WO2011074603A1 - 血液透析装置 - Google Patents
血液透析装置 Download PDFInfo
- Publication number
- WO2011074603A1 WO2011074603A1 PCT/JP2010/072557 JP2010072557W WO2011074603A1 WO 2011074603 A1 WO2011074603 A1 WO 2011074603A1 JP 2010072557 W JP2010072557 W JP 2010072557W WO 2011074603 A1 WO2011074603 A1 WO 2011074603A1
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- flow rate
- blood flow
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- hemodialyzer
- dialysis
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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
- A61M1/14—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis
- A61M1/16—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis with membranes
-
- 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
- A61M1/14—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis
- A61M1/16—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis with membranes
- A61M1/1601—Control or regulation
-
- 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
- A61M2205/00—General characteristics of the apparatus
- A61M2205/33—Controlling, regulating or measuring
- A61M2205/3331—Pressure; Flow
- A61M2205/3334—Measuring or controlling the flow rate
Definitions
- the present invention relates to a hemodialysis apparatus capable of calculating and displaying dialysis conditions with a simple operation while keeping costs low.
- the therapeutic amount in a single hemodialysis treatment is defined as the amount of dialysis.
- As an index of the dialysis amount there are urea removal rate and Kt / V, but generally Kt / V is used.
- Kt / V is usually calculated by substituting the serum urea concentration at the start and end of hemodialysis treatment, the water removal amount, and the treatment time into a predetermined arithmetic expression.
- factors affecting the serum urea concentration at the end of hemodialysis treatment include patient fluid volume, treatment time, water removal amount, overall mass transfer area coefficient of the dialyzer used (so-called KoA), blood flow volume, There is a dialysate flow rate, and usually the medical staff adjusts the serum urea concentration at the end of hemodialysis treatment by adjusting the blood flow volume of these factors before the start of hemodialysis treatment, and sets Kt / V. It is adjusted.
- the water removal amount which is one of the factors that determine the serum urea concentration at the end of hemodialysis treatment and is also one of the items that are substituted into the calculation formula for calculating Kt / V
- the hemodialysis treatment to be performed is not necessarily equal.
- the relationship between the blood flow rate and Kt / V in hemodialysis treatment varies depending on the patient and the dialyzer used. Therefore, even if the blood flow volume is adjusted, it is difficult to achieve the Kt / V value as intended after the end of hemodialysis treatment, and the blood necessary for achieving the target Kt / V value is difficult.
- the work for determining the flow rate is time consuming and labor intensive. In recent years, there is an idea to reduce the amount of dialysate used as much as possible from the viewpoint of cost.
- the present invention has been made in view of the above circumstances, and provides a hemodialysis apparatus capable of calculating and displaying dialysis conditions with a simple operation while keeping costs low.
- the hemodialysis apparatus of the present invention comprises a hemodialyzer and a blood circuit, a blood pump provided upstream of the hemodialyzer, a dialysate supply line, and a water removal line.
- a hemodialyzer and a blood circuit
- a blood pump provided upstream of the hemodialyzer
- a dialysate supply line provided upstream of the hemodialyzer
- a water removal line When the clearance of the hemodialyzer to be used is set and the blood flow rate is set, the dialysate flow rate corresponding to the set clearance and the set blood flow rate is calculated and displayed.
- the dialysis condition calculation / display means when changing the blood flow, continuously calculates and displays the new dialysate flow rate corresponding to the set clearance and the changed blood flow as the blood flow changes. It may be.
- the dialysis condition calculation / display means may be incorporated in a control device to be described later.
- the dialysate flow rate is calculated corresponding to the set clearance and the set blood flow volume, and the set blood flow volume is changed. If the dialysate flow rate is configured to be changed, the dialysate flow rate can be lowered to the most efficient level within the settable range. Dialysis treatment cost can also be reduced from the amount of dialysate used, and the patient's economic burden can be reduced.
- Dialysis condition calculation / display means for calculating and displaying the dialysate flow rate corresponding to the set clearance and the set blood flow rate is provided.
- the dialysis condition calculation / display means continuously calculates and displays the new dialysate flow rate corresponding to the set clearance and the changed blood flow volume when the blood flow volume is changed. Yes.
- FIG. 1 is a schematic explanatory view of a hemodialysis apparatus according to Embodiment 1 of the present invention.
- the hemodialysis apparatus of the present invention includes a hemodialyzer 1, a blood circuit 2, a blood pump 3 provided on the upstream side (arterial blood circuit 21) of the hemodialyzer 1, and a dialysate supply line. 4 and a water removal line 6, and when setting the clearance of the hemodialyzer to be used and setting the blood flow volume, the dialysate flow rate corresponding to the set clearance and the set blood flow volume is calculated and displayed.
- the calculation / display means 9 is provided.
- the hemodialysis apparatus is controlled by the control device 8, and the dialysis condition calculation / display means 9 is electrically connected to the control device 8.
- the dialysis condition calculation / display means 9 may be incorporated in the control device 8.
- 22 is a venous blood circuit
- 41 is a dialysate supply line
- 42 is a dialysate discharge line
- 5 is a dialysate pump
- 7 is a dewatering pump
- 10 is a dialysis condition calculation / display unit 9. It is an input means.
- the dialysis condition calculation / display means 9 calculates and displays the dialysate flow rate corresponding to the set clearance and the set blood flow when the clearance of the hemodialyzer to be used is set and the blood flow is set.
- the dialysate pump 5 has an optimum discharge amount range.
- the dialysate flow rate has a settable range, and the dialysate flow rate can be set only within the range.
- the dialysate flow rate under a given clearance and blood flow rate may be outside the settable range of the dialysate flow rate. In such a case, the blood flow rate must be changed to recalculate the dialysate flow rate within the settable range. Such determination of a new blood flow usually has to be done by trial and error.
- the dialysate flow rate corresponding to the set clearance and the changed blood flow rate is continuously calculated and displayed as the blood flow rate is changed. ing. Therefore, in the hemodialysis apparatus of the present embodiment, it is not necessary to determine the blood flow rate by trial and error so that the dialysate flow rate corresponding to the set clearance and the changed blood flow rate falls within the settable range of the dialysate flow rate. That is, the hemodialysis apparatus of the present embodiment has an advantage that the blood flow rate such that the obtained dialysate flow rate falls within the settable range can be determined by visually observing the display board.
- a hemodialysis treatment is started with the set clearance, blood flow rate, and dialysate flow rate by pressing a dialysis start button (not shown).
- the hemodialyzer clearance varies depending on the hemodialyzer, and normally the values when the blood flow rate is 200 ml and the dialysate flow rate is 500 ml are displayed. And when using a large amount of filtration, such as hemodiafiltration, or in hemodialyzers with large internal filtration using a highly permeable dialysis membrane, the dialysate flow rate and blood flow rate are low when used for acute blood purification.
- the clearance (CL) representing the removal performance of the hemodialyzer is determined by three values of the blood flow rate (QB), the dialysate flow rate (QD), and the overall mass transfer area coefficient (KOA), except for a small case.
- the expression of the relationship among CL, QB, QD, and KOA is expressed as a formula for evaluating the performance of a hemodialyzer and expressed by the following formula.
- the dialysis condition calculation / display means 9 calculates and displays the dialysate flow rate using Equation 1 from the set clearance, the overall mass transfer area coefficient, and the blood flow rate.
- urea clearance is normally used as the set clearance.
- KOA is originally an index that explains the phenomenon of diffusion only without filtration. Therefore, blood with a large amount of internal filtration using a highly permeable dialysis membrane, such as hemodiafiltration, If the KOA is calculated from data measured under conditions where the original definition does not hold, as in the case of a dialyzer, the results obtained do not make sense. In addition, KOA may not be considered constant, such as when the dialysate flow rate or blood flow volume is small when used for acute blood purification. In these cases, the dialysis apparatus of the present invention is applied. Therefore, it is necessary to turn off the dialysis condition calculation / display means 9 and adopt the conventional operation method.
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- Health & Medical Sciences (AREA)
- Heart & Thoracic Surgery (AREA)
- Urology & Nephrology (AREA)
- Anesthesiology (AREA)
- Vascular Medicine (AREA)
- Engineering & Computer Science (AREA)
- Emergency Medicine (AREA)
- Biomedical Technology (AREA)
- Hematology (AREA)
- Life Sciences & Earth Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
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Abstract
Description
Kt/Vは、通常、血液透析治療の開始時と終了時の血清尿素濃度と、除水量、治療時間とを、所定の演算式に代入して算出する。ここで、血液透析治療終了時の血清尿素濃度に影響を与えるファクターとしては、患者の体液量、治療時間、除水量、使用する透析器の総括物質移動面積係数(所謂、KoA)、血流量、透析液流量があり、通常、医療スタッフは、血液透析治療の開始前に、これらのファクターのうち血流量を調整することにより、血液透析治療終了時の血清尿素濃度を調整し、Kt/Vを調整している。
また、血液透析治療における血流量とKt/Vとの関係も患者や使用する透析器によって異なる。従って、血流量を調整しても、血液透析治療の終了後にKt/V値が目標通りに達成されることは困難であり、しかも、目標とするKt/V値を達成するために必要な血流量を決定するための作業は、多大な時間と労力を要するものであった。また、最近では、コスト面から、透析液の使用量を出来るだけ抑制しようとする考えもある。
使用する血液透析器のクリアランスを設定し、血流量を設定したときに、設定クリアランスと設定血流量に対応する透析液流量を算出し表示する、透析条件の算出・表示手段を備えてなることを特徴とする。
尚、透析条件の算出・表示手段は、後述する制御装置に内蔵されていても良い。
以上、一般的に本発明を記述したが、より一層の理解は、いくつかの特定の実施例を参照することによって得ることが出来る。これらの実施例は本明細書に例示の目的のためにのみ提供されるものであり、他の旨が特定されない限り、限定的なものではない。
図1は本発明の実施例1に係る血液透析装置の概略説明図である。
本発明の血液透析装置は、図1に示すように、血液透析器1と血液回路2、血液透析器1の上流側(動脈側血液回路21)に設けられた血液ポンプ3、透析液供給ライン4および除水ライン6を含んでなり、使用する血液透析器のクリアランスを設定し、血流量を設定したときに、設定クリアランスと設定血流量に対応する透析液流量を算出し表示する、透析条件の算出・表示手段9を備えている。血液透析装置は制御装置8によって制御されており、透析条件の算出・表示手段9はこの制御装置8に電気的に接続されている。透析条件の算出・表示手段9はこの制御装置8に内蔵されていても良い。尚、図中、22は静脈側血液回路、41は透析液供給ライン、42は透析液排出ライン、5は透析液ポンプ、7は除水ポンプ、10は透析条件の算出・表示手段9への入力手段である。
さて、透析液ポンプ5には最適吐出量範囲があり、その結果として、透析液流量には設定可能範囲があり、透析液流量はその範囲内でしか設定することができない。ところが、与えられたクリアランスと血流量の下における、透析液流量は、透析液流量の設定可能範囲の外にあることもある。そのような場合には、血流量を変更して、設定可能範囲内の透析液流量を算出し直なければならない。そして、そのような新たな血流量の決定は、通常、試行錯誤で行わざるを得ない。このような問題を解決するため、本実施例の血液透析装置では、血流量を変えていくに従って、設定クリアランスと変更血流量に対応する透析液流量が連続的に算出・表示されるようになっている。したがって、本実施例の血液透析装置では、設定クリアランスと変更血流量に対応する透析液流量が透析液流量の設定可能範囲内に入るように、血流量を試行錯誤で決定する必要がなくなる。すなわち、本実施例の血液透析装置には、得られる透析液流量が設定可能範囲内に入るような血流量を、表示板を目視することで決定できるという利点がある。
効率的な透析液流量が決まれば、透析開始ボタン(図示していない)を押すことにより、設定されたクリアランスと血流量、透析液流量で血液透析治療が開始される。
2 血液回路
21 動脈側血液回路
22 静脈側血液回路
3 血液ポンプ
4 透析液ライン
41 透析液供給ライン
42 透析液排液ライン
5 透析液ポンプ
6 除水ライン
7 除水ポンプ
8 制御装置
9 透析条件の算出・表示手段
10 入力手段
Claims (2)
- 血液透析器と血液回路、前記血液透析器の上流側に設けられた血液ポンプ、透析液供給ラインおよび除水ラインを含んでなり、
使用する血液透析器のクリアランスを設定し、血流量を設定したときに、設定クリアランスと設定血流量に対応する透析液流量を算出し表示する、透析条件の算出・表示手段を備えてなる血液透析装置。 - 透析条件算出・表示手段が、血流量を変更する場合に、血流量の変更にともなって、設定クリアランスと変更血流量に対応する新たな透析液流量を連続的に算出・表示するようになっている請求項1に記載の血液透析装置。
Priority Applications (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
EP10837629.4A EP2514449A4 (en) | 2009-12-17 | 2010-12-15 | hemodialyzer |
JP2011546146A JPWO2011074603A1 (ja) | 2009-12-17 | 2010-12-15 | 血液透析装置 |
CN201080057466.5A CN102665790B (zh) | 2009-12-17 | 2010-12-15 | 血液透析装置 |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
JP2009285912 | 2009-12-17 | ||
JP2009-285912 | 2009-12-17 |
Publications (1)
Publication Number | Publication Date |
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WO2011074603A1 true WO2011074603A1 (ja) | 2011-06-23 |
Family
ID=44167354
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
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PCT/JP2010/072557 WO2011074603A1 (ja) | 2009-12-17 | 2010-12-15 | 血液透析装置 |
Country Status (4)
Country | Link |
---|---|
EP (1) | EP2514449A4 (ja) |
JP (1) | JPWO2011074603A1 (ja) |
CN (1) | CN102665790B (ja) |
WO (1) | WO2011074603A1 (ja) |
Cited By (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
JP2014529453A (ja) * | 2011-09-01 | 2014-11-13 | フレゼニウスメディカル ケアー ドイチュラント ゲゼルシャフト ミット ベシュレンクテル ハフツングFresenius Medical Care Deutschland GmbH | 透析液流制御 |
Families Citing this family (3)
Publication number | Priority date | Publication date | Assignee | Title |
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DE102014011699B4 (de) | 2014-08-07 | 2023-11-02 | Fresenius Medical Care Deutschland Gmbh | Vorrichtung zur Ermittlung eines optimalen Dialysatflusses für eine extrakorporale Blutbehandlung mit einer extrakorporalen Blutbehandlungsvorrichtung |
JP7276155B2 (ja) * | 2018-01-10 | 2023-05-18 | ニプロ株式会社 | 細胞外液量算出装置及び細胞外液量算出方法 |
CN112805044A (zh) * | 2018-08-23 | 2021-05-14 | 尼普洛株式会社 | 细胞外液量计算装置和细胞外液量计算方法 |
Citations (4)
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WO1995032010A1 (en) * | 1994-05-24 | 1995-11-30 | Baxter International Inc. | Method and system for optimizing dialysis clearance |
JP2005245667A (ja) * | 2004-03-03 | 2005-09-15 | Koninkl Philips Electronics Nv | 薬剤投与設計システム |
JP2006285488A (ja) * | 2005-03-31 | 2006-10-19 | Asahi Kasei Medical Co Ltd | 透析管理システム |
JP2007029705A (ja) * | 2005-06-24 | 2007-02-08 | Jms Co Ltd | 腹膜透析及び血液透析併用プランニング装置 |
Family Cites Families (7)
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JPH09168587A (ja) * | 1995-12-20 | 1997-06-30 | Cytec Kk | 血液透析装置 |
DE19746367C2 (de) * | 1996-11-30 | 1999-08-26 | Fresenius Medical Care De Gmbh | Verfahren zur in-vivo-Bestimmung von Parametern der Hämodialyse und Vorrichtung zur Durchführung des Verfahrens |
WO2004039436A1 (en) * | 2002-10-30 | 2004-05-13 | Gambro Lundia Ab | A method and an apparatus for determining the efficiency of dialysis |
EP1779880A1 (en) * | 2004-05-28 | 2007-05-02 | JMS Co. | Hemodialyzer capable of intermittent repetition of infusion and water removal operation |
JP4726045B2 (ja) * | 2005-04-08 | 2011-07-20 | 日機装株式会社 | 血液透析装置 |
CN101466419B (zh) * | 2006-06-08 | 2012-07-04 | 弗雷泽纽斯医疗保健德国有限公司 | 用于控制体外血液处理设备的装置和方法 |
DE102006045437A1 (de) | 2006-09-26 | 2008-04-03 | Fresenius Medical Care Deutschland Gmbh | Vorrichtung und Verfahren zur Vorgabe einer Dialysierflüssigkeitsrate oder Blutflussrate für eine extrakorporale Blutbehandlung |
-
2010
- 2010-12-15 WO PCT/JP2010/072557 patent/WO2011074603A1/ja active Application Filing
- 2010-12-15 JP JP2011546146A patent/JPWO2011074603A1/ja active Pending
- 2010-12-15 CN CN201080057466.5A patent/CN102665790B/zh not_active Expired - Fee Related
- 2010-12-15 EP EP10837629.4A patent/EP2514449A4/en not_active Withdrawn
Patent Citations (4)
Publication number | Priority date | Publication date | Assignee | Title |
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WO1995032010A1 (en) * | 1994-05-24 | 1995-11-30 | Baxter International Inc. | Method and system for optimizing dialysis clearance |
JP2005245667A (ja) * | 2004-03-03 | 2005-09-15 | Koninkl Philips Electronics Nv | 薬剤投与設計システム |
JP2006285488A (ja) * | 2005-03-31 | 2006-10-19 | Asahi Kasei Medical Co Ltd | 透析管理システム |
JP2007029705A (ja) * | 2005-06-24 | 2007-02-08 | Jms Co Ltd | 腹膜透析及び血液透析併用プランニング装置 |
Cited By (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
JP2014529453A (ja) * | 2011-09-01 | 2014-11-13 | フレゼニウスメディカル ケアー ドイチュラント ゲゼルシャフト ミット ベシュレンクテル ハフツングFresenius Medical Care Deutschland GmbH | 透析液流制御 |
US9724455B2 (en) | 2011-09-01 | 2017-08-08 | Fresenius Medical Care Deutschland Gmbh | Dialysate flow control |
Also Published As
Publication number | Publication date |
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JPWO2011074603A1 (ja) | 2013-04-25 |
EP2514449A1 (en) | 2012-10-24 |
CN102665790B (zh) | 2016-11-16 |
EP2514449A4 (en) | 2015-06-24 |
CN102665790A (zh) | 2012-09-12 |
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