張液との混合液を処理して等張液と血液とを生体に戻す分離返液返血装置の構造に関する。   The present invention relates to a structure of a separating and returning blood return device that processes a mixed solution of blood and isotonic solution taken out from a body cavity to return the isotonic solution and blood to a living body.

内視鏡による手術は医学分野で急速に発展している技術である。この手術は開腹手術に比べて傷が小さく、患者の回復が早いことが特徴である。一方、内視鏡を用いた手術では腹腔を膨らませなければならない。現在、腹腔を膨らませる技術としては、無水炭酸ガスを使用する方法と、生理食塩水のような等張液を使用する方法とがある。ガスを使用する方法は、二酸化炭素が血中に入り込んだり、内臓が乾燥したりするという問題があり、このような問題を解決するために、等張液を腹腔に充填して手術を行う腹腔内液充填手術がある（例えば、特許文献１参照）。   Endoscopic surgery is a rapidly developing technology in the medical field. This surgery is characterized by smaller wounds and faster patient recovery than open surgery. On the other hand, in surgery using an endoscope, the abdominal cavity must be inflated. Currently, techniques for inflating the abdominal cavity include a method using anhydrous carbon dioxide gas and a method using an isotonic solution such as physiological saline. The method using gas has the problem that carbon dioxide gets into the blood and the internal organs are dried. To solve such problems, the abdominal cavity is filled with an isotonic solution to perform surgery. There is an internal fluid filling operation (see, for example, Patent Document 1).

一方、手術中に患者が出血を起こす場合がある。この場合、出血量が多くなると患者に輸血が必要となってくる。そこで、出血した血液を患者から回収し、洗浄して患者に返血する方法が提案されている。このような装置は、患者から吸い込んだ血液に洗浄液を混合した後、フィルタによって空気泡や比較的大きな粒子を除去し、膜フィルタを通してヘマトクリット値が患者への返血が可能となる程度の血液を抽出し、患者に返血するものである（例えば、特許文献２，３参照）。   On the other hand, patients may bleed during surgery. In this case, if the amount of bleeding increases, the patient needs to be transfused. Therefore, a method has been proposed in which the bleeding blood is collected from the patient, washed and returned to the patient. Such a device mixes cleaning fluid with blood drawn from the patient, then removes air bubbles and relatively large particles with a filter, and passes blood with a hematocrit value that can be returned to the patient through the membrane filter. Extracted and returned to the patient (see, for example, Patent Documents 2 and 3).

特許第３３０１６１４号公報Japanese Patent No. 3316614 特許第３０１２６８９号公報Japanese Patent No. 3012689 特開２０００−２１７９０８号公報JP 2000-217908 A

ところで、引用文献１に記載されたように、人体の腹腔内に等張液を入れて内視鏡によって手術を行う場合でも、手術中に出血が発生する場合がある。この場合、出血した血液は腹腔内に満たされている等張液ににごりを生じさせて、内視鏡の視野が妨げられ、手術の継続が困難になる場合が多い。このような場合、従来は、腹腔の中に充満させている等張液を交換したり、出血した血液を含む等張液を還流し、出血した血液をフィルタで分離し、血液を患者に戻したりする方法が用いられている。   By the way, as described in Cited Document 1, even when an isotonic solution is placed in the abdominal cavity of a human body and an operation is performed by an endoscope, bleeding may occur during the operation. In this case, the blood that has bleed often causes turbidity in the isotonic solution filled in the abdominal cavity, obstructing the visual field of the endoscope, and making it difficult to continue the operation in many cases. In such a case, conventionally, the isotonic solution filled in the abdominal cavity is replaced, the isotonic solution containing the bleeding blood is refluxed, the bleeding blood is separated by a filter, and the blood is returned to the patient. Method is used.

一方、血液を人体に戻す場合には、そのヘマトクリット値を、例えば、４０％程度まで高めるように、血液の濃縮を行う必要があるが、ヘマトクリット値（血球濃度）の低い血液を人体に返血できる程度のヘマトクリット値まで高めるには、別途設置した血液濃縮機などが必要となり、タイムリーに患者に返血することができないという問題があった。   On the other hand, when returning blood to the human body, it is necessary to concentrate the blood so that the hematocrit value is increased to, for example, about 40%, but blood with a low hematocrit value (blood cell concentration) is returned to the human body. In order to increase the hematocrit level to a level that is possible, a blood concentrator installed separately is required, and there is a problem that blood cannot be returned to the patient in a timely manner.

そこで、本発明は、出血による血液を含む等張液から連続的に血液を分離、濃縮して患者に返血することを目的とする。   Therefore, an object of the present invention is to continuously separate and concentrate blood from an isotonic solution containing blood due to bleeding and return the blood to a patient.

本発明の分離返液返血装置は、体腔内から取り出した血液と等張液の混合液から等張液を分離し、等張液は前記混合液を取り出した体腔内に返液し、血液は血管に返血する分離返液返血装置であって、
体腔内からの混合液の取り出しと、等張液の体腔内への返液と、血液の血管への返血とを平行して行うこと、を特徴とする。 The separation and return device of the present invention separates an isotonic solution from a mixture of blood and isotonic solution removed from the body cavity, and the isotonic solution returns to the body cavity from which the mixture solution has been removed, and blood Is a separation and return device that returns blood to the blood vessels.
The extraction of the mixed solution from the body cavity, the return of the isotonic solution into the body cavity, and the return of blood to the blood vessel are performed in parallel.

本発明の分離返液返血装置において、体腔内から取り出した血液と等張液の混合液から等張液を分離するフィルタと、前記フィルタに流入する前記混合液の流量を規定する第１のポンプと、前記フィルタから流出する血液のヘマトクリット値を検出する血液モニタと、前記血液モニタによって検出したヘマトクリット値に基づいて前記フィルタから流出する血液の量を増減する第２のポンプと、を備えること、としても好適である。   In the separation liquid return device of the present invention, a filter that separates an isotonic solution from a mixture of blood and isotonic solution extracted from the body cavity, and a first flow rate that regulates a flow rate of the mixed solution flowing into the filter. A pump, a blood monitor that detects a hematocrit value of blood flowing out of the filter, and a second pump that increases or decreases the amount of blood flowing out of the filter based on the hematocrit value detected by the blood monitor. And is also suitable.

本発明の分離返液返血装置の制御方法は、体腔内から取り出した血液と等張液の混合液から等張液を分離するフィルタと、前記フィルタに流入する前記混合液の流量を規定する第１のポンプと、前記フィルタから流出する血液のヘマトクリット値を検出する血液モニタと、前記血液モニタによって検出したヘマトクリット値に基づいて前記フィルタから流出する血液の量を増減する第２のポンプと、を備え、体腔内から取り出した血液と等張液の混合液から等張液を分離し、等張液は前記混合液を取り出した体腔内に返液し、血液は血管に返血する分離返液返血装置の制御方法であって、前記第２のポンプの流量が所定の流量に達したら返血を停止すること、を特徴とする。   The control method of the separation and return apparatus of the present invention defines a filter that separates isotonic fluid from a mixture of blood and isotonic fluid that has been removed from the body cavity, and a flow rate of the mixed fluid that flows into the filter. A first pump; a blood monitor that detects a hematocrit value of blood flowing out of the filter; a second pump that increases or decreases the amount of blood flowing out of the filter based on the hematocrit value detected by the blood monitor; The isotonic solution is separated from the mixture of blood and isotonic solution removed from the body cavity, the isotonic solution is returned to the body cavity from which the mixture solution has been removed, and the blood is returned to the blood vessel. A method for controlling a liquid return apparatus, wherein the blood return is stopped when the flow rate of the second pump reaches a predetermined flow rate.

本発明の分離返液返血装置の制御方法において、前記第２のポンプは、前記フィルタの血液流出側に取り付けられ、前記所定の流量は、第２のポンプの最低流量であること、としても好適であるし、前記第２のポンプは、前記フィルタの等張液の流出側に取り付けられ、前記所定の流量は、第１のポンプの運転流量であること、としても好適である。   In the method for controlling the separation and return apparatus of the present invention, the second pump is attached to the blood outflow side of the filter, and the predetermined flow rate is the minimum flow rate of the second pump. Preferably, the second pump is attached to the isotonic liquid outflow side of the filter, and the predetermined flow rate is an operation flow rate of the first pump.

本発明は、出血による血液を含む等張液から連続的に血液を分離、濃縮して患者に返血することができるという効果を奏する。   The present invention has an effect that blood can be continuously separated from an isotonic solution containing blood due to bleeding, concentrated and returned to the patient.

本発明の実施形態における分離返液返血装置の構成を示す系統図である。It is a systematic diagram which shows the structure of the separation liquid return apparatus in embodiment of this invention. 本発明の実施形態における分離返液返血装置の第２のポンプの流量の変化を示すグラフである。It is a graph which shows the change of the flow volume of the 2nd pump of the isolation | separation return liquid return apparatus in embodiment of this invention. 本発明の実施形態における分離返液返血装置のタンクと腹腔内のヘマトクリット濃度の変化を示すグラフである。It is a graph which shows the change of the hematocrit density | concentration in the tank and the abdominal cavity of the isolation | separation return liquid return apparatus in embodiment of this invention. 本発明の他の実施形態における分離返液返血装置の構成を示す系統図である。It is a systematic diagram which shows the structure of the separation liquid return apparatus in other embodiment of this invention. 本発明の他の実施形態における分離返液返血装置の第２のポンプの流量の変化を示すグラフである。It is a graph which shows the change of the flow volume of the 2nd pump of the separation liquid return apparatus in other embodiment of this invention.

以下、本発明の実施形態について図面を参照しながら説明する。図１に示すように、本発明の実施形態の分離返液返血装置１００は、体腔である患者の腹腔１０に差し込まれた内視鏡手術用のトロッカー１１の充填液出口１２から腹腔１０の中に充填されている等張液１５と血液１６が混合した第１の混合液１７を吸い出してフィルタ２０に送る第１のポンプ５１と、第１の混合液１７から等張液１５を分離して所定のヘマトクリット値の第２の混合液１８を流出するフィルタ２０と、フィルタ２０によって分離された等張液１５を腹腔１０に戻す返液流路２３と、フィルタ２０から流出する第２の混合液１８の流量を規定する第２のポンプ５２と、第２の混合液１８のヘマトクリット値を検出する血液モニタ５６と、第２の混合液１８を貯留するタンク６０と、タンク６０に溜まった第２の混合液１８を血液として患者に返血する返血流路４３と、返血流路４３を開閉する返血弁４８と、第１、第２のポンプ５１，５２の流量の増減及び返血弁４８の開閉を行うと共に、血液モニタ５６の検出信号が入力される制御部７０とを含んでいる。制御部７０は、内部に演算を行うＣＰＵとプログラムや制御データを格納するメモリを含むコンピュータである。なお、図１では、各流路あるいは管を流れる流体の流れの方向を矢印で示し、その矢印に流れている流体の種類の符号を付して、各流路あるいは管を流れる流体の流れの方向と種類を示す。例えば、図１の返液流路２３に沿って記載された矢印には符号１５が付されているが、これは、返液流路２３を流れる流体が等張液１５であることを示す。以下、同様に、矢印に付された符号１７，１８はそれぞれ第１の混合液１７、第２の混合液１８の流れの方向を示す。   Hereinafter, embodiments of the present invention will be described with reference to the drawings. As shown in FIG. 1, the separation and return apparatus 100 according to the embodiment of the present invention is configured such that the abdominal cavity 10 is inserted from a filling liquid outlet 12 of an endoscopic surgical trocar 11 inserted into a patient's abdominal cavity 10 which is a body cavity. The isotonic solution 15 is separated from the first pump 51 and the first pump 51 that sucks the first mixed solution 17 mixed with the isotonic solution 15 and the blood 16 filled therein and sends it to the filter 20. A filter 20 that flows out the second mixed liquid 18 having a predetermined hematocrit value, a return flow path 23 that returns the isotonic liquid 15 separated by the filter 20 to the abdominal cavity 10, and a second mixture that flows out of the filter 20. A second pump 52 that regulates the flow rate of the liquid 18, a blood monitor 56 that detects a hematocrit value of the second mixed liquid 18, a tank 60 that stores the second mixed liquid 18, and a first reservoir that has accumulated in the tank 60. 2 mixture 18 A blood return channel 43 that returns blood to the patient as a liquid, a blood return valve 48 that opens and closes the blood return channel 43, increases and decreases the flow rates of the first and second pumps 51 and 52, and opens and closes the blood return valve 48. And a control unit 70 to which a detection signal of the blood monitor 56 is input. The control unit 70 is a computer that includes a CPU that performs calculations therein and a memory that stores programs and control data. In FIG. 1, the flow direction of the fluid flowing through each flow path or pipe is indicated by an arrow, and the type of the fluid flowing through the arrow is marked with the arrow to indicate the flow of the fluid flowing through each flow path or pipe. Indicates direction and type. For example, the reference numeral 15 is attached to the arrow written along the liquid return flow path 23 in FIG. 1, which indicates that the fluid flowing through the liquid return flow path 23 is the isotonic liquid 15. Hereinafter, similarly, reference numerals 17 and 18 attached to arrows indicate the flow directions of the first mixed liquid 17 and the second mixed liquid 18, respectively.

トロッカー１１の充填液出口１２と第１のポンプ５１の入り口とは第１のポンプ入り口管２１によって接続され、第１のポンプ５１とフィルタ２０とは第１のポンプ出口管２２で接続され、フィルタ２０の出口にはフィルタ出口管３１が接続され、フィルタ出口管３１には第２のポンプ５２が接続され、第２のポンプ５２の出口に接続された第２のポンプ出口管３２はタンク６０に接続されている。また、第２のポンプ出口管３２には第２混合液１８のヘマトクリット値を検出する血液モニタ５６が取り付けられている。   The filling liquid outlet 12 of the trocar 11 and the inlet of the first pump 51 are connected by a first pump inlet pipe 21, and the first pump 51 and the filter 20 are connected by a first pump outlet pipe 22, and the filter A filter outlet pipe 31 is connected to the outlet 20, a second pump 52 is connected to the filter outlet pipe 31, and a second pump outlet pipe 32 connected to the outlet of the second pump 52 is connected to the tank 60. It is connected. A blood monitor 56 for detecting the hematocrit value of the second mixed liquid 18 is attached to the second pump outlet pipe 32.

第１、第２のポンプ５１，５２は例えば、蠕動ポンプなどのポンプであり、フィルタ２０は、中空糸膜フィルタなどの膜フィルタであって、血球をフィルタリングすることができるものである。また、トロッカー１１は、円筒形状を有し、その中空部に手術用器具１４または内視鏡（図示せず）を挿入して、液で充填された腹腔内で内視鏡手術を行うことができるものである。   The first and second pumps 51 and 52 are, for example, peristaltic pumps, and the filter 20 is a membrane filter such as a hollow fiber membrane filter, which can filter blood cells. The trocar 11 has a cylindrical shape, and an endoscopic operation can be performed in the abdominal cavity filled with the liquid by inserting a surgical instrument 14 or an endoscope (not shown) into the hollow portion. It can be done.

以上のように構成された、分離返液返血装置１００の動作について、以下に説明する。腹腔１０の中に浸透圧が血液と同一の等張液である生理食塩水を充填し、手術用器具１４によって手術をしている最中に出血が発生すると、出血した血液１６は腹腔１０の中に広がり、腹腔１０に充填された等張液１５は血液１６が混合した第１の混合液１７となる。第１の混合液１７は血球が含まれているので、トロッカー１１に挿入された内視鏡の視野を妨げ、手術を続行することが困難となってくる。このような等張液１５と血液１６の混合した第１の混合液１７は、トロッカー１１の充填液出口１２からポンプ入り口管２１を通って第１のポンプ５１に吸い込まれ、第１のポンプ５１によって加圧されてフィルタ２０に流入する。   The operation of the separation liquid return device 100 configured as described above will be described below. When the abdominal cavity 10 is filled with a physiological saline that is an isotonic solution having the same osmotic pressure as blood, and bleeding occurs during the operation with the surgical instrument 14, the blood 16 that has bleed is stored in the abdominal cavity 10. The isotonic solution 15 that spreads inside and fills the abdominal cavity 10 becomes the first mixed solution 17 in which the blood 16 is mixed. Since the first liquid mixture 17 contains blood cells, the visual field of the endoscope inserted into the trocar 11 is obstructed, making it difficult to continue the operation. The first mixed liquid 17 in which the isotonic liquid 15 and the blood 16 are mixed is sucked into the first pump 51 from the filling liquid outlet 12 of the trocar 11 through the pump inlet pipe 21, and the first pump 51. Is pressurized and flows into the filter 20.

フィルタ２０に流入する第１の混合液１７の流量は、第１のポンプ５１の流量Ｆ１によって規定される。フィルタ２０で分離される等張液１５の流量と、フィルタ２０から流出する第２の混合液１８の流量及び第２の混合液１８のヘマトクリット値は、第２のポンプ５２の流量Ｆ２によって規定される。つまり、フィルタ２０で分離される等張液１５の流量は、Ｆ１−Ｆ２であり、第２の混合液１８のヘマトクリット値は、第１の混合液１７のヘマトクリット値の（Ｆ１／Ｆ２）倍となる。例えば、Ｆ１＝１００、Ｆ２＝５０の場合には、腹腔１０に返液される等張液１５は第１のポンプ５１の流量の半分（１００−５０＝５０）であり、第２の混合液１８のヘマトクリット値は第１の混合液のヘマトクリット値の１００／５０＝２、つまり２倍となる。   The flow rate of the first liquid mixture 17 flowing into the filter 20 is defined by the flow rate F 1 of the first pump 51. The flow rate of the isotonic solution 15 separated by the filter 20, the flow rate of the second mixed solution 18 flowing out from the filter 20, and the hematocrit value of the second mixed solution 18 are defined by the flow rate F 2 of the second pump 52. The That is, the flow rate of the isotonic solution 15 separated by the filter 20 is F1-F2, and the hematocrit value of the second mixed solution 18 is (F1 / F2) times the hematocrit value of the first mixed solution 17. Become. For example, when F1 = 100 and F2 = 50, the isotonic solution 15 returned to the abdominal cavity 10 is half the flow rate of the first pump 51 (100−50 = 50), and the second mixed solution The hematocrit value of 18 is 100/50 = 2, that is, twice the hematocrit value of the first mixed liquid.

このように、フィルタ２０から流出する第２の混合液１８のヘマトクリット値は、第１のポンプ５１の流量Ｆ１と第２のポンプ５２の流量Ｆ２との比率となる。従って、例えば、第１の混合液１７のヘマトクリット値が１０％の場合、第２の混合液１８のヘマトクリット値を患者に返血できるような４０％程度とするためには、第２のポンプ５２の流量Ｆ２は、第１のポンプ５１の流量の１／４とすればよいこととなる。   Thus, the hematocrit value of the second mixed liquid 18 flowing out from the filter 20 is a ratio between the flow rate F1 of the first pump 51 and the flow rate F2 of the second pump 52. Therefore, for example, when the hematocrit value of the first liquid mixture 17 is 10%, the second pump 52 is used to set the hematocrit value of the second liquid mixture 18 to about 40% so that blood can be returned to the patient. The flow rate F <b> 2 may be ¼ of the flow rate of the first pump 51.

一方、腹腔１０の中のヘマトクリット値は、第１の混合液１７が取り出されて、等張液１５が返液流路２３からトロッカー１１の充填液入り口１３から流入してくるので、時間とともに次第に減少してくる。このため、第２のポンプ５２から流出する第２の混合液１８のヘマトクリット値を４０％程度の一定値に保つためには、図２に示すように、時間と共に第２のポンプ５２の流量をＦ２１からＦ２０に減少させていけばよい。   On the other hand, the hematocrit value in the abdominal cavity 10 is gradually increased with time because the first mixed solution 17 is taken out and the isotonic solution 15 flows from the return channel 23 through the filling solution inlet 13 of the trocar 11. It will decrease. Therefore, in order to keep the hematocrit value of the second mixed liquid 18 flowing out from the second pump 52 at a constant value of about 40%, as shown in FIG. 2, the flow rate of the second pump 52 is changed with time. What is necessary is just to reduce from F21 to F20.

第１のポンプ５１の流量Ｆ１が一定で、第２の混合液１８のヘマトクリット値を第１の閾値Ｈｔ2に保つためには、第１の混合液１７のヘマトクリット値をＨｔ1として、第２のポンプ５２の流量Ｆ２は、
Ｆ２＝（Ｈｔ1／Ｈｔ2）×Ｆ１＝Ｃ×Ｈｔ1 （ここで、Ｃは定数）
となる。つまり、第２のポンプ５２の流量Ｆ２は、腹腔１０の中の第１の混合液１７のヘマトクリット値Ｈｔ1に比例して減少されればよいこととなる。しかし、第１の混合液１７のヘマトクリット値Ｈｔ1がどのように変化するかを予測することはむずかしいことから、本実施形態では、第２のポンプ５２の出口に第２の混合液１８のヘマトクリット値を検出する血液モニタ５６を取り付け、この血液モニタ５６の検出値を制御部７０でフィードバックして第２のポンプ５２の流量を増減し、第２の混合液のヘマトクリット値が略Ｈｔ2となるようにしている。 In order to keep the flow rate F1 of the first pump 51 constant and the hematocrit value of the second mixed liquid 18 at the first threshold value Ht 2 , the hematocrit value of the first mixed liquid 17 is set to Ht 1 , The flow rate F2 of the pump 52 is
F2 = (Ht 1 / Ht 2 ) × F1 = C × Ht 1 (where C is a constant)
It becomes. That is, the flow rate F2 of the second pump 52 only needs to be reduced in proportion to the hematocrit value Ht 1 of the first mixed liquid 17 in the abdominal cavity 10. However, since it is difficult to predict how the hematocrit value Ht 1 of the first liquid mixture 17 changes, in this embodiment, the hematocrit of the second liquid mixture 18 is discharged to the outlet of the second pump 52. A blood monitor 56 for detecting the value is attached, and the detected value of the blood monitor 56 is fed back by the control unit 70 to increase or decrease the flow rate of the second pump 52, so that the hematocrit value of the second liquid mixture becomes substantially Ht 2. I am doing so.

この場合、図３に示すように、第２のポンプ５２から流出してタンク６０に溜まる第２の混合液１８のヘマトクリット値は、第１の閾値Ｈｔ2略一定となり、腹腔１０のヘマトクリット値は最初のＨｔ1から次第に低下してくる。 In this case, as shown in FIG. 3, the hematocrit value of the second liquid mixture 18 that flows out of the second pump 52 and accumulates in the tank 60 becomes substantially constant at the first threshold value Ht 2, and the hematocrit value of the abdominal cavity 10 is It gradually decreases from the first Ht 1 .

一方、第２のポンプ５２の流量はある範囲で調整できるが、調整することのできる最低流量が存在する。そして、図２の時間ｔ0には、第２のポンプ５２の流量は最低流量のＦ２０に達してしまう。この後も、腹腔１０の中の第１の混合液１７のヘマトクリット値はしだいに低下してくるので、フィルタ２０から流出する第２の混合液１８のヘマトクリット値は図３の時間ｔ0以降に示すように、第１の閾値Ｈｔ2から次第に低くなってくる。このように、第２の混合液１８のヘマトクリット値が第１の閾値Ｈｔ2よりも低くなってくると、第２の混合液１８を血液として患者に返血できなくなってくる。そこで、時間ｔ0になると、制御部７０は、返血弁４８を開としてタンク６０に溜まったヘマトクリット値が第１の閾値Ｈｔ2となっている第２の混合液１８を血液として患者の血管に返血し、その後にタンク６０に溜まった第２の混合液１８は、別の血液濃縮機に送り、別途、返血できる程度までヘマトクリット値を上昇させてから患者の血管に返血する。 On the other hand, the flow rate of the second pump 52 can be adjusted within a certain range, but there is a minimum flow rate that can be adjusted. At time t 0 in FIG. 2, the flow rate of the second pump 52 reaches the minimum flow rate F20. After this, since the hematocrit value of the first mixed solution 17 in the abdominal cavity 10 gradually decreases, the hematocrit value of the second mixed solution 18 flowing out from the filter 20 becomes after time t 0 in FIG. shown way, becomes gradually lower from the first threshold value Ht 2. As described above, when the hematocrit value of the second mixed solution 18 becomes lower than the first threshold value Ht 2 , the second mixed solution 18 cannot be returned to the patient as blood. Therefore, at time t 0 , the control unit 70 opens the blood return valve 48 and the patient's blood vessel using the second liquid mixture 18 in which the hematocrit value accumulated in the tank 60 is the first threshold value Ht 2 as blood. The second mixed liquid 18 collected in the tank 60 after that is sent to another blood concentrator, and the hematocrit value is increased to the extent that blood can be returned separately, and then returned to the patient's blood vessel.

以上説明したように、本実施形態では出血による血液を含む等張液から連続的に血液を分離、濃縮して患者に返血することができるという効果を奏する。   As described above, in the present embodiment, there is an effect that blood can be continuously separated and concentrated from an isotonic solution containing blood due to bleeding and returned to the patient.

また、本実施形態では、第２のポンプ５２の流量を低減することによってＦ１／Ｆ２の比率を高め、第２の混合液１８のヘマトクリット値を第１の閾値Ｈｔ2一定に保つこととして説明したが、第１の混合液１７にヘマトクリット値Ｈｔ1を測定し、それによって第２のポンプ５２の流量Ｆ２を低減してもよいし、第１のポンプ５１の流量Ｆ１の増加と第２のポンプ５２の流量Ｆ２の減少とを同時に行い、よりタイムリーに血液を患者の血管に返血するようにしてもよい。なお、上記実施形態において、体腔として患者の腹腔１０に等張液を充填して内視鏡手術を行う場合について説明したが、腹腔１０に限るものではなく、体腔であれば本発明を適用可能である。また、本発明は、人間に限らず、動物の内視鏡手術にも適用可能である。 Further, in the present embodiment, increasing the ratio of F1 / F2 by reducing the flow rate of the second pump 52 has been described as keeping the hematocrit value of the second mixture 18 to the first threshold value Ht 2 constant May measure the hematocrit value Ht 1 in the first liquid mixture 17, thereby reducing the flow rate F 2 of the second pump 52, and increasing the flow rate F 1 of the first pump 51 and the second pump. It is also possible to simultaneously reduce the flow rate F2 of 52 and return the blood to the patient's blood vessel in a more timely manner. In the above embodiment, the case where the patient's abdominal cavity 10 is filled with an isotonic solution as the body cavity and the endoscopic operation is performed has been described. However, the present invention is not limited to the abdominal cavity 10 and can be applied to any body cavity. It is. Moreover, the present invention is applicable not only to humans but also to endoscopic surgery on animals.

なお、本実施形態では、第２のポンプ５２は、フィルタ出口管３１に設けられていることとして説明したが、フィルタ２０から流出する血液の量は、第１のポンプ５１と返液流路２３を流れる等張液１５の流量の差となることから、図４に示すように第２のポンプ５２を返液流路２３に設けるように構成してもよい。この場合、第２の混合液１８のヘマトクリット値を第１の閾値Ｈｔ2一定に保つためには、先に説明した実施形態とは逆に、図５に示すように、第２のポンプ５２の流量を時間とともに増加させていくことが必要となる。そして、第２のポンプ５２の流量Ｆ２が第１のポンプ５１の運転流量Ｆ１と略同じ流量になった場合には、それ以上の血液の濃縮はできなくなるので、返血を停止する。 In the present embodiment, the second pump 52 is described as being provided in the filter outlet pipe 31, but the amount of blood flowing out of the filter 20 is the same as that of the first pump 51 and the return flow path 23. Therefore, the second pump 52 may be provided in the liquid return flow path 23 as shown in FIG. In this case, in order to keep the hematocrit value of the second liquid mixture 18 constant at the first threshold value Ht 2 , as shown in FIG. It is necessary to increase the flow rate with time. When the flow rate F2 of the second pump 52 becomes substantially the same as the operation flow rate F1 of the first pump 51, the blood cannot be concentrated any more, so the return of blood is stopped.

１０ 腹腔、１１ トロッカー、１２ 充填液出口、１３ 充填液入り口、１４ 手術用器具、１５ 等張液、１６ 血液、１７ 第１の混合液、１８ 第２の混合液、２０ フィルタ、２１ 第１のポンプ入り口管、２２ 第１のポンプ出口管、２３ 返液流路、３１ フィルタ出口管、３２ 第２のポンプ出口管、４３ 返血流路、４８ 返血弁、５１ 第１のポンプ、５２ 第２のポンプ、５６ 血液モニタ、６０ タンク、７０ 制御部、１００ 分離返液返血装置、Ｈｔ2 閾値。 10 abdominal cavity, 11 trocar, 12 filling liquid outlet, 13 filling liquid inlet, 14 surgical instrument, 15 isotonic liquid, 16 blood, 17 first mixed liquid, 18 second mixed liquid, 20 filter, 21 first Pump inlet pipe, 22 first pump outlet pipe, 23 liquid return flow path, 31 filter outlet pipe, 32 second pump outlet pipe, 43 blood return flow path, 48 blood return valve, 51 first pump, 52 2 pumps, 56 blood monitor, 60 tanks, 70 control unit, 100 separation return blood return device, Ht 2 threshold.

Claims (5)

体腔内から取り出した血液と等張液の混合液から等張液を分離し、等張液は前記混合液を取り出した体腔内に返液し、血液は血管に返血する分離返液返血装置であって、
体腔内からの混合液の取り出しと、等張液の体腔内への返液と、血液の血管への返血とを平行して行うこと、を特徴とする分離返液返血装置。 The isotonic solution is separated from the mixture of blood and isotonic solution removed from the body cavity, the isotonic solution is returned to the body cavity from which the mixture solution has been removed, and the blood is returned to the blood vessel. A device,
A separation and return blood return apparatus characterized in that the liquid mixture is extracted from the body cavity, the isotonic liquid is returned to the body cavity, and the blood is returned to the blood vessels in parallel. 請求項１に記載の分離返液返血装置であって、
体腔内から取り出した血液と等張液の混合液から等張液を分離するフィルタと、
前記フィルタに流入する前記混合液の流量を規定する第１のポンプと、
前記フィルタから流出する血液のヘマトクリット値を検出する血液モニタと、
前記血液モニタによって検出したヘマトクリット値に基づいて前記フィルタから流出する血液の量を増減する第２のポンプと、を備えること、
を特徴とする分離返液返血装置。 The separation and return blood return apparatus according to claim 1,
A filter that separates isotonic fluid from a mixture of blood and isotonic fluid removed from the body cavity;
A first pump for defining a flow rate of the mixed liquid flowing into the filter;
A blood monitor for detecting a hematocrit value of blood flowing out of the filter;
A second pump for increasing or decreasing the amount of blood flowing out of the filter based on a hematocrit value detected by the blood monitor;
Separating and returning blood return device. 体腔内から取り出した血液と等張液の混合液から等張液を分離するフィルタと、
前記フィルタに流入する前記混合液の流量を規定する第１のポンプと、
前記フィルタから流出する血液のヘマトクリット値を検出する血液モニタと、
前記血液モニタによって検出したヘマトクリット値に基づいて前記フィルタから流出する血液の量を増減する第２のポンプと、を備え、体腔内から取り出した血液と等張液の混合液から等張液を分離し、等張液は前記混合液を取り出した体腔内に返液し、血液は血管に返血する分離返液返血装置の制御方法であって、
前記第２のポンプの流量が所定の流量に達したら返血を停止すること、
を特徴とする分離返液返血装置の制御方法。 A filter that separates isotonic fluid from a mixture of blood and isotonic fluid removed from the body cavity;
A first pump for defining a flow rate of the mixed liquid flowing into the filter;
A blood monitor for detecting a hematocrit value of blood flowing out of the filter;
A second pump that increases or decreases the amount of blood flowing out of the filter based on the hematocrit value detected by the blood monitor, and separates isotonic fluid from a mixture of blood and isotonic fluid removed from the body cavity The isotonic solution is returned to the body cavity from which the mixture has been taken out, and the blood is returned to the blood vessel.
Stopping the return of blood when the flow rate of the second pump reaches a predetermined flow rate;
A control method for a separation / return blood return device characterized by the above. 請求項３に記載の分離返液返血装置の制御方法であって、
前記第２のポンプは、前記フィルタの血液流出側に取り付けられ、
前記所定の流量は、第２のポンプの最低流量であること、
を特徴とする分離返液返血装置の制御方法。 A method for controlling the separation and return blood return apparatus according to claim 3,
The second pump is attached to the blood outflow side of the filter;
The predetermined flow rate is a minimum flow rate of the second pump;
A control method for a separation / return blood return device characterized by the above. 請求項３に記載の分離返液返血装置の制御方法であって、
前記第２のポンプは、前記フィルタの等張液の流出側に取り付けられ、
前記所定の流量は、第１のポンプの運転流量であること、
を特徴とする分離返液返血装置の制御方法。 A method for controlling the separation and return blood return apparatus according to claim 3,
The second pump is attached to the isotonic liquid outflow side of the filter;
The predetermined flow rate is an operation flow rate of the first pump;
A control method for a separation / return blood return device characterized by the above.
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