[0034] The preferred embodiments of the present invention will be described below with reference to the accompanying drawings, and the preferred embodiments described herein are intended to illustrate and explain the present invention, and are not intended to limit the invention.
[0035] The embodiment of the present invention provides a double-filter over-adsorption blood pulp displacement system, including a blood purification passage, a primary plasma separator 3, a secondary plasma separator 5, a perfusion device 9, the blood purification passage will The primary plasma separator 3, the secondary plasma separator 5, the perfusion 9 is in communication; the primary plasma separator 3 is used to isolate plasma, the secondary plasma separator 5 for filtering plasma The triglyceride in the midplane is used to isolate the cytokine in which filters over the plasma is filtered.
[0036] Among them, the primary plasma separator 3 isolates plasma with an OP-08 membrane, the OP-08 membrane pore diameter of 0.3 μm.
[0037]Among them, the secondary plasma separator 5 uses an EC-50 membrane to filter the triglyceride in the plasma, the EC-50 membrane pore diameter of 0.035 μm.
[0038] Among them, the perfusion 9 is adsorbed by an ion exchange resin adsorbent, and plasma separation filtration is performed, and the ion exchange resin is adopted by BS330.
[0039] Among them, an anticoagulant injection micro-pump 1, an arterial pump, a dialysis pump 4, and the arterial pump are connected to the arterial pump, the arterial pump and the primary plasma. The separator 3 is connected, and the artery pump is used to deliver blood to the primary plasma separator 3; one end of the dialysis pump 4 communicates with the primary plasma separator 3, the dialysis pump 4 One end is in communication with the secondary plasma separator 5, the dialysis pump 4 for delivering blood pads in the primary plasma separator 3 into the secondary plasma separator 5.
[0040] Among them, a filtrate pump 6 and a waste liquid bag 8 are also included, and the filtrate pump 6 is inserted with the secondary plasma separator 5, and the other end of the filtrate pump is in communication with the waste liquid bag 8, The filtrate pump 6 is configured to deliver the waste liquid separated from the secondary plasma separator 5 to the waste liquid bag 8.
[0041] Among them, a replacement liquid bag and a replacement pump 10 are also included, and one end of the replacement pump 10 is in communication with the vein input end of the blood purification path, and the other end of the replacement pump 10 communicates with the replacement liquid bag, the replacement The pump 10 delivers the substantial fluid in the replacement liquid bag to the loss of the filtrate in the blood purification kettle.
[0042] Wherein, the perfusion 9 inlet end is in communication with the secondary plasma filler film outer tube, and the outlet end is in communication with the venous pot port.
[0043] Wherein, the primary plasma separator 3 is connected to the output of the blood purification path.
[0044] A method of using a double-filtration over-adsorption blood pulp displacement system, including the following steps:
[0045] Step 1: Turn on the power pump 2, which will be filtered through the power pump 2 to the primary plasma separator 3;
[0046] Step 2: The blood is separated by the primary plasma separator 3, and the primary plasma separator 3 is separated from the OP-08 membrane;
[0047] Step 3: Open the dialysis pump 4, and the blood padded by the primary plasma separator 3 is transferred to the secondary plasma separator 5 by the dialysis pump 4;
[0048] Step 4: Blood paddles by the secondary plasma separator 5, the secondary plasma separator 5, using EC-50 membrane filtrates triglycerides in plasma;
[0049] Step 5: Open the filtrate pump 6, the filtrate pump 6 is used to deliver the waste liquid separated by the secondary plasma separator 5 to the waste liquid bag 8.
[0050] Step 6: Separate the secondary plasma separator 5 to the replacement of the paste to convey the perfilor 9;
[0051] Step 7: The perfusion 9 is adsorbed by an ion exchange resin adsorbent to adsorb the cytokine, performing plasma separation filtration, which is obtained by separating filtration over adsorption purification.
[0052] Step 8: Open the replacement pump 10, adjust the speed to the same speed of the filtrate pump 6, maintain the imbalance; simultaneously open the anticoagulant injection micropump 1, and the separated filtration After adsorbing plasma retransmission to the venous pot The vein returns to the human body.
[0053] Double Filtration ADSORPTION PLASMAPHERESIS, DFAPP) The Japanese JUN-55X blood purification machine was used to operate the treatment machine for the first time for the treatment of the retaining femoral dual-needle duplex (Ebel 11.5 cm × 13.5 cm).
[0054] DFAPP system: The plasma is isolated from the primary plasma separator (OP-08, membrane diameter 0.3 μm), and the serial secondary plasma separator (EC-50, membrane pore diameter 0.035 μm) is filtered out of the monolecule, and the parallel dispensing device - ion exchange resin (BS330) Adsorbent Adsorption Molecules, plasma separation filtration adsorption treatment, can quickly and efficiently remove glycerol triglycerides, fatty acids, endotoxin, inflammatory media, cytokines, phenol, sulfur, and alcohol. The treatment time is 4-6 h, and the amount of absorbent blood pulp is about 5 L. In order to prevent the treatment allergies, intravenous dexamethasone (H20130301, 5mg, Belgian Pfizer) 5mg + 5% gluconate 20ml; anticoagulant selected low molecular heparin sodium needles (H31022051, 40U, Shanghai first biochemical pharmaceutical industry Ltd. The whole process of monitoring, blood pressure, oxygen saturation, etc., closely observes the changes of patients.
[0055] For high-fat severe acute pancreatitis, currently, domestic and foreign guidelines, expert consensus use hematurized or persistent plasma filtration adsorption combined with blood pulp replacement techniques, including: (1) Existing technical treatment time required 24- More than 28 hours, divided into two or three different treatment models, in turn, for the treatment of high-triglyceridemia, cytokine storm, etc., which makes itself increasing the condition that the condition continues to deteriorate or even death in patients with critically ill However, the technique of the present invention only needs one-time surgery to treat 4-6 hours, no need to divide, daily surgery, while solving high-glycid triaphochloridemia caused by pancreatitis, cytokine storm pathogenesis, to a large extent Treatment time, greatly reduced the risk of deterioration and even death in the condition, and improved clinical treatment rate. (2) Existing technical treatment process requires a total of 3 blood purification pathways, 2 primary plasma separators, 1 secondary plasma separator, 1 perfusion, 2-3 blood filters, high cost, treatment reaction Slow speed, complex operation, cost, material, material, financial resources. This new invention requires only one set of blood purification pathways, 1 primary plasma separator, 1 secondary plasma separator, 1 perfusion device, low cost, easy operation, time consuming human financial resources.
[0056] Technical operation
[0057] (1) boot preparation
[0058] Open the switch behind the JUN-55x machine, press the [Preparation] button, touch [Working] on the screen, select the cleared cumulative quantity and after the time, touch [execution].
[0059] Touch screen [Set the operating condition] module, touch therapy mode, set to [Custom mode], confirm that the metering container is selected by the selection of the liquid circuit, the dialysate circuit, and the filter fluid circuit is not used.
[0060] Touch the [Set Alert Condition] module, touch the [Set Alert Pressure] module again, and set the pressure alarm value according to the clinical usage habits:
[0061]
[0062]
[0063] 4, DFAPP pipeline installation order
[0064] Step 1: Install the arterial pipe (red mark), install it according to the installation of the machine on the machine.
[0065] Arterial pot → arterial pump tube → closing arterial pump cover → blood flow is insufficient monitoring liquid pillow
[0066] Step 2: Install the venous line (blue mark), install the installation indication of the venous line of the machine
[0067] Iriometric pot → air detection
[0068] The third step is installed with a grade membrane plasma separator membrane outer tube (coffee columns and green markers),
[0069] Filtration liquid → leakage test → dialysate pump tube → close dialysis pump cover (note green marker pipes on the left)
[0070] Fourth step mount filter liquid line yellow mark)
[0071] Filtering 过 → → → → Filter fluid blocker control valve → filtered liquid pump tube → close filter fluid pump cover
[0072] Step 5: Install the liquid exchange line (blue)
[0073] Pin-free replacement liquid pipeline → block control valve → replacement liquid measurement chamber → Replacement liquid pump tube → closing replacement pump cover → Pumping liquid pump tube blue marker end and the blue bottle above the Y-tone line The tag end is connected.
[0074] Step 6: Install plasma ingredient separator membrane outer tube
[0075] The white mark end of the plasma component separator membrane outer tube is connected to the white mark end line of the Y-tone line on the intravenous pot. After connecting, use the pliers to clamp this paragraph. After the pre-charge of all pipes and filters, the two-way connecting tube is required to connect the pre-charged perfusion in the secondary blood slurry separator exterior mold and the Y-tube line on the venous pot.
[0076] Step 7: Connect all monitoring pressure pipes and pressure sensor protection cover, and use the three-way valve that comes on the line (which end of the OFF point to indicate this end is closed), and hold the pressure monitoring in the monitoring state. (Arterial pressure, venous pressure, filter crush, external pressure)
[0077] Step 8: Connect the metering pot with the pressure sensor protection cover. (Replacement solution, filter over)
[0078] (2) DFAPP prefunction
[0079] Washing amount: The amount of liquid is 3000 ml, wherein the physiological saline 2000 mL and 5% 1000 of heparin is physiological saline.
[0080] Rinse steps:
[0081] 1. Insert the supplemental excitation needle into a physiological saline, and place the liquid empty monitor and dialysis liquid empty detector.
[0082] 2. Connect the infusion tube on the arterial pipe to 1000 ml of physiological saline, first use gravity to pre-rushing the heating path from the blood transfer, filling, using a blood pulley from the blood pulley.
[0083] 3. Set the blood pump speed 50ml / min, the other pump speed is 0.
[0084] 4. Press [Linkage Start], flush the arterial pipeline, when the liquid enters the arterial pot, remove the arterial pot on the machine, invert the arterial pot, the prestige reaches 3/4, corrected the artery pot, re-re- Planted on the machine, when the liquid exits the liquid from the arterial filter inlet, use the hemostasis clamp, press the liquid outflow end, press [Linkage Stop].
[0085] 5. Connect all ports of the separator to confirm that the separator is connected to all the pipelines, loosen all the hemostatic clamps on the pipeline.
[0086] 6. Set the blood pump speed of 100 ml / min, the dialysate speed is 3000 ml / h, the other pump speed is 0, press [linkage start], and start pre-press. When the liquid enters a liquid filter, remove the liquidket from the machine, invert the liquid suction liquid, the prefinder reaches the pot 3/4, correct the filtrate liquid, and re-placed on the machine. Continue to precharge. When the liquid flows out of the liquid from the pipeline, the liquid outflow end is used to sandwise the liquid flow. Press [Linkage Stop].
[0087]7. Connect each of the ports of the plasma component separator to the pipe, after connecting, loose all the pliers on the line.
[0088] 8. Set the replacement liquid pump to 3000 ml / h, filter the liquid pump speed of 2000ml / h, press [Linkage Start], and start pre-press.
[0089] 9. When the liquid enters the venous pot, remove the vessel pot on the machine, inverted the vein pot, and the prestige reaches 3/4, corrected the vessel pot, re-placed on the machine, and continues to precharge.
[0090] 10. Note that the artery side, the preparation of the liquid side, prevents the liquid from being used, air into.
[0091] 11. When replacing the precharge, touch [Linkage Stop]. Re-starting the prechart, please touch [Joint Start] until the end of the precharge, press [Linkage Stop] again.
[0092] 12. After the pre-flush is completed, press the monitor [OFF].
[0093] 13.HA330-II resin hemorrower precharge and connection: The infusion line can be used or taken out of the primary plasma separator (four-port disinfection seal) and sandwich the membrane pipeline 2 Motivated venous end: (1) Unloading the cover of the perfusser discharges the liquid in the perfusion, allowing the blood circuit of the blood circuit to connect the arterial end of the filling. After the prefinder is filled with a perfusion, the perfusion venior is connected to the venid of the blood circuit. The perfilor artery is facing down, and the venid is fixed vertically on the bracket. (2) 500 ml of 500 ml of 5% glucose injection is used, and 2500 ml of normal heparin 1250-1875 unit / 500 ml of physiological saline is 500ml, and the pump flow rate is 100 mL / min. Tap the perfusion and pipeline in the pre-fence process to row although the gas in the road and the perfusion. (3) 500ml of physiological saline containing 1,0500 units of ordinary heparin is slowly pre-rushing, and the air in the road and the perfusion is allowed to reach the perfusion. (You can also pre-press the perfusion and pipelines of 500ml of physiological saline 12,500 units, and after 90% of heparin brine enters the pipeline, the pump is stopped, and the heparin salt is allowed to stand for 20 minutes. (4) Finally using one The bottle of heparin-free physiological saline is rolled into the line, and the hydraulic saline containing heparin can be discharged vertically to the bracket on the bracket in the press-containing physiological saline. The liquid level in the intravenous pot is slightly higher, and there are more room for caught more.
[0094] 14. Set all the pump speed to 0.
[0095] 15. Clip the venous pipeline connection, waiting for the connection treatment.
[0096] (3) treatment
[0097] Separately connect by arteriovenous:
[0098] 1. The arterial blood collection line is used to sandwrap the arterial blood tube, and the arterial blood supply line is connected to the double cavity tube, pay attention to the air bubble.
[0099] 2, turn on the blood pump 10 ml / min, gradually increase the speed of 30-50 ml / min, when there is blood into the odor, turn off the blood pump, use the blood pump to clip the venous line, connect the venous line to double cavity catheter venue Pay attention to not entering the bubbles when connecting.
[0100] 3. After confirming the connection, release all hemostasis clamps, open the blood pump, and the flow rate is set to 30-50 mL / min.
[0101] 4, press the monitor [ON] button to start treatment.
[0102] 5. Set the dialysis liquid pump speed, replacement liquid pump, and filtrate speed of the dialysis liquid pump. Proportional relationship is:
[0103] The dialysate pump / blood pump speed is 20-30% × 60
[0104] The filtration rate is 0-10% of the dialysate pump speed,
[0105] The replacement liquid pump speed is the same as the filtrate pump.
[0106] The amount of anticoagulant usage and the target treatment amount is calculated according to the case of the patient.
[0107] 6. After the blood pump is running for 10 minutes, the blood pump speed is preferably 30ml / min, pressed [linkage start].
[0108] 7. After the treatment begins, with the increase of external pressure (secondary membrane internal pressure), the filtrate liquid pump speed can be adjusted, but the maximum ratio does not exceed 20% of the dialysis pump speed. The liquid change pump is a supplement, and the filtrate is filtered into the discarded liquid, the treatment requires supplementation and discarding liquid as an equal amount.
[0109] 8. During the treatment, the speed of the blood pump is maintained at 50-150 mL / min.
[0110] 9. The treatment time is 4-6 hours.
[0111] 10. During treatment
[0112] (4)
[0113] 1. Touch monitor [OFF]. First use gravity, use physiological saline to return blood from blood into the patient, and after the segment is completed, the blood collection end is closed.
[0114] 2.1 return blood: Turn the blood pump speed to about 50-100 ml / min, open the blood pump, use a physiological saline to return blood in the blood, until the venous liquid is pink, and the blood pump is closed. 2 return blood: separate the ABCD port to the pliers, separated, these four ports, and connect the B port to the C, then open the B-port and C port pliers, use the replacement liquid pump to implant the secondary plasma Separator (EC series) membrane plasma, set the vacuum pump speed of 1200 ml / h. Open the replacement pump and return it. Until the plasma completed completely, the treatment was over.
[0115] Advantages of the present invention
[0116] 1. The present invention only needs disposable surgery for 4-6 hours, no need to divide, daily surgery, while solving high-glycid triaphochloridemia caused by pancreatitis, cytokine storm pathogenesis, reducing the condition to severe disease Even the risk of death, improved clinical treatment rate.
[0117] 2. This new invention requires only 1 set of blood purification pathways, 1 primary plasma separator, 1 secondary plasma separator, 1 perfusion, low cost, easy operation, time consuming human financial resources.
[0118] Alternative 1: Foreign models of single-mode blood pulp + blood dialysis perfusion, alternatives need 2-3 surgical completion of treatment requirements, requiring 4000-6000 ml of fresh plasma, but the number of treatment is relatively frequent, and plasma albumin The loss of useful components, supplementing a large number of foreign plasma not only need sufficient plasma resources, but also increases the occurrence of transfusion incidents and the risk of propagating infectious disease through blood pathways.
[0119] Alternative 2: Domestic Upper December 2019 China Acute Pancreatitis Negative Guide Recommendation Scheme for continuous plasma filness adsorption, CPFA, replacement requires 2-3 times to go to treatment target requirements, cannot High triglyceridemia is solved in a short period of time, resulting in the risk of disease toxicity, pancreatic microcirculation disorders, may increase the risk of disease deterioration and progress.
[0120] Alternative 3: Pure drug treatment, such as low molecular weight heparin, insulin, benzaite, hormone, etc. The risk of failure, or even death.
[0121] It will be apparent to those skilled in the art, and various modifications and variations can be carried out without departing from the spirit and scope of the invention. Thus, the present invention also intends to include these modifications and variations if these modifications and variations of the invention are within the scope of the claims and equivalents of the present invention.
